Health Communication Strategy for RNTCP

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A Health Communication Strategy

for RNTCP

Published by

Central TB Division

Directorate General of Health Services

Ministry of Health and Family Welfare

Government of India

in collaboration with

DANTB



A Health Communication Strategy for RN TCP

Published by

Central TB Division


Ministry of Health and Family WelfareGovernment of India

in collaboration with

DANTB



Contents

Foreword v

Abbreviations vii

Executive Summary xi

Part 1

Strategic Planning Framework 1

1. Introduction 5

2. Communication in a TB Control Programme 63. Communication Strategy for TB Control Programme 15

4. Monitoring and Evaluation of Communication in RNTCP 33

5. Capacity-building 37

6. Special IEC Needs in RNTCP Phase II 40

Part 2

Planning and Implementing a Health Communication Strategy of

RNTCP – A Practical Guide

1. Introduction 47

2. Implementation of the Strategy 59

Annexures

1. Implementation Guide to Health Communication Activities 73

2. IEC Resource Centre of Central TB Division User Guidelines 145

3. Index of Materials Available in the Central TB Division’s 149

Web-based IEC Resource Centre

4. Index of Health Communication Materials Used in Orissa 156

5. User Guidelines for the Health Communication Video Modules CD 173

6. Suggested Format for Planning IEC Activities at State and District 175

7. IEC Reporting Formats 176



Foreword

India has the largest number of tuberculosis (TB) cases in the world, accounting

for more than one-third of the global burden, and TB is the leading cause of

death among adults in the country. With this background, the Governments of

Denmark and India agreed in 1996 that the Danish development cooperation in

India should be further expanded to include the fight against TB. This happened

at a time when India was playing a pivotal role in developing and testing the

DOTS strategy (Directly Observed Treatment, Short-course) for TB control—a

strategy that was subsequently globally recommended by WHO. There was a need

to establish solid experiences in implementing DOTS in different parts of India.

In agreement between Danida, Government of India (GoI) and Government of

Orissa (GoO), the State of Orissa was selected as a relevant and important locus

for the Danish support, being one of the poorest states of India, with a large tribal

population and high TB prevalence.

The Danish assistance to the Revised National Tuberculosis Control Programme

in India, DANTB, was established in 1997. In addition to the financial and

technical support to establishing the necessary infrastructure for RNTCP, the

project made Orissa special compared to other states of India by the development

of two specific components dedicated to work with TB-related information,

education and communication (IEC) and health systems research (HSR) by

DANTB. DANTB has been fortunate to have highly creative and dedicated staff

working with IEC throughout the project and while HSR provided input for

IEC in terms of formative and problem-based research, the IEC activities werealso set to develop innovative approaches and strategies as well as making use

of successful experiences with health communication from other projects. The

project attracted substantial additional funding for IEC in Orissa in comparison

with other states of India, and examples of innovations include: patient-

provider interaction meetings; interactive stalls at weekly markets; a wide range

of folk media; involvement of panchayati raj institutions, self-help groups and

community-based organisations; as well as locally-designed IEC materials. Orissa

became an IEC laboratory with involvement of villagers, DOT Providers, former

patients, health staff at all levels and NGOs and voluntary organisations as lab

technicians. When all the districts were covered by the end of 2004, the projectset focus on mass media in support of IEC, and the trialogue approach, originally

developed by the Danida-supported leprosy programme, was introduced.

The development of IEC in Orissa has taken place in a continuous dialogue with

both GoO and GoI. It has always been the aim of Danida and DANTB to ensure

that, whenever possible, successful approaches, activities and materials should

be considered for large-scale adoption at the national level. An example of this



is the jointly-produced web-based IEC Resource Centre, placed at the website of

the Central TB Division, a landmark for IEC not only for RNTCP but for health

programmes in general due to its innovative use of the Internet. In August 2005,

IEC officers from all states of India were invited to Orissa to share experiences. The

present Health Communication Strategy, which was circulated and discussed on

that occasion, is a logical outcome of this long-standing collaboration betweenstrong partners on IEC for RNTCP.

As Danida is phasing out development activities by the end of 2005, DANTB will

also cease its operations. It is indeed positive that the project leaves behind an

IEC heritage that is well appreciated by GoI and that will continue to live at the

national level in RNTCP II. It is hoped that the present volume will be helpful to

planners at state- and district-levels in the implementation of the IEC component

of RNTCP II, and that it will be widely used and disseminated.

Mariann Lyby

Development Counsellor for Health

Royal Danish Embassy

New Delhi

November 2005



Abbreviations

ADMO Assistant District Medical Officer

AIDS Acquired Immunodeficiency Syndrome

AIR All India Radio

ANM Auxiliary Nurse Midwife

ATD&TC Anti-Tuberculosis Demonstration and Training

Centre

AWW Anganwadi Worker

BCC Behaviour change communication

BDO Block Development Officer

BEE Block Extension Educator

BPL Below poverty line

Cat I, II & III Category I, II & III (anti-tuberculosis drugtreatment classification)

CBO Community-based organisation

CDMO Chief District Medical Officer

CDPO Child Development Project Officer

CHW Community Health Worker

CII Confederation of Indian Industry

CME Continuing medical education

CTD Central Tuberculosis Division

Danida Danish International Development Assistance

DANLEP Danish Assistance to the National Leprosy

Eradication Programme

DANTB Danish Assistance to the Revised National

Tuberculosis Control Programme

DD Doordarshan (Indian national television network)

DDG Deputy Director General

DfID Department for International Development (UK)

DHS Director of Health ServicesDMET Director of Medical Education and Training

DOTS Directly observed treatment, short-course

DP DOT provider

DTC District Tuberculosis Centre

DTO District Tuberculosis Officer



ESI Employees’ State Insurance

FW Family welfare

GoI Government of India

HIV Human Immunodeficiency Virus

HSR Health systems researchHW Health worker

ICDS Integrated Child Development Services

IEC Information, education and communication

IMA Indian Medical Association

IPC Inter-personal communication

LHV Lady Health Visitor

LT Laboratory Technician

MC Microscopy Centre

MCI Medical Council of India

MDR-TB Multi-drug resistant-TB

MEIO Mass Education and Information Officer

MO Medical Officer

MO-PHI Medical Officer of the peripheral health institution

MO-TU Medical Officer, Tuberculosis Unit (sub-district)

MoH&FW Ministry of Health and Family Welfare

MPHS Multi-purpose Health Supervisor

NGO Non-governmental organisationNTI National Tuberculosis Institute

NTP National Tuberculosis Programme

NYK Nehru Yuva Kendra

NSS National Service Scheme

OHP Overhead Projector

OPD Outpatient department

PHC Primary Health Centre

PHI Peripheral health institution

PIP Project Implementation Plan

PMOE Participatory monitoring and ongoing evaluation

PRA Participatory rapid appraisal

PRI Panchayati raj institution

RD Rural Development

RMP Registered Medical Practitioner



RMS Review, monitoring and supervision

RNTCP Revised National Tuberculosis Control Programme

SC Scheduled Caste

SDTU Sub-district Tuberculosis Unit

SHG Self-help GroupSIH&FW State Institute for Health and Family Welfare

SSC State Steering Committee

ST Scheduled Tribe

STD Sexually transmitted diseases

STDC State Tuberculosis Demonstration Centre

STI State Tuberculosis Institute

STLS Senior Tuberculosis Laboratory Supervisor

STO State Tuberculosis Officer

STS Senior Treatment Supervisor

TAI Tuberculosis Association of India

TB Tuberculosis

TBA Traditional Birth Attendant (trained)

TOT Training of trainers

TRC Tuberculosis Research Centre

TU Tuberculosis Unit

VHG Village Health Guide

WB World BankWCD Women and Child Development

WHO World Health Organization



Executive Summary

The purpose of this health communication strategy is to provide a framework

to those who are in a position to plan, design, implement or support a strategic

communication effort for the Revised National Tuberculosis Control Programme

(RNTCP). This document addresses various target groups:

Central level decision-makers/planners

State-level decision-makers/planners

District-level managers and implementers

Service providers (public and private)

NGOs/CBOs

The communication strategy framework for RNTCP draws on the experiences

of communication in RNTCP in the various states as well as the experiences in

other health programmes such as the National Leprosy Eradication Programme

(NLEP), Reproductive and Child Health Programme (RCH) and the National AIDS

Control Programme (NACP). It builds on the Orissa model of communication in

RNTCP developed by the Danish Assistance to the Revised National Tuberculosis

National Programme (DANTB) and also draws pertinent lessons from the health

systems research conducted by DANTB in Orissa.

The Orissa model of communication involved seven strategic elements:

1. Universal right to know 2. Cultural sensitivity

3. Gender sensitivity

4. Community participation

5. Multi-level partnership

6. Appropriate media mix

7. Research, monitoring and evaluation

The document is divided into two parts. Part I provides a framework for designing

and planning a communication programme for RNTCP.

While the implementation of directly observed treatment, short-course (DOTS)

in India is beginning to bear fruit in terms of decreased morbidity and mortality,

TB is still the leading cause of death among adults. From an estimated one TB

death per minute in India in 1999, the death rate has decreased to an estimated

two deaths every three minutes in 2004.



Communication has played a prominent role in RNTCP. While the project was

being implemented in a phased manner during Phase I, the Centre, states and

districts have realised the importance of communication to reach the vast

number of people in a nation characterised by tremendous diversity. But, given

the diversity and uneven development of the country in terms of infrastructure

and socioeconomic indicators, this is a challenging task.

Building on Phase I, the communication component of RNTCP in Phase II has

three main objectives:

1. Awareness-raising for behaviour change to increase understanding about TB

and the use of RNTCP services and preventive action among

the public, so that they make use of DOTS and

medical practitioners across the country, so that they know about correct TB

diagnosis and treatment and they refer symptomatic cases for sputum test, orbecome DOT providers themselves.

2. Advocacy to create, facilitate, develop and forge political, administrative and

community-level commitment to TB control in India.

3. Patient-provider communication and counselling to help ensure patient

compliance with the treatment regimen, enhance the reputation of a patient-

friendly service, improve provider-attitude and skills, and encourage patients

and their families to become advocates for the programme.

The communication strategy is guided by the following principles:

The communication approach is people-centred and client-friendly.

Communication efforts and initiatives are process- rather than product-

oriented.

Detailed planning, choice of communication channels and monitoring are

decentralised

Communication strategies address social and cultural issues related to TB

In resonance with the three objectives of communication in the TB-control

programme, three basic essential behavioural goals are critical for success, viz.

1. Treatment-seeking

2. Timely detection

3. Completion of treatment



The target groups for the communication strategy are:

Primary target group

1. TB patients/potential TB patients

2. Families/neighbours/general public

Secondary target group

1. Doctors/RMPs/clinic operators/medical students

2. DOT providers

3. Local leaders

4. ANMs/AWWs

5. SHGs/CBOs/NGOs/PRIs

The strategic communication framework identifies target behaviour and

barriers and suggests a set of key messages and support services to be used for

communicating to the group. The framework also suggests channels to reach thetarget group.

Of particular importance to inter-personal communication (IPC) is the trialogue

approach. Trialogue is a strategy that which aims at changing community attitudes

and behaviour through active participation in caring for persons affected by the

disease as well as open and honest discussions regarding fears, prejudice and

problems concerning TB.

The framework encourages the use of participatory techniques such as

participatory rapid appraisal (PRA), for assessing group and community resources,

identifying and prioritising problems and appraising strategies for solving them.

Monitoring and ongoing evaluation are essential components of the

communication framework.

Planning for ongoing communication capacity-building is essential in

implementing an information, education and communication (IEC) strategy,

whether in regard to formative IEC assessment, design, communication product

development, pre-testing, monitoring or evaluation. The framework takes

cognizance of this.

In order for the Government of India (GoI) to meet the challenge of coming up

with an effective response to the TB situation, the involvement and reach of

partners such as NGOs and CBOs is very important.

Part II of this document provides detailed steps in designing and implementation

of the activities, events and materials at the central, state-, district- and PHI-



levels. This part, along with the Annexures, is particularly relevant for micro-

planning and may guide implementers of IEC in the adoption of a wide range of

IEC activities to address specific needs and target audiences.

The steps and processes are supported by a list of suggested communication

activities and communication materials. In addition, a set of video modules isenclosed with the book on a VCD. They demonstrate a number of IEC activities,

taking RNTCP in Orissa as an example. Also, the Annexures provide an overview

of and guidelines for the web-based RNTCP IEC Resource Centre set up by the

Central TB Division in collaboration with DANTB.



Part 1Strategic Planning Framework



Contents

1. Introduction 5

2. Communication in a TB Control Programme 6

2.1 TB control programme in India 6

2.2 Communication in RNTCP 7

2.3 Key concepts 8

2.4 Knowledge and behavioural change 9

2.5 The Orissa IEC model—an example 12

3. Communication Strategy for TB Control Programme 15

3.1 Objectives and focus of communication in RNTCP Phase II 15

3.2 Strategic framework 16

3.3 Guiding principles for IEC in TB control programme 16

3.4 Behavioural goals for IEC strategy 17

3.5 Health systems research for IEC 18

3.6 Defining behavioural change objectives 19

3.7 Planning at state and district level 30

3.8 Checklist for strategic planning framework 31

4. Monitoring and Evaluation of Communication 33in RNTCP

4.1 What is monitoring and evaluation? 33

4.2 Monitoring 33

4.3 Evaluation 33

4.4 Monitoring and evaluation in RNTCP Phase II 34

4.5 An example: IEC and acceptability of DOTS 35



5. Capacity-building 37

5.1 Central level: advocacy and IEC unit 37

5.2 State-level capacity for IEC 37

5.3 District-level 38

6. Special IEC needs in RNTCP Phase II 40

6.1 Improving access to hand to reach people 40



Introduction1

The purpose of this planning and implementation strategy is to provide a

framework for planning, designing, implementing and supporting strategic

health communication activities for the Revised National Tuberculosis Control

Programme (RNTCP).

The first part of the communication strategy provides a conceptual framework

and is particularly intended for state-level decision-makers and planners,

district-level managers and non-governmental organisations (NGOs) in charge

of implementing information, education and communication (IEC) activities.

The second part of this volume focuses on planning and implementing the

strategy. It is particularly relevant for district- and block-level managers and

implementers and for NGOs working with IEC activities.

During RNTCP Phase I, IEC activities were given particular attention in the state

of Orissa, where special funding and technical assistance was made available for

the development of IEC activities and materials through the Danish Assistance to

the Revised National Tuberculosis Programme (DANTB) project funded by Danish

International Development Assistance (Danida). While the comparatively high

level of IEC activities in Orissa has provided important input for the development

of the present strategy, which is developed by the Central TB Division of the

Directorate General of Health Services, under the Ministry of Health and Family

Welfare of the Government of India, in collaboration with DANTB, it is important

to point out that IEC activities have taken place in most other states in India as

well, and that the present strategy is intended for a national programme. Actual

implementation at state- and district-levels should take place through flexible

adaptation in view of local needs and constraints; however, care has been takento make this strategy relevant and applicable to all states of India.



Tuberculosis (TB) is an infectious disease caused by a bacillus, Mycobacterium

tuberculosis . Nearly two billion people around the world are infected with the

bacillus that causes TB. Each year, about 8.4 million people develop active, or

infectious, TB and about two million deaths are related to TB.

TB is the world’s biggest single infectious cause of death among adults. India

accounts for one-fifth of the global TB incidence and is estimated to have the

highest number of active TB cases amongst the countries of the world. Nearly

1.8 million new cases occur each year. TB has killed more people than any other

infectious disease in India.

2.1 TB Control Programme in India

The National Tuberculosis Control Programme (NTCP), established in 1962,

created an infrastructure for TB-control throughout the country and wasintegrated with the general health services. The programme provided free service

to the community. There was no specific focus on health communication.

The NTCP was reviewed during 1992 by a panel of experts. Based on the findings

and recommendations of the review, the Government of India (GoI) evolved a

Revised National Tuberculosis Control Programme (RNTCP) on the basis of the

strategy of directly observed treatment, short course (DOTS) recommended by

the World Health Organization (WHO). Objectives of RNTCP included achieving

a 70 percent case detection rate and a treatment success rate of 85 percent of new

smear-positive cases.

This strategy was pilot-tested in 1993-94 in five sites covering a population of

2.35 million, and thereafter expanded to 17 project sites covering a population

of 13.85 million, to assess technical and operational feasibility. Encouraged by

the results of the pilot studies, the GoI decided to expand the programme in a

phased manner to cover the entire population of India by the end of 2005 with

assistance from the World Bank. Danida supported the programme in Orissa, and

Communication in aTB Control Programme

2



the Department for International Development (DfID) in Andhra Pradesh, Global

Fund to Fight AIDS, TB, and Malaria (GFATM) in Bihar, Chhattisgarh, Jharkhand,

Uttaranchal and Uttar Pradesh and the United States Agency for International

Development (USAID) in Haryana.

