National Consultative Meeting of PartnersPARTNERSHIP FOR TUBERCULOSIS CARE AND CONTROL IN INDIA

30th September 2009

Hotel Claridges, New Delhi

Ravi BhatnagarProject ManagerADRA‐INDIA

Goal of the ACSM Project 

To  strengthen the efforts of RNTCP in reducing T.B. mortality and morbidity in  eight  Districts of Bihar. 

Specific Objectives of the ACSM Project :

1. To engage and empower communities for a greater role in TB control and care through improved knowledge, changed attitudes, and participation.

2. To improve access to and utilization of TB diagnosis and treatment through engagement of the private health sector

Where we work Sr.No.

DistrictPopulation(in 100,000)

CDR

1 Supaul 19 10

2 Bhojpur 25 20

3 Gaya 39 15

4 Madhubani 40 17

5 Nawada 20 22

6 Saran 36 17

7 Sheohar 6 14

8 Siwan 30 24

90

82

91

88

101

0 20 40 60 80 100 120

HIV/AIDS Project experience in carrying out targeted interventions, with core/ vulnerable groups, home based care, community care centres, dropincentres for PLHAs, counseling and testing etc.

Managing other health projects such  as RCH, sexual health project, TB  family planning /social marketing *.    

Managing community development Projects.

Experience in Community awareness issues.

organizational   experience in forming / establishing community based networks *

Our  NGO/CBO/ FBO Partners in Bihar

N= 110 { organizational    experience  of (more than one year) in  any of the following areas (HIV/AIDS Project experience in carrying out targeted interventions, with core/ vulnerable groups, RCH,  networking, community awareness, home based care, community care centres, drop in centres for PLHAs, counseling and testing etc.)}

24

18

11

25

25

19

12

16

18

13

168

7

8

2

2

1

9

9

4

2

42

31

26

13

27

26

19

21

25

22

15

225

32

15

8

17

16

13

14

16

14

10

124*

All 8 

DistrictsSheo

harM

adhu

bani

Gaya

Saran

Siwan

Naw

ada

Supaul/

Madhu

bani

Bhojpu

r

District 

Mix 

Group

Total 

Training participants for organizational Development and Leadership Training 

No. Of Male participants No. Of Female participants Total No. Of participants

Services Delivery Area:  Advocacy, Communication and Social  Mobilization : Mobilizing Communities through local NGOs/ FBOs/ CBOs. 

1. Profiling of NGOs /FBOs/ CBOs in the 8 operational districts‐ 120

2. Sensitization and involvement of  the NGOs ; CBOs on TB related issues‐ 12o NGOs ;240 members  and 300 volunteers. (Important networks include Patna network of Positive people, Mahila Samakhyas, Development Alternatives, Women Development Cooperatives). 

3. Celebrations of International women day‐ in this 40,000 women Participated in the various events.

4. Celebrations of  World TB week‐ 3 20,000 lakh people were sensitized through different events across the 8 districts.

5. Culturally Adaptive Social Messaging through Street Plays, IEC Van, Rickshaw miking,Cycle miking, TB Information Kiosks.

Community based tools used for (ACSM) for Awareness generation dissemination at the grassroots level : 

1. Sensitizing the communities; PRI / FBOs‐ through ‐Nukkad Natak(local folk media).

2. Use of IEC material for information dissemination both at district and at field level.

3. Use of Mobile /IEC van for information dissemination on TB

4. Setting up information kiosks in the focus Tuberculosis unit.(TU).

5. Paddling for TB through Rickshaw miking in the most vulnerable pockets

6. Interpersonal communication ‐Community meetings / Interaction at the field level.

Services Delivery Areas: Community System Strengthening 

1. Building capacity of Community based organization / NGO on Organizational developmentand leadership for taking a greater role in TB control.

2. Capacitating the NGOs / Private Providers on RNTCP new Schemes in the 8 operationaldistricts of Bihar .

Community  Systems Strengthening

The Materials produced in the project in consultation with State WHO RNTCP and Government of Bihar  (State TB Unit) has been  used  at different podium  in  the district and the field level.

For Training purpose flipbook in Hindi is made inconsultation with State WHO RNTCP team and StateTB officer (with source WWW.tbcindia.org).

Patient Charter is developed in Hindi and is put in all15 TU’s in eight districts and is used by 120 +organizations in their project activites.

• DM, Bhojpur Flaging the Nukkard team 

The Ayushman Launching by Govt officials  and ADRA‐ India 

N=64

1. Advocacy and partnership with Govt and PRI makes an initiative more sustained.

2. Community based tools like Information kiosks; Rickshaw miking; mobile van are quite a powerful toolfor information dissemination.

3. Social mobilization and information dissemination in local language could be very powerful instimulating people

4. Partnership with local level NGOs gives an sense of ownership and built a pressure at local level for largerinvolvement of civil society in RNTCP.

5. From beginning of the project advocating ,meeting ,partnering with District Health Society and StateHealth society is very vital for accomplishment of the laid program objectives.

6. NGO/CBO/FBO regular meetings on progress update is very instrumental for better planning and tappingopportunity gaps.

7. Media, Political, PRI advocacy is very useful in early redressal of pending issues regarding the RNTCPprogram.

8. Civil society organizations play a vital role in improving referrals, adherence, social mobilization etc.but they need constant handholding to reduce “Community Leadership Deficit”.

9. Gram Sabha plays a very important role to make TB (RNTCP) as an priority issue.

Lessons’ Learnt

1. Facilitating the NGOs and Private Providers enrollment with GOB.

2. Working and maintaining the motivation of Private providers and DOTS Providersas many of them have not received payments from last few years

3. Administrative issues like DTO and civil surgeon transfers .

4. 4. Organizational Development and Leadership skill enhancement for LocalNGO/CBO’s/ FBO’s needs to be further strengthened for taking up the challengesof program implementation.

5. High Migration

Key Challenges

Case detection rate ‐ 2009

Name of the DistrictsQuarter 3, 2008

(Baseline)

CDR in %

Quarter I ,2009 Quarter II, 2009

Referral of Patient from NGO/CBO’s of 

ADRA ‐INDIA

Bhojpur 20 16 27 652

Gaya 15 26 37 846

Madhubani 17 43 53 512

Nawada 22 37 42 728

Saran 17 40 45 568

Sheohar 14 30 56 721

Siwan 24 51 63 559

Supaul 10 17 26 596

Total 5182

Important : Attributed to the work jointly done by State , District TB Cells, WHO and ACSM Partners.

Note : Attributed to the work jointly done by State , District TB Cells, WHO  RNTCP Team and 120+ NGO’s/CBO’s/FBO’s engaged in ACSM Activities funded by USAID‐India through World Vision‐India.

Thanks