Words Rusen Kumar
In the rugged terrains of India’s tribal areas, tuberculosis (TB) remains a formidable adversary, claiming lives and undermining quality of life. The Piramal Foundation has been at the forefront of combating this epidemic through innovative strategies and substantial community involvement. The Piramal Foundation‘s CEO Aditya Natraj, a key figure in these efforts, shares insights into the challenges, solutions, and impacts of their initiatives aimed at eradicating TB, especially within vulnerable tribal communities. The conversation sheds light on the foundation’s holistic approach and the potential path to achieving India’s ambitious goal of eliminating TB by 2025. This exclusive interaction by Rusen Kumar, Editor of India CSR highlights the critical role of innovative solutions and community engagement in moving towards a TB-free India by 2025.
Excerpts:
What are the biggest challenges to eliminating TB from India, especially within tribal communities?
The problem of eradicating tuberculosis in India is complex.Thetribal populationcarries a disproportionate burden of the diseaseowing to lack of information regarding TB symptoms and treatment options. The challengesarefurther heightened by difficulties to access tohealthcare services in these areas. As India is striving to become tuberculosis (TB) free by 2025, there is an urgent need for innovative solutionsthat will reach the remote communities of India.
Additionally, factors likepoverty and inadequate infrastructure further impede efforts in TB detection and treatment. Therefore, implementing innovative strategies tailored to reach remote communities becomes necessary to effectively address these challenges. By prioritizing interventions that directly confront these obstacles, significant progress can be made towards eliminating TB, particularly within vulnerable tribal communities, thereby leading to overall improved health outcomes.
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How do social and economic factors contribute to the prevalence of TB in these marginalized groups?
Social stigma and discrimination associated with TB within themarginalized groups discourage individuals from seeking necessary help, resulting in underreporting and undertreatment of TB cases. The marginalized communities lack the understanding of the symptoms and prevention,thereby contributing to an overburdened state of TB carriers.
Often, they do not have access to healthcare services, likediagnostic facilities and treatment options.Even when they have access to the services, thelack of trust in the public health system due to illtreatment often leads to delays in diagnosis and treatment initiation. This allows TB to thrive within these communities. Furthermore,factors like malnutrition and substance abuse compromise the immune system, increasing susceptibility to TB infection and impeding recovery from the disease.
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What are the key barriers to accessing proper TB diagnosis and treatment in tribal areas?
In tribal areas, accessing proper TB diagnosis and treatment is hindered by several key barriers. These include inadequate healthcare infrastructure, geographical obstacles, socioeconomic disparities, limited education, cultural beliefs, stigma, and historical mistrust in healthcare systems. Overcoming these hurdles necessitates holisticapproaches to enhancing healthcare infrastructure, raising awareness, addressing socioeconomic inequalities, reducing stigma, and building trust within tribal communities.
What specific strategies and programs does Piramal Foundation employ to address TB in tribal communities?
Piramal Foundation has adopted a comprehensive approach to address TB in tribal communities, focusing on building awareness, collaboration, healthcare access, and technological innovation. We ensure a coordinated response to TB by engaging community influencers and fostering partnerships between stakeholders likegovernment agencies and tribal representatives. Advocating for increased access to healthcare infrastructure and integrating technological solutions is crucial for enhancing TB diagnosis and treatment.
In our programs, we conduct targeted awareness sessions for tribal healers and Panchayati Raj Institutions (PRIs)/village council members to facilitate early identification and referral of TB cases. So far, we have engaged 3,878 tribal healers, and sensitized 29,494 PRIs and village council members.Empowering communities is also important to achieve our aim of significantly reducing the TB burden.We are advocating for tribal representation in decision-making forums and educating children in government-run schoolsin tribal populations and improving overall health outcomes.
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How can communities be leveraged to support the public health system to better support the fight against TB, particularly in underserved regions?
Enhancing infrastructure and leveraging community influencers are two crucial factors in combating TB in strategically reinforcing India’s public health system. A community influencer is an individual or group, like PRI members, healers, youth self-help groups (SHGs), TB champions and others, who can wield their influence to advocate for specific causes, mobilize support, and drive change within their respective communities. In underserved regions, their influence over communities helps to improve accessibility to diagnosis and treatment serviceswhile fostering community engagement through awareness campaigns and initiatives.
Piramal Foundation works towards sensitizingPRI members to integrate TB-related awareness in panchayat activities and meetings, refer symptomatic cases to public health system for testing and treatment, and take ownership of TB-Mukt panchayats. In many places, traditional healersareprimarytrusted points of contact. We havetrained them to recognize TB symptoms and later refer the cases to the public health system for diagnosis and treatment. Also, youth involvement helps inadvocacy and education initiatives.
Their involvement helps in dispelling the stigma related to TB and mobilizingcommunity members for TB testing. SHGs offer platforms for TB education and advocacy, fostering community support and empowerment. And most importantly, when TB champions share their personal stories as influencers, they inspire others to seek treatment and fight stigma, offering hope and motivation for recovery.
