Introduction
Tuberculosis is more common among poor, marginalised and malnourished people especially in the tribal regions of Koraput, Malkangiri and Rayagada districts. TB affects the economically most productive age group of individuals, hence it had considerable impact on patients” households; their children, health, education and nutrition, particularly when the patient is a wage earner. This results in lost earnings. When the women are affected, they being the primary care givers in the household, the disease affects not only them but the whole family and especially the health and welfare of their children.
There is an increasing recognition that TB is a leading cause of HIV-related morbidity and the extent to which HIV is fuelling tuberculosis in HIV prevalence populations, which has also reinforced stigma and discrimination against those who are infected and affected. The government’s RNTCP programme, and its benefits, did not reach the predominantly tribal districts. Tribal groups are suffering disproportionately from TB and its poverty. In addition, though Orissa is, officially, a low HIV prevalent state, HIV is on the rise and there is an urgent need for sensitive dissemination of information to raise awareness about TB/HIV co-infection. If they are not adequately treated now, the future prognosis would be unfavourable.
In this context, with support from European Union (EU) and LEPRA UK, ‘SAHYOG’ – Reaching the un-reached project was initiated to address the specific challenges of TB control and TB-HIV co-infection in tribal regions of Koraput, Rayagada and Malkangiri in an integrated approach. The project is implemented by establishing linkages with RNTCP and HIV/AIDS prevention and care & support Programme of Govt. of Orissa.
Duration of the project : 1st January 2008 to 31st December 2011
Overall objectives
To support the goals of the Govt. of India’s Tribal Action Plan to increase the coverage of the Revised National Tuberculosis Control Programme (RNTCP) to cover tribal groups in order to reduce the burden of poverty.
Specific Cbjective
To reduce the burden of TB and TB/HIV co infection on tribal communities in Rayagada, Koraput and Malkangiri districts of Orissa.
Area of Operation
The project will be operated in three tribal districts of Orissa, i.e. Rayagada, Koraput and Malkangiri covering 16 blocks in 3 districts with a population of about 1.3 million. The map alongside shows the operational areas of the project with proposed interventions blocks in these districts.
Activities
A. Attaining Norms of RNTCP
- Baseline Study
- GIS Mapping
- Establishment of Sputum Collection Centre (SCCs)
- Selection and Training of Dots Providers (DPs)
- Support to Government TB/HIV Services
B. Awareness, Livelihood and Stigma Reduction
- Development and dissemination of BCC on TB and TB/HIV
- Formation And Strengthening Of Village Health Committees
- Training and capacity building to community and NGOs
- Awareness programmes on government income generation activities
- Establishment of Grain Banks
C. Building capacities of govt. and non-governmental service providers
- Capacity building to traditional healers and PMPs.
- Strengthen TB/HIV Referral Mechanisms.
- Establish inter-sectoral coordination.
- Documentation of models and best practices.
- Conduct Operational Research.
- Dissemination and Advocacy.
- Conduct Mid-term and Final Evaluations.
Uniqueness Of The Project
The project is unique in the State of Orissa because in addition to benefiting people with HIV/AIDS, tackling TB-HIV co-infection presents an opportunity to significantly improve care for TB. Mapping of TB cases (and HIV cases with VCCTC) in the un-reached tribal areas using GIS and Global Positioning System (GPS) technology will help to understand vulnerable areas and target interventions in order to improve both case detection and treatment compliance. Ultimately, the project will support RNTCP and AIDS control programme in the said districts being implemented by Govt. of Orissa.
Good nutrition is particularly vital for the people with HIV. The establishment of grain banks in these villages for socio-economic impact provides the required nutritious food for people with TB and HIV. The idea is to enable the patients to get additional food support and help people recover from illness.
Linkages
- Governmenthealth institutions/agencies (OSACS, State TB Cell, DTCS, VCCTC/ICTC, DHH), NGOs and community based organisations for referral services, follow up, reduction of stigma and discrimination and social security.
- People living with HIV/AIDS will be given attention with referrals for care and support in the Community Care Centre of LEPRA Society.
