STLS: Advocacy, Communication & Social Mobilization in NTEP

Advocacy refers to activities that seek to influence the influencers and decision-makers, so as to make TB more central as a public health agenda and enlist their (influencers’) support to create an enabling environment in support of the National TB Elimination Programme (NTEP) to eliminate TB. Advocacy fosters political will, increases financial and other resources on a sustainable basis, and holds authorities accountable to ensure that pledges are fulfilled and results achieved.

 

 

Communication is a process people use to exchange information about TB through media, including such channels of communication as mass media, mid-media, and Interpersonal Communication (IPC). Much of the communication effort on TB is concerned with transmitting a series of messages to the people affected by TB through mass media and mid-media, which are necessary but not sufficient. As ‘participation’ and ‘dialogue’ are necessary for effective communication, IPC occupies a place of vital importance. Communication aims to improve knowledge about TB and TB services and change attitudes and practices to encourage people to seek care and complete TB treatment.

 

Social mobilisation is the process of bringing together different stakeholders and building partnerships to prevent, detect, and cure TB. It targets different sections of the targeted population, say a village community, ward, or other small groupings, and raises awareness of and demand for the TB elimination program. The emphasis here is on community participation and involvement in TB case detection and cure.

 

Resources

• Operational Handbook on Advocacy, Communication & Social Mobilisation for RNTCP, Central TB Division, MoHFW, GoI, 2014.

Assessment:

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
Placing TB higher on the political agenda of governments is an achievement of:	Advocacy	Coordination	IPC	None of the above	1	Advocacy is a broad set of coordinated efforts to place TB higher on the political agenda, strengthen government commitment to implement or improve TB-related policies and increase and sustain financial and other resources for TB.	​	Yes	Yes

In ACSM, "A" stands for Advocacy. "Advocacy" is an activity by an individual or a group that aims to influence the decisions within political, economic and social institutions. 

Advocacy focuses on influencing policy-makers, funders and international decision-making bodies through a variety of channels:

• Conferences, summits and symposia
• Celebrity spokespeople, press conferences, news coverage
• Meetings between various levels of government and civil society organizations
• Official Memoranda of Understanding (MoU), parliamentary debates and other political events
• Partnership meetings, patients’ organizations, private physicians, radio and television talk shows, and service providers.

Types of advocacy

• Policy advocacy: Mainly targets policy-setting, influencing policymakers to incorporate the latest evidence and informs senior politicians and administrators how an issue will affect the country, and outlines actions to take for improving the laws and policies.
• Programme advocacy: Targets opinion leaders at the community level on the need for local action.
• Media advocacy: Validates the relevance of a subject, puts issues on the public agenda and encourages the media to cover TB-related topics regularly and in a responsible manner so as to raise awareness of possible solutions and problems.

 

Resources

1. Advocacy, Communication & Social Mobilization (ACSM) for Tuberculosis Control - A Handbook for Country Programmes, WHO, 2007.
2. Operational Handbook on Advocacy, Communication & Social Mobilization for RNTCP, Central TB Division, MoHFW, GoI, 2014.

 

 

Assessment:

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
News reports on World TB day celebrations are an example of which of the following types of advocacy?	Policy advocacy	Programme advocacy	Media advocacy	None of the above	3	Media advocacy encourages the media to cover TB-related topics regularly and in a responsible manner so as to raise awareness of possible solutions and problems.	​	Yes	Yes

Communication aims to favourably change knowledge, attitudes and practices among various groups of people. 

Types of communication in healthcare are:

• Oral/verbal communication- by word of mouth (speech/talk)
• Written communication- exchange of facts, ideas and opinions through the use of written materials
• Non verbal communication- through gestures, body language or posture, facial expressions, and eye contact 
• Visual communication- exchange of ideas through visuals

Health communication aims to influence and empower individuals, populations and communities to make healthier choices. It frequently informs the public of the services that exist for diagnosis and treatment and relays a series of messages about the disease. It aims to inculcate behaviour change for healthy life choices.

E.g.: “Seek treatment if you have a cough for more than two weeks”, “TB hurts your lungs” or “TB is curable”.

Approaches to health communication

1. Informative communication

Provides information about a new idea and makes it familiar to people.

2.Educative communication

A new idea on health behaviour is explained, including its strengths and weaknesses.

3.Persuasive communication 

Usually in the form of a message that promotes a positive change in behaviour and attitudes, and which encourages that audience to accept the new idea. This approach to message development involves finding out what most appeals to a particular audience. Persuasive approaches are more effective than coercive approaches in achieving behaviour change.

4.Prompting communication

Messages are designed so that they are not easily ignored or forgotten they can be used to remind the audience about something that reinforces earlier messages.  

