TB is a bacterial infection that has been curable for decades. Governments have made diagnosis and treatment free of cost. So why do 10.4 million people contract the illness every year? And why do 1.7 million die from it? Because of poverty.
Here’s the journey of Ram, a poor, rural TB patient. Ram initially ignores his cough. He gets concerned when he starts losing weight and develops a fever. With no qualified physician around, Ram seeks help from an informal, unlicensed medical provider, who tries a variety of treatments, some harmful. Ram feels better for a bit, but the weight loss and fever returns. Finally, when Ram can no longer work, he makes the long trek to see a private physician. (He doesn’t trust the public health system.) The labs and drugs are financially ruinous (and some are unnecessary). Ram takes his TB drugs for a few weeks until he feels better. Then, unable to afford them, he stops. The disease relapses. In the meantime, Ram has likely infected others in the family, neighborhood, or at work.
Our interventions have more than doubled access to tuberculosis (TB) treatment for 1,500,000 rural poor.
Our TB program works with the public health system to actively identify possible cases of TB, arrange for diagnosis, and ensures treatment completion, all at no cost to the patient.
Community-based referrals We mobilize communities to report possible cases of TB to us. In the past 8 years, members of the local government, informal medical practitioners, and laypersons, along with community health workers have referred more than 27,000 possible cases to us.
Screening at the doorstep When we receive a referral, a community health worker uses verbal and written screening to decide if the subject should see a physician at a public hospital
Accompanying patients From the time they are screened, to when they are declared TB-free (8-10 months later), a community health worker (CHW) accompanies the patient, literally. CHWs bring the patient’s sputum to a diagnostic facility, accompany patients to hospitals, deliver drugs to the patient’s house, and support the patient throughout treatment, e.g., managing side effects, dispensing nutritional advice, etc.
Training CHWs to manage diagnosis The role of CHWs in the public TB program was limited to drug delivery. We have expanded that to help manage the long diagnostic process in TB. This means CHWs understand the diagnostic protocol and ensure adherence to it. They manage the patient’s medical record and consult with physicians to ensure proper diagnosis and treatment (e.g., they are well versed in the patient’s past treatment history, etc.)
Delivering drugs to the patient’s home CHWs execute the Directly Observed Treatment (DOT) protocol. They carry drugs to the patient’s house, and address challenges to adherence.
Mixing public and private care If a public health institution (PHI) lacks a service, CHWs help patients navigate the private health system, directing them to qualified caregivers, and keeping them away from irrational labs and drugs.