Clearly more needs to be done for effective tuberculosis (TB) control by reaching out to the unreached populations who are least likely to access existing TB care services. Project Axshya, aims to do exactly that. Supported by one of the largest grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund), the five-year project got underway last year with a focus on engaging civil society to improve the reach and effectiveness of India’s Revised National Tuberculosis Control Programme in 374 districts across 23 Indian states, reaching some 744 million people by 2015.
The civil society initiative, led by the International Union Against Tuberculosis and Lung Disease (The Union) and World Vision India (WVI), in close collaboration with the Government of India, is now building up significant momentum towards its objectives. The Union will manage Project Axshya in 300 districts across 21 states with a population of 577 million, and WVI in 74 districts across seven states, five states being common to both principal partners.
“The logistics of Project Axshya sound daunting, but the idea is to extend the impact of our efforts by building new stronger networks for TB control”, says Dr Nevin Wilson, Regional Director of The Union South-East Asia Office in New Delhi. “For The Union, we have put in place a good team and are partnering with nine organisations, each with an excellent track record of working with populations in their respective states. This is the core group, but many more will be involved”.
Involving partners across sectors – government, non-governmental organisations, private doctors, technical agencies, affected communities and the media – is a key strategy of Project Axshya. Equally important is the need to recognise and address linkages that continue to sustain TB as a mammoth challenge for India, especially the linkages with poverty and malnutrition, with diseases like diabetes and HIV, and with the use of tobacco.
“Our national TB control programme has done an outstanding job, but, with about 2 million new cases of TB each year, it is now recognised that TB in India cannot be successfully addressed by the government alone”, says Dr Wilson. “Multiple stakeholders across sectors need to work together to expand access to information and services, increase accountability and truly empower communities. This is what Project Axshya seeks to do.”
A special focus of Project Axshya will be those who have had the greatest difficulty accessing information and treatment for TB – women, children, tribal populations, communities living in geographically difficult areas, and vulnerable groups such as people co-infected with TB and HIV.
The Union is also simultaneously strengthening work on the linkages that interface with TB.
“Addressing the linkages of TB with poverty and with non-communicable diseases (NCDs), and expanding partnerships across sectors, are not just wishful thoughts for us – we have set up concrete mechanisms that we hope will feed into Project Axshya very usefully,” adds Dr Wilson. The Secretariat of the Stop TB Partnership’s sub-group on TB and Poverty now functions from The Union South-East Asia Office, as does the Secretariat of the national Partnership for TB Care and Control in India. NCDs are a major focus for The Union, especially tobacco control.
The Union’s core partners in Project Axshya, sub-recipients of the Global Fund grant who will work with The Union to implement Project Axshya in various states, are:
– Catholic Bishops Conference of India – Coalition for AIDS and Related Diseases (CBCI-CARD)
– Catholic Health Association of India (CHAI)
– Christian Medical Association of India (CMAI)
– Emmanuel Hospital Association (EHA)
– Mamta Health Institute for Mother and Child (MAMTA)
– Mamta Samajik Sanstha (MSS)
– Population Services International (PSI)
– Resource Group for Education and Advocacy for Community Health (REACH)
– Voluntary Health Association of India (VHAI).
“The focus of Project Axshya is on Advocacy, Communication and Social Mobilisation (ACSM) towards universal access to TB care”, says Dr Sarabjit S Chadha, the Project Director. “Through our partners, it will cover a range of activities to empower communities in TB control, advocate for political and administrative support, involve all healthcare providers to increase the reach of TB services, ensure the rational use of drugs and diagnostics, and train on areas of national priority.”
To orient its nine partner organisations, The Union recently held a five-day training for 73 programme managers, assistant programme managers, district coordinators and finance managers who will implement the project in the field. The training covered basic knowledge of TB and TB control systems, project activities, and areas such as recording and reporting. District TB Officers of the project districts also actively participated in the training, at the end of which each district had developed an activity plan.
“Infectious diseases like TB spread from person to person”, says Dr Wilson, “and eventually you have millions of people who are sick. With Project Axshya we are reversing the process – spreading information on TB, telling people that it is curable, and empowering them to access services. In this way, we hope to reach millions – and save many lives.” (CNS)