Behaviour Change Communication (BCC)

• Behaviour Change Communication (BCC) is an interactive process of any intervention with individuals, groups or communities to develop communication strategies to promote positive health behaviours which are appropriate to the current social conditions and thereby help the society to solve their pressing health problems.
• BCC creates an environment through which the affected communities can discuss, debate, organize and communicate their own perspectives on TB.
• It aims to change behaviour – such as persuading people with symptoms to seek treatment – and to foster social change, supporting processes in the community or elsewhere to spark a debate that may shift social mores and/or eliminate barriers to new behaviour.

 

                                                                                           Figure: Behaviour Change Communication

 

 

 

Resources

1. Advocacy, Communication & Social Mobilisation (ACSM) for Tuberculosis Control - A Handbook for Country Programmes, WHO, 2007.
2. Operational Handbook on Advocacy, Communication & Social Mobilisation for RNTCP, Central TB Division, MoHFW, GoI, 2014.

 

 

 

Assessment:

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
What does the environment created by behaviour change communication encourage the TB-affected communities to do?	Discuss, debate, organize, communicate	Discuss, organize, implement, communicate	Organize, enforce, communicate	None of the above	1	Behaviour change communication creates an environment through which the affected communities can discuss, debate, organize and communicate their own perspectives on TB.	​

Social Mobilisation (SM) is the process of bringing together different stakeholders and building partnerships to prevent, detect and cure TB. It generates dialogue, negotiation and consensus among a range of players that includes decision-makers, the media, Non-government Organisations (NGOs), opinion leaders, policy-makers, the private sector, professional associations, TB-patient networks and religious groups.

At the heart of social mobilisation is the need to involve people who are either living with active TB or have suffered from it at some time in the past.

 

Aims of Social Mobilisation

• Increase awareness of the disease (TB) and the demand for diagnosis and treatment services

• Expand service delivery through community-based approaches

• Enhance sustainability, accountability and community ownership of TB services

 

Activities for Social Mobilisation

• Group and community meetings - Engaging yuva/ mahila mandals, village health sanitation and nutrition committees under the National Rural Health Mission (NRHM), sensitization of local and religious leaders on TB and related stigma in the community. Regular meetings at the village level to address myths and misconceptions and help people with TB symptoms seek timely and appropriate care or referrals.
• School activities - Conducting TB awareness campaigns in schools by addressing the school assembly/ class, painting competitions, rallies, road shows, essay competitions, drawing competitions, exhibitions, dramas, pictorial presentations, quizzes, puzzles, puppet shows, leaflet distributions etc.
• Traditional media group performances - Performing entertainment-centred folk performances, street plays with scripts centred around TB awareness messages.
• Rallies and road shows - Spreading TB related messages on World TB day.
• Home visits - Encouraging interpersonal communication and empowering former TB patients and TB champions to become Directly Observed Treatment, Short-course (DOTS) providers.

Here, inter-personal communication and group communication are the main channels of communication for disseminating TB-related key messages.

 

In the National TB Elimination Programme (NTEP), partner NGOs play an important role in social/ community mobilisation. It generates dialogue, negotiation and consensus, engaging a range of players in interrelated and complementary efforts while taking into account people’s needs.

 

Resources

 

1. Advocacy,Communication & Social Mobilisation (ACSM) for Tuberculosis Control - A Handbook for Country Programmes, WHO, 2007.
2. Operational Handbook on Advocacy, Communication & Social Mobilisation for RNTCP, Central TB Division, MoHFW, GoI, 2014.

 

Assessment:

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
A roadshow was conducted by local PHC in a village on World TB day with message to End TB. This is an example of:	Policy making	Social mobilisation	Institutional strengthening	Diagnostics	2	Roadshow is one of the activities of social mobilisation strategy which aims at increasing awareness about the disease, involving major stakeholders.	​

 

 

 

 

 

Advocacy, Communication and Social Mobilization (ACSM) strategies are directed at achieving specific goals in terms of TB elimination.

They are:

• Setting and developing the policy based on the latest evidence
• Mobilizing political commitment and resources for TB
• Improving case detection and treatment adherence
• Widening the reach of services
• Combating stigma and discrimination
• Empowering people affected by TB and the community at large

It is useful to determine how ‘ideal behaviour’ in the community relates to these goals. The ‘ideal behaviour’ which is promoted through messages and ACSM strategies should be connected to the overall goal of the TB control programme. A few examples of this are:

• For the general public: Going to a healthcare provider at the first signs of possible TB infection (ideal behaviour) relates directly to the National TB Elimination Programme (NTEP) goal of increasing the case-detection rate for TB.
• For healthcare providers: Following the standards set for the treatment of TB – includes knowing what regimen, how to administer anti-tubercular therapy and what treatment path to take in case of multidrug-resistant or extensively drug-resistant TB. This relates to treatment adherence and outcomes.

