Novel interventions to enhance access to TB services for vulnerable and marginalised populations: experience from Axshya

Abstract

Project Axshya, supported by the Global Fund, and implemented by The International Union Against Tuberculosis and Lung Disease (The Union), works through a network of nearly 1200 community-based organisations and 20,000 volunteers in 300 districts across India. It enhances access of vulnerable and marginalized populations to TB services through two major interventions: (i) active case-finding called Axshya SAMVAD (Sensitization and Advocacy in Marginalised and Vulnerable Areas of the District), under which trained community volunteers conduct house-to-house visits creating awareness about TB and identifying those with symptoms suggestive of TB; these persons are then linked with diagnostic facilities through referral or sputum collection and transportation. (ii) Unqualified rural health-care providers (RHCPs), the first point of contact for the majority of rural and urban poor, are trained to identify those with symptoms of TB and refer them immediately for sputum examination to the nearest public health facility. They also provide directly observed treatment, short-course (DOTS), for which they get incentives.