Planning Process at TU level

Pillars of End TB strategy

Key Focus Areas

Key Problem Areas

Potential Solutions

Detect

Laboratory and diagnostic services, case finding in high-risk population, private sector engagement

Lack of awareness regarding TB leading to delay in treatment initiation

Non-achievement of projected case detection rate

Poor management of partnership with private sector

Inadequate funding / improper management of funding

- Plan Information, Education, Communication (IEC) activities involving Accredited Social Health Activists (ASHA), Mahila Arogya Samithi, TB champions etc to improve awareness on TB symptoms and testing at the community level

- Plan and advocate incorporation of private sector engagement approaches in the Programme Implementation Plan (PIP) budget.

Plan combined activities and review meetings  with Public Private Mix (PPM) coordinators and the Private Provider Support Agency (PPSA) [where available] and establish clarity on the performance expectations.

Treat

Initiation of appropriate TB treatment regimen for all diagnosed patients and sustaining them on treatment until successful completion, provide patient-centred services along with social support.

High Treatment interruption and Lost to follow up rate

Success rate

Delay in treatment initiation due to non-availability of pre treatment evaluations at the rural level

Co-morbidities and Adverse Drug Reactions (ADRs)

- Plan home visit sessions for patients and their family members (upon consent) to assess the psycho-social aspects that could impact treatment adherence and provide regular counselling whenever required.

- Regularly review if all Ni-kshay related entries for the TU has been updated by the concerned staff.

- Implement a robust mechanism at TU level to triage as per severity and address/ refer patients  with ADR and co-morbidities.

Prevent

Prevent the emergence of TB in susceptible populations through scaling up Air-borne Infection Control (AIC) measures at health care facilities; treatment for Latent TB Infection (LTBI) for the contacts of people with confirmed TB, address the social determinants of TB through intersectoral approach

Poor AIC in health care settings

Non achievement of LTBI diagnosis and initiation of TB preventive treatment

Social determinant affecting TB treatment uptake and adherence 

- Plan patient movement in the out-patient setting so as to avoid over crowding

- Avoid mixing up infective TB patients (eg: patients not initiated on treatment yet, patients lost to follow up etc) with others in the setting.

- Ensure Personal Protective Equipment (PPE) is used by the personnel handling critical aspects such as sputum collection, sample handling etc. in the health facility.

Display IEC related to cough etiquette in the health facility on most visible walls.

- Conduct regular screening of all new patient contacts for LTBI and plan counselling and initiation of TB preventive treatment.

Build

Setting up of infrastructure and Human Resources (HR) for TB control and elimination, establishment of programme surveillance units to build and strengthen enabling policies.

Inadequate HR capacities

Poor infrastructure management

- Plan to fill up all vacant sanctioned posts.

- Plan capacity building activities for the TU staff on bio-medical and psycho-social aspects.