Innovative approaches to addressing poverty in TB programmes in Jharkhand

Imagine a cycle rickshaw puller and a 'paan' or tobacco shop owner as a DOTS provider – that is a reality since 7 years now in the Indian state of Jharkhand. The state TB programme in Jharkhand has taken many innovative steps to increase new TB case detection, provision of and adherence to anti-TB treatment under DOTS, and to reach the unreached people who might need TB care, said Dr R Dayal, State TB Officer, Jharkhand state, India. Dr Dayal was speaking at the consultative workshop of the TB and poverty sub-working group of the Stop TB Partnership in India (29-30 October 2010), the secretariat of which has now moved to the South-East Asia office of the International Union Against Tuberculosis and Lung Disease (The Union). The forthcoming 41st Union World Conference on Lung Health (11-15 November 2010) will be a great opportunity to document community-centric and innovative approaches in addressing poverty in TB control programmes. Read more

In Jharkhand, there are 17,738 DOTS centres in the entire state with population of 30.9 million.

The state TB programme in Jharkhand has engaged many community healthcare volunteers, NGOs, private medical practitioners, as DOTS providers. The honorarium for these DOTS providers should be enhanced, said Dr Dayal.

There is a need to increase access of the most vulnerable communities to quality diagnostics. Laboratory services need attention in the state. Presently the state has 296 designated microscopy centres (DMCs) for a population of 30.9 million. The three notified tribal districts in Jharkhand are likely to have more DMCs soon.

Community healthcare volunteers help with sputum collection and they are provided with incentives, said Dr Dayal. There are more than 12,000 community DOTS providers in the state which includes many cured TB patients. This is also supported by the WHO Stop TB Strategy, a component of which is the Patients’ Charter for TB Care.

Dr Dayal said that there is a compelling need to align TB control programmes with the poverty initiatives being undertaken in the state, and the state TB programme is already contemplating to do so very soon. They are planning to link the state TB programme in Jharkhand to the welfare department, Red Cross society, confederation of Indian Industries (CII) in Jharkhand, among others.

Cash compensation is also being provided by the state TB programme in Jharkhand to meet expenses incurred on local transportation or to compensate for loss of daily wages or adverse drug reactions or complications.

Dr Dayal said that in 2010-2011 the state TB programme in Jharkhand is committed to further improve basic DOTS services by intensified monitoring and supervision, enhancing community-based approaches and involving other sectors. They are also planning to start DOTS Plus services in Jharkhand in a phased manner. Moreover there is a plan to strengthen TB-HIV collaborative activities to reach out and provide appropriate healthcare services to TB patients among people living with HIV (PLHIV) and PLHIV among TB patients.