India, as the country with the largest tuberculosis burden in the world, has become a leader in finding the community-driven solutions to TB now seen as key to the World Health Organization’s strategy to End TB by 2035.
“We have engaged the community because there is literally no other way to defeat TB here,” says Dr Sarabjit Chadha, Project Director of The Union’s Project Axshya, a massive civil society initiative designed to help the Revised National TB Control Programme (RNTCP) extend its reach from crowded slums to remote villages. “TB is in the communities, so, with our support, they understand that they have a vested interest in doing more about it.”
With this year’s World TB Day on 24 March taking the theme of Unite to End TB, The Union arranged to take several international and national journalists out into the field to see Axshya’s community solutions first hand. The participating journalists met and interviewed past and present TB patients in the villages of West Ram Nagar and Datauli in the Sonepat district, as well as interviewing local providers, Union staff, local government health officials, medical staff and community volunteers.
For example, they met Rakhi and Sonu, a married couple, both going through treatment for the second time; Shabham, an 18-year-old whose parents did not want her tested because having TB would hurt her marriage prospects; and Jyoti, who is now cured, but whose sputum negative TB went untreated until an Axshya volunteer persuaded him to get a chest X-ray.
They also met rural healthcare practitioners such as Dr Balraj, who was trained by Axshya and has put 56 patients on DOTS since 2013; and Dr Panchai, who says the blessing of seeing a TB patient recover is more than enough, he does not even want a fee.
“We’re pleased to be able to share what we’ve learned with others,” says Dr Chadha. “The model used by Project Axshya can be used in any part of the world to help communities and public health systems to end TB.”
How Axshya works and its results
Supported by The Global Fund, Project Axshya began in 2010 and is now at work in 300 districts over 21 states that were identified as offering sub-optimal TB services. In particular, the project focuses on reaching vulnerable and marginalised groups, including women, children, tribes, migrants, people with HIV and diabetes, people in high-risk professions, such as miners, and those living in hard-to-serve areas, such as urban slums.
Working through eight sub-recipient organisations with deep community roots, Axshya is demonstrating how the branches of a community-focused project work together to create a much stronger network of TB services than could be provided before: