TB and poverty: a dangerous mix in hilly Uttarakhand

In Uttarakhand state of India, 93% of land area is hilly and 47.1% families live below poverty line. Not surprisingly, tuberculosis (TB) is a challenge in this state too. At the consultative workshop of the TB and poverty sub-working group of the Stop TB Partnership held in India (29-30 October 2010), the state TB officer of Uttarakhand presented the efforts of state TB programme in addressing poverty in TB control. The secretariat of the TB and poverty sub-working group of the Stop TB Partnership has also moved now to India since August 2010, being housed in the South-East Asia office of the International Union Against Tuberculosis and Lung Disease (The Union). The ongoing 41st Union World Conference on Lung Health in Berlin, Germany (11-15 November 2010) will also address issues related to TB and poverty. Read more

The state TB officer of Uttarakhand said that efforts are still needed to improve the health seeking behaviour especially in the cases of poor or uneducated. Healthcare is a low priority in the social structure and the problem is more acute in the BPL families, said the state TB officer.

The state of Uttarakhand has 16,414 villages, 80% of them are small sized and scattered. 74% population of this state lives in rural areas.

The state TB programme in Uttarakhand has made several sustained efforts to reach the unreached TB patients in their state. Engaging affected communities and private healthcare providers, working with 47 non-governmental organizations (NGOs) and 142 public-private mix (PPM) linked programmes majority of which are DOTS centres or DOTS providers, levying no charge for any of the services offered under Revised National TB Control Programme (RNTCP) in the private healthcare facilities, are some of the steps of the state TB programme to reach the unreached TB patients.

Most of the poor people seek healthcare from the local registered medical practitioners (RMPs) hence most of the PPM programmes are with the local RMPs, said the Uttarakhand state TB officer.

He stressed on the critical need for empowering and enabling TB patients and affected communities. This is in line with the WHO Stop TB Strategy that has enshrined the Patients’ Charter for TB Care. In Uttarakhand, TB forums have been formed to effectively engage cured TB patients, ASHA workers and other community volunteers. Many of them work as DOTS providers. In 1st quarter of 2010, 53% of TB patients in Uttarakhand received DOTS through community DOTS providers, in 2nd quarter of 2010, 52% and in 3rd quarter of 2010, 54% of TB patients received DOTS through community DOTS providers. This clearly highlights the phenomenal difference affected communities can bring to the TB programme performance.

The Global Fund to fight AIDS, TB and Malaria (GFATM) round 9 grant which has also come to this state, is dedicated to training of healthcare workers to increase responsiveness.

There is a range of social and cultural barriers to accessing TB care, said the Uttarakhand state TB officer. These social and cultural barriers are addressed by information dissemination and behaviour change and communications initiatives. There are awareness activities around TB issues carried out by ASHA workers, which include placing stickers and wall clock with advocacy messages to raise awareness and mobilize people to access existing TB-care services as required.

Apart from planning to scale up the number of designated microscopy centres (DMCs) to reach the unreached TB patients in the state, new community-based organizations (CBOs) are being identified for sputum collection and transportation schemes through the GFATM round-7 project of civil society involvement.

There are some steps undertaken to align TB control programmes with poverty alleviation initiatives in Uttarakhand. TB patients who are seriously ill are provided grant assistance from the State Illness relief fund as and when required. Those TB patients who require hospitalization can seek reimbursement through ‘Rashtriya Swaasthya Beema Yojna’ (national health insurance scheme). The TB programme in Uttarakhand also works closely with ASHA workers of National Rural Health Mission (NRHM), Angan Wadi Workers (AWW) from the ICDS, and Sudurvarti Sahayak from Chief Minister’s Sudurvarti Gram Yojana.

The urban poor people in Uttarakhand cities are being covered by special DOTS centres, 9 such DOTS centres exist for urban poor people in Dehradun (state capital), 6 in Haridwar and 3 DOTS centres for urban poor people each in Roorkee and Haldwani.

Bobby Ramakant - CNS