An estimated one billion people in India were covered under the DOTS strategy for TB control and more than four million people were treated as of March

2005. However, TB control in India still faces many challenges and health

communication is seen as an essential component to ensure a growing public

demand for RNTCP services.

2.2 Communication in RNTCP

Health communication activities for RNTCP presuppose that free quality services

are in place for the target group. Accordingly, the initial emphasis in RNTCP has

been on establishing and maintaining the required quality of services. From 2000onwards, once quality services were established and their availability ensured,

IEC played a more prominent role in the programme. DOTS services are now

available to more than one billion people and the Centre, states and districts have

realised the importance of communication to reach the vast number of people in

a country characterised by tremendous diversity.

Several states have taken up IEC for RNTCP using new and innovative ways.

Orissa, Tamil Nadu, Gujarat, Delhi, Rajasthan and Maharashtra have tried several

initiatives and developed strategies that have proved very successful.

In RNTCP Phase II, the IEC component has three main objectives:

1. Awareness-raising to increase understanding about TB amongst:

the public, so that they make use of RNTCP services and

medical practitioners across the country, so that they know about correct

TB diagnosis and treatment and they refer patients to DOTS services, or

become DOT providers themselves.

2. Advocacy to develop political, administrative and community-level

commitment to TB control in India.


compliance with the treatment regimen, to enhance the reputation of a

patient-friendly service, and to encourage patients and their families become

advocates for the programme.



The IEC strategy will be guided by the following principles:

1. IEC should be process-rather than product-oriented. This has two dimensions.

TB-control requires a long-term commitment from patients, providers, policy-

makers and communities; this commitment is built through interaction

and partnerships, not by simply transmitting information. Communicationstrategies for TB-control therefore need to maximise opportunities for

interactive communication, such as engaging cured patients to convince

and support others, group meetings to discuss all aspects of TB-control,

including social aspects. The other dimension of the concept of process

rather than product is the list of steps required to plan IEC within a national

disease control programme. To avoid over-reliance on media and materials,

overall IEC planning should be based on an analysis of the needs and include

a package of three components (formative research, strategy to address the

needs and monitoring).

2. Detailed planning, choice of communication channels and monitoring

should be decentralised to ensure local relevance and wide reach of

information. The Centre will provide leadership and develop core messages,

mass media and advocacy events. The states and districts will base their

specific strategies on the core framework and messages, and will encourage

local adaptation and innovation to reach all possible groups with the most

appropriate communication tools.

3. Strategies should address social issues related to TB such as stigma and

gender.

2.3 Key Concepts

In the field of communication, a number of different terms are currently in use, with

different meanings and emphases, leading at times to a narrow focus on method

rather than purpose. In this document the concept of ‘health communication’ is

used as a generic term, whereas ‘information, education and communication’

(IEC) has been preferred over more recent terminology that stressed this or

that specific aspect of health communication. For the sake of clarity, we wish to

emphasise that IEC is used here as a broad category, including, for example, inter-

personal communication (IPC) and behaviour change communication (BCC).

Behaviour change communication (BCC) – An approach that is specifically

designed to change or sustain the behaviour of individuals or social groups,

using a variety of communication techniques.



Information and communication technologies (ICT) – A broad concept

describing a range of communication and computing media that includes

e-mail, the Internet, satellite and digital communication as well as television,

radio, film and video.

Information, education and communication (IEC) – IEC can be defined as‘a public health approach aiming at changing or reinforcing health-related

behaviours in a target audience, concerning a specific problem and within a

pre-defined period of time, through communication methods and principles’

(WHO).

Social mobilisation – This is an approach that empowers people to actively

participate in the development process actively through local initiatives and

well-informed dialogue.

Social marketing – A market-oriented strategy that seeks to utilisecommercially-developed marketing techniques for public health purposes

by promoting and selling products, ideas, or services that are considered to

have social value, using a variety of outlets and marketing approaches. Often,

goods are made available at subsidised prices.

2.4 Knowledge and Behavioural Change

The concept of knowledge

In the past, health communication activities assumed that if medically-based

information was disseminated in the public, this would be sufficient to lead

people to change their behaviour to optimise their health. An obvious example of

the failure of this assumption is smoking. If knowledge about the negative impact

of smoking on health would in itself be sufficient to achieve healthy behaviour

change, no medical doctors would be smokers. Human Immunodeficiency Virus-

(HIV) prevention campaigns during the 1980s and 1990s showed that human

behaviour is, at best, only partially guided by ‘textbook knowledge’ about risky

behaviour. In terms of sexual behaviour, emotions obviously constitute a very

important motive; in certain situations, this is further modified by other factors,

such as financial circumstances, use of substances like alcohol and drugs,

inter-personal power relations, access to prevention, positive values associated

with risky behaviour etc. Knowledge about transmission of infection and how

to protect oneself against it is a necessary, but not sufficient, pre-condition.

Therefore, health communication with the objective of HIV-prevention through

the promotion of safe practices needs to be based on an analysis of human

behaviour of relevance to the issue at hand. The lessons from HIV prevention

are also relevant for TB: it is equally true, that merely providing factual messages

like ‘Go for sputum test if coughing persists for more than three weeks’ may



be insufficient to stimulate people to follow the advice. This is so because the

message competes with local knowledge, e.g. about common cold which may be

perceived as both non-serious and long-term. Therefore, the message must be

packaged in such a way that it challenges this perception. Programmes, which

take into account local realities when identifying key behavioural determinants,

are much more likely to be effective.

Examples of contextual factors that influence behaviour change

For IEC to lead to the desired objective, contextual factors play a significant role.

Stigma

Tuberculosis is very unevenly stigmatised. Experiences

in India indicate that TB patients are more frequently

stigmatised in urban than in rural and tribal areas.

Stigmatisation cannot generally be seen as associated

with lack of knowledge about tuberculosis, and it is morefrequent among more educated groups than among

uneducated or illiterate people. Stigma is known to be closely related to fear,

and fear in relation to TB is associated with the disease being potentially fatal

and infectious. Therefore, information in itself is not sufficient to de-stigmatise

TB. Specific IEC activities must address the emotional aspects of stigma at the

community-level. This can be done by showing carefully how care of and support

to TB patients at the same time can protect the community from infection. In

urban areas, mass media and involvement of role models should be utilised

to address stigma. In rural areas, the trialogue approach (see below) has been

developed with this purpose in mind.

Gender

There is a gender imbalance in TB case detection. Proportionally

however female cases are detected and treated. The reasons

for this are not clearly understood yet and both biological and

social determinants may be involved. In terms of IEC, gender

as a social determinant for TB infection needs to be addressed.

A special concern is delay of diagnosis among women due to

limitations in access to diagnostic services. A study in Orissa1

found substantial gender differences when it came to action taken in response to

the symptoms. Fifteen percent of women took no action when having symptoms

as compared to eight percent of men. Fifty percent of women did not go to a

peripheral health institution (PHI) as the first point of treatment, as compared to

1 DANTB and New Concept Information Systems: Low Utilisation of TB Services by Women. New Delhi, 2002.



41 percent of men. Nearly a third of the female respondents who did not go first

to the PHI waited anywhere between one and four months before they took any

action. Another study in rural Maharashtra2 queried respondents without active

disease about vignettes depicting a man and a woman with typical features of

TB. Emotional and social symptoms were frequently reported for both vignettes,

but more often considered most distressing for the female vignette; specifiedproblems included arranging marriages, social isolation, and inability to care for

children and family. Job loss and reduced income were regarded most troubling

for the male vignette. Men and women typically identified sexual experience

as the cause of TB for opposite-sex vignettes. With wider access to information

about TB, male respondents more frequently recommended allopathic doctors

and specialty services.

The planning of IEC activities must take gender aspects into account to reach

women effectively both in terms of ensuring that IEC reaches women and that

IEC messages are relevant in view of the constraints that women may face insociety. But gender issues also include attention to health issues that are specific

to men; an example in some communities could be the problem use of alcohol

being more common among men and requiring special attention to increase

completion of treatment.

Poverty

The epidemiological pattern of tuberculosis follows income

patterns and the disease is closely linked to poverty, poor

housing conditions and poor hygiene. It follows that TB

patients are more likely to be poor and illiterate than the

average population. Accordingly, a variety of means and

media must be used to reach the target groups. Furthermore,

it must be acknowledged that poverty itself drastically decreases the freedom to

make choices in life. Hence, it may be very difficult for patients to give priority

to treatment over work, once they feel better. The IEC strategy must take into

account the living conditions of the target groups and the limited possibilities for

poor people to follow advice provided from a public health perspective.

2 Atre SR, Kudale AM, Morankar SN, Rangan SG, Weiss MG. Cultural concepts of tuberculosis andgender among the general population without tuberculosis in rural Maharashtra, India. Trop Med Int Health. 2004 Nov. 9 (11):1228-38.



Behavioural Change

A Basic Model of Communication for Behavioural Change can be Summarised as Follows:

Accurate and timely information is a necessary, but not

sufficient, prerequisite to behavioural development andchange. Information alone seldom leads to behavioural

change.

Communicating information through appropriate channelsin motivating formats is one essential component of

successful programmes.

People need to be empowered to make basic everydaydecisions about their own lives in order for them to act onthe information received, no matter how motivated they

are.

Their wider environment must support and facilitate changefor the effect of the programme to be sustained.

2.5 The Orissa IEC Model—An Example

From the outset, communication activities have been a major part of the RNTCP/

DANTB partnership in Orissa. While many new and innovative communication

activities have been tried in various states, the Orissa experience was a well-

documented one. Based on the experience and learning over the years in severalphases of implementation and scaling up of the TB control programme in

Orissa, a model of communication has emerged, which is characterised by seven

elements:

TB

Con trol

Elements of OrissaCommunication Model

Right to KnowCultural Sensitivity

G e n d e r S

e n s i t i v i t y

R e s e a r c h , M o n i t o r i n g

a n d E v a l u a t i o n

Multi-level Partnership

C o m m u n i t y

P a r t i c i p a t i o n

A p p r o p r i a t e

M e d i a

M i x



2.5.1 Universal right to knowThe over-riding principle of the strategy is that every person

has a right to essential health information, including the basics

about DOTS. It is the responsibility of the government at all

levels to ensure that this information is made available to all

people, irrespective of their social and economic status, level of education, gender, religion or any other specific individual or

group characteristics.

2.5.2 Cultural sensitivityIt has been characteristic of the development of IEC activities

for RNTCP in Orissa that communities have been involved in

a bottom-up approach. This has been guided by a systematic

effort to challenge the marginalisation of certain groups and

individuals at the community-level, and which has worked

to reduce the distance between service providers, patients and communities.For example, special initiatives have been designed to decrease social distance

between tribal communities and non-tribal service provides, targeting the latter

to increase their understanding and tolerance of cultural variation.

2.5.3 Gender sensitivityGender issues influence timely detection and treatment

completion for both men and women. The communication

strategy needs to address gender through special gender

sensitisation initiatives and through mainstreaming gender

in the planning, development and implementation of any communication activity.

2.5.4 Community participationCommunity involvement in planning and implementation of

IEC activities foster a sense of ownership of the programme

at the local level. Social mobilisation is based on direct

dialogue with the community to understand and explore

existing concerns and possible social conflicts with relevance

to diagnosis and treatment. Potential or actual processes of

social marginalisation need to be identified and addressed. Ideally, this will create

a self-supporting and sustainable system for voluntary reporting of people with

TB symptoms. Only by creating a shared understanding that DOTS is possible in

spite of these factors, and that cure of TB is necessary for individuals, the active

involvement of communities in demanding RNTCP services can be ensured.



2.5.5 Multi-level partnershipIt requires the involvement and multi-level partnership of

a broad range of people to support large-scale adoption

of health practices that can bring down TB morbidity and

mortality. It is a strategic aim to involve relevant partners

in IEC activities as the patient may come into contact with a range of differentpeople and institutions in connection with diagnosis and treatment. Partners may

include private practitioners, NGOs at local, state and national levels, corporate

bodies and commercial establishments including pharmaceutical companies;

community groups (in particular women’s groups); local government and

panchayati raj institutions (PRI); self-help groups (SHG) and other community-

based organisations (CBO).

2.5.6 Appropriate media mixDifferent media have different qualities of communication and

they carry different aspects (intellectual, emotional etc.) of amessage. In addition, different target groups may have different

degrees of access to different media. Importantly, illiteracy is a

barrier for some people in accessing any written IEC. Material

development is an essential component of any IEC programme. It is necessary to

develop different types of materials for different types of audiences with focused,

targeted messages. Professional designers may often belong to the middle class

and employ middle class aesthetics. In Orissa, the use of drawings made by

artists from tribal communities proved highly successful both in terms of the key

audience’s ability to understand the messages and of increased ownership of the

programme.

2.5.7 Research, monitoring and evaluationResearch is required to assess communication needs and to

understand barriers to the desired health-related behaviour in

order to develop an optimal communication strategy and design. Particularly

for needs assessment and impact evaluation, and to address identified problems

and bottlenecks, participatory research methods should be used to involve

communities in analysing inputs and outcomes.

Monitoring and evaluation are separate from research and should be built into

the IEC activities as a routine component. Monitoring and evaluation help to

identify problems, measure progress towards achievement of objectives and

assess results in order to correct the problems identified. In addition, a routine

monitoring system with standard formats to document all IEC activities needs to

be in place (see Annexure 7 for monitoring formats).

TB

Con trol



While the implementation of the DOTS strategy in India is beginning to bear fruit

in terms of decreased morbidity and mortality, TB is still the leading cause of

death among adults. From an estimated one TB death per minute in India in

1999, the rate has come down to an estimated two deaths every three minutes in

2004.

During Phase I, the Centre, states and districts realised the importance of

communication to reach the vast number of people in a nation characterised

by tremendous diversity. But, given the diversity and uneven development of

the country in terms of infrastructure and socioeconomic indicators, this is a

challenging task.

3.1 Objectives and Focus of Communication inRNTCP Phase II

Building on Phase I, the communication component of RNTCP

in Phase II has three main objectives:

1. Awareness-raising for behaviour change to increase

understanding about TB and the use of DOTS services and

preventive action among:


medical practitioners across the country, so that they

know about correct TB diagnosis and treatment and

they refer patients to DOTS services, or become DOT

providers themselves.

2. A dvocacy to create, facilitate, develop and forge political,

administrative and community-level commitment to TB

control in India.


compliance with the treatment regimen, to enhance the reputation of a patient-

Communication Strategy for TBControl Programme

3



friendly service, to improve provider attitude and skills and to encourage

patients and their families to become advocates for the programme.

3.2 Strategic Framework

The aim of developing a strategic framework for IEC is to identify thecommunication need (objectives), communication players/audience (target

groups) and communication tools (channels, activities and materials). This

framework will build on the work already undertaken within RNTCP in Phase I.

It will be further modified to encourage a needs-based approach and will include

aspects of monitoring and assessment.

The focus in RNTCP Phase II is on a combination of Centrally-produced core

messages and media, and needs-based planning to develop state-and district-

specific strategies, with local innovations to reach all possible groups through the

most appropriate channels, materials and activities. The Central core framework provides the general outline, and each state will come up with a more detailed

strategy based on their own needs, analysis of the problem and the target groups,

so that IEC activities are tailored to address local needs, and reflect local culture.

The framework has six components: objectives, target groups, messages,

channels, activities/materials and research and monitoring. These are applied to

each of the three objectives or IEC components. All IEC sub-components will be

analysed qualitatively to assess the needs, correct and refine the programme as it

evolves and help in gauging programme success in real-time.

The core strategic framework has been developed for use across the programme

to ensure a clear and unified strategic direction for IEC throughout RNTCP. Core

messages for the broad categories of target groups for each of the three objectives

will be standardised at the Central level to ensure that the accuracy of messages

is not compromised or diverted from the national programme’s key objectives.

The framework’s contents may be modified over time.

More detailed segmentation of audiences at the state and district levels will help

to formulate more specific and targeted messages, identify appropriate channels

and to develop context-specific activities and materials.

3.3 Guiding Principles for IEC in TB Control Programme

The over-riding principle of a communication strategy in the TB control

programme is that every person has a right to essential health information,

including the basics about DOTS, which involves timely diagnosis and necessary

treatment.



The communication strategy is guided by the following principles:

1. The communication approach is people-centred and client-friendly. This

means understanding the audience, their context, their perceptions and their

beliefs, and that too from their perspective, by learning from them, listening

to them and working with them.

2. Communication efforts and initiatives are process- rather than product-

oriented. TB control requires a long-term commitment from providers, policy-

makers and communities; this commitment is built through interaction and

partnerships, not simply by transmitting information. A systematic analysis

of needs and ongoing monitoring and evaluation are required to continuously

guide this process.

3. Detailed planning, choice of communication channels and monitoring are

decentralised to ensure contextual relevance and a wide reach of information.The Centre provides leadership, develops core messages and mass media and

advocacy events but otherwise supports a decentralised approach. The states

and districts base their local strategies on the core framework and messages

and promote local adaptation and innovation to reach all possible groups

with the most appropriate communication tools.

