Tuberculosis and social disease
“Tuberculosis (TB) is a social disease with medical consequences,” said Sir William Osler over a hundred years ago. India is the leading contributor to the global burden of TB, with over 2 million infections out of a global count of 10 million infections. The largest infectious disease killer globally, TB took 1.5 million lives in the year 2020, of which 85,000 were from India.
Eliminating TB necessitates addressing a complex web of causation and consequences – a vicious cycle of malnutrition, multi-dimensional poverty, tobacco consumption, marginalisation, disrupted livelihoods, orphaning, other diseases such as HIV, diabetes, Covid etc. migration, lack of access to quality health care for prevention, diagnosis, treatment and follow up, poor housing, overcrowding, indoor air pollution, consumption of tobacco and alcohol, as well as resource allocation and innovation. How we tackle these multi-dimensional issues will determine our goal to End Tuberculosis in India by 2025
Burden of TB among Tribal People
Nearly 10.4 per cent of TB infections in India are among the tribal populations who constitute 8.6 per cent of the country’s population. The National Family Health Survey (NFHS) 4 data shows a 1.5 times higher self-report of TB in Tribal people compared to non-tribal people in 70 per cent of tribal districts.
Tribal communities are especially vulnerable to TB, being already disadvantaged on account of intergenerational poverty and poor access to healthcare leading to a greater degree of social devastation.
Launched in 2021 by the Ministry of Tribal Affairs, Ministry of Health and Family Welfare, United States Agency for International Development (USAID) and Anamaya, Tribal Health Collaborative (an initiative of Piramal Foundation, The Bill and Melinda Gates Foundation and USAID), the Tribal TB Initiative aims to improve TB care and support among tribal populations in India.
A forerunner in collaborative efforts by government and development agencies to tackle multi-dimensional issues specific to TB in tribal people, fosters community engagement, forging partnerships with community-based organizations and community-influencers to influence behavior change to reduce the burden of TB. It also works with the public health system to enhance screening and diagnosis, increase notification and complement government efforts for timely treatment and adherence.
Under the aegis of this initiative, the Aashwasan campaign was launched in January 2022, to reach 10 million tribal people in all the blocks across 177 tribal districts, over a 100-day period. The campaign’s objectives are to accelerate early detection of TB cases and increase awareness while at the same time addressing issues posed by the Covid pandemic.
So far, over 1,000 block level personnel have been trained to reach out to all tribal and hard-to-reach blocks to complement the staff of the National TB Elimination Program (NTEP) and frontline health workers for Active Case Finding for TB, collection and transport of sputum for diagnosis and follow-up for treatment initiation.
Shobha, a 28-year-old woman in Simdega Jharkhand weighed as low as 22 kg, and suffered from severe cough. With joint efforts of the government frontline staff and the Aashwasan campaign staff, she was advised and encouraged to visit the hospital where she was diagnosed with TB and started on treatment.
There are several such examples of tribal people who continue to suffer quietly, going unnoticed. This lays emphasis on the need for early diagnosis, treatment and care, and the significance of the Aashwasan campaign to address this urgency.
Pivotal role of health-workers in eliminating TB
In just over two months, the joint efforts of NTEP, frontline health workers and the Aashwasan team, has resulted in screening of over 1.2 million people, testing of 30,631 people and detection of 1,542 new TB patients in tribal areas.
Yapi a 26-year-old woman from East Siang valley Arunachal Pradesh, was diagnosed with pulmonary TB in 2019. Asked to keep her illness a secret by her family, despite facing side effects of anti TB drugs, she emerged a healthy TB survivor in 2020, and today is a Community Mobiliser of the Aashwasan Campaign. Her personal experience helps her motivate many others in her community to seek early diagnosis and treatment.
Another shining example is that of paramedical worker Neelima, who travels miles in conflict-prone, politically sensitive areas to find and fight TB in the remote areas of Simdega, Jharkhand.
As we launch a multi-pronged attack on TB, with a focus on tribal people, it is important to recognize the role of frontline health workers in identifying persons with symptoms, mobilizing them for diagnosis and ensuring treatment and follow up. The efforts of NTEP laboratory technicians (LT), Senior treatment supervisors (STS) and Senior TB lab supervisors (STLS) are pivotal in ensuring testing, treatment, follow up and preventive measures in tribal blocks and districts.
This World TB Day 2022, we celebrate the community health care work force in their fight towards TB free Tribes as India takes another step towards a TB Free India.
Piramal is Vice-Chairperson of Piramal Group, and Hegde is Head Strategy and Knowledge, Tribal Health Collaborative, Piramal Foundation
March 24, 2022