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What role can technological innovations play in improving TB detection, treatment, and prevention?
Technological innovations, aligned with the Government of India’s target to eliminate TB by 2025, offer significant promise in improving TB detection, treatment, and prevention efforts. For instance, artificial intelligence (AI) for TB detection can also alleviate the burden on public health resources and expedite diagnosis. Piramal Foundation forged a strategic partnership with Qure.ai, which has enabled the piloting of AI-guided TB detection using analogue X-rays and fast tracks treatment in Chhattisgarh’s tribal districts.
Similarly, a pilot project is implemented utilizing automated drones to expedite the transportation of sputum samples in hard-to-reach areas of Odisha’s Kalahandi district. Implemented in collaboration with Redwing Labs, this initiative significantly reduced the time taken for samples to reach the diagnostic centres, underscoring our commitment to leveraging innovative solutions to enhance TB control efforts in tribal communities.
In addition, Piramal Foundation has also adopted mobile-based platforms like Active Case Detection and Management (ABDM) to enhance access to healthcare services, especially in remote or underserved regions, in collaboration with Digital Bharat Collaborative (also under Piramal Foundation). A successful pilot project in Darrang, Assam, highlights the efficacy of ABDM in enabling timely TB detection and management.
With a focus on electronic documentation by service providers like Accredited Social Health Activists (ASHAs) and HWOs, the system ensures that crucial information is easily accessible and retrievable. Notably, the integration of various digital platforms, including Nikshay and HMIS, breaks down silos and streamlines data sharing across the healthcare network.
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Can you share some examples of the Piramal Foundation’s impact on reducing the TB burden among tribal populations?
Anamaya, the Tribal Health Collaborative (under Piramal Foundation),has made significant strides in reducing the TB burden among tribal populations through initiatives like the Tribal TB Initiative. For instance, the Aashwasan campaign was a pivotal initiative in combating the dual challenges of COVID-19 and TB among tribal and hard-to-reach populations during the pandemic.
Encompassing a vast geographic coverage spanning 68,413 villages, and 1,122 blocks in 174 districts, the campaign made remarkable strides in raising awareness and screening for these infectious diseases. With apopulation coverage of 16,677,804 individuals reached for awareness and 10,384,538 screened for TB, the campaign significantly contributed to early detection and intervention. Notably, the presumptive testing and diagnosis efforts identified 10,249 persons with confirmed TB, of whom 9,588 commenced treatment.
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How does the Foundation collaborate with government agencies and other stakeholders to achieve its goals?
The vision of Piramal Foundation aligns with the national goalto eliminate TB from India by 2025, especially in tribal districts. Spanning across 11 states and78 districts, the initiative embodies a concerted effort to mobilize resources and strengthen National Tuberculosis Elimination Program (NTEP) services in tribal areas. Notably, the initiative embraces a holistic approach by integrating tribal healers into the TB continuum of care, leveraging their expertise for referral, treatment support, and nutrition counseling.
Furthermore, it extends support to state NTEP teams in realizing TB-free panchayats within tribal geographies and aids initiatives like the TB Elimination Accelerator Initiative in Mizoram. Additionally, the integration of AMRIT, a health information management system, as a Digital Public Good, accelerates Active Case Finding efforts in districts like Darrang, Assam.
In line with the broader mandate, the initiative organizes integrated health camps for TB, sickle cell disease, and non-communicable disease screenings, particularly targeting geographies inhabited by Particularly Vulnerable Tribal Groups (PVTGs) under the aegis of the Ministry of Tribal Affairs (MoTA).
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What are the biggest challenges the Foundation faces in its work, and how are you addressing them?
At grassroots levels, we encounter challenges like restricted access to healthcare infrastructure, especially in remote and underserved regions, which obstruct the delivery of essential healthcare services. Moreover, socioeconomic disparities, including poverty, limited education, and insufficient access to clean water and sanitation, significantly contribute to adverse health outcomes within the communities we serve. Sometimes, cultural barriers and entrenched social norms hinder the acceptance and effectiveness of health interventions.
We prioritize strategic partnerships with government agencies, NGOs, and community stakeholders to address these challenges, leverage resources, and enhance service delivery. Additionally, we implement innovative approaches, such as community-led interventions and technological solutions, to overcome barriers to healthcare access. Withcontinuous monitoring and evaluation,weadapt to situationstorefine our strategies to better meet the evolving needs of our communities.
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What are your thoughts on the feasibility of India achieving its goal of eliminating TB by 2025? What needs to be done to make this a reality?
India’s goal of eliminating tuberculosis by 2025 faces significant challenges due to the country’s high TB burden, underdiagnosis, treatment adherence issues, and social determinants contributing to the spread of the disease. To eradicate TB, India must strengthen diagnosis, improve treatment adherence, and increase community engagement. The National Strategic Plan for TB Elimination and awareness campaigns have laid the groundwork for progress towards TB elimination in India.
(India CSR)
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