TB free village adoption model is an initiative to improve community participation by involving private practitioners.
Dr Mahesh MG
Recommended ArticlesView All
A look back at wild November: The biggest winners and losers
IST7 Min(s) Read
'Elephant in the room' — Finance Minister red-flags gold smuggling
IST2 Min(s) Read
While famous for its historical landmarks, the Koppal district in Karnataka has recently been gaining popularity for its efforts in eliminating tuberculosis (TB). In 2018, 1200 missed cases were identified in this district. An important intervention that the Koppal District TB office implemented recently to reduce these figures and improve TB care in the district has been the TB free village adoption model.
TB free village adoption model is an initiative to improve community participation by involving private practitioners. The main purpose of this initiative is to detect-treat-prevent TB with the aim to eliminate the disease in the respective villages. The interventions at the community level include awareness, outreach to engage marginalized or remote groups, screening, detection, counselling, treatment and follow up till the patient is cured. The unique feature in this model is the involvement of private practitioners in the community through notification of TB cases from their clinic and active campaign in villages for awareness, case detection and treatment adherence to complete the cascade of care
The village adoption practice helps in universal access to TB care and prevention whilst addressing rural and urban bias. Though there is a suboptimal engagement of the private practitioners with the public sector in the TB program due to lack of co-ordination, preconceived notion, prejudices against private sector and lack of innovative approaches, this adoption model aims to bridge these gaps in the cascade of care and thereby contribute to improving the quality of TB care that health seekers in this village receive. The key elements of the “TB free village” adoption model are:
1. Early detection of TB
TB patients usually approach multiple service providers before getting detected by the public sector. Whereas through this initiative, private practitioners visit the villages to conduct camps every fortnight and screen for presumptive TB patients. During these camps they create awareness and participate in active case finding activities being conducted at the village level by public sector for early detection.
2. Wholistic Treatment
The treatment does not stop at just prescribing anti-tuberculous drugs. Private practitioners also contribute to treatment adherence by providing nutritional support and counseling the patients on co-morbid practices like tobacco consumption and alcohol consumption. They also refer patients to tobacco cessation centers and alcohol de-addiction centers, if needed.
Private practitioners advocate about hygiene practices and cough etiquette to prevent the spread of infection. Tuberculosis prevention therapy (TPT) for household contacts and people living with HIV (PLHIV) is closely monitored by these private practitioners.
This practice at Koppal District has helped in building an understanding about private sector dynamics and patient preferences. As each village has different practices and unique attitude towards TB care, the adaptation of such flexible models, tailors the involvement of private practitioners according to the local context and requirement. The private practitioners who contribute their time set an example to their peers and motivate other private practitioners to adopt a village. They are compensated for their time through fixed incentives from the program.
The District TB center at Koppal has currently adopted 25 villages through this program and covers a population of 69800. The total case notification rate in the covered villages has increased from 153 before the initiation of the model to 209 in the past 6 months of practicing this model. The treatment adherence has also improved significantly with patient centric care. They have plans to expand to 100 villages in the coming years and include more private practitioners and private pharmacists in this program and work towards making Koppal, a TB free district.
Despite COVID-19 and associated lockdown, the notification rate of TB cases in Koppal district has not been affected mainly due to the identification of presumptive TB cases through this village adoption model. The Koppal district TB center has also initiated a transport facilitation service to transport sputum from community to diagnostic center during lockdown.
The proactive involvement of private practitioners bridges the gaps in TB care and ensures early access to diagnosis and treatment to complete the cascade of care. As countries move towards universal health coverage (UHC) and “END TB” strategy, engaging Private sector in similar village adoption models in TB care is a crucial way forward. Private practitioners have a critical role in the National TB programs and this model increases the accountability of private providers as a community advocate for the National TB program.
Dr Mahesh MG is presently working as District Tuberculosis Officer in Koppal district, Karnataka, India. He is a Physician with MD in anesthesiology and works as a District Program Manager under National Tuberculosis Elimination Program.
First Published: IST