Project Axshya

Tuberculosis Control in India

AXSHYA_logoWith 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 9 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. Equal importance has been given to identify and address linkages which make TB 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 project completes three years

Project Axshya, which is a five-year project completed its first three years in March 2013. The next two years will be crucial for both consolidating as well as extending the gains made under the project during which significant momentum was 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. Some unique project interventions have worked towards:

Strengthening engagement of non-programme providers and communities: More than 900 NGOs have been sensitized on RNTCP schemes, and increased civil society involvement under the project has led to complementary programme efforts in human resource development, supervision and monitoring, access to diagnostics, increased commitment to DR-TB and TB-HIV from all levels, enhanced engagement of community-based ASHAs (Accredited Social Health Activists), engagement of private providers & NGOs in RNTCP's revised schemes, and some exemplary awareness raising efforts.

Engaging Village Health and Nutrition Committees: The project has systematically targeted the Gaon Kalyan Samitis (Village Health, Sanitation and Nutrition Committees) constituted under the National Rural Health Mission (NRHM) and informed them about TB with simple messages on identification of TB symptomatics and sputum testing at the nearest RNTCP microscopy centre. More than 40,000 such meetings have been held.

Broadening the scope of civil society involvement in TB services: More than 100 partners have joined the 'Partnership for TB Care and Control', creating an enduring National Partnership to link RNTCP to other stakeholders through national and state coordination committees. (www.tbpartnershipindia.org/)

Establishing sputum collection and transport mechanisms in difficult to reach areas, to ensure that sputum is collected from the patient and transported to the designated microscopic centre by an identified community volunteer, who also delivers the result to the patient. If the patient is suffering from TB, s/he is linked for treatment initiation thus closing the loop.

Facilitating the creation of TB forums at districts level to give a voice to the affected community and advocate with the programme managers for resolution of challenges faced by TB patients in accessing services. More than 200 districts have a functional district TB forum in them.

Disseminating the Patient Charter for TB Care and Control, which outlines the rights and responsibilities of TB patients, aims at empowering those with the disease and their communities and making the relationship with health care providers a mutually beneficial one. The Union developed an illustrated version of the Charter, translated into 19 Indian languages. The Charter is being displayed at various public health facilities and disseminated to all stakeholders across Project Axshya districts.

Engaging Rural Healthcare providers: More than 10,000 RHCPs have been trained to refer TB symptomatics for sputum examination and incentivised to serve as DOT providers by the programme.

Soft skills training for public health system healthcare workers: More than 9,000 health staff have undergone trainings focused on interpersonal communication and behaviour change that help health care workers empathise with patients and address their needs. This has resulted in greater patient satisfaction and improved treatment adherence.

'Bulgam Bhai' Campaign: Axshya developed a unique mass media campaign titled 'Bulgam Bhai' ('Mr Sputum') focussing on creating  awareness on treating 2 weeks of cough as a symptom of TB, and promoting sputum testing for TB diagnosis. The campaign consists of TV spots, radio spots, outdoor, street theatre performances, video van activities, and an inter-personal toolkit containing games and puzzles to be used by front line health workers to raise awareness on TB.

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