CHO-CH25: Guidelines and Protocols for ACSM activities

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:

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Resources

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

Assessment

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:

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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.

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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

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:

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

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•      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: