Published Paper Details:

Background : Keeping in view, the growing concern of TB as a major public health challenge, Public Health Foundation of India (PHFI) in collaboration with key stake holders viz. the Indian Medical Association (IMA), Meerut Branch, District TB Center, key hospitals, private providers, students, teachers and parents of select schools and madrasas, workers of small factories, residents in urban slums and district administrators initiated a two-year (2016-2018) pilot intervention project in Meerut city, Uttar Pradesh - Project CHETNA (Communications, Health Education and Tuberculosis Notification Awareness). Objectives: Project CHETNA was designed with the key objectives; (i) to increase TB notifications from the private providers treating TB patients; (ii) to enhance community awareness on TB for an improved care seeking behaviour and (iii) to enhance capacity of private providers to deliver services through improved diagnosis, management & adherence to treatment. Approach: Project CHETNA adopted a non-incentivized model with no financial incentives paid to stakeholders associated with the project. During the inception phase, baseline studies were undertaken to identify the gaps in the knowledge levels among the community on prevention and care for TB and knowledge and capacity of the private providers in adherence to standard treatment guidelines on notification, diagnosis, treatment and adherence. A comprehensive mapping of TB providers, schools, madrassas, factories and slums was undertaken to understand the geo-spatial spread of TB case load, point of care and treatment. This analysis served in designing effective communication strategies for the project. Innovative time-saving tools for notification were developed based on the RNTCP format, Capacity building of clinic support staff and doctors and an array of innovative communication activities were undertaken to achieve the objectives of the project. Learnings: The project played a critical role in bridging the gap between the public and private sector players by almost doubling notification on TB cases diagnosed by the private sector. This was mainly attributable to the innovative tools and capacity building of support staff and doctors on TB diagnosis, treatment, case management, counselling and notification protocols. Coupled with an array of innovative communication activities, team CHETNA reached out to patients, caregivers and community members, factory workers etc. and sensitized them on TB. A mnemonic "CHETNA Didi" was developed to carry messages to the community. Posters, Leaflets, Films, Stickers, Banners, Calendars, Situation Cards, Skits and host of other communication materials were designed with CHETNA Didi as the main character. School children rallies, painting competitions, poetry and essay writing competitions, parent-teacher meetings, involvement of slum elders, informal service providers, and madrasas, house visits, Nauchandi Mela, wall writings at key locations in the slums, etc. have resulted in enhancing public awareness on health promotion with specific focus on TB. Special efforts were made to include various cottage industries, factories and other work places in Meerut city to spread key messages on TB symptoms and its treatment to this largely migrant work force. Based on the success of the pilot intervention, the model may be considered for scale up in districts with low TB notification, higher presence of private sector and high prevalence in order to enhance notification especially from the private sector and enhance public awareness on health promotions.