Saksham, Tata Institute of Social Sciences

Introduction

Saksham (“making people capable”) is a project of TISS that is committed to supporting the Ministry of Health and Family Welfare in its HIV and TB response. The Saksham project focuses on supporting and strengthening national response for both HIV and TB without creating parallel structures. Saksham in partnership with the National AIDS Control Programme (NACP) pioneered the development of curriculum for HIV Counsellors across India and has partnered with the National TB Elimination Programme (NTEP) to provide counselling and psycho social support for People living with Drug Resistant TB in Maharashtra, Gujarat, Karnataka and Rajasthan.

Notable Features of Saksham

 Funded by The Global Fund for AIDS, TB and Malaria since 2008, Saksham is an apt example of a sustainable health intervention project that has three other notable features to its credit. It is a successful model of public-public partnership where the govt – Ministry of Health and Family Welfare has successfully partnered with a public funded University (TISS), and a consortium of academic partners has led the fight against TB and HIV at the community level and provided critical evidence for what works. The third credit is on account of successfully transferring learnings of one national program to another – from HIV prevention to TB control. India has few such examples to show case.

Currently Saksham has two major grants in the area of TB counselling, Capacity Building and HIV evaluations.  

Project Details

I Saksham Pravaah – TB Component (2015 – 2024)

Saksham Pravaah is the TB component of Saksham that introduced psycho-social counselling for TB in Maharashtra, Gujarat, Karnataka, Rajasthan and has demonstrated the need for moving from a bio -medical approach and addressing social determinants of TB. The project is named “Saksham Pravaah” and 214 Professional Counsellors (Masters in Social Work/Sociology/Psychology) are integrated within the NTEP. From Programme Initiation in October 2015 until September 2023, Saksham Pravaah has provided counselling and psycho –social support to1,09,083 People living with Drug Resistant (DR) TB and their caregivers and counselled 80% of treatment interrupters to continue treatment. The counsellors provide ongoing home-based counselling and address a range of issues including TB related Stigma and Discrimination, Gender based concerns and Mental Health.  In order to reduce the catastrophic burden of TB, the Counsellors link people living with TB to the available Government of India Social Protection Scheme and Nutrition Support. To mitigate the financial burden associated with TB treatment, the counsellors work towards connecting TB patients and their families with government social protection programmes and nutrition support services, often facilitated through private donors and NGOs. Between September 2016 to July, 2023 Saksham has counselled 109083 persons with DRTB (all types of drug resistance), retrieved 80% of DR TB treatment interrupters and linked 13688 persons with TB and their family members to GOI social protection schemes and 27814 to nutrition support.

The Counselling services will be transitioned to the NTEP in December 2023. Saksham Pravaah will undertake capacity building of the TB staff and create counselling focal points to sustained counselling efforts. 

Capacity Building of Front-Line TB Staff on Counselling Soft Skills (December 2023 onwards)

Owing to the counselling acumen and demonstrated impact of counselling services for TB treatment outcomes, the national programme entrusted Saksham Pravaah with the crucial task of formulating a comprehensive national strategy for enhancing the counselling soft skills of Pan India frontline TB personnel. 

This proposed endeavour marked a pioneering effort, representing the first systematic and in-depth national programme aimed at building the capacity of TB frontline staff in the domain of counselling soft skills – unprecedented until now!

Saksham Pravaah has trained 83 Pan India DR TB Counsellors employed under the NTEP on counselling skills. Saksham engaged five university partners, developed a pool of 409 Master Trainers and has trained 3,000 front line TB staff from December 2023 – September 2023. More than 80% of the training programmes are conducted from the domestic state government funding.

The training programmes are experiential and participatory in nature and focus on “un-learning” as much as on learning. The training programmes are power points presentation free and are designed for reflection, introspection and developing a patient centric, empathetic approach and practicing skills – unprecedented until now!

90% of the participants said the training programme equipped them with the skills required for counselling TB patients and their families. 88% said the training has helped them develop a new perspective towards TB patients and families. Principles of Empathy, non– Judgemental Attitude, Acceptance was identified as three most useful learnings from the Saksham training.

Saksham Jan Urja (January 2020 onwards)

Saksham Pravaah in collaboration with the Mumbai District TB Control Society undertook an initiative to meaningfully and gainfully engage TB survivors under the Saksham Jan Urja project.   The project is funded by Tata Power Development Trust and was initiated in January 2020. The Survivors are termed. “Saksham (Against TB) Saathi” and undertake telephone counselling to address stigma, presenting a positive picture of TB treatment, debunking the myths around TB and emphasize the importance of treatment adherence. The model was presented to the Municipal Corporation of Greater Mumbai
(MCGM) following which it was integrated with NTEP from November 2021 onwards
in Mumbai metro. Currently 24 Saksham Saathis are placed with the TB
Centres in Mumbai – again a first such initiative in MCGM.

II Saksham Pramaan- HIV Component

Saksham Pramaan (April 2021 - March 2024) is the HIV component of Saksham to support NACO for intervention evaluation and mid-term programmatic evaluation of the NACP. TISS ha...