The ACSM goals are planned in such a way as to achieve/ address:

• Structural or systemic issues (such as the lack of community Direct Observation Treatment, Short-course (DOTS) programmes)

• Communication interventions (such as behaviour change)

• Individual and social barriers (such as stigma, risk perception and knowledge among populations and health staff)

• Social mobilization activities that promote changes throughout a community or priority group.

 

Resources

 

1. Advocacy, Communication & Social Mobilization (ACSM) for Tuberculosis Control - A Handbook for Country Programmes, WHO, 2007.
2. Operational Handbook on Advocacy, Communication & Social Mobilization for RNTCP, Central TB Division, MoHFW, GoI, 2014.

 

Assessment:

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
Seeking healthcare at the earliest symptom of TB directly relates to which goal of NTEP?	Mobilizing political commitment and resources for TB	Improving case detection	Widening the reach of services	Combating stigma and discrimination	2	Improving case detection is an important goal of NTEP and seeking health care early helps in the detection of more number of cases.	​	Yes	Yes

 

 

Identifying target audience is a key step in the process of developing Advocacy, Communication and Social Mobilisation (ACSM) strategy.

Specific target audience need to be addressed to prevent hinderances in achieving the programme objectives.

Figure: Steps in Identifying Target Audience for ACSM Activities 

 

Target Audience for ACSM Activities

1. Advocacy

• Decision-makers at national, regional and district levels (National Health Mission officials, District Magistrate, National TB Elimination Programme leadership)

• Policy-makers

• Professional groups

• Funders

• Media

 

2. Communication

• General public, including different vulnerable groups, healthcare workers (i.e., primary healthcare providers, Allopathic and Ayurvedic, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) doctors, private healthcare providers, traditional healers, etc.)

• TB patients currently on treatment as well as cured TB patients

• Contacts of patients with active TB

• People at high risk of developing TB

 

3. Social mobilisation

• Communities

• Community groups, e.g., mahila mandals, youth groups

• National and local level leaders

• Local Non-government Organisations (NGOs), Youth organizations, Community-based Organisations (CBOs)

 

Resources

• Operational Handbook on Advocacy, Communication & Social Mobilisation for RNTCP, Central TB Division, MoHFW, GoI, 2014.

 

Assessment  Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​
Identifying target audience is crucial in the process of developing ACMS strategy.	True	False			1	Specific target audiences need to be addressed to remove the causes/ reasons that are hindering programme objectives.

 

Once Advocacy, Communication and Social Mobilisation (ACSM) objectives are designed, linking them with activities strengthens the overall programme effectiveness. Several ACSM approaches can be considered for TB. Decisions on which approach or combination of approaches to use should take into account the benefits and risks, the time frame and the expertise and financial resources needed for effective implementation.

 

There are two parameters to determine:

(1) What ACSM activities to conduct?

(2) Which channels of communication to use?

 

Following are the various ACSM approaches relevant to the National TB Elimination Programme (NTEP) and the activities included in it:

 

NTEP Goal	ACSM Approaches	Activities & Channels
Gaining political commitment to TB elimination	Educate national policy-makers and political leaders about the health and economic benefits of TB elimination. Aim to have TB declared a national health priority. Educate local and community level authorities to encourage them to contribute to TB elimination efforts. Solicit the support of international and national partners.	Seminars and briefing meetings Print information (letters, fact sheets) Events around World TB Day and other occasions
Improving case detection	Raise public awareness about TB. Reduce stigma against people with TB and correct misconceptions about TB infection by actively involving current and former TB patients. Help health workers, communities and individuals identify TB cases. Encourage individuals to seek care from appropriate sources. Target hard-to-reach populations (prisoners, urban poor, homeless).	Formative research to determine the best messages and approaches Mass media including radio and television Distribution of print materials at community meetings or events Interpersonal communication and counselling training for health workers Community mobilisation activities
Increasing treatment success and discouraging the spread of Multidrug-resistant TB (MDR-TB)	Give people with TB hope of complete cure. Encourage people with TB to seek treatment from appropriate sources. Provide materials to counsellors. Encourage people with TB to complete treatment even if they improve before treatment ends. Make people with TB aware of possible side effects, and where to seek care, if present. Encourage health workers, family and community members to directly observe people with TB taking their medicine. Engage people who are fully recovered to encourage people currently affected by TB to complete treatment.	Interpersonal communication and counselling training for health workers Mass media, including radio and television Extensive distribution of print materials at healthcare facilities Community mobilisation activities Peer education at community or interest group meetings

 

 

Resources

 

1. Advocacy, Communication & Social Mobilisation (ACSM) for Tuberculosis Control - A Handbook for Country Programmes, WHO, 2007.
2. Operational Handbook on Advocacy, Communication & Social Mobilisation for RNTCP, Central TB Division, MoHFW, GoI. 2014.