4. Communication strategies address social and cultural issues related to TB

such as stigma, social distance between patients and providers, poverty,

illiteracy and gender. Addressing socio-cultural issues has a positive impact

on treatment-seeking and -completion.

3.4 Behavioural Goals for IEC Strategy

In RNTCP, three basic essential behavioural goals are

critical for success, viz.

1. treatment-seeking,

2. timely detection and

3. completion of treatment.

1. Treatment-seekingGeneral awareness of TB symptoms forms a necessary

backdrop for treatment-seeking behaviour during the

early stages of disease.

2. Timely detectionTreatment-seeking leads the person with symptoms

into contact with the health system, where diagnosis

T r e a t m

e n t Se e k i n

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f T

r

e

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e n

t



can be performed. The earlier the correct diagnosis is established, the sooner the

treatment can begin and the patient cease to be a potential source of infection.

3. Completion of treatmentThe treatment for TB is long and must be completed for a patient to be cured.

After one or two months of treatment, the symptoms of TB subside and thisoften leads to a shift in the patient’s priorities. Patients may live in circumstances

where earning a living, family responsibilities or job compulsions are seen as

more compelling than going to the DOT provider or the health centre. Since it

has proved impossible to predict risk of defaulting, it is critical that the patient is

given unremitting support and counselling.

We shall consider treatment-seeking, timely detection and completion of

treatment as our strategic behavioural goals.

3.5 Health Systems Research for IECHealth systems research (HSR) can provide essential input for IEC. HSR is an

umbrella concept for multidisciplinary research on identified health system-

related problems. Complementary research methods are selected accordingly.

3.5.1 Utilisation of research for IEC development: an examplePrior to the development of the Orissa IEC model for RNTCP, an HSR project was

undertaken with the objective of determining the knowledge, perceptions and

health-seeking behaviour of three tribal districts of Orissa with regard to chest

symptoms and to assess local sources of information on health and disease. 1

The findings of this study revealed that blood in sputum was perceived as the main

distinctive symptom of TB and was also seen by villagers as leading inevitably to

the death of the victim. The causes of TB were perceived to be alcohol, tobacco

and hereditary disposition, while at the same time TB could spread through direct

social interaction. The first point of contact for people with TB symptoms was

the traditional healer. Half the population knew that TB treatment was now free,

but most knew patients who had spent lots of money on treatment. The defaulter

rate was as high as 15 per cent, and the average minimum delay in diagnosis was

111 days for men and 146 days for women.

These results pointed to the need to develop new kinds of communication

activities that could effectively make appropriate TB information available

to largely illiterate populations, including the tribal communities. With the

1Health-Seeking Behaviour of Tribal Communities for TB: Perceptions and Practices — a study inthree districts of Orissa, October, 2000, DANTB, Orissa. www.dantb.org



expansion of RNTCP coverage beyond the initial districts, the communication

activities also expanded, and, in 2003, a comprehensive IEC strategy for RNTCP

in Orissa was developed on the basis of the experiences gained.

The ultimate goal of health research is to contribute to the solution of priority

health problems. However, the purpose is to produce research results of sufficientquality to inform and guide policy decisions. The above example illustrates how

research, when integrated into health programme planning and implementation,

can play an important role in improving the utilisation and coverage of health

services by creating a dialogue between programme staff, policy-makers and

researchers.

3.6 Defining Behavioural Change Objectives

Whether the target population is a particular group or the general public, it

is important first to refer to the TB control programme’s behavioural changeobjectives. What changes in behaviour does the programme intend to achieve?

3.6.1 Understanding audience and target behaviour While selecting and addressing the target groups we need to consider that the

ultimate goal is to promote behavioural change among potential and current

patients so that they seek treatment, get diagnosed and complete treatment.

Given these goals, the primary and secondary target groups for the communication

strategy include (but is not limited to):

Primary Target Group

TB patients/potential TB patients

Families/neighbours/general public

Secondary Target Group

Doctors/RMPs/clinic operators/medical students

DOT providers

Local leaders

ANMs/AWWs

SHGs/CBOs/NGOs/PRIs



Often, intermediate agents, such as media and influential community members,

play an important role in reaching both primary and secondary target groups.

3.6.2 Defining the communication objectives for the targetaudience

Once local needs have been assessed, a matrix is developed to identify the

objectives for each target group. Below is given an example for illustration.

Primary target group Secondary target group

1. TB patients/potential TB patients

2. Families/neighbours/general public

1. Doctors/RMPs/clinic operators/

medical students

2. DOT providers

3. Local leaders

4. ANMs/AWWs

5. SHGs/CBOs/NGOs

6. PRIs

Raising awareness about TB

1. Seeking timely treatment

2. Taking care of self and family members

3. Reducing stigma and discrimination

1. Equipping with information tocommunicate better

2. Increasing capacity for providing careand making services more accessible

3.6.3 Identifying and defining barriersHaving defined the primary and secondary target audiences and the

communication objectives, the next step is to use the available knowledge and/or findings of the needs assessment to identify barriers and means to overcome

them. It must be noted that not all barriers can be addressed by communication

alone. The table below shows possible barriers that could emerge in such an

exercise:

Target audience Barriers


TB patients/potential TB patients Low awareness about TB

Low risk perceptionMisconceptions about cure and treatment

Fear of TB

Stigma and discrimination

Accessibility to services

Cost of services and treatment

Attitudes of service providers

Treatments process and time taken

Low awareness about TB




Families/neighbours/generalpublic

Low risk perception

Misconceptions about cure and treatment

Fear of TB




Secondary target group

1. Doctors/RMPs/clinicoperators/medical students

2. DOT providers

3. Local leaders

4. ANMs/AWWs

5. SHGs/CBOs

6. PRIs

Inability to communicate effectively

Lack of relevant information

Lack of counselling skills

3.6.4 Understanding barriers and target behaviour A participatory communication strategy with emphasis on community

participation needs to have a bottom-up approach, which systematically seeks

to challenge the dynamics that marginalise certain groups and individuals at

the community level. A key concern is to overcome communication gaps and

social distance between service providers, patients and communities. A small

but symbolically very important example of this is to insist that all participants

sit at the same level during meetings, irrespective of their status outside. An anti-

hierarchical approach establishes a context in which it is seen as meaningful for

people to change their behaviour actively and participate in the implementation

of the DOTS programme for themselves as patients and for other patients in their

community. In order to involve all members in group activities, participatory

learning methods are required.

Participatory learning

Participatory learning is a creative problem-solving method in which every

member participates actively. In the participatory approach, the learning process

is just as important as the subject of learning.

Participatory learning:

focuses on the needs and problems of group members,

uses each group member’s knowledge, experience and skills,

considers every participant a trainee and a trainer,

uses practical real-life activities so participants learn by doing and

takes place at a location and in a setting where participants feel at ease.



Participatory learning increases group members’ understanding of their situation

and makes them more aware of their own values, attitudes, skills and knowledge.

It allows them to discover their hidden talents and capacities and strengthens

democratic community-level problem-solving and decision-making processes.

One of the well-established forms of participatory learning is participatory rapidappraisal (PRA). Individuals with PRA experience should be involved and/or

specific literature be consulted when adopting PRA techniques.

An illustrative list of behavioural barriers is provided below that may be identified

through participatory learning processes.

Illustrative List of Behavioural Barriers with Examples

S No. Behaviour Example Reason

1. The target behaviour exists butnot to an adequate degree or withsufficient frequency.

Patients do not approach a health facility forinvestigation after the onset of TB symptoms for morethan three weeks.

Early symptoms are notconsidered serious.

2. The target behaviour exists but notfor sufficient duration.

Patients do not complete treatment but stop when thesymptoms disappear.

Implications of stopping treatment arenot understood.

3 The target behaviour exists but notin the form desired.

The DOT provider visits the patient for follow-up butgives information in a patronising manner and doesnot provide support for completing the treatment.

The DP has beeninsufficiently trainedand/or supervised.

4 The target behaviour exists but notat the right time.

The patient is not taken for sputum test and treatmentuntil a late stage where chances of cure are small.

Importance of early treatment notunderstood. Servicesare not trusted.

5 The social and cultural aspects of the disease in question may block the desired practice.

Stigmatisation may effectively block timely detectionof TB for particular groups, e.g. women.

DOTS and/or curability of TB is not accepted.

6 The life conditions of the targetpopulation block them fromaccessing either IEC information orservices or both.

A woman may not be allowed to leave the house at thetime of an interaction meeting because no man willaccompany her.

Gender discriminationblocks women’s accessto services.

7 The target behaviour has acompeting priority behaviour.

The opportunity cost for continuing treatment or theneed to resume work after the relief of symptoms may affect treatment completion.

Poverty affects choicesof patient.

8 Desirable health practices arefrequently more complex than they may appear to be.

Taking seven pills every alternate day for two to threemonths, followed by a sputum examination, followedby three to four months of continued medication,may appear simple on paper, but practising it may bedifficult for a variety of reasons as mentioned above.

As provided above.



3.6.5 Developing approaches to address the barriers After having defined the barriers to be addressed, the next step is to identify the

relevant communication approaches. The matrix below provides an example with

target groups to be addressed, barriers, key messages that will be communicated

and support services that would be needed to achieve these changes.

Target groups Barriers Key Messages Support Servic

Primary targetgroup

TB patients Potential TB

patients


Low risk-perception

Misconceptions about cure andtreatment

Fear of TB




Attitude of service providers

Treatment process and time taken

A cough that lasts formore than three weekscould be TB

There is a sure cure forTB through DOTS

Availability of freediagnosis and treatmentthrough PHCs

Provision of ato user-friendservices

Counselling s

Testing facilit

Treatment fac

Primary targetgroup

Families Neighbours General public


Low risk-perception

Misconceptions about cure andtreatment

Fear of TB




There is a sure cure forTB through DOTS

Save somebody’s life by convincing them to takethe full treatment for TB

Provision andhealth servic

Counselling s

Information

Secondary targetgroup Doctors RMPs Clinic operators Medical students DOT providers Local leaders ANMs/AWWs SHGs/CBOs NGOs

Inability to communicateeffectively

Lack of relevant information

Lack of counselling skills

Today there is a surecure for TB but yoursupport is needed tomake it fully effective

Provision or ahealth servic

Education se

Counselling s

Information

3.6.6 Develop themes and messages While the strategy puts emphasis on understanding the local needs, state-

and district-level implementers need not re-invent the wheel. The online IEC

Resource Centre should be consulted to assess whether suitable materials exist

that can be adapted to the local needs.



When a new campaign is developed, it should have an overall theme that will

appeal to and attract the target populations. The theme should stem from the

BCC formative assessment and further consultation. It should provide overall

guidance for the development of messages, which should therefore be consistent

with the theme.

The theme should be positive. It is now commonly understood that fear campaigns

and campaigns blaming particular groups are ineffective. Most experts agree that

fear tends to focus an audience’s attention on what not to do, or what to avoid,

and they may increase victim-blaming and stigma that in turn cause people to

avoid services that may benefit them. Approaches are more effective when they

promote positive messages that state clearly what audiences can and should do.

The theme should be catchy and devised in such a way that all target populations

can relate to it and identify with it. People who see different messages for different

audiences should be able to link any of these diverse elements with the theme of the campaign.

3.6.7 Developing a creative brief After collecting information on the target audience and determining the best

communication materials to be used, and before beginning the actual design

of communication materials, the material development team should prepare a

‘creative brief’ for each material to be prepared. The creative brief serves as a

guide, assisting those who carry out actual material design and production. The

creative brief should define the objectives of the IEC material, identify obstacles

to be expected in its use or acceptance, develop draft messages or advice and

support statements, define the tone of the messages and list any other necessary

creative considerations such as different language versions or social conditions.

In short, the creative brief serves as a map or guidebook for the IEC material

development team and the creative designers.

3.6.8 Designing messages A message is a short phrase or sentence that summarises an idea in a simple,

attractive and understandable term. It is the ‘take-away’ information that is

repeated to friends, colleagues and other interested parties. A good message is

short and to the point and answers to the hopes and aspirations of the target

population: ‘If I do X (get information, go for diagnosis), I will benefit by Y’ (not

get very ill and lose income, protect my family, be completely cured). Whatever

the benefit, it will have to outweigh any disadvantage or ‘cost’ the audiences

might perceive. People may also need messages that help them feel they can

succeed. This may be accomplished through messages that model success and

positive outcomes.



3.6.9 Pre-testing materialsThe pre-testing of IEC materials is an important step in the development

process. Without pre-testing, IEC materials stand the risk of becoming inefficient

and detached from the needs of the target audience. Such IEC materials may

be neutralised, transmit useless information, not motivate, or not build upon

existing positive practices.

Pre-testing draft materials can help determine whether the materials and

messages are acceptable to the intended target audience and the individuals

charged with using or distributing the material. Pre-testing of draft IEC material

ensures that the material is ‘right’ from the audience’s perspective.

3.6.10 Selecting suitable channelsCommunication channels are used to access the target groups with the intended

messages. While the profiles of target groups are indicative of how they can be

reached, it is important to understand and clarify the main mechanisms to beadopted for reaching each target group.

Typology of media (interpersonal/mass media) (one way/two way, advocacy)

Folk media/street theatre Interactive/IPC Events/exhibition/World TB Day rallies Mass media—electronic, broadcast, print, outdoor Advocacy Capacity-building

For each type of media, there can be a number of specific forms of implementation.

To choose the best mix for a particular target audience and communication

purpose, the advantages and disadvantages of the different types and forms

should be carefully considered. The table below provides a sample analysis of

this.

Media Type Advantages Disadvantages/Special Requ

Mass Media

Main televisionchannels

Reaches communities on a large scale Does not reach the poorestmost disadvantaged group

Expensive to produce

Local televisionchannels

Reaches communities through theirdialects

Reach is limited


Film Information/education throughentertainment

One-way communication


Print Can use the material more than once

Can mobilise public opinion

Can contain more detailed information

Requires writing/reading sknot reach illiterate people)



Outdoor

Hoardings High visibility if well-placed Easily removed


Stationary

Bus panels High visibility if well-placed

Mobile

Requires writing/reading skills (doesnot reach illiterate people)

Wall paintings High visibility if well-placed Can be used in relevant context (i.e,

PHI walls)


Exhibitions Can combine numerous materials andmedia

Can be interactive

Expensive

Requires staff

Folk Media

Street plays Focuses directly on real-life issues andprovides a platform for solutions

Flexible infotainment method foreducating communities

Can effectively reach illiterate

communities Can be combined with counselling

Is liked by all age groups (including children)

Requires troupe of actors

Requires travel from village to village

Puppets Requires puppet theatre


Song andDance

Requires singing and dancing troupe


Communi-cationMedia

Haats Interactive method to addressquestions from target audience

Weekly market setting reaches bothmen and women

Requires skilled persons forcommunicating


Community radio

Can generate vivid local-leveldiscussion

Particularly useful at village clubs/gatherings

Women may not attend

Rally Large-scale participation Short-lived

Events World TB Day Strong coordination of activities at alllevels simultaneously

Requires organising capacity

IPC

Patient-providerinteractionmeetings

Decreases social distance

Creates mutual confidence betweenpatients and providers

Requires good communication skills

Trialogue Establishes community support forpatient

Addresses stigma

Requires good communication andfacilitation skills

Peer education Critical-awareness-building Requires careful selection andtraining of peer educators

Groupmeetings

Can create critical mass of changeagents at community-level

Interactive and participatory communication process

Effect depends on socialcohesiveness of group outside theactivity

Community meetings

Can create critical mass of changeagents at community-level

Interactive and participatory communication process

Requires good communication skills



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I n d i c a t o r s

T i m e l y D e t e c t i o n

A w a r e n e s s

C

o m m u n i t y

m e m b e r s

C

o m m u n i t y

g r o u p s

C

o m m u n i t y

l e a d e r s

P

o l i t i c a l

r e p r e s e n t a t i v e s

H

e a l t h s y s t e m

s t a f f

N

G O s / P R I s /

S H G s

I n

s u f fi c i e n t a t t

e n t i o n

i m p o r t a n c e b e

i n g g i v e n

t o T B s y m p t o m

s a m o n g

h e a l t h s t a f f

L

o w r i s k - p e r c e

p t i o n

M

i s c o n c e p t i o n

s a b o u t c u r e

a n d t r e a t m e n t

F

e a r o f T B

S

t i g m a a n d d i s

c r i m i n a t i o n

A

c c e s s i b i l i t y t o

s e r v i c e s

N

e g a t i v e a t t i t u

d e s o f

s e r v i c e p r o v i d e r s

I l

l i t e r a c y

R

o l e m o d e l s

P

e r c e p t i o n

— r i g h t , r e s p e c t ,


K

n o w l e d g e o f

T

i m e l y

d e t e c t i o n

A

v a i l a b i l i t y o f

f r e e d r u g s

D

O T S s t r a t e g y

M

a s s m e d i a

P

r i n t m e d i a

F o l k m e d i a

D

i s p l a y m e d i a

A

d v o c a c y

S o c i a l m o b i l i s a t i o n

I n t e r s e c t o r a l

p

a r t n e r s h i p w i t h

N

G O s / P R I s / S H G s /

t

e a c h i n g i n s t i t u t i o n s .

