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Civil society participation vital for public-health programming

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Rahul Kumar Dwivedi, Citizen News Service -- CNS


"We have always known that alongside scaling up diagnostic and treatment services, engaging communities is vital for the success of disease-control efforts. This is especially the case for tuberculosis (TB) -- an ancient disease surrounded by stigma, discrimination, and misconceptions. The Knowledge-Attitude-Practice (KAP) survey results underline the payoffs of civil-society participation in public-health programming," said Dr Sarabjit Chadha, Project Director of 'Axshya' at the International Union Against Tuberculosis and Lung Disease (The Union). The KAP midline survey results were released on 27th March 2014 in New Delhi.


This KAP survey aims to measure changes in knowledge, attitude, and practice as an outcome of specific interventions on TB care and control being carried out by project 'Axshya'. Project 'Axshya' was initiated in April 2010 under the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) grant (round 9), and is being implemented in 300 districts across 21 states of India. The focus is mainly on advocacy, communication, and social mobilization to support India's response to TB. 'Axshya' is being implemented through eight sub-recipient partners, informed Dr Chadha.


The thrust on community engagement is not new, but the evidence to show that community engagement works and positively impacts a public-health programme is certainly another major step forward as it adds to the existing body of evidence calling for community-centric approaches in health programming. Working with community to improve TB care and control in India is important and at times "it is not very easy to show impact. But I am glad that this evidence has come," said Prabodh Bhambal, Interim Deputy Executive Director of The Union.


Anshu Prakash, Joint Secretary with the Ministry of Health and Family Welfare, Government of India, said that this KAP survey, which began in 2011, tells us the direction where we are going so that whatever mid-course correction is required could be made for maximal public-health impact. "But survey also has very interesting findings. I was surprised to find that the number of households who use wood as a fuel [for cooking] is so high." Using wood for cooking adds to indoor air pollution and increases risk manifold of a range of lung illnesses (especially for the children). The number of households using wood as a fuel for cooking and possessing a mobile phone was also significant. Central TB Division is going to gain from these midline survey results as it provides important and useful data, said Prakash.



Dr Karuna Sagili, Research Associate, The Union, informed Citizen News Service (CNS) that: "KAP surveys have been identifying the knowledge gaps, cultural beliefs and behavioural patterns that may facilitate or create a barrier for a proposed public-health initiative. So we did the KAP baseline survey in 2011 at the beginning of project 'Axsyha', followed it up with a midline survey in 2012, and then in 2015 an endline survey will be conducted to measure the impact [of specific interventions carried out under project 'Axshya']."


Survey respondents included 4804 people from the general population, 496 TB patients, 523 healthcare-service providers, 611 opinion leaders, and 93 representatives of non-governmental organizations (NGOs) or community-based organizations (CBOs), said Dr Karuna Sagili.


88% of all the respondents from general population had heard of TB. 81% had knowledge that a cough of over 2 weeks could be TB. 71% knew that TB is caused by germs/bacteria and transmits through air. 83% of the respondents had knowledge that TB is curable. 48% knew that correct duration of the treatment is 6-8 months. Only 23% have heard about DOTS.


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