 

 

Assessment:

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
Factors to be considered while adopting an ACSM approach include:	Risks & benefits	Time frame	Expertise & financial resources	All of the above	4	Decisions on which ACSM approach or combination of approaches to use should take into account the benefits and risks, the time frame and the expertise and financial resources needed for effective implementation.	​	Yes	Yes

 

 

 

There are several communication channels for the effective dissemination of messages.

Below are various channels with their advantages and disadvantages listed.

Channels/ Tools	Audiences Reached	Advantages	Disadvantages
Mass media channels
Television	Households, families	Wider reach in urban and rural areas Maximum impact due to audiovisual elements	Expensive production costs Less reach among rural and migrant populations, who are vulnerable to TB.
Radio	Individuals, households, families	Radio production is simple and much less expensive than TV. Relatively wider reach than TV among rural and migrant populations. Accessible even on mobile phones	Radio listening is no more popular; TV viewing/online portals are more popular.
Newspapers and magazines	Educated individuals, households	Timely and fixed schedule of dissemination. Pictorial description of message.	Not useful for the illiterate population People read newspapers for news about political developments, crime, etc., and not for advertisements per se, unless the advertisement is attractive and eye-catching enough.
Mid-Media - Outdoor Publicity Materials and Folk Arts/ Dramas
Posters	Individuals	Strong pictorial description of the message. Useful in high-traffic areas	Brief messages Short lifespan
Pamphlets	Individual	Good for communicating core messages with illustration/ visual support. Mass distribution and a kind of take-home message. Not very expensive. Can be used for repeated exposure and to reinforce messages broadcasted through mass media.	Useful for the literate population, but can be used by the illiterate people as well If the pamphlet looks attractive enough, it is taken home and contents are deciphered with the help of literates or children at home/ in the neighbourhood.
Brochures	Individuals, groups	Detailed information/ instructions with illustrations/ visuals/ graphs etc.	Production costs may be relatively high.
Flip charts	Individuals	Good support in counselling sessions.	Production costs may be relatively high.
Wall writings/ hoardings	Individuals, households	Useful in high-traffic areas. Good for identification, pictorial description and reinforcement of message	Only for the literate population. Message retention is low
Kiosks	Individuals	Face-to-face communication along with audio-visual communication for better message retention. Useful in dispelling myths and practices.	Expensive to scale up. Requires trained staff. Relatively small reach.
Mobile vans and videos on wheels	Groups, community	Entertaining and can grab audience attention and better message retention	Expensive to implement and scale up Relatively small reach Requires precision of timing
Folk dramas	Groups, community	Entertaining and can grab audience attention and better message retention Can touch an emotional chord with individuals/ households; useful for sensitisation.	Relatively small reach. Expensive to scale up. Requires precision of timing. Requires good artists with prior training.
Interpersonal Communication (IPC)
Counselling	Individuals	Credible source due to face-to-face communication. Allows detailed explanation of key health messages. Can help dispel myths and check wrong practices.	Time-taking to build reach. Small reach (individual). Costly to scale up. Requires special training.
Home visits	Households	Credible source due to face-to-face communication. Allows detailed explanation of key health messages. Can help dispel myths and check wrong practices. Useful for rapport building.	Time-taking to build reach. Small reach to the target audience. Requires adequate capacity building.
Community Dialogue
Seminars, workshops, and Parliament questions	Policy-makers, implementers, urban population	Brainstorming of key stakeholders. Identification of key communication challenges, Key inputs from experts and academicians.	Not timely. High cost of implementation. Time-taking to bring about change. Difficulty in mobilizing key stakeholders.
Public meetings and gatherings	Key influencers, individuals, households	Emphasis on key messages by influencers/ stakeholders. Useful for addressing different segments of the target audience together.	Intermittent in occurrence. High organising cost. Only verbal communication involved. Reach is relatively small.
Working with groups	Households, individuals	Dissemination of key messages among communities. Word-of-mouth communication.	Low frequency. Only verbal communication involved.
Social Media
Facebook, Blogs, YouTube, SMS	Individuals	Targets individuals but has a wide/ mass reach. An effective method of reaching a large number. High visibility among decision-makers.	Only limited people have access to internet accounts on Facebook, and an even smaller number have blogs.

