Health and Development Initiative-India, (www.healthinitiative.org), publishes 'TB News from India' once every two months. The objective of newsletter is to highlight issues related to Tuberculosis and HIV/AIDS control in India and enlist political, public, professional and administrative support for its cause. Health and Development Initiative-India is a not-for-profit organization and the news items have been quoted from various sources for fair use and in public interest. Reproduction of the material published is welcome provided a reference is made to the original source of the news item and TB News from India.

Editorial note:  

World TB Day 2003: `Focus TB patients'

"By now, we should be starting to turn the tide against tuberculosis. After all, we have the tools so let's finish the job," says Jacob Kumaresan, the outgoing Executive Secretary of Stop TB Partnership who has done a yeoman's service to bring tuberculosis to the centre stage of global agenda.

"Thanks to DOTS, the five-point anti-TB strategy, the world's embattled health care providers have a proven, standardized method of fighting the disease. And thanks to the establishment of Stop TB's Global Drug Facility to increase free access to quality drugs, they now have the means. Given these advantages, you might think suspect TB cases have it relatively easy. If they consult a DOTS clinic without delay, they can be diagnosed promptly and accurately, receive a correct treatment prescription, obtain the correct drugs, and by taking the full treatment regimen, be cured", explains Dr. Kumaresan

"So now that we have mastered the technical aspects of curing TB, it's time to examine more closely the "human factor" - the people who have the illness, and the health care providers charged with curing them", he adds. Sounding a note of caution he says, "Unless we more clearly understand why so many TB sufferers slip through the net, and improvise new methods to capture them, we will not achieve the 2005 targets." (To detect 70% of all active TB cases and cure 85% of those detected.)

In essence, this is the job Stop TB must now tackle: while we now have a sure-fire method of winning the war against TB, we still have to "sell" it to the people who need it. This is where a research tool called COMBI, for "Communication for Behavioural Impact", comes in. Beginning January 2003, Stop TB-sponsored COMBI pilot programmes will air in Bangladesh, India and Kenya. 

Dr. Jacob Kumaresan is absolutely correct when he says, "People aren't robots. They don't just fall meekly into line when some medical official passes through their city slum or remote village and tells them what's good for them."

Understanding the needs of TB patients in diverse settings and helping them overcome the obstacles, which they encounter while trying to access DOTS services, is of paramount importance. This year the World TB Day rightly focuses on TB patients. In fact the `Human Factor' in our approach to TB patients as Kumaresan calls it, holds the key to success of global campaign against TB. 

WHO prepares to launch COMBI project to support TB control in India

World Health Organization (WHO) over the past two years has been applying a concept called "COMBI: Communication for Behavioural Impact" in the design and implementation of behaviourally focused social mobilization and communication programmes for the elimination of leprosy in India and Mozambique, the prevention of lymphatic filariasis in India and Tanzania, and dengue prevention and control in Malaysia. Dr. Everold N. Hosein, Communication Advisor to 
Communicable Diseases Division of World Health Organisation says, "It is an approach, which may be well suited for achieving behavioural impact in confronting HIV/AIDS, TB and malaria. COMBI interprets social mobilization as the process, which judiciously and strategically blends a variety of communication interventions intended to `mobilize' the societal and personal influences, which prompt an individual to adopt and maintain a particular behaviour", he adds.

COMBI, drawing on consumer communication experience, begins with the "people" (clients, patients, beneficiaries, consumers) and their health needs, wants, desires, and a sharp focus on the behavioural result expected in relation to these needs, wants and desires. "It is rooted in people's knowledge, understanding and perception of the recommended behaviour", Dr. Hosein explains.

Describing the methodology followed by COMBI programme, Dr. Hosein says, "the `market/community' is intimately involved from the outset through practical, participatory community research and situation analysis relating desired behaviour to expressed or perceived 
needs/wants/desires". People are then engaged in a review and analysis of the suggested healthy behaviour through a judicious blend of integrated communication actions in a variety of settings, appropriate to the "market" circumstances and based on the community research, recognizing that there is no single magic intervention. The blend of communication actions include advocacy and public relations, administrative/managerial mobilisation, community mobilisation, sustained appropriate advertising, interpersonal communication/ counselling/ personal selling, and point-of- service promotion.

"We have just completed a small COMBI project for leprosy in three districts of Bihar with impressive results. We have also done a successful COMBI programme for Lymphatic Filariasis mass drug administration in Tamilnadu also," says Dr. Hosein, who is very enthusiastic about extending the COMBI approach to TB control in India. "In TB we are just starting a COMBI programme in Kerala State as our first India demonstration project," says Dr. Hosein.