I n

c r e a s e d

d e m a n d f o r

d i a g n o s t i c

s e r v i c e s

I n

c r e a s e i n c o r r e c t a n d

c o m p l e t e i n f o r m a t i o n

D

e c r e a s e i n s t i g m a a n d

d i s c r i m i n a t i o n

I n

c r e a s e d

c o m m u n i t y

s u p p o r t f o

r d i a g n o s i s

A d v o c a c y

O

p i n i o n l e a d e r s

P

o l i t i c a l


M

e d i a


C

o m p e t i n g i n t e r e s t s a n d

p r i o r i t i e s

C

o m p e t i n g d e m a n d s f o r

a t t e n t i o n

K

n o w l e d g e

a b o u t T B ,

s y m p t o m s ,

m o d e o f

i n f e c t i o n a n d

t r e a t m e n t

I n

f o r m a t i o n o n

D O T S s t r a t e g y

M

a s s m e d i a

I P C

F o l k m e d i a

A

d v o c a c y

S o c i a l m o b i l i s a t i o n

I n t e r s e c t o r a l

p

a r t n e r s h i p w i t h

N

G O s / P R I s / S H G s /

t

e a c h i n g i n s t i t u t i o n s

I n

c r e a s e d

s u p p o r t f o r D O T S

I n

c r e a s e d

d e m a n d f o r

d i a g n o s t i c

s e r v i c e s

I n

c r e a s e d

s u p p o r t f r o m

P R I s a n d o

t h e r i n s t i t u t i o n s

I n

c r e a s e d

m e d i a c o v e r a g e

o f T B

P a t i e n t -

p r o v i d e r


P

a t i e n t s

F

a m i l y m e m b e r s

o f a f f e c t e d

p e o p l e w i t h T B

S

t a f f o f P H I

I n

s u f fi c i e n t a t t

e n t i o n /

i m p o r t a n c e b e

i n g g i v e n

t o T B s y m p t o m

s a m o n g

h e a l t h s t a f f

L

a c k o f c o u n s e

l l i n g s k i l l s

P

o o r c o m m u n i c a t i o n s k i l l s

R

o l e m o d e l s

P

e r c e p t i o n

– r i g h t , r e s p e c t ,


K

n o w l e d g e o f

D O T S s t r a t e g y

I P C

R

o l e p l a y

G

a m e s

D


I n t e r a c t i o n i n g r o u p s

C

o m m u n i c a t i o n

I n

c r e a s e d

s u p p o r t t o

p a t i e n t s w

i t h T B o r T B

s y m p t o m s

I n

c r e a s e d

t r u s t b e t w e e n

p a t i e n t s , f a m i l i e s a n d

p r o v i d e r s

D e c r e a s e o f b o t h d i a g n o s i s

2 .

T i m e l y D e t e c t i

o n

T B

C O N T R O L



G o a l s

O b j e c t i v e s

A u d i e n c e


T h e m e s / M e s s a g e s

F o c u s


M e d i a

I n d i c a t o r s

T r e a t m e n t C o m p l e t i o n

A w a r e n e s s

T

B p a t i e n t s

C

o m m u n i t y

G

e n e r a l p u b l i c

L

o w r i s k - p e r c e p t i o n

M

i s c o n c e p

t i o n s a b o u t c u r e

a n d t r e a t m

e n t

A

d v e r s e e f f e c t s o f t r e a t m e n t

D

i f fi c u l t y i n s w a l l o w i n g

m a n y t a b l e

t s

A

c c e s s i b i l i t y t o s e r v i c e s

A

t t i t u d e o f

s e r v i c e p r o v i d e r s

T

r e a t m e n t

p r o c e s s a n d t i m e

t a k e n

F

i n a n c i a l c

o n s t r a i n t s

P

r o p e r c o u n s e l i n g

o n r o u t e s o f

t r a n s m i s s i o n ,

m e t h o d s o f

p r e v e n t i o n

R

o l e m o d e l s

P

e r c e p t i o n

E

f f e c t s o f c o r r e c t ,

c o m p l e t e t r e a t m

e n t

a n d r e g u l a r s p u t u m

c h e c k - u p

I m

p l i c a t i o n s o f n o t

c o m p l e t i n g t r e a t m e n t

M

a s s m e d i a

I P

C

F

o l k m e d i a

A

d v o c a c y

S


I n


p a r t n e r s h i p w i t h

N G O s / P R I s / S H G s

G

a m e s

I n c r e a s e i n

c

o r r e c t a n d

c

o m p l e t e

t

r e a t m e n t

D

e c r e a s e i n

d

e f a u l t i n g

A d v o c a c y

C

o m m u n i t y

g r o u p s

F

o r m a l / i n f o r m a l

c o m m u n i t y

o r g a n i s a t i o n s

L

a c k o f r e l e v a n t

i n f o r m a t i o

n

L

a c k o f c o m

m u n i c a t i o n

s k i l l s

P

o o r c o m m

u n i c a t i o n s k i l l s

I m

p o r t a n c e o f c o r r e c t ,

c o m p l e t e t r e a t m

e n t

a n d r e g u l a r s p u t u m

c h e c k - u p

M

a s s m e d i a

I P

C

F

o l k m e d i a

A

d v o c a c y

S


I n


p a r t n e r s h i p w i t h

N G O s

I n c r e a s e d s u p p o r t

f o r D O T S

P a t i e n t -

p r o v i d e r


P

a t i e n t s

F

a m i l y m e m b e r s

o f T B p a t i e n t s

C

o m p e t i n g p r i o r i t i e s f o r

p a t i e n t / f a m i l y

I n

a b i l i t y t o

t a k e m e d i c i n e s /

g o f o r s p u t

u m t e s t

D

i s t a n c e b

e t w e e n D P a n d

p a t i e n t

L

a c k o f c o u

n s e l l i n g s k i l l s

P

r o p e r c o u n s e l l i n g

I P

C

R

o l e p l a y

S

t r e e t t h e a t r e

G

a m e s

D


I n

t e r a c t i o n i n g r o u p s

I n c r e a s e d u s e o f

D

O T S s e r v i c e s

I n c r e a s e d s u p p o r t

f o r p a t i e n t

t

o c o m p l e t e

t

r e a t m e n t

I n c r e a s e d

r

e g u l a r i t y o f

t

r e a t m e n t s

3 .

T r e a t m e n t C o m

p l e t i o n

T B

C O N T R O L



3.7 Planning at State- and District-level

It has been described above that a plan of action should be based on audience

needs, putting objectives and goals first. This could be filled in a matrix, as given

below.

Action Plan

S.No. Goal Objective Audience Activity/Materials/

Events

Budget

1 Awareness

2 Advocacy

3 PP

Communication

The next step is to develop a media plan of how the activities and materials will

flow over the months in the year. This should ensure that activities and materials

are taking place in the planned manner. It should also help to synchronise

activities for maximum benefit. This requires knowledge of media habits and the

differential reach of various media and their relevance to the target audience. A

planning matrix has been given below that can be used to get an overview of the

media mix over a period of 12 months.

Media Plan

TV Radio Press Outdoor

Jan

Feb

Mar

Apl

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec



3.8 Checklist for Strategic Planning Framework

1. Analysis of the situation

1. Purpose (health situation that the programme is trying to improve)

2. Key health issue (behaviour or change that needs to occur to improve the

health situation)3. Context (wtrengths, weaknesses, opportunities and threats (SWOT) that

affects the health situation)

4. Gaps in information available to the programme planners and to the audience

that limit the programme’s ability to develop sound strategy. These gaps will

be addressed through research in preparation for executing the strategy

5. Formative research (new information that will address the gaps identified

above)

2. Communication strategy

1. Audiences (primary, secondary and/or influencing audiences)2. Objectives

3. Positioning and long-term identity

4. Strategic approach

5. Key message points

6. Channels and tools

3. Management considerations

1. Partner roles and responsibilities

2. Timeline for strategy implementation

3. Budget

4. Monitoring plan

4. Evaluation—tracking progress and evaluating impact strategy

review checklist

The table below is a checklist to help you ensure that the communication strategy

is completely integrated into the RNTCP. As mentioned at the beginning of the

book, strategic communication is the steering wheel that guides the rest of the

programme. This checklist helps to ensure that the steering wheel is working

successfully.



Review Checklist

Subject Key Question Degree of

integration

(Score)

(1-lowest,10-highest)

Objectives Do the behaviour change objectives fit

with the programme objectives?

Programme

implementation

Do the communication activities fit

well with other programme functions

such as service delivery, logistics,

policies and staffing?

Message

integration

Are the communication messages

consistent with availability, access and

cost (financial and psychological) of the service?

Communication

mix integration

Are the tools and channels being used

to guide the audience through the steps

to behaviour change?

Message design

integration

Is the message design consistent with

the positioning of the product, service

or behaviour?

Management

integration

Are all internal and partner

organisations working together in

accordance with an agreed upon planand strategy with regular progress

meetings?

Financial

integration

Is the budget being used in the most

efficient and effective way to ensure

that the economies of scale are

achieved?

Level of integration (total)

(Total possible score=70)



The design of any health communication campaign needs to include monitoring

and evaluation activities to be complete. Monitoring and evaluation help to

identify problems, measure progress toward objectives and assess results.

4.1 What is Monitoring and Evaluation?

Monitoring is a regular assessment of routine records of decisions, activities,expenditures and, if possible, outcome indicators to ensure that actions are

taken according to plan and that the expected outcome is achieved.

Evaluation is an analysis of activities and outcomes relative to project or

programme objectives.

4.2 MonitoringDocumentation of activities is a necessary pre-condition for ongoing monitoring.

Therefore, standard formats need to be used. Sample formats have been annexed

in this book, but additional formats will have to be developed according to the

specific needs and further development of the IEC component.

Monitoring is particularly useful in two areas:

1. Monitoring for management: Careful monitoring is essential throughout

implementation to be able to identify bottlenecks and critical barriers that

may otherwise derail the programme.

2. Monitoring for accountability: Monitoring enables the state and funding

agencies to assess the value of the programme and demonstrates appropriate

use of funds.

4.3 EvaluationEvaluation questions are formulated by using the behavioural objectives as

criteria after the media are finalised, reproduced and put to use.

Evaluation may look at processes and/or outcomes. Process evaluation will often

be qualitative in nature and analyse organisational, managerial, administrative

and technical aspects of a programme, a project or an intervention. Outcome

Monitoring and Evaluation ofCommunication in RNTCP

4



evaluation may often use both qualitative and quantitative methods and will

assess whether the objectives of the activity were achieved.

While outcome indicators seem straightforward in terms of IEC activities for

RNTCP, in practice they are not. Even though it is known that IEC will certainly

strengthen both case-detection and case-holding, it is difficult to know whatis the contribution of IEC is in a particular case, compared to other factors

(such as vacancies at PHI level, personal relationship between DP and patient,

role of private practitioners in community etc.). Because of the many possible

compounding factors the success of IEC activities cannot simply be read from

the standard quantitative IEC indicators. What can be assessed are qualitative

indicators such as general awareness of signs and symptoms at the community-

level, reasons for preferring a particular first-line treatment option, and

community-level acceptability of DOTS.

4.4 Monitoring and Evaluation in RNTCP Phase II At the Central level, monitoring and evaluation has been the policy of the

programme and will be continued. An end-term impact assessment of the Phase

I media activities would be the basis for developing a media plan for the Phase

II project. At least one mid-term review/impact assessment will be conducted

to help in fine-tuning the media campaign during the project period, and one

detailed end-term impact assessment will be carried out. Opportunities for

feedback on IEC activities would be found during routine meetings, such as the

weekly meetings of PHIs and designated MCs, fortnightly reviews of the STS/

STLS by the MO-TC, monthly district-level review meetings between the DTO

and staff, state-level review meetings held at the end of each quarter and CTD

review meetings of STOs twice a year. These review meetings are useful tools for

monitoring the implementation of the IEC components.

Focused qualitative studies would be encouraged to be undertaken by some

states. These would be useful both in designing and refining IEC strategies. These

could be outsourced to local institutes or NGOs. Larger studies would fall under

the operational research agenda.

Process indicators for monitoring state capacity to formulate and implement

needs-based IEC activities will be developed over the course of the first year,

and used for monitoring the decentralisation of IEC activities. An appropriate

checklist designed by the programme would be used as a standard tool for

monitoring state level activities.

State annual action plans would be monitored against achievements at the state-

level, and IEC would be included in the periodic internal evaluations conducted

by states and CTDs.



The following issues are some examples included in the National Operational

Research Agenda:

Study profile of initial defaulters and analyse barriers to their access to DOT

Qualitative studies to document the impact of stigma on access to andutilisation of RNTCP services

Qualitative assessment of effectiveness of patient information leaflets and

other materials

Qualitative assessment of impact of IPC training on sensitivity of providers to

socio-economic needs of patients

Qualitative study to understand the barriers to utilisation of RNTCP services

in tribal areas

Evaluation of IEC messages prepared in locally relevant tribal

dialects/languages

4.5 An Example: IEC and Acceptability of DOTS A study was carried out in 2005 to assess the impact of IEC/BCC activities

in RNTCP, with special attention to the issue of acceptability of DOTS at the

community-level in selected districts of Orissa.3

Of the 30 districts of Orissa, 14 districts with RNTCP implementation

before 1 January 2003, were included and stratified according to the year of

implementation of the RNTCP. One district from each stratum was randomly

selected for the study and IEC activities mapped and ranked under a three-

pronged classification according to direction and purpose:

1. One-way communication (IEC)

2. Two-way communication (IPC/BCC)

3. Advocacy

Based on the calculated intensity of IEC activities, MCs were sorted into quartiles.

Two MCs, one with high and one with low intensity of IEC activities, were selected

in each of the four districts. Two villages for each of these MCs were selected

randomly for in-depth study. In addition, six villages were included where street

theatre performances (which is a key tool for community-level IEC) about TB had

taken place. In all villages, group discussions and semi-structured interviews at

3 A detailed study report will be published at www.dantb.org by the end of 2005.



the community-level were conducted to assess the awareness and acceptability

of DOTS. In addition, available RNTCP statistics were analysed.

In one district, the qualitative study showed that knowledge about TB as an

infectious disease that could be cured by DOTS after diagnosis on the basis of a

sputum test (and X-ray) was substantially more consolidated in villages of the MC with high IEC-intensity than in the MC with low IEC-intensity. The information

about TB was more coherent, and more people were able to volunteer information

about signs and symptoms, treatment and curability. The study also showed that

in both areas, there was cause for some concern about indirect cost of treatment

and/or travel to the health facility. Perhaps most importantly in terms of IEC and

acceptability of DOTS, it was clear that health communication is perceived in a

context of :

1. what is already known,

2. competing interests of various actors (including, for example, traditionalhealers, drug vendors and private practitioners),

3. the quality and accessibility of health services in the community, and

4. prior experiences in the community with TB in particular and with various

practitioners and services offering treatment in general.

It was also found that the RNTCP indicators were not sufficiently sensitive to

assess IEC impact directly.

One of the main conclusions of the study is that former patients play an essential

role as RNTCP advocates and sources of knowledge. This implies that patient-

provider interaction meetings and the trialogue approach should be given high

priority in the future.



5.1 Central Level: Advocacy and IEC Unit

An Advocacy and IEC unit within the CTD will be established to provide overall

leadership for the IEC component, to procure services of the IEC agency at the

central level and coordinate activities, to manage the mass media component

at the national level, and to provide oversight, assess capacity and ensure

consolidation of further development of IEC materials.

During Phase I, the programme took advantage of expertise from outside sources.

For example, deciding on indicators for the baseline studies and tracking, and

the review of IEC materials for developing the web-based Resource Centre

(December 2002 to December 2003), the CTD IEC team was assisted by a number

of institutions such as WHO, the World Bank, Danida, media and social research

agencies and NGOs. In RNTCP Phase II, this concept of profiting from outside

advice is formalised in the form of an IEC advisory group for infusion of ideas

and sharing of experience.

WHO consultants provide technical assistance to districts, states and the

Centre. They assist districts and states in developing action plans including IEC

activities.

5.2 State-level Capacity for IEC

At the state-level, responsibility for IEC activities within the State TB Cell rests

with the STO who is assisted by an IEC officer. Responsibilities include:

Vision for communication aspects in RNTCP

Planning of IEC activities Monitoring of IEC activities

Tapping resources for IEC activities

Supervision of IEC activities

Support to districts

Developing material in local languages

Organising events for advocacy

Capacity-building

5



Supervision by IEC officer

Capacity building of the districts for implementing activities for awareness

generation and social mobilisation.

