Mentors for Community health is a women-led intervention to spearhead TB case detection, prevention and care in Tamil Nadu. This initiative is supported by a Wave 7 TB REACH grant from the Stop TB Partnership and began in January 2020. The project empowers women to become ‘Community Health Mentors’ and ‘Women TB Leaders’ who are trusted providers of health information and act as gateways to care. The creation of a cadre of women from the grassroots as health mentors, in effect, establishes a skilled female workforce at the district level who can potentially contribute to the health of communities in the long term. The project is being implemented in Vellore, Villupuram, Salem and Tirunelveli districts of Tamilnadu.
The project has two arms - one led by the Women TB Leaders, who undertake screening at health facilities. This aids in case detection, treatment initiation and holistic person-centered approach to TB care and services. The second arm is led by Community Health Mentors, who are involved in organising and conducting community meetings to create awareness on TB and to reduce stigma surrounding TB. Women TB Leaders were identified from among the Community health Mentors and trained on screening people for symptoms of TB.
400 women have been empowered in the community to become go-to persons for health in their villages or wards through an over-the-phone training which does not require an internet connection. This IVR-based training module, developed in association with GramVaani, covers health issues such as TB, HIV, mentrual disorders and first aid and was delivered in a colloquial, easy to understand format.
Women TB Leaders screened all Out Patient Department attendees for symptoms of TB in select hospitals identified in collaboration with the TB programme. The Women TB Leaders also followed up with people with symptoms of TB till they got a diagnosis. Screening was also done among in-patient wards and evening OPDs in select hospitals where such facilities exist.
The Women TB Leaders are trained on sputum fixation and staining to assist the NTEP in TB diagnosis. Most Women TB Leaders undertake sputum fixation and staining daily, particularly useful in case of shortage of lab technicians. In facilities where sputum testing is not available, the Women TB Leaders and Community Health Mentors also transport samples or fixed smears, reducing the delay in diagnosis.
To train and empower women prioritising TB survivors, self-help group leaders, nurses, volunteers - from the community as health mentors through a Community Health Mentorship (CHM) Programme.
To increase case finding among the key and vulnerable populations via a cascade of screening from health facility to contact tracing at the household level and the community level
To develop a cadre of Women TB Leaders among Community Health Mentors who are engaged in TB outreach, screening at health facilities, case detection, community mobilisation and advocacy at the district level.
Rathika, Woman TB Leader, Vellore
Both Women TB Leaders and Community Health Mentors conducted community meetings in coordination with NTEP to raise awareness of TB and to identify people with symptoms who have not sought care.
Women TB Leaders screened close contacts such as household members of people with TB for symptoms of TB and directed them to the nearest X-Ray centre for screening. For those contacts who were able to produce sputum, AFB testing was also done. They also facilitated consultation with medical officers and initiation of chemoprophylaxis for children aged under six.
In places where the nearest public X-ray facility was difficult to access, the project tied up with private centers to provide free chest X-rays both for people with symptoms of TB and their household contacts.
Women TB Leaders actively followed up with people who were tested for COVID-19 to screen them for TB too. They obtained the list of people tested for COVID-19 from the health facilities with support from the NTEP staff and followed up over the phone. Those who had symptoms of TB were further tested. Women TB Leaders are also actively involved in the COVID-19 vaccination programme and mega vaccination camps conducted by the government.
During NTEP’s ACF, Women TB Leaders are involved in community preparedness and screening of community members. Women TB Leaders counsel people in communities vulnerable to TB to get tested and mobilise them for getting chest X-rays through mobile X-ray vans. They also collect samples on the spot and transport them for further evaluation.
World TB Day was observed in all the health facilities where the Women TB leaders (Community Volunteers) are placed. The Women TB leaders along with the NTEP staff led a pledge to end TB and TB stigma in the health facilities. They also held a signature campaign in these health facilities. They distributed communication material on TB to people coming to the health facilities on World TB day. All the Women TB leaders also conducted community meetings engaging panchayat leaders, other prominent people in the community on World TB day.