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Reaching the unreached: ENGAGE TB initiative

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Shobha Shukla, Citizen News Service - CNS

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(CNS): Despite great strides made in TB care and control over the last few years, the latest data shows that 1/3 of all TB cases are still either not detected or not reported to public-health systems. These are people who either seek treatment in the private sector and are not notified to the National TB programmes (NTPs) or have not been diagnosed at all. Some of them would die and all of them would continue to spread TB to others, unless treated. Communities affected by TB are often marginalized--poor people, migrants, injecting drug users, prisoners, refugees, sex workers--and face challenges in securing TB services from public healthcare facilities. Then there are women and children, for whom also it is not easy to access healthcare.

Thomas Joseph of the World Health Organization (WHO)'s Global Tuberculosis Programme, told Citizen News Service (CNS) that: "We have to find these missing people by reaching out to them as they are not coming to us on their own for a variety of reasons. We have to get them diagnosed and put on treatment. Non-governmental organizations (NGOs) and Civil Society Organizations (CSOs) can do this best as they are already working with these target groups. So it is easy for them to reach out to this missing population of neglected communities through community health workers and volunteers.

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"But the tragedy is that, even though many NGOs may be working on HIV, they are not working on TB. We know that a large number of deaths (one in four) in people living with HIV (PLHIV) are due to TB, which is treatable and curable and not because of HIV, which is not curable. If NGOs working with PLHIV can integrate TB care and control in their existing programmes, it will dramatically reduce these unnecessary deaths," said Thomas.

He added: "Another neglected population is that of women. TB affects the health of the mother and the unborn child. In case of pregnant women, TB doubles the risk of low birth weight of infants, which is predictive of a host of other health problems in later life. It also doubles the risk of premature birth, increases 10-fold the risk of fetal death, and doubles the risk of vaginal bleeding. Pregnant women living with HIV have more than 10-fold higher risk of developing active TB than HIV-negative pregnant women. Ignoring TB in women has ghastly results."

Thomas insisted that, as a matter of policy, government programmes should screen all pregnant women for TB symptoms (like night sweats, fever, cough, weight loss). All NGOs working on maternal and child health should integrate TB in their programmes. Likewise they must screen PLHIV for TB symptoms and accordingly refer them for diagnosis. If they have TB, they should be put on TB treatment, and if they test negative for TB, they should be put on TB prevention treatment.

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He informed: "The ENGAGE-TB operational guidance from the WHO Global TB Programme, provides guidance to (i) NGOs on how they can integrate TB in their programmes and (ii) National TB programmes (NTPs) on how they can collaborate and work together with NGOs and other CSOs working on community-based TB activities. This collaborative approach is built in an enabling environment based on mutual understanding and respect between NGOs and governments. Through supportive policies and simple procedures, it aims that NGOs/ CSOs provide a broad range of TB services."

A few examples of successful application of this model were shared at the recently held 45th Union World Conference on Lung Health in Barcelona:


Despite a gradual decline of approximately 2% annually, TB has remained a major public health challenge in Kenya. About 21% of all estimated new TB cases are still unreached and hence undiagnosed. Kenya also has a high dual TB-HIV burden. The ENGAGE-TB approach was launched in Kenya in 2012. The initiative aimed to enhance collaboration between CSOs and the government for purpose of better TB control and services at the community level. Before this, due to lack of a clear mechanism of their engagement, most NGOs/CSOs remained unengaged in TB control activities. The national NGO Coordination Body was formed in May 2012 and a steering was team was established representing both urban and rural CSOs.

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