 

Resources

1. Advocacy, Communication & Social Mobilisation (ACSM) for Tuberculosis Control - A Handbook for Country Programmes, WHO, 2007.
2. Operational Handbook on Advocacy, Communication & Social Mobilisation for RNTCP, Central TB Division, MoHFW, GoI, 2014.

 

Assessment

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
Home visits for communication are an example of:	Mass media	Interpersonal communication	Community dialogue	Mid-media approach	2	A home visit is a form of Interpersonal Communication (IPC). Credible source due to face-to face communication Allows detailed explanation of key health messages Can help dispel myths and check wrong practices Useful for rapport building	​	Yes	Yes

 

Advocacy, Communication and Social Mobilization (ACSM) activities must place the individual at the centre and bring in the family, community and society to bring about sustained changes in TB perceptions and behaviours. ACSM activities must target these 4 groups accordingly:

 

1. Individual: Specific interventions that ensure sustained engagement of people or individuals in maintaining positive behaviours/ changing to desired behaviours. E.g., counselling, use of positive TB messages, message by TB champions, etc.
2. Family: Interventions that create an enabling environment for promoting positive behaviour change and developing necessary skills for a person affected by TB. E.g., counselling of the entire family.
3. Community: Mobilizes groups toward a common goal, raises local resources and fosters support and awareness for TB-related issues. E.g., conducting TB awareness campaigns in public meeting places, melas, street dramas, etc. 
4. Society: Advocates for rights-based and socially inclusive approaches and seek support for the TB programme. E.g., workshops and seminars to drive change in legislation, policy, partnerships and resource allocation.

 

Aimed at individuals, families, communities, and the society, varied ACSM activities are undertaken at the national, state, district and community levels to:

• Create awareness and an enabling environment
• Build capacities to bring about desired changes in TB-related health behaviour
• Sustain positive behaviour

 

These are shown in the figure below.

Figure: ACSM Activities Spanning Across All Levels

Resources

• Operational Handbook on Advocacy, Communication, and Social Mobilization (ACSM), NTEP, 2014.
• NTEP Training Modules 5-9 for Programme Managers & Medical Officers, 2020.

Assessment

 

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
ACSM activities span across which levels?	Individual only.	Individual, family, community, society and from central down to the village level.	Individual and family levels only.	ACSM activities do not span across any level.	2	ACSM activities must span across the individual, family, community, societal levels, and from the central down to the village level.	​

 

 

Components of Advocacy, Communication and Social Mobilisation (ACSM) Planning Format

• Activity - The number of planned activities is mentioned against the timeline (for every quarter). Common activities listed in the format include community meetings, patient-provider meetings, school activities and outreach activities.
• Timeline - Timelines are divided into four quarters, but one must ensure that activities are spread across all the quarters and not aggregated in the last quarter of January–March.
• Budget - Budgeting for ACSM activities should cover materials, events, training, monitoring, evaluation, etc.
• Justification - The reason/ purpose for undertaking the ACSM activities is recorded.

The planning format also collects historical budgets proposed, allotted and spent for previous years to see if allotted budgets were properly utilised. The current allocation depends on the historical trend of spending. 

Table: Example of ACSM Implementation Plan Format  

 

Activity	Timeline				Budget	Justification/ Remarks
	Q1	Q2	Q3	Q4
	(Apr - June)	(July - Sep)	(Oct - Dec)	(Jan - Mar)

 

 

1. State Level

2. District Level

 

Advocacy, Communication and Social Mobilisation								Justification/ Remarks
Activity	Budget Proposed in last annual action plan (2012 – 2013)	Amount available in this Head (2012 – 2013)	Amount spent by district (2012 - 2013)	Approved ACSM Plan for 2013 -2014	Amount spent in 2013-2014 (till Sep 2013)	Permissible Budget as per population norm for 2014 - 2015	Budget proposed for 2013 - 2014
Total						0

 

 

 

 

Name of Activity	Number of activities undertaken in 2012-2013	Number of activities undertaken in 2013-2014 (till Sep 2013)	Number of Activities Proposed in 2014-15					Budget Proposed for Next FY 2014-2015
			Apr-Jun	Jul-Sep	Oct-Dec	Jan-Mar	Total
Community meeting							0
Patient – provider meeting							0
School activity							0
Outreach activity							0
CME							0
							0
							0
							0
Total	0	0	0	0	0	0	0	0

 

Resources

• Operational Handbook on Advocacy, Communication & Social Mobilisation for RNTCP, Central TB Division, MoHFW, GoI, 2014.

Assessment

 

Question​	Answer  1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​
How many components are there in the ACSM planning format?	3	4	5	2	2	Activity, Timeline, Budget and Justification are the key components of PIPs for ACSM.

