Tamil Nadu has a unique context as it is among the better performing states of India in terms of addressing poverty. Poverty in the Tamil Nadu state dropped from 51.7% in 1983 to 21.1% in 2001. For the period 2004–2005, the Trend in Incidence of Poverty in the state was 22.5% compared with the national figure of 27.5%. However, it is one of the HIV high-incidence states of India and the response to HIV and TB both has been commendable, said Dr C Udayashankar, State TB Officer, Tamil Nadu. "The poverty is still high in Tamil Nadu, especially in the rural areas" said Dr Udayashankar. He was speaking at the consultative workshop of TB and poverty sub-working group of the Stop TB Partnership, the secretariat of which has now moved to the South-East Asia office of the International Union Against Tuberculosis and Lung Disease (The Union). The forthcoming 41st Union World Conference on Lung Health in Berlin, Germany (11-15 November 2010) will also address issues around TB and poverty. Read more
Dr Udayashankar said that the World Bank is currently assisting the state in reducing poverty. DOTS centres have been located at places which are easily accessible to the vulnerable group thus making drug accessibility easy. Drug supply chain to these centres is maintained as per guidelines thus ensuring drug availability at all times, said Dr Udayashankar.
Various stakeholders that are involved in poverty alleviation are also involved in TB related advocacy, communication and social mobilization (ACSM) activities thus taking the message of TB control into the vulnerable population, said Dr Udayashankar. These stakeholders working on poverty alleviation are not only working in the field of healthcare and health promotion but are also involved in socioeconomic development among the rural and urban poor. Their staff members are also involved as DOTS providers so helping them meet the required TB-related healthcare need of the community.
In Tamil Nadu, there are designated microscopy centres (DMCs) as per the population-based guidelines of revised national TB control programme (RNTCP) in India. In areas where need based analysis have shown the requirement of additional diagnostic services, these have been provided through collaborating partners in the programme under the private-public mix (PPM) schemes, said Dr Udayashankar.
Patient engagement in TB control is central to effective TB control, and the WHO Stop TB Strategy also enshrines the Patients’ Charter for TB Care that provides the rights and responsibilities based framework for community engagement. One of the outstanding features of Tamil Nadu TB programme is selecting members from affected communities and encouraging them to be the DOTS providers for their community. "This removes the barrier between the patient and the healthcare provider" said Dr Udayashankar. These DOTS providers are also paid an honorarium at the end of the anti-TB treatment which serves as an incentive as well as a motivating factor to continue as DOTS providers in the same community and to advertise available treatment services through word-of-mouth, said Dr Udayashankar.
There are efforts made in Tamil Nadu to align TB control programmes with poverty initiatives. The Tamil Nadu government has initiated a system of supporting Self Help groups (SHG) in rural areas to increase self sustenance through microfinance. The TB programme in Tamil Nadu involves these SHG as DOTS providers. The SHG leaders are also part of the advocacy, communication and social mobilization (ACSM) campaigns which are part of the TB control programme, said Dr Udayashankar.
Providing nutritional support to the undernourished TB patients has been initiated in many places in Tamil Nadu. In some TB programmes in Salem, Vellore and Namakkal, rice supplements are given, in Thoothukudi and Salem, ‘daal’ (lentil) supplements are given, and in some other TB programmes in Salem and Vellore, egg supplements are also provided.
In rural areas, the Mahatma Gandhi National Rural Employment Guarantee Act (MNREGA) has helped those looking for employment.
Tamil Nadu has demonstrated relatively good response to HIV, TB and other conditions, and health systems strengthening has yielded benefits. Dr Udayashankar informed in one of the small group discussions that TB patients are routinely tested for diabetes in Tamil Nadu. People with diabetes are at a high risk of TB. According to several studies and systematic reviews, people with diabetes might have 2 to 3 fold higher risk of getting TB.
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