Training for the IEC officers will be provided in two stages: 1) induction training

when they first join, which will introduce them to the RNTCP; and 2) specifictraining in IEC for RNTCP will be conducted in batches by the CTD with the

support of Danida in Orissa. The curriculum developed with the support of

Danida would be used for subsequent training and retraining of IEC Officers at

the national/regional institutes. Inter-state visits will provide opportunities for

IEC officers to learn from others and share ideas.

A communication facilitator who may be an individual or a group/institution/

NGO will work with the state TB Cell to facilitate activities across about five

districts to address a felt need that experienced and helping hands are needed at

the district level to support the medical officers to organise and implement socialmobilisation activities.

5.3 District-level

Districts will have an active role in developing plans for IEC activities with

sufficient flexibility to allow for local initiatives and variations. IEC activities at

the district-level would use the appropriate local medium for dissemination of

information. IEC activities at the district-level would involve local organisations,

leaders, panchayats and NGOs for IEC.

Each district will organise a certain minimum number of minimum activities,

such as community meetings, mike publicity, display of posters at each PHI,

interaction meetings, trialogue meetings, wall paintings and puppet shows and

street plays. Each PHI will have one such activity organised at the village-level in

a year. Wall writings are proposed in each village. Facilitation of IEC activities will

be by the newly-created level of Communication Facilitator from the state who

will support in planning and organising social mobilisation activities at district

and sub-district level.

In addition, support from outside the formal health system would be sought. The

wide range of players such as gram panchayats , NGOs, mahila mandals , youth

groups, and schools along with support and resources from state and district

administration, such as information/ education officer would be co-opted.

Capacity-building would also include sharing of material and innovations across

districts and states. While the Centre takes the leadership, states and districts will

plan and implement need based health communication activities. There would



be a two-way flow of information from and to the Centre and the states. The

establishment of a web-based IEC Resource Centre at the official website is the

first step in this direction. This would be strengthened further with the regular

addition of new material.

The local communication teams at the district-and sub-district-levels arerecommended to try different approaches and resources in view of the different

local resources in terms of leadership and groups. For example, in one district the

team might revolve around PRIs and in another a local NGO might take the lead.

States and districts would be encouraged to explore innovative approaches in

communication, particularly for hard-to-reach groups. The lessons learnt from

these approaches could be disseminated widely across districts and states.

A detailed guide for implementation with special attention to district and sub-

district level activities is provided in Part 2 of this document.



6.1 Improving Access to Hard-to-Reach Populations

During Phase II, RNTCP has prioritised hard-to-reach groups and IEC will play an

important role. The following groups have been identified for special attention:

Tribal populations

Marginalised populations in urban slums

Other marginalised and vulnerable sections of the community

Tribal populationsThe studies done in the first phase of the project, i.e. studies on accessibility

and utilisation of RNTCP services by the marginalised sections, along with field

experience, have identified specific areas for IEC attention. These studies have

made the following suggestions for promoting community participation and

intersectoral coordination:

Involvement of NGOs, traditional healers, private practitioners, AWWs,

community health workers (CHWs), cured patients, tribal youth and other

community based volunteers in IEC activities and to provide DOT, using

local (tribal) origin as a selection criterion

Developing locally relevant IEC messages and patient education material

using local vocabulary, prepared by taking help of local primary school

teachers and members of PRIs

Using local chemists, grocery shops and other places frequently visited by

tribals to disseminate information on RNTCP and DOTS Using the opportunity offered by village fairs and festivals as well as weekly

market days to inform the tribal population about DOT

Link IEC in RNTCP with the social mobilisation campaigns held in other

disease control programmes

Decrease communication gaps and social distance between non-

tribal service providers and tribal communities through culture and

communication sensitisation workshops and other similar activities

Special IEC Needs in RNTCP

Phase II

6



Marginalised populations in urban slumsEvidence from studies suggest that special efforts are needed to increase access

to DOT for the marginalised population in urban areas – the poor, homeless and

migrants – and for patients who are under-represented in RNTCP, like working

and elderly males and males and females of marriageable age. IEC interventions

to reach these groups would include:

Involvement of cured patients, student and community volunteers to

motivate patients, provide DOT and trace defaulters

Involvement of NGOs and support groups working with alcoholics and

drug addicts in counselling and DOT provision

Involving support groups for migrants working in cities such as social

networks in the city encompassing relatives and friends extending from the

places of origin of migrants to help in case detection, patient motivation

and DOT

Providing workplace information about TB and DOTS, particularly in sites where male representation in the programme is poor and in cities where

migrant populations are engaged in specific activities (hotel workers,

taxi and rickshaw drivers and daily wage labourers engaged in loading

and unloading activities in ports, railway stations etc) by sensitising and

involving employers and contractors as DOT providers

IEC for people living with HIVOpportunities for reaching HIV-positive patients with information about TB, and

for reaching TB patients with information about the possible link with HIV, will

be found through strengthening the links between TB and HIV programmes. TB–HIV coordination has been initiated in the first phase of the project, and includes

IEC activities.

Measures to synergise efforts for IEC would be taken in future for the benefit

of patients. Both the programmes will ensure availability of health education

material to the other programme. RNTCP believes that the most useful channel is

interpersonal communication, and there is an existing infrastructure of services

and NGOs to facilitate this.

While TB is stigmatised to some degree and among some populations, HIV/AIDS

is much more so. While de-stigmatisation of both HIV/AIDS and TB should be

pursued as a high priority, IEC activities addressing the co-infection of TB and

HIV should seek to avoid the inadvertent message that all TB patients are believed

to have HIV/AIDS, since this could inadvertently jeopardise the gains that have

been achieved by RNTCP.



IEC for non-public providersThis target group can be further segmented into

private providers,

practitioners of other health systems and

traditional health providers

Data from available studies suggests that a neighbourhood private provider

continues to be the people’s first port of call for TB in urban and semi-urban

areas. The involvement of private practitioners and NGOs is a crucial component

of the IEC strategy. The IEC activities to address this groups would include:

A sensitisation package for healthcare providers as well as for the

beneficiaries will be developed and disseminated by the CTD. This will

contain a guide to RNTCP for medical practitioners, PowerPoint and OHP

slides presentations, a booklet on frequently-asked questions, desktopreference material, posters, provider-specific definitions, diagnostic

algorithms, treatment regimes and DOTS directory of MCs and DOT

providers.

Advocacy of the RNTCP amongst health providers by sensitisation and

training through the Indian Medical Association and other professional

bodies

Workshops and continuing medical education (CME) programmes for

medical colleges and the private sector

Use of newsletters, the press and other media to spread the RNTCP

message to a wider audience

Enhancing patient-provider communicationInterpersonal communication builds trust with patients, their families and

their social networks. RNTCP aims to create and maintain good interpersonal

communication and counselling skills among the programme staff, bridge the

gap between patients and providers, and provide support to patients during

the course of treatment so that they complete treatment and continue to be

advocates for DOTS.

Interpersonal communication skills and counselling are important at all levels

of the programme. Communication pervades diagnostic services, treatment

administration and patient supervision. A module on improving interpersonal

communication skills in RNTCP training was introduced in the training

curriculum of all key TB personnel and is implemented as part of the overall

training package. The module, in the form of a book, contains role-plays that

enable trainees to experience field situations in the classroom. The training and

associated curricula are research-based.



Part 2Planning and Implementing a Health

Communication Strategy for RNTCP –

A Practical Guide



Contents

1. Introduction 47

1.1 Goal and essential elements of the health communication strategy for RNTCP 47

1.2 Target audiences 48

1.3 Messages 49

1.4 Channels 51

1.5 Main objectives of the health communication strategy 51

1.6 Health communication strategy framework 53

1.7 Involving partners 54

1.8 Timeframe for health communication activities 54

1.9 Development of health communication materials and pre-testing 57

1.10 Monitoring, evaluation and research 58

2. Implementation of the Health Communication Strategy 59

2.1 Implementation at the central level 60

2.2 Implementation at the state-level 61

2.3 Implementation at the district-level 63

2.4 Implementation at the PHI-level 64

2.5 Health communication activity implementation matrix 65

Annexures 69



3. Index of Materials Available in the Central TB Division’s 149

Web-based IEC Resource Centre

4. Index of Health Communication Materials Used in Orissa 156

5. User Guidelines for the Health Communication Video Modules CD 173





Introduction1

This part of the document provides information to facilitate

the implementation of the health communication strategy

for RNTCP at the central, state-, district- and PHI/MC-

levels.

It provides information on how to implement a range of

health communication activities covering:1. Support for policy implementation and RNTCP

2. Media advocacy

3. Health communication activities for capacity-

building

4. Health communication material development

5. Involvement of partners in BCC for RNTCP

6. Involvement of other organisations and individuals in

BCC

7. Monitoring, evaluation and research

The Annexures give detailed instructions on the use of the web-based IEC

Resource Centre set up by the CTD as well as the video-based modules on health

communication activities produced by DANTB.

The document is accompanied by two compact disks (CD). The first CD contains

the video-based modules on health communication activities that can be viewed

on a desktop computer or shown to an audience using a projector. The second

CD contains resource material for the communicator, including an index of

communication materials developed by DANTB for RNTCP in Orissa that can

be adapted and used for various communication activities suggested in the

document.

1.1 Goal and Essential Elements of the HealthCommunication Strategy for RNTCP

Large-scale adoption of health practices by the people, resulting in lower

TB morbidity and mortality rates, requires appropriate behaviour change



tools and techniques throughout the planning, design and implementation

of communication activities. A necessary pre-condition is to learn the most

appropriate ways to communicate desirable behavioural change and convert this

information into effective health messages for IPC, broadcast media and print

materials to provide skills-based training and implement programmes to support

health practices over time. This process pre-supposes a thorough understanding of RNTCP and of working with stakeholders in applying an appropriate health

communication methodology.

The goal of such a communication strategy for RNTCP can be defined as

follows:

To facilitate and enable clients, service providers and the community at large to

engage themselves in informed and supportive counselling, interaction and action

at all levels and at all stages of tuberculosis detection, diagnosis and treatment,

thereby empowering individuals, families and communities to be responsible for behavioural change to achieve the cure of people infected and infectious with

tuberculosis.

The strategy to achieve this goal is built on three essential elements of the

successful cure of a potential TB case: timely detection, treatment seeking and

completion of treatment.

1.2 Target Audiences

Following the importance of timely detection, treatment-seeking

and completion of treatment, the primary audiences for health

communication activities for the TB programme are:

Primary Target Group TB patients/potential TB patients

Families/neighbours/general public

Secondary Target Group Doctors/RMPs/clinic operators/medical students

DOT providers

Local leaders

ANMs/AWWs

SHGs/CBOs

PRIs



The following secondary audiences are equally important from a communication

perspective:

Centre, State,District

Central TB Division (CTD), National Tuberculosis Institute (NTI),Tuberculosis Research Centre (TRC), State TB Institute (STI), State

Steering Committee (SSC)

ProfessionalBodies

Indian Medical Association (IMA), Tuberculosis Association of India(TAI), Medical Council of India (MCI), Nursing Council of India (NCI)

DevelopmentPartners

Bilateral and multilateral agencies, e.g. Danish InternationalDevelopment Assistance (Danida) Department for InternationalDevelopment (UK) (DfID), World Bank ( WB), World Health Organization(WHO)

Mass Media Press, radio, television

Corporate

Bodies

Confederation of Indian Industries (CII), Employees' State Insurance

(ESI), Indian Railways, industrial houses, pharmaceutical companies

IntersectoralLinkages

Departments of Women and Child Development (WCD), RuralDevelopment (RD), Integrated Child Development Services (ICDS),Family Welfare (FW )

It is important to assess the needs of these audiences at state-, district- and sub-

district levels and to map or otherwise assess their demographic and geographical

distribution. Providers need training in IPC and management of IEC programmes.

Community-members and families obviously constitute a primary target group

and should be involved in health communication activities. The need to involve

the community and educate them to support symptomatic persons for early diagnosis and registering for treatment or to act as DOTS providers implies

participatory education and information activities. The involvement of other

audience segments like drug companies, local leaders and the media helps to

create a supporting environment.

1.3 Messages

Messages should be tailor-made for the target audience. These messages

should be pre-tested at various levels so that they conform to the

contextual variables and may be suitably modified for a given local setting. Healthcommunication messages can be generic or specific. Some of the messages

would be of a generic type to create an enabling environment. This could be

handled by the state and central agencies. Along with generic messages there

would be development and utilisation of specific messages related to access and

quality treatment. Message design should take into consideration factors like

gender, rural-urban population ratios, socioeconomic status, literacy and media

exposure.



For analytical purposes the dimensions of a message are defined as follows:

Appeal

Approach

Content

Text or image

Context Source

Recipient

These dimensions help to decide the message and to design it appropriately.

Some of the standard messages in RNTCP are as follows:

“If you have cough for three weeks or more go to the nearest health centre to get

your sputum checked.”

"TB is curable."

"Diagnosis and treatment is available free of cost." "If you stop the treatment in-between, it has dangerous consequences."

"Take DOTS and you will be free of TB."

"We have a cure for TB—we have to tell the people about it."

The importance of these simple messages rests in their ability to convey the ideas

behind them and thus have an impact on timely detection, treatment seeking and

completion of treatment. For example, is the universal World TB Day 2003 message

`DOTS cured me—it will cure you too' understandable for a patient in a village? Will

it help a person to approach the health centre or seek treatment? Is it clear to the

patient what DOTS refers to? Is the message placed in the context of the patient?

One needs to break the apparently simple messages carefully into understandable

information that would prompt the desired health behaviour.

The key issues for message development are the following:

1. Message selection needs a careful and systematic analysis. Seemingly simple

messages need to be looked at closely for their meaning, comprehension,

effect and adequacy.

2. Messages need to be creatively designed and tested methodically. Different

evaluation designs for different messages for different audiences may be

required.

3. The benefit or gain aspect for the patients instead of the provider needs

additional emphasis in message selection and design.

4. The elements of message selection and design should be incorporated in the

standard RNTCP training modules.



1.4 Channels

A number of channels can be used effectively to disseminate health communi-

cation messages. These are:

1. Folk media

2. Melas /festivals3. Interpersonal communication

4. Trialogue approach

5. Sensitisation meetings for PRIs

6. Print media

7. Electronic media

8. Broadcast media

9. Workshops and seminars

10. Health camps

11. Other innovative channels

Using an appropriate multimedia mix enhances the reach and impact of health

communication messages. The point of contact for interaction with patients at

the health facility or the DOTS centre can be effectively used for patient education

and information. However, this calls for skills in IPC. Supportive supervision as

part of monitoring can be used to address misinformation and misunderstandings

concerning TB. Other channels that can be used are exhibitions, camps, radio,

television shows, public service announcements, panel discussions, print

advertisements, workshops and seminars.

As certain mass media activities are expensive, intersectoral and cross-providersystems and private donors should be tapped to sponsor media space and

time, and appropriate links with commercial agencies and NGOs should be

explored and their experiences and expertise adopted. Within the RNTCP set-up,

competent and responsible personnel at the state- and district-levels are trained

to manage a media plan.

1.5 Main Objectives of the Health CommunicationStrategy

The health communication component in RNTCP has three main

objectives:

1. Awareness-raising and capacity-building to increase understanding about

TB amongst


practitioners across the country, so that they know about correct TB

diagnosis and treatment and they refer patients to DOTS services, or

become DOT providers themselves.



2. Advocacy and social mobilisation to develop political, administrative and

community-level commitment to TB control in India.


compliance with the treatment regimen, to enhance the reputation of a

patient-friendly service, and to encourage patients and their families tobecome advocates for the programme.

1.5.1 Awareness-raising and capacity-building While the dissemination of necessary information on TB is

an essential element for achieving this goal, and indeed is

a right of the community, it is not a sufficient factor. The community will also

discuss issues of poverty, access, availability, fear of stigma, illiteracy problems,

competing health beliefs and barriers for motivation (such as alcoholism, work

routines, etc.) with the facilitator. Only by creating a shared understanding that

DOTS is possible in spite of these factors, and that cure of TB patients will help toovercome such barriers, the involvement of communities be ensured.

Training activities form a very important part of the health communication

strategy. Training focuses primarily on three levels: 1) training of health workers

2) training of DOT providers and 3) training of IEC staff as well as training of

trainers for all three levels. All training consists essentially of two components:

1) TB-specific information concerning all stages of TB management and 2)

communication skills concerning different types of health communication

activities. The training should involve hands-on use of IEC materials by relevant

audiences as well as mutual assessment of IEC implementation practices.

Modules for medical officers, senior treatment supervisors and other health

workers should be suitably modified to incorporate IPC and counselling, dynamic

and participatory group interaction and use of available IEC materials. These

exercises should take into account male/female differentials in behaviour and

treatment-seeking patterns and social dynamics, and particular emphasis should

be placed on role-plays and similar activities whereby providers can experience

the patient's point of perspective.