The Stop TB Task Force on Advocacy and Communications chose Kerala in India because it has high DOTS coverage and low detection rates, but nevertheless boasts of good infrastructure support in place to implement social mobilization activities.

COMBI uses a variety of communication interventions to "mobilize" the target population into adopting and maintaining a particular desired goal - in this case, taking the sputum test. It also attempts to identify the barriers and constraints that may prevent people from taking up the treatment, and thereafter following it through to the finish.

(We will keep our readers updated about progress of COMBI plan in India.For more information about the philosophy behind the COMBI approach, see chapter three of WHO's 2002 report, "Scaling Up the Response to Infectious Diseases" at: http://www.who.int/infectious-disease-report/2002)

The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFTAM) announces its first grant for India

The Global Fund to Fight AIDS, Tuberculosis and Malaria on 31st January 2003 announced the latest agreements to fund thirteen programs around the world. Grant agreements have been signed with Argentina, Cambodia, India, Indonesia, Madagascar, Mongolia, Panama, Senegal (two agreements), Ukraine (two agreements), Zimbabwe and the Lutheran World Federation totaling US$93.5 million.

The main objective of first ever US $ 5.6 million GFTAM grant to India is to help expand the Revised National Tuberculosis Control Program (RNTCP) to cover 56 million people in all 47 districts of the three newly created states of Jharkhand, Uttaranchal and Chhattisgarh. It also aims to improve quality and reach of RNTCP through the availability of free and uninterrupted high-quality tuberculosis diagnostic and curative services, more patient-friendly treatment observation, greater involvement of other government agencies and the private sector (including nonprofit nongovernmental organizations) in the RNTCP. 

The grant aims to ensure patient friendly services through decentralization of DOTS to peripheral health workers, anganwadi workers (honorary village level workers), elected community leaders 
and other community members.

To help overcome the bottlenecks faced by urban slum dwellers to access DOTS services the grant will help provide one Tuberculosis Health Visitor for every 150,000 urban dwellers.

The intended outcomes include initiating 1,15000 new TB patients on treatment, saving 20,000 lives and preventing spread of TB to 230,000 individuals.It is hoped that this will help reduce number of families falling into the cycle of debt and poverty caused because a family member has tuberculosis. 

The grant will also help develop a model to establish sustained partnerships for TB control between private and public sector through advocacy and training by Resource Group for Education and Advocacy for Community Health (REACH). The Program includes REACH's activities in four selected Corporation Zones of Chennai, reaching 50% of all the private practitioners and private hospitals in the RNTCP in a phased manner.

You can read complete fact sheet at:
http://www.globalfundatm.org/journalists/fsheets/india.html#top 

Courses to give an edge to the doctors (The Hindu, February 17,2003)

Themis Medical Education Cell, established by Themis Medicare Limited, plans to conduct 200 certificate courses to train about 10,000 doctors across India in the diagnosis, chemotherapy and 
treatment of tuberculosis as well as the sinister combination of HIV-TB infection. The cell would be spending US $ 200,000 on conducting these courses in collaboration with Indian Medical Association. The objective is to standardize the treatment of dreaded disease says K C  Mohanty, the cell's convener.

Dr. Mohanty points out that to achieve the objective of controlling TB; a standardized easy and effective diagnostic procedure; uniform and cost-effective treatment and effective vaccination of children, would have to be ensured. The Themis programme is aimed precisely at adopting these methods.

He says the courses, open to the members of Indian Medical Association, would be of three hours duration and will promote WHO-recommended fixed dose anti-TB drug combination.

The medical education cell will concentrate on the rural areas in Rajsthan for its training programme and organize the courses at various district headquarters. The first course in the State was organized in Sikar on 16th February 2003. A large number of local doctors participated in it. The certificate courses, strengthening the TB Control Programme have already been launched in Maharashtra. 

DOTS services available to only 10% in Bihar 

Bihar is one of the most economically backward States of the country. In the year 2000-2001 more than 55% of its population lived below the poverty line. The State has the lowest literacy rate (47.53%)in the country.

Currently DOTS facilities are available only in three districts out of thirty-seven districts of the state.

Read 'DOTS Watch' Bihar: 
http://www.healthinitiative.org/html/dotswatch/bihar.htm 

Tuberculosis scene in Orissa 

It is estimated that there are 500,000 TB patients in the state and out of them 125,000 are sputum positive. About 80,000 new cases are being added every year to the existing pool of  cases. The number of TB patients dying every year is estimated to be around 17,500.

Read `DOTS Watch' Orissa:
http://www.healthinitiative.org/html/dotswatch/orissa.htm 

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