A female migrant worker who lives in an urban slum in
India’s national capital Delhi lost both her children to
TB. When the best of standard TB diagnostics and latest
treatments are available (and also made in India), even one
TB death is a death too many. Over 1.25 million people died
of TB worldwide in 2023, as per the latest WHO Global TB
Report 2024. Every TB death is a reminder that we could have
done better to prevent, find, treat TB and support those
dealing with the disease.
If people are facing
barriers in accessing public services, then why cannot
public services go to the people instead? It is critically
important for public health and social support services to
go closer to the communities and serve them – so as to find
TB early, treat them promptly, stop the spread of infection,
reduce the risk of untimely deaths, and also help needy
people avoid catastrophic costs and diagnostic
delays.
We can only be on the track towards ending TB
if we are finding, treating and preventing all TB –
especially among those who are at a very high risk of it.
And we have to do it in a people-centred, rights-based and
gender transformative manner. Failure to do so will move us
on a wrong track, further away from ending TB.
With
technological advancements (and a lot of them are made in
India), there is no excuse now to not take laboratories and
healthcare services closer to the communities, or even at
their doorsteps, in a people-centred and rights-based
manner.
Integrated health and development responses
are key
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Homeless and migrant people in urban cities
have higher rates of not just TB but also alarmingly high
levels of malnutrition – which is the biggest risk factor
for TB too. Other TB risk factors are also high in key and
other vulnerable populations for TB.
That is why Dr
Sreenivas Achuthan Nair calls for well-integrated and
coordinated multi-sectoral health and development responses
which would not only help us do better in finding, treating
and preventing TB but also improve programme outcomes
towards achieving zero hunger, zero poverty, prevention and
control of non-communicable diseases (NCDs) like diabetes,
ending tobacco and alcohol, ending AIDS, among other goals
and targets enshrined in the UN Sustainable Development
Goals (as well as in several domestic and regional plans,
declarations and agreements). Dr Nair came to India’s
national capital Delhi to speak in India Innovation Summit
organised by the Government of India’s National TB
Elimination Programme and the Indian Council of Medical
Research (ICMR).
Dr Sreenivas Achuthan Nair, Senior
Advisor of Stop TB Partnership (hosted by United Nations
OPS), has contributed to strengthening TB responses over the
past two and a half decades. He has earlier served as the
government TB Programme Officer of Kerala state in India, as
well as worked with the International Union Against
Tuberculosis and Lung Disease (The Union), and also with WHO
India supporting India’s national TB
programme.
Commit, invest and deliver
World TB
Day is observed globally on 24th March to amplify the
urgency of ending TB – which is the world’s deadliest
infectious disease. This year’s theme, “Yes! We Can End
TB: Commit, Invest, Deliver” is a bold call for hope,
urgency and accountability.
Dr Nair visited few sites
where female TB Affected Street Activists (TASAs) work with
female homeless and migrant women (and other genders). TASA
themselves are TB survivors or affected by TB. This model is
developed by Humana People to People India, and funded by
Stop TB Partnership’s Challenge Facility For Civil Society
Grant (through which, 143 local groups get support to do
similar community-led work to reach the unreached people
with TB and supporting them).
There are
twenty TASA frontline leaders in Delhi serving female
homeless people and migrant workers. Each TASA works with 5
or more ‘Sahelis’ (a Hindi language word for female
friends). So a network of 100 or more Sahelis and TASAs have
united to stop TB among female homeless and migrant
workers.
The female migrant worker
mentioned in the opening of this article is also one of the
Sahelis, helping others get diagnosed with TB early on and
promptly treated, supported and get cured.
Dr Nair
went with TASA workers Chanda and Geeta, their coordinator
Ravindra and other ‘Sahelis’ to a government-run shelter
home which is hardly a kilometre away from a prominent
government-run Jhandewala TB clinic in the heart of
India’s capital Delhi. But challenges which homeless and
migrant people face in accessing services make the journey
of a kilometre almost impossible for many, without the help
and support of frontline workers.
Jahangir Alam, who
is himself a TB survivor, works with Humana People to People
India and has played a defining role in helping roll out a
high impact intervention model to reach the unreached
homeless and migrant people in Delhi, as well as in other
places across India. Subrat Mohanty, is also with Humana
People to People India and member of the Board of Stop TB
Partnership. Subrat has contributed over the past years in
strengthening community engagement and partnerships to boost
India’s TB response. They both accompanied Dr Nair
too.
When a person with presumptive TB is identified,
then frontline workers of Humana People to People India get
an X-Ray and TB test done. If found positive the treatment
is initiated without delay at the nearest public TB clinic.
TASA follows up on a daily basis.
There are over 400
homeless people who live in this dilapidated multi-storeyed
shelter home. Some residents said that it is threatened with
demolishment. The upper floor looked as if it had been
demolished already.
