Tuberculosis Control in India

With some 2 million new cases of TB yearly, India bears the highest burden of TB globally. It also has among the highest number of MDR-TB and TB-HIV co-infected cases. While India's national TB programme, the Revised National Tuberculosis Control Programme (RNTCP) has done an outstanding job, it is now also well recognised that the spread and complexity of TB in the country requires a concerted effort from multiple stakeholders across all sectors working together to tackle it, and not just from the government. This would expand access to TB information and services, increase the accountability of service providers, and empower communities – objectives crucial to TB care and control in India's setting.

Project Axshya (meaning "free of TB")

It was with this in mind that Project Axshya (meaning 'free of TB') was launched in April 2010 as the civil society component of a five-year project funded by a Round 9 grant from the Global Fund to Fight AIDS, TB and Malaria (The Global Fund). The principal recipients of the overall US$199.54 million grant are the Government of India, The Union and World Vision India (WVI). While the government is focusing on scaling up access to MDR-TB diagnosis and treatment, The Union and WVI are leading the civil society component 'Project Axshya' engaging all sectors to strengthen TB care and control in 374 districts across 23 states of India, reaching some 750 million people by 2015. The project is being implemented through sub-recipient partners in respective states.

Focus is on universal access to TB care

The focus of Project Axshya is on Advocacy, Communication and Social Mobilisation (ACSM) towards universal access to TB care. It aims to improve access to quality TB care and control through a partnership between government and civil society, and is supporting RNTCP to expand its reach, visibility and effectiveness. It is covering a range of activities to empower communities on TB control; advocate for political and administrative support; involve all health care providers to increase the reach of TB services, ensure the rational use of drugs and diagnostics, and train on areas of national priority. Its guiding principles are universal access to quality TB services, community participation, sustainable interventions and equitable distribution with social and gender sensitivity. The project is especially addressing those who have had the greatest difficulty in accessing information and treatment for TB – women, children, tribal populations, communities living in geographically difficult areas, and vulnerable groups, such as people co-infected with TB and HIV.

Partnerships are key to the project's success

A key strategy of the project is to involve partners across sectors – government, non-governmental organisations, private doctors, technical agencies, affected communities and the media. Equally important is to recognise and address linkages that continue to sustain TB as an enormous challenge for India, especially the linkages of TB with poverty and malnutrition, with diseases such as diabetes and HIV, and with the use of tobacco. The Union is therefore trying to synergise its work on Project Axshya to incorporate these related challenges. USEA also houses the secretariat of the Partnership for TB Care and Control in India that brings together on one platform a range of organisations engaged in TB control, in support of Project Axshya. Please visit www.tbpartnershipindia.org for more details.

The Union will reach 577 million people across 21 states

Of the 23 states covered by Axshya, The Union is implementing the project in 21 States. A Project Management Unit in The Union South-East Asia Office (USEA) in New Delhi is dedicated to this initiative. The Union will eventually reach a population of about 577 million in 300 districts across 21 states, working through nine committed partners, each with an excellent track record of TB-related work in their states. These are the Catholic Bishops Conference of India – Coalition for AIDS and Related Diseases (CBCI-CARD), Catholic Health Association of India (CHAI), Christian Medical Association of India (CMAI), Emmanuel Hospital Association (EHA), MAMTA Health Institute for Mother and Child (MAMTA), Mamta Samajik Sanstha (MSS), Population Services International (PSI), Resource Group for Education and Advocacy for Community Health (REACH), and Voluntary Health Association of India (VHAI). These organisations are reaching out to the farthest nooks and corners of this large diverse country through their own networks and sub-networks of community-based organisations and providers.

The project completes two years

Project Axshya, which is a five-year project, completed its first two years in March 2012. The subsequent years will be crucial for both consolidating as well as extending the gains made under the project in the last two years during which significant momentum has been generated in involving the civil society and other sectors nationally. The project's ACSM focus has been a very successful and strategic complement to the national programme and has allowed people access to TB services in hitherto untapped ways. In recent months, a major mass media campaign 'Bulgam Bhai' (meaning 'Mr Sputum', a spoof to turn the grave perception of TB in the country on its head) has been launched under the project.

For more information on Project Axshya, please visit www.axshya-theunion.org.