According to the World Health Organization (WHO), 10 million people are infected with tuberculosis (TB) annually. Although preventable and treatable, each year, 1.5 million people die, making TB the world’s leading infectious disease killer. India bears the greatest burden of TB worldwide – affecting an estimated 2.4 million. In addition, nearly 40 percent of Indians have latent tuberculosis. Given the number of TB cases in the country, there is an urgent need to foreground the problem and place TB patients at the center, surrounded by a supportive ecosystem of family and community. Since TB patients suffer socioeconomic consequences such as stigma and job loss, they often hide their disease, preventing both treatment and full recovery. The current approach to TB prevention, care and support in India is largely biomedical and these elements are often overlooked. While the National TB Eradication Program (NTEP) provides targeted benefits and nutrition programs like the Nikshay Poshan Yojana that significantly ease the TB patient’s treatment journey, structural barriers of stigma, discrimination, poor knowledge, lack of psychosocial support and lack of patient- The central approaches in facilities make the TB treatment journey painful and difficult for most. Although adequate emphasis is placed on treatment adherence solutions, much remains to be done to prevent TB infection and transmission. Prevention approaches are rooted in community participation, and addressing structural barriers also requires ecosystem-level initiatives closely interlinked with all those who shape the environment of TB-vulnerable communities and also the community of people infected and affected by TB . This is where KHPT’s TB-focused project, Breaking Barriers, comes in. It uses a social-ecological approach that recognizes the structural and underlying barriers that exist in specific vulnerable population groups. This ongoing project (2020-2024) attempts to fill the critical gap by innovating, testing and demonstrating a set of pilots designed to address specific barriers to health in contexts unique to diverse vulnerable populations such as miners, migrants, urban poor, tribals . , tea garden workers etc. Historically, public health programs around the world have taught us an important lesson, namely, to achieve goals, reduce health inequalities, reduce disease prevalence and address gaps in prevention, diagnosis, care and adherence to treatment remains unattainable if communities are left out of response mechanisms. . There are many ways in which TB eradication can benefit when it is seen as a community agenda rather than solely the responsibility of a health programme. This can be done very easily as there are many formal and informal community networks and influencers that represent these vulnerable populations. They have the ability to be the voice of the communities they work with and can spearhead TB initiatives at the ground level. Then, the entire village must participate. In diseases like HIV and TB, people’s perception of the disease needs to change. KHPT was able to do this with HIV very successfully and all stakeholders came together. The same is seen in the polio campaign. Various groups participated — from health departments across the country to Rotary Clubs and ASHA workers. There is a need for collaboration with frontline workers in all departments — this is the critical need to eradicate TB. In addition, we should consider the involvement of Panchayati Raj institutions. We all know the power that the sarpanch wields in the local community. Pradhan has the power to spread accurate messages, fight misconceptions and stigma, and ensure TB care services are available to the last mile. Gram Pradhans can use the Village Sanitation and Nutrition Committees to bring up issues related to TB in monthly meetings. The gram pradhan after being trained on TB and empowered enough to point out challenges related to TB services where needed. We also saw how people came together to fight the COVID-19 pandemic. If we want to accelerate progress towards the goal of eliminating TB in the country, we need to implement a whole-of-society approach to eliminating the disease, always at the forefront of the community-centred approach. Dr Rehana Begum is the Project Manager, Breaking the Barriers, TB eradication program of KHPT. (DISCLAIMER: The views expressed are solely those of the author and ETHealthworld does not necessarily subscribe to them. ETHealthworld.com shall not be liable for any damage caused to any person/organization directly or indirectly.)