Three Levels of Advocacy, Communication and Social Mobilisation (ACSM) Activities 

 

• Preparation of district- and state-level Project Implementation Plans (PIPs) is an important component of the National TB Elimination Programme (NTEP) under the umbrella of the National Health Mission (NHM).
• State PIP is prepared annually which helps states in identifying and quantifying their targets for programme implementation during the year.
• This takes a bottom-up participatory approach that promotes need-based and decentralised planning.

 

Figure 1: Bottom-up approach used in developing ACSM annual action plan

Steps in Planning ACSM PIP

• Draft of district PIPs are discussed in groups of 4–5 districts and ‘finalised’ as district PIPs.
• The district PIPs are consolidated into one document as the draft of state PIP by the IEC officer, in consultation with the STO and other concerned staff.
• In the process, the district PIPs and the state PIP are finalised and sent to Central TB Division (CTD) for approval.
• Once the state ACSM PIP and budget are approved by the CTD, the State IEC Officer (SIECO) should rework the state and district PIPs to reprioritise ACSM activities based on the allotted budget.

 

Community meetings are organised by the Senior Treatment Supervisor (STS) or the partner Non-Government Organisation (NGO) under the supervision of the Medical Officer.

• These meetings are conducted to create awareness about TB among the general population, community leaders, people’s representatives, Self-help Groups (SHGs), community volunteers, traditional healers, etc.
• These meetings are organised in a community centre or any other suitable place at the village and slum level.
• To maximise the output, the community meetings should be planned appropriately.

Following are the steps involved in planning a community meeting:

 

Resources

• Operational Handbook on Advocacy, Communication and Social Mobilisation (ACSM) for RNTCP, Central TB Division, Ministry of Health and Family Welfare.

 

Assessment

 

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
Who supervises the conduct of community meetings?	DTO	STO	MO	STLS	3	Community meetings are organised by the STS or the partner NGO under the supervision of the Medical Officer.		YES	YES

 

Community or peer-led measures penetrate better into the intricate layers of key population and facilitate Intensive Case Finding (ICF). Peer group support helps patients deal with challenges that they face during the treatment period. Several Tuberculosis (TB) patients find their treatment period stressful and having a peer to talk to, who has undergone similar challenges, and a doctor or counsellor to answer their questions, helps build confidence and realization that they are not alone in this journey.

 

 

Figure 1: Characteristics of a Peer Group

 

 

 

Figure 2: Peer group interventions has an influence on the knowledge, attitude, and quality of life of the pulmonary tuberculosis patients

 

• Peer group intervention is human centered approach as it involves perspectives from the patients and their care givers encouraging them to openly discuss their concerns. Peer group intervention builds collective strength and solidarity among patients attending the group meeting and improve their treatment experience by learning from experience of peers. Talking to others in support groups reduces anxiety, improves self-esteem, and helps members' sense of well-being overall.

 

• Peers are an underused resource for strengthening TB control among socially excluded populations. There is a need for further research into the contribution of peers to TB control, including analyses of economic effectiveness.

 

 

Peer group interventions for TB patients are:

 

• Conducting patient support group meetings where patients and care givers can discuss their concerns and invite other patients who have addressed similar issues in their treatment. Social support from family and friends, helps in patient’s adherence to treatment. Treatment adherence is a key to the completion of TB treatment. The support is part of an external stimulus which can develop a particular behavior in human.

 

• Peer group members can facilitate linkages to nutrition and other forms of support for TB patients – Patients or caregivers can be linked to support services like counselling, nutrition and social entitlements, either from the NTEP or through other public schemes or community structures.

 

• Peer group members can help each other by sharing their knowledge to create linkages with the medical support systems – TB patients who develop side effects due to medication, should be linked for medical support during the meetings. Medical Doctor/STS/TBHV/CHO shall provide counselling to patients regarding side effects of the TB treatment and how to address the issues. Members act as role models for each other. Seeing others who are contending with the same adversity and making progress in their lives is inspiring and encouraging.

 

• Peer group members can facilitate interactions of family members with Medical officer (M.O.)/National TB Elimination Programme  (NTEP) staff – Peer group meetings can be used to counsel the caregivers on how to take care of the patient at home. A support group is a safe place for someone who needs to talk about intensely personal issues, experiences, struggles, and thoughts.

 

 

 

Resources

 

Guidance document on community engagement under NTEP Central TB Division, MoHFW, GoI September 2021

 

Operational handbook on Advocacy, Communication & Social Mobilization for RNTCP, Central TB Division, MoHFW, GoI 2014  

 

NTEP Training Modules 5 to 9, Central TB Division, MoHFW, GoI 2020

 

 

Assessment

 

Question	Answer   1	Answer 2	Answer 3	Answer 4	Correct answer	Correct explanation
Peers are an underused resource for strengthening TB control among socially excluded populations. There is a need for further research into the contribution of peers to TB control, including analyses of economic effectiveness.	True	False			1	Community or peer-led measures penetrate better into the intricate layers of key population and facilitate Intensive Case Finding (ICF).

