Wake up call for community engagement in TB programmes

In Andhra Pradesh state of India, a doctor gulped down sleeping pills when pulled up by authorities for not doing field visits to follow up tuberculosis (TB) patients (source: The Times of India). "There was no other medical officer" in the clinic so she couldn't go to field visits and rather attended to her duties within the clinic – argued the doctor.

India's national TB programme (officially called the Revised National TB Control ProgrammeRNTCP) has incorporated the Patients' Charter for TB Care (The Charter) which is also an integral component of the WHO Stop TB Strategy (2006-2015) at the global level.

The Patients' Charter for TB Care (The Charter) puts forth a rights-and-responsibilities based framework to engage affected communities effectively in TB programmes at all levels, with dignity.

The question is: who has the expertise required to do effective advocacy, communication and social mobilization (ACSM) at the community level? Who can better work on solutions for challenges that confront TB programme outcomes? Are we recognizing, respecting and utilizing the expertise available within affected communities in fighting TB optimally? Are we willing to look beyond a clinical or biomedical response to TB, recognize where the gap lies and engage affected communities with dignity?

The issue of no-doctor-in-clinic is also a sad and disappointing reality – if TB programmes want doctors to do field visits (assuming they can do it better than say the cured TB patients). Engaging communities effectively to play this key role might help.

The question of financial resources shouldn't arise – because doctors have been given resources to do these field visits, which includes a vehicle! "They [doctors] do not go to the field. Hyderabad is the worst performing district in the state. We have given vehicles to these officers, but still they do not go for field work," said Gulzar Natarajan, district collector who had pulled up doctors who were not performing their duties (including the one mentioned above who took sleeping pills) – as per the news published in The Times of India (6 February 2011). Why cannot these existing resources be invested more wisely in engaging communities to get the desired outcome of increased TB case detection and treatment success rate?

Dr KS Sachdeva, Chief Medical Officer (CMO), RNTCP, Central TB Division, Government of India, said in a press conference held in Hyderabad on 24 January 2011: "As we all know, TB is an infectious disease and it is very important for us to detect the TB at the early stages and provide complete treatment. It is seen that most patients do not feel the need to continue the treatment as they feel better of the programme emphasizing for adherence to the treatment and keeping default rate to the minimum with the help of community DOTS provider, majority of the patients enrolled under the programme complete their treatment."

Dr Sachdeva had further informed the media on 24 January 2011 that having achieved the global objectives of 70% case detection and 85% treatment success rate for last three consecutive years, the programme has set for itself an ambitious target of Universal Access to Quality TB Care for all TB patients from whichever healthcare provider they choose to seek care. This calls for reaching out the unreached and fostering an active involvement of private healthcare providers, non-governmental organisations and empowering community to demand for quality TB care services.

Translating 'empowering community to demand for quality TB care services' into reality is a clear mountainous challenge in no uncertain terms. One way forward can be to implement the Patients’ Charter for TB Care in letter and spirit – as genuinely as possible.

Bobby Ramakant - CNS

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