In India the burden of both communicable and non-communicable diseases is high and the country is now facing a huge double burden of disease. It has both the largest amount of tuberculosis (TB) patients in the world and has the second largest amount of diabetes (DM) cases. Hence the associated link between TB and DM is a matter of growing concern for India. The country is undergoing a socio-economic transition with a major increase in urbanisation. Urban areas are more affected than rural in relation to prevalence of both DM and TB which also causes concern. India has a high level of health care spending but most of the spending is direct out-of-pocket payments. Therefore the country ranks among the bottom five countries with lowest public health spending levels in the world. According to the World Bank India is annually losing 6 % of its national GDP due to premature deaths and preventable illnesses. The project seeks to promote a comprehensive TB-DM model in various levels across 12 districts in three states
The project builds on experiences of two previous projects on awareness generation and advocacy on diabetes and gestational DM supported by the WDF (WDF07-295 & WDF10-500) and will be located in three states of India; Bihar, Jharkhand and Uttar Pradesh. The activities are designed to engage multi-stakeholder groups to ensure larger acceptance of the initiative. A baseline and endstudy survey will be conducted to assess the existing level of awareness regarding linkages between TB and DM among different stakeholders and the impact of the intervention. Based on the findings of the baseline survey the strategy and key messages would be fine-tuned in accordance with the existing status and the objectives to be achieved. State and district level multi-stakeholder advocacy forums for generating support around DM and TB linkages in public health delivery program structure will be organized. A total of three state level forums one in each of the 3 states will be organized engaging key health functionaries from the state. Orientation training of district level team members for effective implementation of the project will be organized for two days to ensure a common understanding and will deliver basic inputs on the project, implementation, roles and responsibilities, TB and DM linkage etc. Education and information materials targeted to different areas of DM and TB linkages will be prepared. With simplified messages these will be distributed among general public. Information booklets will be developed and distributed among doctors, paramedics, medical students, and government officials to make them understand the larger issues concerned with DM and TB linkages. Equipped mobile vans with a trained team of outreach promoters will be mobilized in each of the project districts during the intervention period for creating mass awareness through inter personal communication at strategic spots. Mobilization and awareness activities will be undertaken on 1st day and second day will be utilized for health check-up camps. Identified cases or people with symptoms will be invited to attend the health check-up camp at nearest locations and identified cases will be referred to nearest district clinic for further treatment. An awareness campaign will be conducted through several medias. Articles, features and pre and post event coverage’s on issues related to TB- DM linkages. Promotion of the mobile van campaign advertisements will be published in accordance with the mobile van schedule. Radio spots for dissemination and reinforcing the messages and finally wall paintings at strategic spots like health centres, schools and colleges with key messages and illustrations act as a long-term message dissemination strategy. To sensitize and build capacities of health care professional’s orientation workshops at state level for district health officials will be organised. The participants will be trained as trainers and will go back to their clinics to disseminate information on TB and DM to the rest of the staff. Orientation workshops will also be organised for medical/paramedical /nursing students. After completion of the project activities an advocacy forum at the national level will be organised to influence the policies based on field level findings.
• Baseline and end line study based on 1,800 respondents conducted.• More than 1,450 key decision makers targeted in advocacy meetings• 124 doctors and 116 health officials received ToT training• More than 5,500 medical and nursing students sensitised• More than 65,000 people have been reached and screened through screening camps• More than 280,000 people have been sensitized on TB and DM