 

 

 

 

In order to create awareness and mobilise young students to fight against TB, the National TB Elimination Programme (NTEP) encourages TB awareness campaigns in schools.

Common school activities undertaken to create awareness about TB among children include the following:

• Addressing the school assembly/ classes
• Holding painting competitions
• Holding rallies and road shows
• Holding essay competitions
• Holding slogan competitions
• Reading TB leaflets during prayers
• Organising quizzes
• Puzzle games
• Pictorial presentations (presenting TB-related information in the form of pictures)
• Organising exhibitions (posters, models etc.)
• Katputli shows
• Distributing leaflets containing information about TB

 

Steps for Organising School Activities

School activities could prove very effective, provided they are well planned. Following are the steps for effective organisation of school activities:

 

 

Resources

• Operational Handbook on Advocacy, Communication and Social Mobilisation (ACSM) for RNTCP. Central TB Division, Ministry of Health and Family Welfare.

Assessment

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
Training school teachers is a part of the ACSM activities in schools.	True	False			1	Training of school teachers, who will in turn conduct school activities in a planned manner is a part of ACSM activities in schools.		YES	YES

 

Tribal people (10.4 Cr, 8.6% of total population) have higher prevalence (703 per 100,000) of TB compared to national average (256 per 100,000).10.4% of all TB notified patients are from tribal communities. The National TB program has prioritized this subgroup of population through Tribal Action Plans since 2005.

As a part of the Multisectoral collaboration with various Ministries, a guidance note on the joint action plan was developed by Ministry of Health and Family Welfare (MoHFW) and Ministry of Tribal Affairs in October 2020 and shared with the Secretaries of all States/ UTs for field level implementation. Tribal TB initiative, a unique partnership between the Ministry of Health and Family Welfare and Ministry of Tribal Affairs was initiated to improve the cascade of TB care and support services among Tribal Populations in India. The technical assistance for this initiate will be provided by USAID.

Challenges in communities in tribal areas:

Access, availability, and utilization of TB care services of these communities are hindered by:

1. Geographical barriers
2. Poor state of social determinants
3. High impact of malnutrition, insufficient community involvement
4. Health system constraints including lack of trained human resources
5. Cultural and communication gaps between the care provider and the community, etc.
6. The COVID-19 pandemic has probably further worsened the situation.

 

Community mobilization strategies in tribal areas:

 

 

Various departments which play a role in community mobilization in Tribal areas:

1. National Program Management Unit (NPMU) provides technical assistance in monitoring and implementation of the Tribal TB Initiative.
2. Coordination among National Tuberculosis Elimination Programme (NTEP), National Health Mission (NHM), Ministry of Development of Northeastern Region, Ministry of Tribal affairs at National, state and district levels through national level Technical Support Unit.

 

 

3. Coordination with ‘Centre of Excellence’ within the Ministry of Tribal Affairs, with a key focus on TB.
4. Partnering with private sector players for leveraging resources for TB elimination in Tribal communities.
5. Documenting best practices, and commission tribal health research studies in collaborations with identified government institutions.
6. Various departments collaborate for improving the operational excellence of existing demand-side interventions such as Village Health Sanitation and Nutrition Days (and committees), Jan Arogya Samiti platforms, Jan Andolan initiatives, engaging TB-Champions, and training of faith healers and other community influencers.

 

Resource

1. Operational handbook on Advocacy, Communication & Social Mobilization for RNTCP, Central TB Division, MoHFW, GoI 2014  

 

2. Tribal TB Iniative

 

3. NTEP Training Modules 5to9

 

Assessment

 

Question	Answer   1	Answer 2	Answer 3	Answer 4	Correct answer	Correct explanation
Community mobilization strategies in tribal areas include home visits.	True	False			1	Community mobilization is about seeking cooperation and support from different stakeholders in general and the community in specific. Home visits will improve awareness on various government schemes, provisions, facilities available for TB patients and to improve treatment literacy and adherence among TB patients in tribal areas.

 

 

 

 

Rural populations have more limited access to primary care physicians than residents of urban areas, and are older, sicker, and poorer than urban counterparts. Travel to reach a primary care provider may be costly and burdensome for patients living in remote rural areas, with subspecialty care often being even farther away. These patients may substitute local primary care providers for sub specialists, or they may decide to postpone or forego care. Many social determinants act as barriers for rural communities to access health services.

