The annual reduction in poverty ratio in Bihar state is the same as that for the country. There are a range of factors outlined by Dr Jha that would have contributed to decline in poverty in Bihar that include the recent development in Bihar, growth of agriculture economy, extensive outwards internal migration of workers to other states of India, self-employment programmes launched by the government, ‘swarnajayanti grameen swarojgar yojna’ (golden jubilee rural self-employment scheme), Mahatma Gandhi National Rural Employment Guarantee Scheme (MNREGS), public distribution system and nutrition programmes, social security programmes, national old age pension scheme, ‘sarva siksha abhiyan’ (education for all campaign), and National Rural Health Mission (NRHM) among others.
Another major issue in Bihar is migration, particularly male migration for work. “Inter-state inter-census male migrants as percentage of total population was 1.18 in 1981 and increased to 1.32 in 1991: additional 1,700,000” said Dr Jha.
The revised national TB control programmes (RNTCP) in Bihar has taken a range of steps to address poverty in TB control programmes and reach out to the unreached TB patients and provide optimal diagnosis, treatment and care.
The state TB programme in Bihar took several steps to address poverty in TB control programmes like identifying TB vulnerable groups in the state, identifying district health societies, mapping marginalized and discriminated groups and areas where they reside (like 'dalits' and 'maha-dalit tola'), urban poor, or areas where flood affected and displaced people take shelter.
The state TB programme has participated in the regular health 'melas' (fair) which provides a platform for communication with the marginalized community about TB and the services available through RNTCP. These are also effective opportunities to provide information about the nearest designated sputum microscopy centre and referral for sputum microscopy is also done at such community gatherings.
"NGOs like ADRA India are regularly organizing folk media shows for difficult to reach areas and for various ethnic minority groups like the ‘Mushahars’ in Bihar" said Dr Jha.
The communication is always intriguing – and so in Bihar, the state TB programme has combined education with entertainment – so as to convey useful information in a powerful manner in local dialects on issues like how TB spreads, importance of DOTS, rights and responsibilities of TB patients, among others. It is important to underline that Bihar’s communication initiative on rights and responsibilities of TB patients, is in line with the WHO Stop TB Strategy of which the Patients' Charter for TB Care is an integral part of.
"The sputum collection and transport scheme has helped in extending diagnostic services to remote regions in the Purnea division of Bihar" said Dr Jha.
"NGOs like the Damien Foundation (DFIT) and LEPRA India are providing assistance to the patients by providing them food if the patient is the sole earning member of the household" added Dr Jha. "These NGOs also help in providing drugs to the DOTS providers along with the government and programme staff" said Dr Jha.
Despite of commendable efforts of the Bihar state TB programme, challenges continue to confront the fight against TB. Large scale migration of people for work to other states in India is one such challenge. Dr Anil Garg from Chandigarh State TB programme said that the box of anti-TB drugs of the migrant patient should be transferred to the DOTS clinic that migrant is going to access care from. There were concerns raised about cost of courier which is not budgeted currently. Dr Garg said that the cost of wasting two boxes worth (one each in the two DOTS centres where the migrant person will receive treatment) on one person is not justified. It is clear that the issue of migrants needs more attention.
"Participation of TB programme managers in meetings of social welfare department and integrating RNTCP in poverty alleviation programmes will be very useful" said Dr Jha.
Another important challenge Dr Jha highlighted was the need to advocate for a legal framework to protect TB patients from loss of employment during their treatment.