Introduction
‘Buniyad’ is a 4 year long project designed to meet the basic health needs of disadvantaged groups, to improve the quality of their lives and to reinforce their own development capacities. The project aims to work by providing technical capacity building inputs to the government run programs on leprosy, tuberculosis and HIV/AIDS, implementation of innovative models (e.g. establishment of Sputum Collection Centres for TB and building the capacity of the community and resource centres), an advanced locally specific communication strategy and an emphasis on referral, coordination and accountability. The project proposes to function primarily in partnership with the government/community/medical practitioners/traditional healers and recognizes the need to work with all stakeholders in a combined manner.
The Objective
To improve the health and livelihood outcomes of SC and ST in order to reduce the burden of poverty upon them by increasing prevention of and mitigating the health and socio-economic impact of TB, TB/HIV co infection and leprosy on tribal communities
The Major Activities
1. Strengthen 15 Microscopy Centres (MC) and 3 Integrated Counselling & Testing Centers (ICTC)
Madhya Pradesh falls into the category of states which have low case detection rates and low cure rates for TB. Drug compliance is a challenge due to various reasons including inadequate knowledge and skills of DOTS provider, health seeking behaviour of the community due to cultural variations, distance from the Microscopy centre and the DOTS provider, economic reasons, inadequate concern of DOTS provider for the patients which results in lack of regular feedback and counselling in favour of patient and his family and the community. The project seeks to increase community awareness, involve the vulnerable groups and alternative health providers, increase accessibility to services. LEPRA Society would be applying under the RNTCP-NGO participation scheme and strengthening the poor performing MCs in the proposed area. These poor performing MCs have been identified as a result of continuous interactions with the concerned government officials. 15 MCs would be taken up over the first two years for strengthening. Biological hoods would also be provided to 3 MCs.
The State falls in the low prevalence category for HIV/AIDS. This situation is likely to change due to the various risk factors such as tribal practices and values, frequent migration, increased sex work activities, lack of awareness, national highways crisscrossing the state and most importantly poor access to avail services. 3 new ICTCs proposed in the 3 districts of operation would be strengthened and all activities right from the establishment of these ICTCs to increasing referrals in the centre, would be initiated.
2. Liaise with qualified practitioners and traditional healers in the area to establish a screening and referral system through which TB suspects are sent to the designated laboratories for sputum examination and develop a referral system through which functionaries of all public dispensaries and clinics operating in the area are able to refer symptomatic patients to the designated microscopy laboratories.
3. Treatment, including DOTS
(i) Provide anti-TB treatment as per the RNTCP policy
(ii) Develop a system for direct observation and follow up and return to treatment of non-adherent patients according to RNTCP policy. Patients who miss a dose of treatment during the intensive phase would be visited in their homes within one day of the missed dose and during the continuation phase, within one week of a missed dose
(iii) Ensure follow-up and return to treatment of non –adherent patients according to RNTCP policy
4 Improve case detection of TB
A) Capacity building to Lab Technicians, DOTS providers, Medical Practitioners, Traditional Healers
B) Strengthen Drug Supply Mechanism for the established MCs
C) Establish 150 Sputum Collection Centres
D) Capacity building for ASHA workers and ANMs
5 Develop locally relevant IEC and BCC material
The IEC materials for hoardings, community volunteers, Private Medical Practioners, Focus Groups, Health Providers and for General Health facilities would be produced. This would be done in consultation with the stakeholders of the community through participatory techniques.
To provide health education to the community, the following activities would be conducted
a) generate health education and awareness in the community through meetings, discussions, posters, slide shows and home visits
b) Prepare and disseminate literature and training materials
c) Inform the community about the dangers of leprosy, TB and HIV/AIDS signs and symptoms, diagnosis and treatment facilities and prevention of TB through different local community forums. Cured patients can also play an important role in identification and motivation of treatment. These patients can also be mobilized as health educators and DOTS providers
d) Develop films and distribute 2 health education films in local language. Show these educational films in Schools, Panchayats, melas, hat bazaars, public gatherings & common public places in the village
e) Collaborate with different departments
6 Conduct Health Camps
Health camps would be carried out at each worker area to disseminate the information of facilities and to treat the affected diseases among marginalized rural / women population.
7 Project Progress Monitoring
To monitor the project progress, carry out the review meetings (fortnight/ monthly/quarterly), field visits by core team and its report findings and progress reports (monthly/ quarterly). Prepare and submit monthly reports on Programme management and Logistics to the DTCS and MPSACS.
8 Strengthen support network- for sex workers and positive people
Emphasising on the rights of the various categories including people infected with HIV, sex workers and people having different sexual orientations discussions will be promoted and networks will be formed. The project encourages their participation in planning, monitoring and evaluation of activities. Support groups will be formed among the affected communities and trained on various integral aspects
9 Develop Health Workers as change agents in community
300 Health workers from the government, private and the community would be trained to act as change agent in the community for HIV, TB & leprosy.
10 Usage of GPS to map TB, leprosy and HIV/AIDS cases
This will contribute towards the overall effectiveness of the project and can be used to assess the progress of the project and attainment of its outcomes over a period of time.
