All Path-Breaking Initiatives
Locations: Tata Institute of Social Sciences, Mumbai
Sponsor: Global Fund for AIDS TB and Malaria
*Saksham (which means “making capable”) is a project of the Tata Institute of Social Sciences funded by the Global Fund since 2008 to support the Minsitry of Health and Family Welfare in its fight against HIV and TB. 2018 marks a decade of Saksham’s support to the Ministry. From 2008 with National AIDS Control Programme, and from 2015 with the Revised National TB Control Programme (RNTCP), Saksham has shaped the Psychosocial support program for HIV and Tuberculosis (TB) in the country. Globally, Saksham is the only programme managed by a public national academic institution under the Global Fund.
Currently Saksham has three major grants in the area of HIV & TB counselling, capacity building and community engagement. Using the learnings accrued from the engagement with the HIV/AIDS epidemic, in 2015 Saksham Pravaah introduced psycho-social counselling for TB in government’s TB control program in 4 states including Mumbai, and demonstrated the need for moving beyond the “bio-medical”, “disease control” approach and addressing social determinants of TB. From 2018 Saksham Prerak carries forward the mandate of capacity building of HIV counselors and ANMs employed by the national health program. In Collaboration with Tata Power Community Development Trust, Saksham initiated a community engagement project called Saksham Jan Urja in the M Ward of Mumbai; a ward with the highest burden of TB in the country. Community engagement is unprecedented in the area of TB and various community stakeholders were mapped and engaged to work on a common goal to create TB awareness in the community spaces, demystify TB related misconceptions and reduce TB associated stigma.
The Saksham Pravaah counsellors provide home based counselling for the drug resistant TB patients registered with the national program as well as their caregivers (to involve them as partners in treatment completion). The counsellors provide a safe space for the patients to address their psycho-social issues ranging from fear and distress about TB diagnosis and treatment, to stigma and discrimination, depression, suicidal ideation, family and marital discord, and grief and bereavement. The counsellors empower the patients and the caregivers for dealing with treatment side effects and managing co-morbidities. Economic issues can hinder adherence and one of the major thrust of the Saksham Counsellors is linking patients to the available GoI social protection schemes.
During September 2016 and March 2019, Saksham Pravaah counsellors registered 33208 drug resistant TB patients for counselling services of which over 90% continue to be on treatment. Further, 29248 of the care givers of patients were registered for counselling. Counsellors also reach out to caregivers and household members during every follow up visit and 6916 such symptomatic contacts of drug resistant TB patients were counselled for TB testing of whom 352 or 5% were detected with TB, 1% of them having drug resistant TB. Of the 6072 treatment interruption cases, 4434 (73%) patients were counselled and were retrieved on regular treatment while out of the 13191 patients reporting adverse drug reactions, 11881 (90%) were counselled for medical management and brought back on treatment. To address issues of improper nutrition, loss of employment, lack of income opportunities etc, counselors successfully linked 4371 patients with social protection schemes like widow pension, child care, nutrition schemes, and helped them with aadhar cards, ration cards, opening bank accounts, and scholarships.
Saksham Prerak is supporting India’s commitment to achieving UNAIDS 90-90-90 targets to end the AIDS epidemic by 2020. The Project is focused on strengthening human resources for health under NACP as well as its integration into NHM through HR- task sharing and task shifting. A pool of over 30 master trainers has been trained across India for providing hands-on training to HIV frontline workers viz 30,000 ANMS and Staff nurses to do HIV and Syphilis screening of all pregnant women as part of the essential Antenatal Care package and 9,000 HIV counsellors in enhancing their skills under the HIV counselling and testing (HCT) program. Thus far the program has trained over 2600 ANMs and staff nurses for HIV and syphilis screening. The innovation in the counsellors’ training is an additional, online training module developed to enhance the capacity building program of NACP. Saksham Prerak is in the process of developing a virtual training platform and contact training curriculum for HIV Counsellors.
Saksham Jan Urja
In Collaboration with Tata Power Community Development Trust, Saksham initiated a community engagement project called Saksham Jan Urja in the M Ward of Mumbai; a ward with the highest burden of TB in the country. Community engagement is unprecedented in the area. Saksham Jan Urja was initiated in April 2016 and in co-ordination with the District Tuberculosis Office (DTO), eleven ‘Saksham Sathis’ (community social workers) were placed in the health posts of Municipal Corporation of Greater Mumbai (MCGM) in this ward.
Under the programme, various community actors working within the geographic territory of M ward e.g. self-help groups, women groups, youth groups, festival groups, religious leaders, local influential persons, educational societies, employers of daily wagers and rickshaw unions etc. were mapped and engaged to work on a common goal to create TB awareness in the community spaces and to demystify TB related myths and misconceptions and to reduce TB associated stigma. With the help of these community actors (stakeholders), community social workers conducted over 1700 community events viz health talk, poster presentation, health games, movie screening, street plays, rally, group discussions, live installation and health camps etc. The central theme of all these events was to provide a complete and accurate information about TB with an allied theme of demystifying myths and discussing TB associated stigma. The aim was to sensitize the community, to bridge the gaps between the health and the community systems and to encourage symptomatic people to come forward and get tested for TB.
Saksham Jan Urja has created 30 trained multi-sector stakeholders in M Ward and linked them with district TB office for continuing with TB awareness activities. With identity cards and incentives these stakeholders are trained to help in the identification of new TB cases and link them with TB treatment centers. Additionally, the project has established 5 jan bhagidari kendras and a community TB referral center, a first such initiative, supported by the RNTCP
*Saksham Pravaah, Saksham Prerak and Saksham Jan Urja is the result of the learning accrued from the GFATM (Global Fund to fight AIDS, Tuberculosis and Malaria) -Round 7, Counselling Component which was awarded to TISS as Principle Recipient of the grant from September 2008 – June 2015. TISS along with 38 partnering institutions of higher learning, implemented a national level programme on capacity building of HIV counsellors and institutions for the National AIDS Control Programme.
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