One female homeless resident of
this shelter home shared that she even confronts
discriminatory behaviour in accessing public bus or
transport. Another said they face discriminatory or
stereotypical behaviour by the staff of health facilities
which deters them from going there. But when Chanda, a TASA
worker helped support them, took sputum samples to the
government TB clinic, helped those with presumptive TB get
an X-Ray done, TB test done, then those found positive for
active TB disease, could access TB treatment. About 15
people are currently on treatment in this shelter home and
neighbouring areas who are followed up daily by the TASA
worker.
The trust quotient between TASAs, Sahelis, and
homeless and migrant people is evidently high – which speaks
volumes for the laudable community work done
collectively.
Homeless people shared with Dr Nair the
help they got from TASA Chanda in getting their Aadhar
Unique Identification Card made as well as Permanent Account
Number (PAN) Card made with due process. Many got major help
from Chanda in getting bank accounts opened. Without these,
they would not have got the social support benefits which
the government provides to the people with TB. For example,
every TB patient gets INR 1000 transferred directly to their
bank account every month during the
treatment.
One homeless woman who is
currently on TB treatment, confirmed that she has received
INR 3000 so far in her bank account, thanks to Chanda for
helping her get her IDs made, bank account opened and
supporting her access the social support via due
process.
Another ‘Saheli’ Maya (name
changed upon request) told Dr Nair that she has lived in an
urban slum (close to the shelter home) for over 30 years and
she along with her family members do rag picking. Her sister
got diagnosed with TB, accessed treatment and thankfully is
cured now.
Last year in February 2024 this slum was
demolished, making life even more difficult for them. Now,
there is only a temporary plastic sheet which they stretch
out in the night to sleep under. And during the daytime,
wrap it aside to avoid any confrontation (with authorities
who want them removed) and also to have some open space for
rag picking and sorting. She feels that by April 2025 they
would be forced to completely vacate the area they have
lived in for three decades, as barbed fencing and wall
construction work is about to complete soon.
Maya says
that other Saheli members like her do not want others to
delay seeking care for TB. In Saheli support group meetings
with TASA, they regularly educate each other on a range of
TB related and other health issues. Unless they themselves
are informed how will they help others, rightly says
Maya.
She shared that with support from Humana People
to People India they have held regular health camps too, to
screen people for TB as well as for other health conditions
and link them to public care services.
For example, a
mobile van equipped with ultraportable handheld artificial
intelligence enabled X-Rays (managed by Medanta Hospital)
comes close to their slum area where those with presumptive
TB can get screened and linked to public
services.
Another woman rag picker, who is also a
Saheli, said that earlier most of the children went to
government-run school but post-demolishment of their slum,
either they have missed studies in the last year or dropped
out completely. Addiction is another problem that is
catching the young early – especially those out of
school.
Bending the curve
Dr Sreenivas Nair
said at the India Innovation Summit that India has
demonstrated a commendable leadership in trying hard to bend
the TB curve. Indian government’s 100 days campaign to reach
the unreached key and other vulnerable populations with best
of TB services is laudable, said Dr Nair.
Government
of India launched its 100 days campaign (in over half of
districts in the country) on 7 December 2024 to screen
everyone, regardless of symptoms, among key and other
vulnerable populations, with ultraportable handheld
artificial intelligence enabled X-Rays and offer an upfront
molecular test to confirm TB to those with presumptive TB. A
van equipped with such a facility is going daily till 24
March 2025 (100 days duration) to make this difference.
Those who are found with TB disease are put on latest TB
regimens as per the guidelines, and linked to care and
support.
India’s National TB Prevalence Survey
(2019-2021) showed that almost half of TB patients were only
found because of an X-Ray as they were asymptomatic back
then. That is why it is vital to find people with active TB
disease early on (symptomatic or asymptomatic) so that they
can be put on the right treatment (and those with lung TB
may become non-infectious soon after starting an effective
treatment).
Dr Nair said that India’s 100 days
campaign heralds a major programmatic shift to find more TB
(early and accurately) among those who are a higher
risk.
Along with this, we have to advance progress on
all other SDG goals and targets, especially for those most
likely to be left behind: such as, achieving the goals of
zero hunger, zero poverty, prevention and control NCDs,
ending tobacco and alcohol use, ending AIDS, among
others.
India Innovation Summit which was attended by
over 900 people showcased over 300 innovations (almost all
made in India) to prevent TB, screen TB, diagnose TB, treat
TB and community-led interventions that are making (or could
potentially make) a major difference.
Bobby
Ramakant – CNS (Citizen News Service)-
(Bobby
Ramakant is a World Health Organization (WHO) Director
General WNTD Awardee 2008 and Health Editor at CNS (Citizen
News Service). He is also on the executive boards of Global
Antimicrobial Resistance Media Alliance (GAMA) and Asia
Pacific Media Alliance for Health and Development (APCAT
Media). Follow him on Twitter/X:
@BobbyRamakant)