1.5.2 Advocacy and social mobilisation Advocacy is done to win the support of key decision-makers in order

to influence policies and ensure financial and other resources,

and to promote a conducive environment for the implementation

and sustainability of the programme. It is necessary to identify the

target group and how to access and communicate with them. It can be useful to

organise a network and establish strategic coalitions to create a support base that

can convey persuasive arguments to key decision-makers. The media constitute

one such strategic partner. Advocacy works differently at different levels and with

TB

CONTROL



different players. Advocacy at higher levels may facilitate behaviour change at

lower levels by offering a behaviour model and affirming community norms.

Social mobilisation is a type of grass-roots level advocacy whereby the collective

force of a community is mobilised for a cause. It is necessary to meet people at

their own level of understanding and to explore existing concerns and possiblesocial conflicts in the community with relevance to the RNTCP agenda, including

in particular, gender issues and other potential or actual processes of social

marginalisation. The entire community must participate in decision-making in a

way that reinforces the common interest in the objectives of developing a network

of community members who will work actively for timely detection and support

treatment-seeking behaviour and completion of treatment, and thereby create a

self-supporting and sustainable system for voluntary reporting of suspected TB

cases.

1.5.3 Patient-provider communication andcounselling (trialogue approach)Success of any health communication strategy depends largely on

the close interaction and coordination between stakeholders. In

RNTCP, this can be done through the trialogue approach. This is

a community-based activity. In this approach there are three ‘p’s: the patients,

the providers and the people. In this meeting the participants spend a whole day

together, siting on a common mat and eating from a common plate. This meeting

gives an opportunity for people to air their feelings. It also provides an excellent

opportunity for women to participate.

Irregular and defaulter cases are specially addressed to identify their problems

and needs for counseling. Influential people from the community such as

panchayati raj members are encouraged to participate actively in spreading

awareness about TB diagnosis and DOTS.

The trialogue approach reduces the gap between patients, providers and

community through informal, interactive meetings.

1.6 Health Communication Strategy Framework

The matrix shown in page 29 depicts the health communication

strategy framework for RNTCP. Based on this framework, the state-

level and district level implementers can develop detailed needs-

based framework and action plans.



1.7 Involving Partners

The patient comes across and uses many systems for services and is

influenced by many different systems—public, private, NGOs and

community among others. The strategy should take cognisance of

the importance of these players: Private medical practitioners should be educated in the proper diagnosis and

treatment of TB, as well as on important messages to be given to the public.

NGOs, whether grass-roots, state-wide or national, should be involved by

appropriate training in participatory and interactive techniques so that they

can organise and carry out education and community awareness, as also in

service delivery by way of working as DOTS providers.

Corporate or commercial companies, particularly pharmaceutical firms,

can play an important role in influencing the outcome of the programme by providing appropriate information as well as involving private providers for

using the standard regimens for the revised strategy.

Local self-government agencies and community groups have many roles to

play. Through community participation they can help reduce stigma, facilitate

the selection of DOT providers and help in organising health or TB melas .

A sustained interest of the community in the TB control programme will

depend upon the information and benefits provided by the programme and

the sympathetic attitude of public sector providers. Lastly, the involvement of

PRIs would provide an opportunity for coordination among various sectorsand personnel working for rural development such as the ICDS, AWWs, BDOs,

SHGs and ANMs which can have a positive bearing on health programmes.

1.8 Timeframe for Health Communication Activities

There are important differences between communication activities in connection

with the initial phase of implementing RNTCP in a new area and the ongoing

communication activities.

1.8.1 Initiating RNTCP in a new area6-9 months before launch:

Training of trainers in IEC, counselling and communication skills.

3-6 months before launch:

Training of medical officers, DOT providers, laboratory technicians, senior

treatment supervisors and senior tuberculosis laboratory supervisors in IEC

and counselling.



1-3 months before launch:

Development and production of banners, posters and other IEC materials

on

signs and symptoms of TB

availability of free diagnosis and treatment

central slogans of the campaign Advocacy activities involving central stakeholders and the media

At the time of launch of RNTCP in an area:

Conduct campaigns at each primary health centre involving

District Collector/zila parishad Chairman

Panchayat

Health system leaders

Block development staff

Women and youth groups

ICDSUsing

Folk media

Exhibition stalls

Mela kits for demonstration

Demonstration of medicines, given by popular leaders to

patients

Launch area-wide media campaign involving:

Local and area-wide newspaper coverage

Radio and TV coverage

Cable operators, district publicity staff and other availablemedia systems

Using

Regular news coverage

Ads, jingles

Educational and entertaining dramas adapted for radio and TV

1.8.2 Ongoing communication activities throughoutRNTCPThe table in the following page 56 indicate the frequency of ongoing

health communication activities to be carried out on a continuousbasis upon the initial launch of RNTCP in a district, as seen in a

yearly and a three-monthly (13 weeks) perspective. Hence, the timeframes do

not indicate how often one single person/group/institution should be involved

in the same IEC activity, but provide an experience-based indication of the

frequency of communication activities at the district level required to ensure the

successful implementation of RNTCP. However, for a few activities, state-level

implementation has been specifically indicated.



Fortnightly

• Patient-provider interaction meetings

Monthly

• (Re)orientation training of ICDS officers and supervisors (different blocks)

• Orientation of PRI members (different blocks)

• Interactive stalls in weekly markets

• Interaction meetings with SHGs and women's groups

Quarterly

• (Re)orientation training for NGOs and CBOs

• (Re)orientation of tribal link workers (in tribal districts/blocks)

• (Re)orientation of traditional healers, TBAs, VHGs

Half-yearly

• Workshop for media personnel (AIR, DD, DIPRO, field publicity officers)

• (Re)orientation of NSS volunteers

• (Re)training of cured former TB patients as DOT providers

• (Re)orientation of industrial workers, union leaders and representatives

• (Re)orientation of members of NYK

• (Re) orientation of SHG groups at district- and block-level• Workshop to develop posters and other printed materials

• Workshop on the role of media for increasing visibility of RNTCP at state-, district- andblock-levels

• Street theatre technique and script writing workshop

Yearly

• CME programmes at medical colleges and nursing institutions

• (Re)orientation of NGOs at district- and state-level

• Audio-visual material development with tribal and other unreached communities• (Re)orientation of PRI members at block-level

• Trialogue approach with patient group; interaction with people at PHI level

• Workshop on script writing of TB-related dramas for professional writers (usually conductedat state-level)

• Patient group meeting at PHI-level

• (Re)orientation of jail inmates and employees

Special IEC Activities

Health Communication Activities Throughout the Year



In contrast to the planning of communication activities prior to the launch of

RNTCP, where the sequence is to be followed strictly, planning forongoing districts

should be kept flexible according to need-based and practical circumstances.

Hence, the tables are primarily intended to communicate the relative frequency

of the various activities. Training of regular staff involved in IEC activities has not

been included in the figures and should be dealt with separately.

1.9 Health Communication Material Developmentand Pre-testing

Material development is an essential component of any health communication

programme. It is necessary to develop different types of materials for different types

of audiences with focused, targeted messages. An index to the communication

material available in the web-based IEC Resource Centre of the CTD has been

provided in Annexure 3. An index to the communication materials developed in

Orissa by DANTB is given in Annexure 4.

While professional designs may suit the aesthetics of the producer who may

often belong to the middle class, they are no guarantee for high quality products.

In the Orissa experience, through the PRA technique, the use of drawings made

by members of tribal communities proved highly successful both in terms of

the key audience's ability to understand the messages as well as increased

ownership of the programme. One needs to conduct assessments for different

products—pamphlets, posters, radio announcements, TV spots, wall paintings,

handouts, press advertisements and exhibitions. Whether conceptualised in-

house or contracted to NGOs or professional agencies for development and pre-

testing, the products should be grounded in local perceptions of the problems

pertaining to DOTS implementation and should preferably include input from

target audiences. Periodic reviews should be carried out for continued validation

and updating of the information contained in the materials produced.

Pre-testing of health communication materials is a necessary tool to avoid

spending of resources on communication activities that do not achieve the

desired objectives or that can be directly counter-productive. Pre-testing should

take place with a representative sample of the target audience.

The need and methodology to pre-test varies widely according to the type

of communication activity and the costs involved. In relatively inexpensive

communication interventions, one would be reluctant to spend more

resources on pre-testing than the intervention costs, whereas in very expensive

interventions like TV productions, the resources spent for pre-testing to ensure

benefits from large investments would be more. In such cases, the use of focus

groups for previewing the product can often be a useful and effective pre-testing

methodology.



Certain types of communication activities cannot be pre-tested effectively

because they are interactive in a way that pre-supposes the involvement of a real

target audience. Such activities include folk media like street theatre, interaction

meetings and interaction stalls at melas (fairs) and haats (village markets). In such

cases, it is essential to systematically evaluate the activity and feed the results

back to the active IEC agents who then should modify the activity according tothe feedback.

1.10 Monitoring, Evaluation and Research

The response from the field is critical for the successful adoption

and modification of IEC components. Periodic reviews should be

conducted to assess the value and utility of the campaign or its

message. A positive impact of an IEC activity on TB control can be maintained

by refining the message or design as required. Systematic research should be

conducted periodically, preferably by independent agencies and/or persons notdirectly involved in the communication activities, to monitor and evaluate the

IEC programme and the activities undertaken. The process, outcome and impact

parameters should be defined at the outset and the findings utilised to bring

about improvements in the programme.

Monitoring would be particularly useful in three areas:

1. Management: Careful monitoring is essential at the early-implementation or

the pilot-testing stage of the programme.

2. Evaluation: Proper monitoring enables accurate interpretation of final

evaluation results.

3. Accountability: Monitoring enables the state and funding agencies to assess

the value of the programme and demonstrates appropriate use of funds.



Implementation of the Strategy

2

This strategic framework for communication identifies the communication

need (objectives), communication players/audience (target groups), and

communication tools (channels, activities and materials). This framework will

build on the work already undertaken within RNTCP Phase I.

The focus of this framework is on a combination of centrally produced core

messages and media, and needs-based planning and IEC development to

develop state and district specific strategies, with local innovations to reach all

possible groups through the most appropriate channels, materials and activities.

The Central core framework provides the general outline, and each state will

come up with a locally-adapted strategy based on their own needs, analysis of

the problem and the target groups, so that communication activities are tailored

to address local needs, and reflect local culture. A suggested list of activities and

details of implementation have been provided in the following pages.

Financial Provisions for CommunicationThe Project Implementation Plan (PIP) for RNTCP Phase II has recommended

the following budgets for activities at various levels.

State-level

Population Budget** (Rs)

Small States Up to 10 million 500,000

Medium-size States 10-30 million 700,000

Large States 30-50 million 1,200,000

50 million and above 1,700,000

** Each state will have additional budget for engaging agencies/NGOs to work as communicationfacilitators for the state and districts. (The proposed budget is approximately Rs.20,000 perdistrict per year, or about Rs.1,600 per district per month). This budget would be over and abovethe state and district allocation for health communication activities.

1Source: Draft PIP of TB-2, CTD



District-level

Budget allocation at the district levels would be Rs 75,000 per million population

per year. Sixteen urban centres (already identified in the previous project) with

populations of more than one million will have Rs 150,000 lakh per million

populations per year. All other urban cities with a populations of more than one

million will have a budget of Rs 100,000 per year. The district level budget wouldbe over and above the state budget for IEC mentioned above.

In addition, Rs 25,000 per million population is available for NGOs for IEC at the

district-level under schemes for NGOs.

2.1 Implementation at the Central Level

2.1.1 Roles and responsibilities At this level, the CTD is the principal advocate for RNTCP.

As far as implementation of BCC activities is concerned, the CTD provides

leadership and support to the state and district levels.

An advocacy and strategic communication unit within the CTD

provides overall leadership for the IEC component,

procures services of the comunication agency at the central level and

coordinate activities,

manages the mass media component at the national level,

provides oversight of the national level communication strategy, assessing

capacity for strategic communication at the state-level, and providing support where necessary and

ensures that achievements and lessons learnt in RNTCP Phase I are

consolidated and used for further IEC development.

The CTD involves national bodies like the IMA and the TAI and national-level

NGOs to take responsibility to involve their members throughout the state. It

involves the MCI and other bodies to recommend appropriate changes to policies

and curricula with respect to the control of TB. It also reviews the capacity and

competency of the central training institutes with respect to BCC activities.

The media campaign can be effectively and economically handled from the central

level. Given its nature, where media cannot be segmented by states, the Centre

would handle the national media campaign. A media agency would assist the

CTD in planning and executing media activities based on the studies conducted

for RNTCP and the viewership survey and media research. State-specific popular



channels could be included in the media planning and execution. Options for

the careful use of ‘free media’ will also be considered.

2.1.2 Target audience At this level, the target audience consists of:

National-level institutes and bodies such as National Tuberculosis Institute(NTI), Tuberculosis Research Centre (TRC), etc.

Professional bodies such as Indian Medical Association (IMA), Tuberculosis

Association of India (TAI), Medical Council of India (MCI), Nursing Council

of India (NCI), etc.

Development partners such as bilateral and multilateral agencies, e.g.,

Danida, Department of International Development (UK) (DfID) and World

Bank (WB), World Health Organization

Mass media—national-level television, radio and press

Corporate bodies such as Confederation of Indian Industries (CII),

Employees’ State Insurance (ESI), railways, industrial houses, pharmaceuticalcompanies

Ministries, and departments such as the Departments of Women and

Child Development (WCD), Rural Development (RD), Integrated Child

Development Services (ICDS), Family Welfare (FW) at the state-level

Opinion-leaders and politicians—ministers, eminent personalities, religious

leaders etc.

2.2 Implementation at the State-level

2.2.1 Roles and responsibilitiesThe state government is the key operating agency for RNTCP. It has ownership of

communication activities at all levels of the health care system. It makes adequate

budgetary allocations for communication programmes, based on inputs from

the District TB Centres (DTCs). It advocates the use of communication activities

in RNTCP and takes steps to build public-private partnerships at the state level,

by involving NGOs, private practitioners and pharmaceutical and other relevant

industries.

At the state level, the strategic communication responsibility within the State TB

Cell rests with the STO who is assisted by an IEC Officer.

The role of the State TB Cell in strategic communication is as follows:

Vision for communication aspects in RNTCP

Planning of health communication activities

Monitoring of health communication activities

Tapping resources for health communication activities



Supervision of health communication activities

Support to districts

Developing materials in local languages

Organising events for advocacy

Supervision by IEC officer

Capacity-building of the districts for implementing activities for awarenessgeneration and social mobilisation.

The state government develops generic communication materials in close

collaboration with the district and peripheral TB staff and IEC officers.

The State Tuberculosis Officer (STO) is responsible for planning, coordinating

and monitoring the implementation of all communication training activities

through the State Institute of Health and Family Welfare (SIH&FW) and outlines

the personnel requirements for training needs in communication. The state

government is responsible for the initiation and appropriate utilisation of operational research and monitoring evaluation to assess the impact of health

communication activities and to modify them, if required.

The STO is actively assisted in developing and coordinating the communication

activities by the SIH&FW or a designated IEC officer, who is capable of involving

the media and PRIs for disseminating the central messages for TB control. Once

RNTCP services are available in all districts, the programme will embark on mass

media campaign which are envisaged to be powerful in reaching all urban and

peri-urban areas.

The states have a role in mass media as follows:

Pre-testing materials intended for nation-wide use, and in providing feedback

Dissemination of centrally produced media materials

Providing feedback on how national level campaigns are being received

Adapting centrally produced materials to ensure contextual relevance

Sharing media successes with the central level

2.2.2 Target audience/players/partners At this level, the target audience consists of:

Health service providers

Community

State-level institutes and bodies such as state TB institutes, state steering

committees

Professional bodies such as the state-level branches of the Indian Medical

Association (IMA), Tuberculosis Association of India (TAI), Medical Council

of India (MCI), Nursing Council of India (NCI) etc.



Development partners such as state-level offices of bilateral and multi-lateral

agencies, e.g., Danish International Development Assistance (Danida),

Department of International Development (UK) (DfID), World Bank (WB),

World Health Organisation (WHO) etc.

Mass media.

Corporate bodies at the state-level such as industry and business associations,Employees’ State Insurance (ESI), Indian Railways, industrial houses,

pharmaceutical companies, etc.

Ministries and departments at the state-level such as the departments of

Women and Child Development (WCD), Rural Development, Integrated

Child Development Scheme (ICDS), Family Welfare (FW), etc.

Opinion leaders, politicians and administrators at the state-level—MPs,

MLAs, eminent personalities, religious leaders etc.

2.3 Implementation at the District-level

2.3.1 Roles and responsibilitiesThe district is the link between the state and PHIs in terms of training and

dissemination of IEC materials. The district TB society is responsible for planning,

implementing and monitoring RNTCP communication activities at the district

level with the DTO/ADMO being the responsible officer. The DTO is responsible

for involvement of PRIs, NGOs and other relevant district-level organisations in

health communication activities. The CDMO is responsible for actively obtaining

the necessary information from the DTO/MEIO/BEEs in order to ensure the

implementation of the communication strategy.

