(Sanjay Kishan is a BJP MLA from the Tinsukia constituency in Assam. He was the president of Assam Chah Morcha and in-charge president of All Assam Tea Garden Student's Union.)
T he need for involving communities in addressing health issues and ensuring transparency in public health is undisputed. There is evidence to show that involving a wider stakeholder group, such as community leaders, employers and industry representatives, elected representatives and local governce bodies brings sustaibility and equity to public health. Involving employers, as established by the employer-led model initiated and demonstrated well by the tiol AIDS Control Organisation (CO) in the HIV programme has resulted in improved access to quality care. As elected representatives and governments, it is our responsibility to keep exploring innovative ways to expand the involvement of diverse stakeholder groups for important health issues.
One such innovative initiative that I am closely working with in my constituency Tinsukia is directed towards addressing tuberculosis (TB). TB is a grave disease that affects millions of Indians. The tiol Strategic Plan for TB Elimition tells us that nearly 1,400 people in India die of the disease every day. There is a stark paradox here: TB is curable, and timely detection and regular treatment can help prevent the loss of livelihood, health and lives. According to the Annual Status Report for TB India in 2017, over 36,000 cases of TB were notified from the public sector in 2016 in Assam, with an additiol 4,000 cases from the private sector, with a total of over 40,000 cases of TB in Assam. TB is a disease that is caused by and causes poverty and inequality. Several factors that increase vulnerability to it and deplete access to diagnosis and treatment are inextricably linked to the assertion of people's basic human rights.
Assam has been taking visible strides to defeat TB. In 2016, it was the first State to roll out the use of Bedaquiline in India, as a treatment for multi-drug resistant TB. Additiolly, Assam was certified as the best performer among all States in the Revised tiol Tuberculosis Control Programme from 2015-16 to 2016-17 by the Ministry of Health and Family Welfare of the Government of India.
Nevertheless, we need to do more if we are to elimite TB. A large section of the State's population that works in tea plantations, nearly a fifth of the State's population, is vulnerable to TB. They have little information on the disease, nor do they have the means to access diagnostic and treatment services. According to TB India 2014, almost 17 per cent of tea workers are affected by the disease. Their vulnerability is enhanced by crowded housing conditions and idequate nutritiol intake as well as other access issues faced by migrant workers who constitute much of the workforce in these plantations. Given the size of the affected population and the centrality of tea plantations to the revenue of the State, there is an urgent need for us to join hands to address TB among this demographic group.
In this context, the Employer Led Model (ELM) to elimite TB is an innovative model that engages tea estate owners in Dibrugarh and Tinsukia districts in Assam along with government stakeholders, plantation workers and communities to bring awareness and adequate detection and treatment to those affected by TB.The role of employers is key: employers have the potential to help see employees and patients through the detection-treatment-after care journey. Employers, especially tea plantation owners and associations, are a ready bridge that links existing public health systems and facilities to their employees and families. This also adds a layer of implicit sustaibility to the model.
The ELM envisages a 360-degree engagement that addresses sensitization of tea plantation workers on TB, orientation and engagement of school teachers within the tea gardens, amplifying case detection through regular health camps, provision of treatment and nutritiol support and training of family members of TB patients on infection control, cough hygiene and treatment adherence.
TB remains a stigmatized disease and people affected by it face considerable stigma and discrimition. In addition to enhancing access to services, the engagement of employers has the potential to also reduce stigma and social exclusion of such patients. Awareness of proper hygiene practices, as well as following the required treatment and nutrition, is vital to the battle against TB. The engagement of employers can address these aspects of our response to the disease.
The ELM model has been initiated by the Resource Group for Education and Advocacy for Community Health (REACH). REACH has been working for nearly two decades to support the RNTCP and has recently begun working in Assam as part of the TB Call to Action project supported by USAID.
We need to stand together to work for a TB-free Assam.
(Published on the occasion of World TB Day)