Challenges faced by communities in rural areas are:

• Higher poverty rates, which can make it difficult for participants to pay for services or programs
• Cultural and social norms surrounding health behaviors
• Low health literacy levels and incomplete perceptions of health
• Linguistic and educational disparities
• Limited affordable, reliable, or public transportation options
• Unpredictable work hours or unemployment
•     Poor primary healthcare and infrastructure in rural areas
•     Lack of access to tuberculosis testing and treatment centers in remote unreached areas
•     Unregulated indigenous system of medicine
•     Poor airborne infection control
•     Poor nutrition and Malnourishment 

 

Community mobilization strategies in rural areas include:

Various committees which play a role in community mobilization in rural areas:

•      Village Health Sanitation and Nutrition Committees (VHSNCs) - In each Gram Panchayat, Village Health Sanitation and Nutrition Committees (VHSNCs) have been formed at the village level under National Health Mission (NHM). These committees are entrusted with community-level planning and implementation of health and sanitation, and have representation from the local government, local health centre, and the local community. 

 

•      Panchayat Raj Institution (PRI) - Members of PRI refers to local self-government at the village level. The village pradhan (head) and members of the Panchayat are elected members of the Gram Panchayat. They are the key people who can, after sensitization, mobilize the community for TB care and control and make allocations for TB patients’ nutrition and travel requirements.

 

•      Yuva mandal/Mahila mandals (Youth/women’s clubs) - Community-level federations of young boys/girls/women, sometimes even comprising several women SHGs. 

 

•     Self-help groups (SHG) - An SHG is a group of individuals with a homogenous social and economic background, who voluntarily come together to regularly save small amounts of money and contribute to a local fund to meet the members’ emergency needs on a mutual help basis. These groups collectively manage their payments and ensure proper use of credits. Many NGOs currently engaged in the project are involved in formation/registration of these SHGs. It would be advisable to involve these NGOs for ease of implementation. 

 

•     Community-based organizations (CBO) - A CBO is a small group of people from a community, who come together for a particular purpose. It may be a local association of people mobilized around water conservation, mother and childcare, sustainable agriculture, education, or adolescent health; a group of social service persons; or any other such active group in a village. 

 

Resource: 

 

Operational handbook on Advocacy, Communication & Social Mobilization for RNTCP, Central TB Division, MoHFW, GoI 2014  

 

 

Assessment: 

 

Question	Answer   1	Answer 2	Answer 3	Answer 4	Correct answer	Correct explanation
Community mobilization strategies in rural areas includes empowering key decision-makers, people affected by TB, and marginalized and vulnerable populations.	True	False			1	This leads to raising awareness of services available and general health literacy surrounding TB.    More people accessing public health services will lead to better utilization of services.

 

 

Information, Education and Communication (IEC) material for the Public has been made available on the Central TB Division official website. In the home page of https://tbcindia.gov.in under the ACSM/IEC option IEC materials like launch video on World TB Day, Posters on TB Arogya Sathi, Ni-kshay Poshan Yojana, Ni-kshay Patrika, Documentaries, Radio Spots, TV Spots/TVC’s, Script for Nukkad Natak’s and Exhibition Panels are available in the public domain. 

Figure 1: IEC Material available in Public Domain: Source: tbcindia.gov.in 

Information, Education and Communication (IEC) materials for the general public include:

1. Mid-Media  

• Banners
• Flip charts
• Wall writings
• Hoardings
• Posters
• Pamphlets
• Mobile vans and videos on wheels
• Folk performances
• Kiosks individuals - Face-to-face communication along with audio-visual communication for better message retention. Useful in dispelling myths and practices.

Figure 2: Poster for TB Arogya Sathi App: Source: tbcindia.gov.in

Figure 3: Poster for Nikshay Poshan Yojana: Source: tbcindia.gov.in 

2. Mass media

• Newspapers
• Television
• Radio
• Magazines

Figure 4: Snapshots from a TVC’s: Source: tbcindia.gov.in 

3. Social Media

• Facebook
• Blogs
• YouTube
• Twitter

Figure 5: Ni-kshay e-patrika: Source: tbcindia.gov.in 

4. Interpersonal Communication (IPC)

• Counselling
• Home-visits

 

5. Community Dialogue

• Public meetings and gatherings

Figure 6: Script for Nukkad Natak available on Central TB Division website: Source: tbcindia.gov.in 

 

Resources 

Operational Handbook on Advocacy, Communication & Social Mobilisation for RNTCP, Central TB Division, MoHFW, GoI, 2014.  

 

Assessment

Question​	Answer   1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​
Counselling and home visits are not part of the IEC materials/ tools available to the public.	False	True			1	Counselling and home visits are part of the interpersonal communication of the IEC strategy.