In addition, the support from the outside the formal health system would be drawn.

A wide range of players such as gram panchayats , NGOs, mahila mandals, youth

groups and schools along with support and resources from the state and district

administrations such as information/education officers would be co-opted.

Capacity-building would also include sharing of material and innovations across

districts and states. While the Centre takes the leadership, the state and districts

will plan and implement need-based health communication activities. There

would be a two-way flow of information from and to the Centre and the states.

The establishment of a web-based IEC Resource Centre at the official website is

the first step in this direction. This would be strengthened further with regular

addition of new material.

The local communication teams at the district- and sub-district levels are

encouraged to try different approaches and resources, keeping in mind the

different local resources in terms of leadership and groups. For example, in one

district the team might revolve around PRI and in another a local NGO may



take the lead. States and districts would be encouraged to explore innovative

approaches in communication, particularly for hard-to-reach groups. The lessons

learnt from these approaches could be disseminated widely across districts and

states.

It is at the district- and local levels that the challenge of reaching the ‘interiorpockets’ and engaging hard-to-reach populations becomes relevant. Districts

will bear the responsibility of reaching those who may not be exposed to mass

media campaigns, and for complementing the information that is received from

national and state sources with locally relevant activities. Adapting RNTCP’s core

messages will rely on the locally available talent to adapt messages using the

local language and reflecting local interests and concerns. Districts will therefore

have flexibility in planning and implementation to meet the specific needs of the

populations in those areas.

2.3.2 Target audience At this level, the target audience consists of:

Health service providers, CDPOs, MEIO, BEEs

Community

District-level institutes and bodies

Professional bodies at the district-level

Mass media—district-level television, radio and press

Corporate bodies at the district level

Opinion leaders, politicians and administrators at the district-level

NGOs

2.4. Implementation at the PHI-level

2.4.1 Roles and responsibilitiesThe PHI is the community-level centre for health

communication activities. This facility has an active role to

play in timely detection, treatment and promotion of the adoption of DOTS by

patients and the community. The entire staff at a PHI should be specially trained

in IPC and counselling. IEC materials should be easily available and adequately

displayed and used regularly.

The PHC level should explore the possibilities of increasingly utilising the

‘cured person’ for IEC purposes, and should promote local ownership of the TB

programme.

PRIMARY HEALTH CENTRE



2.4.2 Target audience Women and men, rural and urban, hard-to-reach groups such as tribals,

marginalised populations in slums etc.

Patients

Private providers, practitioners of other health systems, traditional health

providers School children, teachers, NGOs, CBOs, SHGs, PRI members, etc

Media

2.5 Health Communication Activity Implementation Matrix

The matrix in the following page suggests a comprehensive list of health

communication activities for RNTCP and the levels at which they are

appropriate.

The health communication activities have been broadly grouped into thefollowing types:

Policy support

Media support

Capacity-building

Communication material development

Involvement of partners in communication activities

Involvement of other organisations and individuals

Detailed guidelines for the planning and implementation of each healthcommunication activity are given In the following pages.

Each activity should be understood in the context of the overall strategic health

communication framework for RNTCP. The activities should be timed at intervals

as described earlier. For each activity, a list of health communication material

has been suggested. Samples of the health communication material that can

be adapted to the requirements at the local level have been provided in the

annexures.



Health Communication Activity Implementation Matrix

Ref No Health Communication Activity CentralLevel

State-level

District-level

PHI-/MC-level

3.1 Support for policy implementation and for

RNTCP

3.1.1 Interactive stall at haats

3.1.2 Organisation of mass rally

3.1.3 Observation of World TB Day—24 March

3.1.4 Exhibition

3.2 Media advocacy

3.2.1 Print media

3.2.2 Electronic media

3.2.3 Display media

3.2.4 Policy support

3.3 Health communication activities forcapacity-building

3.3.1 Training of health workers

3.3.2 RNTCP training of TB programme staff

3.3.3 CME programme for health workers

3.3.4 Training of DOT providers

3.3.5 Strengthening the state IEC organisation

3.4 IEC development material

3.4.1 Poster development workshop

3.4.2 Other display material development

3.4.3 Development of radio spots

3.4.4 Development of TV spots

3.4.5 Development of cinema slides

3.4.6 Development of music cassette

3.4.7 Development of role-play

3.4.8 Training on street theatre technique

3.4.9 Pre-testing of IEC material

3.5 Involvement of parterners in IEC forRNTCP

3.5.1 Use of street theatre

3.5.2 Puppets

3.5.3 Trialogue approach

3.5.4 Orientation of tribal link workers

3.5.5 Orientation of cured, former patients asRNTCP advocates



Health Communication Activity Implementation Matrix

Ref No Health Communication Activity CentralLevel

State-level

District-level

PHI-/MC-level

3.5.6 Orientation of NGOs

3.5.7 Sensitisation meeting for PRI members

3.5.8 Orientation of SHGs

3.5.9 Orientation of volunteers, teachers,students and religious organisations

3.5.10 Orientation of traditional healers,traditional birth attendants and otherindigenous practitioners

3.5.11 Orientation of members of CBOs

3.5.12 Training/workshop for CDPOs/supervisorsat district-level

3.5.13 Group discussion

3.5.14 Kalyani clubs

3.5.15 Workshop on culture and communication

3.6 Involvement of other organisations andindividuals

3.6.1 Orientation of industrial workers

3.6.2 Orientation of jail immates and employees

3.6.3 Sensitisation workshop for journalists

3.7 Monitoring, evaluation and research

3.7.1 RNTCP programme documentation



Annexures




1.1 Support for policy implementation and for RNTCP 73

1.1.1 Interactive stall at haat 73

1.1.2 Organisation of mass rally 74

1.1.3 Observation of World TB Day—24 March 75

1.1.4 Exhibition 76

1.2 Media advocacy 78

1.2.1 Print media 78

1.2.2 Electronic media 801.2.3 Display media 82

1.3 Health communication activities for capacity building 83

1.3.1 Training of health workers 83

1.3.2 RNTCP training of TB programme staff 88

1.3.3 CME for health workers 91

1.3.4 Training of DOT providers 92

1.3.5 Strengthening the state IEC organisation 96

1.4 IEC material development 100

1.4.1 Poster development workshop 100

1.4.2 Other display material development 1021.4.3 Development of radio spots 1031.4.4 Development of TV spots 1041.4.5 Development of cinema slides 1061.4.6 Development of music cassette 1061.4.7 Development of role-play 1071.4.8 Training on street theatre technique 1091.4.9 Pre-testing of IEC material 111

1.5 Involvement of partners in IEC for RNTCP 112

1.5.1 Use of street theatre 1121.5.2 Puppets 1141.5.3 Patient-DP-community interaction meeting 115

1.5.4 Trialogue approach 1171.5.5 Orientation of tribal link workers 1191.5.6 Orientation of cured, former patients as RNTCP advocates 1211.5.7 Orientation of NGOs 1221.5.8 Sensitisation meeting for PRI members 1241.5.9 Orientation of SHGs 1251.5.10 Orientation of volunteers, teachers, students and 127

religious organisations

Contents



1.5.11 Orientation of traditional healers, traditional birth 129

attendants and other indigenous practitioners1.5.12 Orientation of members of CBOs 1301.5.13 Training/workshop for CDPOs/supervisors at district level 1321.5.14 Group discussion 1341.5.15 Kalyani clubs 136

1.5.16 Workshop on culture and communication 137

1.6 Involvement of other organisations and individuals 138

1.6.1 Orientation of industrial workers 1381.6.2 Orientation of jail immates and employees 1391.6.3 Sensitisation workshop for journalists 141

1.7 Monitoring, evaluation and research 143

1.7.1 RNTCP programme documentation 143


3. Index of Materials available in the Central TB Division’s 149

Web-based IEC Resource Centre4. Index of Health Communication Materials Used in Orissa 156

5. User Guidelines for the Health Communication Video

Modules CD 173





Implementation Guide to HealthCommunication Activities

There are a number of health communication activities that can be implemented

as part of the strategy. Illustrated below are activities designed by DANTB in

Orissa.

1.1 Support for Policy Implementation and for RNTCP

1.1.1 Interactive stall at haatsObjective

To inform the community on different aspects of TB and avail

facilities provided by RNTCP.

Duration

Four hours on weekly market day.

Venue

Suitable open place in the haat .

Participants

Local villagers (male/female/children) and vendors.

Facilitators

MO-PHI, Dy. MEIO, BEE, STS, HWs.

Process of organisation

Planning for interactive stall by ADMO/MO-TU, BEE, STS

Selection of haats in a block

Letter to MO-PHI for organising stall

Arrangement of IEC materials by Dy. MEIO/BEE/STS

Invite cured male/female patients to participate

Sharing of responsibility among health personnel and cured patients to

facilitate the process

Display of IEC materials, and a mobile exhibition unit with captions on TB

Annexure 1



Messages used

Cause of TB, how it spreads and signs and symptoms of TB

Free diagnostic and treatment facilities available at PHIs

Importance of early reporting

Methodology Interaction

Explaining exhibit materials

Street play

Health communication materials

Banners (19-23), posters (7-12), exhibition model (32), tent for exhibition stall,

leaflets (5-6), snake and ladder game, tape recorder, mela kits, pocket folders,

register to record comments of audience. While planning your activity view the

‘Advocacy and Social Mobilisation’ module in the accompanying CD.

Outcome

Regular meetings at gram panchayat -level/community-level to discuss RNTCP

by HWs/BEE

1.1.2 Organisation of mass rally

Objective

To disseminate TB messages to the public

ParticipantsSchool students/NSS volunteers/PRI members/SHG members/DOT providers

(HW/[male/female], AWW), NGO members/cured patients and public

(participants around 100 to 200, both male and female)


CDMO invites DTO, MO-TU, MO-PHI, STS, CDPO, DIPRO, MEIO, BEE,

programme officer of NSS, district coordinator of NYK, BDO, CDPO, local

school headmaster, NGO secretary for planning meeting. They decide the

date, time and area to be covered

CDMO informs DTO, MO-TU, MO-PHI, STS, DIPRO, Dy. MEIO, BEE,

Programme Officer of NSS, district coordinator of NYK, BDO, headmaster,

NGO secretary by letter

Programme officer selects the NSS volunteers and informs them about the

rally

District coordinator selects the NYK volunteers and inform them about the

rally

BDO informs sarpanches

Headmaster selects the students and tells them to participate in the rally

TB

CONTROL



NGO secretary selects NGO members and informs them to participate

CDPO selects the AWWs and informs them to participate

STS informs the DOT provider and DOT provider informs the cured patients

Caption preparation by MO-PHI, DIPRO/Dy. MEIO/BEE/STS/DOT providers/

NSS volunteers/NYK volunteers

Arrange ambulance (DTO) Arrange drinking water (municipality)

Arrange media personnel (like press, TV, radio, photographer) by DIPRO


Banners (19-23), leaflets (5-6), placards

Messages for slogans, e.g.

TB is curable.

Stop TB—use DOTS.

DOTS cured me. It will cure you too.

Outcome

Increased awareness of TB among the public.

Symptomatic case reporting increases at PHI-level.

Report-writing

DIPRO/Dy. MEIO

1.1.3 Observation of World TB Day—24 march

Objective

To create large-scale awareness in the community

To motivate and encourage community to avail the facilities

available at the PHI for TB

To highlight special messages on World TB Day

Target group

General public/patients/providers/peoples’ representatives

Venue

District-/sub-district-/block-/PHI-level, any suitable place


CDMO/ADMO invites MO-TU/STS/STLS/MO-PHI/Dy. MEIO/DIPRO/

BEE/NSS/NYK Programme Officer/NGO representative for planning the

observance of World TB Day

Listing of health communication activities with detailed planning, including

budget, by concerned MO-TU/MO-PHI/BEE/Dy. MEIO and submission to

CDMO

M AR C H

2 4



MO-TU/STS/STLS/Dy. MEIO/DIPRO plan to observe World TB Day at district

level

CDMO releases funds to carry out the activities

MO-PHI invites all block-level officials/PRI members/cured patients/

active NGOs/teachers/ICDS personnel to participate in the World TB Day

arrangements At the district-level, CDMO invites collector/sub-collector/zila parishad

Chairman/PRI members/cured patients/ICDS personnel/DSWO/block

officials/doctors/nurses of district hospital to participate in World TB Day

observance.

Sharing of responsibility at district-/PHI-level to carry out these activities.

Procurement of IEC materials for distribution to PHIs by ADMO (Med.)/MO-

TU/Dy. MEIO.

Emphasis is given to involve cured, former patients to share their experiences

in different activities.

Suggested health communication activities

Rally by cured and former patients, school students and health personnel

Orientation of students followed by debate/quiz competition among high

school/college students

Exhibition on RNTCP at district and PHI levels

Mass meeting with block officials, PRI members, NGOs and chief functionaries

from colleges and AIR

Street play in weekly markets in each block to disseminate the messages on

RNTCP

RNTCP chariot

Interactive stall at weekly haats

Talks on TB and RNTCP jingle/spot could be organised for broadcast by local

private channels, All India Radio and Doordarshan stations

Other innovative activities may be carried out as per need


Mela kit, banners, posters, leaflet, booklet, pamphlet, exhibition models, mike

set, cassette with player, TV, VCR, placard, folders

Reporting

MO-PHI/MO-TU/DTO are responsible for submitting a detailed report on the

observance of World TB Day to CDMO who reports to Dy. Director of Health

Services

1.1.4 ExhibitionExhibition is one of the important health communication activities

that meets the information needs of different target groups from

various parts of a district and state.



Purpose

To create awareness in the community regarding different technical aspects of

TB and encourage people to avail the services provided under the RNTCP.

Venue

At a suitable place of festival/mela/function.

Target group

General community, patients and service providers.

Duration

Depends upon the length of the festival or function. Usually one day to one week.


A request letter is written by the MO-PHC to the district authority (CDMO/DTO)

to organise and provide support for such an exhibition sufficiently ahead of theoccasion. After the decision is taken, a suitable place is identified in consultation

with the local organiser of the festival/mela.

Construction of the stall

In many instances, ready-made stalls are provided by the organiser of the

festival. Otherwise, a contractor is entrusted to erect a stall with the provision

of sufficient lighting arrangements, electricity and cloth decoration.

Usually the size of the stall is 15’ x 12’ with two gates, i.e. entrance and exit.

Health communication materials Exhibits and other display materials pertaining to necessary information on

TB and RNTCP are put up in the stall. These may be models, boards, posters,

banners, equipments, medicines, etc. Sometimes, story boards are put up

to explain to the audience the disease or programme. This is very useful for

practical demonstrations, which are generally appreciated by many people.

TV, VCR and audiocassettes are played to disseminate information in

an entertaining way. A person is given responsibility to explain about

TB to the audience as well as to answer queries through interpersonal

communication.

Video-based training modules

While planning your activity, view the ‘Advocacy and Social Mobilisation’ module

in the accompanying CD.



1.2 Media Advocacy1.2.1 Print mediaPrint media can be a useful way of reaching the community with

IEC messages. It will only reach those who can read and can afford

to buy them. The audience will often include opinion leaders and

influential persons.

Newspapers

Can provide detailed information about a topic. It is easy to present technical

data, such as achievements of RNTCP in a clearly-designed text. Important

topics, such as five important components of RNTCP, can be covered in a series

of articles.

Objective

To create awareness and mobilise public opinion on TB/RNTCP.

Formats used in newspaper

News: Description of important, recent events accompanied by photographs (e.g.

launching of RNTCP in a PHI).

Future events: Details of future events, public announcements (mass run on

World TB Day).

Advertisements:These can be of any size from small ads to full-page ads containing

important messages on TB (e.g. ‘Use DOTS, Fight Poverty’).

Features: Features are longer articles describing events or reviewing topics. They

contain items of general interest and short stories. RNTCP can be a subject for

features, such as description of TB as a disease, problems emerging from late

diagnosis and irregular treatment and effects of utilising DOTS.

Letters: There is usually a section with letters from the public responding to

various issues of RNTCP.

Special interest sections: Many newspapers have a health section. Often, this

contains an ‘advice column’ responding to issues raised by readers that can

include TB.

Advantages

Influential in creating awareness and mobilising public opinion

Can be used to support radio and TV for educational purposes

TB

Con trol



Disadvantages

Can be used only for literates

Can be expensive for the poor

It is a one-way communication

Requires special writing and editing skills

Leaflets

Use of leaflets is most common in health education.

The simplest leaflet is a single sheet of paper, printed on one/both sides and

folded into half or three parts.

Leaflets can be larger with two or more sheets of paper (pamphlets/

brochures).

Target audience

All literate women and men.

Objective

To spread mass awareness in the community regarding TB as a disease and the

availability of free treatment.

