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Finding the Missing TB Patients

Despite rapid economic transformation over the last three decades, the state of Haryana has witnessed high rural-urban disparity with respect to access to quality healthcare. While the status of health infrastructure in Haryana is better than the national average, the provisions of healthcare facilities are largely concentrated in few pockets and locations in urban centers. About 92% of total hospitals in the state are located in urban areas. This, when 70% of the state’s total population of 25 million souls (Census of India, 2011) reside in rural areas. In addition, there is a large marginalized migrating population, which is often unable to leave their daily wage jobs to access quality healthcare.

Most peripheral public health facilities – Primary and Community Health Centers (PHCs & CHCs) rely on one of the cheapest and quickest ways to screen TB patients – sputum microscopy. Due to high level of skills required in sputum microscopy upto half of the cases my go undetected. Medanta Hospital – one of India’s largest super speciality hospital located in Haryana, stepped in to reach the unreached – identify the missing sputum negative TB cases in Haryana.

Intervention

Mission TB Free Haryana, launched in 2015, is a public private partnership between the Government of Haryana and Medanta Hospital to increase access to TB care in rural Haryana. Medanta’s tripartite intervention model is hinged on strengthening the robust National TB Program by finding missing TB patients and establishing linkages between the patients and the government health care and treatment Medanta has mobilized over Rs. 30 million for the project.

Three-pronged intervention strategy

Championing pvt-pvt partnerships X-Ray Tests at rural government health facilities

Medanta identified and activated corporates that shared their values – Siemens, Oriental Bank of Commerce, RJ Corps, Philips, RITES — who financed 3 vans fitted with X-Ray machines. The strategy was to complement the existing government system with additional diagnostic infrastructure. These X-Ray vans move across a cluster of districts in a cyclic manner, dedicating 4-6 weeks to each district, supporting each PHC/CHC by conducting X-rays of presumptive patients for almost a week and then returning again within 6-8 months to it. The routes of the vans are designed in consultation with the District TB Officers.

Enhanced case finding Community outreach camp

Community outreach activities is the second strategy to essentially spread awareness, screen and test anyone who is chest symptomatic. Community is informed ahead of the camp, using the help of the front line health workers like ASHA, ANMs who are essentially the link between the community and health services. Vans fitted with confirmatory, CBNAAT tests serve as a missing link. State-of-the-art services are delivered right at the doorstep of patients, reducing the delay in diagnosis.

Active case finding Door to door screening

The third strategy, added in November 2019 upon becoming a CTP Member, ensured 100% population coverage. Launched in a block of Pataudi, a team equipped with a questionnaire covered entire the block through door-to-door screening and identified patients. Local level stakeholders like ASHA workers, sarpanch and civil society organizations are engaged via meetings, workshops, etc. to increase awareness and community ownership. The entire continuum of care – awareness, screening, diagnosis, treatment and counselling for adherence, is offered in the block.

Impact

The X-ray vans have provided screening support across 19 of the 22 districts of the state. Of the total no. of people screened, about 30% had abnormal X-Rays and around 10% have been moved to the Directly Observed Treatment, Short-Course (DOTS) program said Dr. Bornali Dutta, Project Lead, Mission TB-Free Haryana. The success of the intervention is proven by the project being scaled up in 4 additional states of India – Uttar Pradesh, Rajasthan, Jharkhand and Meghalaya.

Key Lessons

The model showcases that supporting the National government program by converging resources and filling gaps has proven successful. The project identified innovative solutions, effectively utilized resources available and mobilized additional funds from CSR kitties. This then, led to scaling up the project to include active case finding and a comprehensive approach in Pataudi block.

]]> Apollo Tyres Foundation https://www.corporatetbpledge.org/apollo-tyres-foundation-impact-story/ Thu, 19 Nov 2020 14:40:19 +0000 http://www.corporatetbpledge.org/?p=5201
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Pitshop for Health - Apollo Tyres

Eight million truck drivers and twelve million helpers criss-cross the country’s highways for hours at a stretch. Belonging to different states and cities, they are away from their homes for 10-12 days to six months at a stretch. Truckers have been identified by the National AIDS Control Organization as a Bridge Population, as they are at higher risk and vulnerability of contracting infections like TB and HIV. Their nomadic lifestyle pose difficulties in TB treatment, which requires a referral for diagnostics and long-term medication. Inadequate follow-ups lead to high default rates as many of them disappear from the system

 Intervention Outline

The mass media campaigns are used to convey behaviour-change messages that aim to impact and influence the public knowledge, attitudes and practices.

Engagement and CSR investment by corporates can disseminate information on TB widely to vast audiences through the use of media, such as television, radio, local media channels, traditional media, newspapers, Internet, books, posters and billboards. The corporate can adopt a district or state and implement campaigns around prominent dates like world TB day or the company’s foundation day etc

 

Expected Impact

  1. Increase in knowledge, attitudes, awareness and opinions about TB and health-seeking behaviour for TB
  2. Decrease in stigma
  3. Increase in uptake of government services for TB service
  4. Corporate brand positioning

Expected Investment

Capital Cost – INR 10 – 50 lakhs

Support from CTP Secretariat

  • Project designing
  • Providing IEC material to use in the campaign – audio/video clippings
  • Facilitating collaboration with the government program including approvals wherever necessary
  • Coordinating with technical experts for their quotes etc
  • Training volunteers for the campaign

Our 1st Healthcare Centre was established in 2000 at the transshipment hub of Delhi to spread awareness and prevent HIV/AIDS for our trucking community. This has now transformed into providing services on other emerging healthcare needs at our 32 different locations in 19 states across India. In 2017, we introduced Tuberculosis prevention programme as it usually co-exists with HIV.

Onkar S Kanwar, Chairman, Apollo Tyres

Behavior Change Strategies

Prevention is better than Cure

  • One to One Sessions
    Healthcare providers counsel the truckers
  • One to One Sessions
    A health educator/outreach worker educatesthe driver/helper aboutTB and motivate them toprevent, test and adhereto treatment, clarifyingthe myths and facts
  • One to One Sessions
    Targeted at increasing participation in the program
  • One to One Sessions
    A large network of peereducators trained tospread awareness andenable a robust referralsystem across thetransshipment hub

Healthcare Services

Each trucker is given a unique registration number, which is valid at all healthcare centers to enable access to health services across state borders. The program adheres to confidential counselling where a trained counsellor devotes his/her time, attention and skills to support the drivers/ helpers in understanding their health issues and identify and act upon solutions.

  • Static Clinic

    Healthcare providers counsel the truckers

  • Satellite Clinic

    Arranged near broker/transport Offices for 3-4hours a day, offering the same services as StaticClinic.

  • Integrated Health Camp

    Organized in project area to provide services at the doorstep to ensure maximum outreach in a short duration of time

  • Mobile Medical Unit

    A large network of peer educators trained to spread awareness and enable a robust referral system across the transshipment hub

Key Lessons

With minimal resources, adequate training and technical support, TB management was introduced successfully in ongoing health services being offered to truckers. Additional support by the Corporate TB Pledge (CTP) secretariat intensified their commitment and increased outreach. The program has been prolific, deploying creative and fun tools like street theatre, pamphlets and conversation to engage with its audience. ATF’s model facilitates continuous treatment to truckers at points of entry and exit in their journey, which is instrumental in ensuring adherence to treatment.

To cater to the high-risk population, additional interventions such as surveillance, behavior change communications, customized health service solutions tailored to their needs was made possible by this healthcare program. The recently introduced MIS Tool aids the foundation in tracking progress as well as using the data to analyze and make informed decisions for future interventions.

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