Preparation and production

Should be interesting to look at

Should contain relevant information for target readership (e.g. signs and

symptoms of TB, free diagnosis and treatment, PHIs providing DOTS)

Language should be easy to read and understand

Complicated technical words should be avoided Should mention place for getting further information

Pre-testing

All leaflets/pamphlets/booklets should be pre-tested and changes made

accordingly before printing.

Distribution

Look out for opportunities to distribute materials, such as:

Campaigns and rallies

Group discussions

Public meetings—World TB Week

In-service training programmes

Exhibitions

Advantages

Excellent format for presentation of technical information

Can support other media for educational purposes



Useful in individual and group sessions; can serve as a reminder of the main

points made

Helpful for sensitive subjects like TB and AIDS—when people are too shy to

ask, they can pick up a leaflet and read the information

Disadvantages Can be used only by literates

Can only be effective only if well-designed and appealingly produced

1.2.2 Electronic mediaFor mass communication of ideas, messages and important events.

Objectives

To spread mass awareness regarding basic scientific facts about TB

To bring about a change in the beliefs and attitudes towards TB as a disease

and its curability To support parallel initiatives for behavioural change

Target audience

Patients, service providers and the community at large.

Radio

It is the media channel that now reaches the widest audience. Our country still

depends on centralised production of broadcast programmes. However, local

radio stations produce programmes in regional languages with locally-relevant

content that are increasingly common.

Advantages

Radio technology is available all over the country and can reach mass

audiences cheaply

Receivers are cheap and are available in the remotest areas (unreachable

areas)

Messages can be repeated at low cost

Easy to reach illiterate population

Is flexible and formats can be of varied types

Effective in spreading awareness and announcing events (e.g. World TB Day)

Can mobilise community to participate in public events and projects (e.g.

mass run for ‘Use DOTS, Stop TB’ campaign)

Disadvantages

One-way channel

Difficult to assess audience reaction and interest

Content may not be suitably-tailored for small communities



Television

DOTS programmes containing stories and educational elements could be

shown from VCR equipment generating a one-night cinema hall experience at

village-level (using VCR, projector, simple screen, electricity from generator).

The existence of many channels reduces the audience of any one channel and

provides stiff competition for health-related messages on TV.

Advantages

Its novelty attracts audiences (spots on effective use of DOTS)

Messages can be repeated and thus reinforced (helps in behavioural

change)

Suitable for motivation through utilisation of different formats (drama,

music, folk-media, events)

Can create awareness, even among illiterates

Disadvantages Expensive to operate

One-way method – no audience participation

Not available among very poor people

Requires extensive planning and preparation

Formats for radio and TV

News – An IEC activity mentioned in the news bulletin gives wide coverage

and credibility at no cost (e.g. mass meeting on ‘Use DOTS, Stop TB’ on

Independence Day)

Spot announcements, for example on the inauguration of RNTCP in a district with a list of PHIs where DOTS is available. Spot announcements are useful

for quick circulation of messages in the community.

Slogans and jingles

Slogans are short catchy sentences, designed to attract attention, usually

moulded on well-known sayings or rhymes. They can identify a campaign,

e.g. ‘World TB week’

Jingles are slogans set to music and are more memorable; set to identify a

programme (RNTCP)

‘Phone-in’ programmmes

Programmes in which listeners ring a studio either ‘live’ or ‘off-air’ and give their

views, ask questions or ask for advice. They are dealt with by an expert, or by a

panel in the studio.



Talks and documentaries

Five to ten minute talks by doctor/DOT provider/cured patient are used.

Documentaries explore a single topic and include different effects.

Drama

Long/short plays, soap operas, serials and dramas have enormous potential forIEC because the audience can identify with the characters and their problems

(patients/traditional healers/providers). Dramas are expensive to produce.

Quizzes and panel games

Quizzes and panel games are popular. Those watching them try to answer

the questions themselves and learn something from the answers. This can be

effectively used for awareness-building on RNTCP.

All these activities are jointly taken up with the State Institute of Health and

Family Welfare (IEC Cell).


Posters, folders, leaflets, booklets


While planning your activity view the ‘Types of IEC Material and their Use’ module


1.2.3 Display media

Display materials present information and ideas on health and TBin exciting and challenging ways.

Display materials commonly used are:

Exhibits

Models

Tin plates

Banners

Hoardings

Wall paintings

Display boards

Posters

Photographs

Objective

To disseminate messages to create awareness amongst the community



Target group

Patients and their families, service providers and the community at large.

Using display materials as teaching/learning aids can stimulate participatory

teaching, e.g. a model on a TB patient’s experience of diagnosis, treatment and

outcome or an actual demonstration of food to be taken while on treatment forTB.

People are more likely to believe something if they can see, feel and touch it for

themselves.

Display materials can be used to promote learning and spread awareness.

Well-developed and properly used display materials can

convey vital information (banners on signs and symptoms of TB);

show something that people cannot see in real life (positive slide under amicroscope with TB organism);

provide a substitute for the real thing (pictures/posters of persons suffering

from TB—now and then);

arouse people’s interest and gain attention (mela kit with key messages);

help people to remember key points (exhibition set); and

make difficult ideas easy to understand (wall painting).

1.3 Health Communication Activities for Capacity-building

Orientation at state-level of CDMOs/ADMOs/DTOs/RNTCPMOs

1.3.1 Training of health workers

Objective

To orientate district-level managers on technical, operational and programme

management aspects of the RNTCP and update them

To involve participants in micro-planning exercises for the selection of PHI/

TU/DTC and personnel identification for DOT providers, STS, STLS, LT, MO-

PHI, MO-TU, etc., and make district resource mapping/identification and

prepare RNTCP District Action Plan

Review RNTCP performance indicators as per national guidelines and

generate problem-solving discussions

Duration

Two days



Venue

Conference hall of the SIH&FW or in a hotel at the state capital

Participants

CDMOs, ADMOs, DTOs and RNTCP MOs. Ideally, 30 participants in each batch; a

total of three batches for the state of Orissa. Participants from 10 districts in onebatch (CDMO, ADMO/DTO, RNTCP MO).

Date

Once every six months. Date is fixed as per the convenience of the participants

and the facilitators. The orientation should be made mandatory before the

RNTCP preparatory work starts for new areas/districts.

Facilitators

Dy. Director General TB and/or representative from Central TB Division

Secretary, Health and Family Welfare and/or Dy. Secretary, Health and Family Welfare

Director, Health Services, Jt. Director (TB/Leprosy), Dy. Director TB

RNTCP trainer from State TB Demonstration and Training Centre

WHO consultant and Danida representatives.

Process

An official letter is issued from the Government/Director of Health Services to

CDMO requesting him/her to participate in the programme and CDMO, in turn,

allowing the other two to join.

CDMOs are asked to bring certain data related to the programme for discussion/

planning.

Session content

Inaugural formalities, objective of the workshop, key issues and general

address, etc., done by the Secretary, Jt. Director and Director respectively

Brief introduction on RNTCP, extent of problem of TB and control measures

Technical and operational aspects of RNTCP

Assessment of resources at district level as per district-wise information

presented by the participants

Programme review, micro-planning and action to be taken

Problems and bottlenecks—an open discussion to sort out issues

Preparation of district-wise action plans and follow-up action plans

Teaching methodology

Lecture, presentation, participatory process, group discussion, panel discussion,

question and answer, demonstration, audio-visual etc.




Banners, posters, flipbooks, leaflets


While planning your activity view the ‘Orientation’ module in the accompanying

CD.

Outcome

RNTCP information updated and district-level programme managers

orientated

Problems and difficulties discussed and sorted out to the extent possible

Review of RNTCP activities done

District Action Plan and Gannt chart prepared for the next six months

Report writing

Report/proceedings preparation by the ministerial staff of the State TB Cell.

Evaluation

At the end of the training, an evaluation is carried out using developed question

formats to assess whether the objective of the training has been achieved.

Follow-up

Apprise the District Collector and discuss in the District Health Society

meeting

Discussion at the district-level monthly meetings and RNTCP in regular

review agenda Preparation of Gannt chart and District Action Plan

Micro-planning exercises at PHC level involving all staff

Regular organisation of quarterly review, monitoring and supervision

workshops

Modular training for MO-PHI at state level

Objective

To train the designated medical officers of PHIs in diagnosis and treatment

of TB patients in their respective areas and in overseeing quality control of

microscopy activities and drug distribution

To enable the designated medical officers to participate in and review all

technical aspects of RNTCP and preparation of monthly and quarterly reports

to be submitted to the TU/district and make supervisory visits

To be able to act as training coordinator during the DOT providers’ training

and ensure participation of all



Duration

Seven days, including one day for field exposure (residential).

Venue

Any of the Chest and TB departments of the three medical colleges in Orissa.

Participants

CDMO selects medical officers of a designated MC who are willing and regular

in service. Ideally, 20–24 medical officers in a batch will be trained in two groups

with three facilitators.

Date

The date is decided by the state based on the training needs and workload. As per

the RNTCP national norm, there should be a trained designated medical officer

in each PHI at any given point of time.

Facilitators

Professors/assistant professors/lecturers of the Chest and TB and SPM

departments of three medical colleges who are trained as trainers of trainers

(TOT) in RNTCP.

Other senior medical officers with specialisation in TB and chest diseases

from the districts who are also trained as TOTs in RNTCP.

Retired professors/assistant professors/DMETs who may have been involved

in the training programmes earlier.

Process A state-wide training calendar to be prepared by the STO as per the needs and

load of the districts. The professors of the respective medical colleges need to be

consulted and a formal letter from the Director of Health Services, along with

the approved training calendar, to be served to the districts/medical colleges/

facilitators for information and necessary action.

Session content

All ten modules (1 to 10) of the training course with relevant exercises for

each module

One-day field visit to a district to experience the practicalities and interaction

with patients and providers


Reading the modules, lecture, participatory discussion, doing exercises, quiz,

question answer, ice-breaker and demonstration (medicine, sputum container,

TB register, forms etc.).




Training modules, banners, posters, flipbooks, leaflets and booklets.



CD.

Outcome

The medical officer

is sound in RNTCP and is updated with the latest information on the disease

and can advise on sputum microscopy examination,

is confident of diagnosing and treating a TB patient in accordance with

RNTCP guidelines and

can counsel the TB patients properly and advise the DOT provider on the do’s

and don’ts of treatment.

Evaluation


formats to assess whether the objectives of the training have been achieved.

Follow-up

The medical officer

ensures identification of TB suspects, collects sputum from them, refers

patients for diagnosis or further examination and advises treatment;

supports laboratory services, monitors documentation related to microscopy

examinations, maintains an adequate supply of re-agents and other materialsand ensures disposal of contaminated materials;

communicates with patients, monitors drug administration and administers

preventive treatment;

ensures that patients brought under treatment are registered, monitors the

regularity of sputum examinations and identifies and records treatment

outcomes; and

periodically assesses the quality of reports, conducts support supervision

visits, maintains a regular supply of drugs and other materials and participates

in and presents quarterly progress reports in the quarterly review, monitoring

and supervision workshops to be held at the TB Unit-level.



1.3.2 RNTCP training of TB programme staff

Training of Senior Treatment Supervisors (STS) at state-level

Objectives

To train and orient key RNTCP personnel in order to make them well-acquainted and skilled to perform relevant job responsibilities

under RNTCP,

ensure proper treatment and

ensure proper registration and reporting.

Duration

Six days, including two days of field visit.

Venue

The training hall of Anti-tuberculosis Demonstration and Training Centre(ATD&TC), Cuttack, or in an RNTCP district having conference facilities.

Participants

Existing supervisory staff at PHC level Multi-purpose Health Supervisor

(MPHS), Sanitary Inspector, Senior Health Worker, Pharmacist, Ophthalmic

Assistant) to be decided by the CDMO/ADMO of the district.

Contractual personnel (in this case an extensive training plan is needed on

duration, curriculum and module).

Must know two-wheeler driving and be willing to travel extensively.

20-24 participants in one batch to be trained in two groups.

Date

As per workload and requirements. One STS to be selected for a TU with 500,000

population. S/he should be trained before the DOT provider training starts at the

PHI level.

Facilitators

State-level RNTCP (TOT) trainer.

Process

A state-wide training calendar is to be prepared by the STO. A formal letter from

the Director of Health Services to be sent to the CDMOs of the districts where the

training need is assessed along with the calendar.

Session content

DOT provider training module



STS module 1 and 2

Dummy TB register

Training exercise sheet

Field visit

Teaching methodology Lectures, readings, presentations, participatory processes, questions and

answers, demonstrations, practical exercises, audio-visuals etc.


Banners, posters, flipbooks and leaflets



CD.

Outcome

The STS is

well-acquainted with RNTCP,

confident of doing the job,

well-versed with field practicalities and

able to plan and report independently.

Evaluation



Follow-up

The STS

ensures identification of TB suspects and proper treatment of patients during

frequent and regular visits to the PHIs;

records results of follow-up sputum smear examinations till end of

treatment;

records drug collection (during the continuation phase) and records

remarks;

communicates with patients and gives health education to community;

ensures proper drug administration and appropriate preventive treatment

for children;

maintains the TB register and ensures that all patients under treatment are

given TB numbers; and

helps prepare the quarterly reports including programme management and

logistics.



Training of Senior Tuberculosis Laboratory Supervisor (STLS)at state-level

Objectives

To train and orient STLS to perform laboratory quality control in the PHI.

To plan and make regular supervisory visits to PHIs at least once a month inorder to ensure that all sputum-positive slides and 10-15 percent of negative

slides are cross-checked.

To ensure that contaminated materials are disposed of safely, and monitor

the maintenance of the TB laboratory register at regular intervals.

Duration

Five days including field visit. In order to be eligible for STLS training, it is a

prerequisite for the participant to first undergo the six-day laboratory technician

training.

Venue

Training hall of the ATD&TC, Cuttack, or in an old RNTCP district.

Participants

Qualified pathology laboratory technicians. Ideally, 20 participants in a batch to

be trained in two groups. Must know two-wheeler driving.

Date

State training calendar to be prepared by the STO. Training to be organised as per

workload assessment and convenience of the facilitator and the participants.

Facilitators

State RNTCP (TOT) trainer

Senior Laboratory Technicians of ATD&TC, Cuttack

Experienced STLS of the old RNTCP districts

Process

A formal letter from the Director of Health Services to be issued to all CDMOs

concerned. The venue details and training schedule is attached to the training

calendar of the STS. Both the STLS and STS visit the same PHI but with different

checklists—the STS on the treatment part and the STLS on laboratory aspects.

Session content

DOT provider module

Laboratory technician module

Module for STLS



Field visit

Training exercise sheet


Lectures, readings, demonstrations, participatory processes, questions and

answers, audio-visual presentations, practical exercises etc.


Banners, posters, flipbooks and leaflets.



CD.

Outcome

The STLS is sensitised on RNTCP,

sound and confident in laboratory supervision work and

able to prepare independent travel plans and report back from the field.

Evaluation



Follow-up

The STLS

conducts visits to microscopy centres;

performs laboratory quality control;

ensures that contaminated materials are disposed of safely;

ensures that treatment cards are correctly filled;

monitors the maintenance of the TB laboratory register; and

monitors documentation related to microscopy.

1.3.3 CME for health workers CME in medical colleges

Objectives

To update the participants’ knowledge on RNTCP

To apprise the participants about the objectives and strategies adopted under

RNTCP

To encourage the participants to follow the principles of diagnosis and

treatment procedures as prescribed under RNTCP



Target group

House surgeons, post-graduate students.

Duration

Half day.

Venue

Conference hall of medical college.

Organising process

DANTB issues a request letter to the Principal/Professor and HoD of TB and

Chest Department to organise a CME programme, under intimation to the

Director of Medical Education and Training. A suitable date is decided as per the

convenience of all concerned.

Facilitators State trainer on RNTCP

Director/Jt. Director (TB) of Health Services

Deputy Director

Session content

Brief introduction on RNTCP

Components of DOTS

Diagnosis and treatment procedures

Role of doctors in the promotion of RNTCP.


Lectures/discussions/demonstrations.

Training materials

OHP, handouts, writing materials.

1.3.4 Training of DOT providerstraining and re-training of DOT providers at PHI level

Objectives

To train and re-orientate DOT providers in basic information about various

aspects of TB; this includes exercises on various activities and skills which the

DOT provider has to perform while implementing RNTCP

On successful completion of training, DOT providers working at the periphery

will be well-acquainted with and skilled to perform all job requirements

related to RNTCP.



To keep DOT providers abreast and updated about RNTCP in order to treat

and cure TB patients smoothly and effectively.

Duration

One day at the MC.

Venue

PHC training/meeting hall, local school premises, meeting hall of the BDO office

or any public place free of outside disturbance.

Participants

Multi-purpose health workers, anganwadi workers, volunteers, village health

guides, NGOs, teachers and cured patients. Ideally, 20-30 participants in a batch

for one facilitator.

DateOnce a year in PHIs. MOs-PHI to send the list of participants; ADMO/RNTCP-

MO to prepare the calendar for the district, and CDMO to issue letters to PHIs

for the training.

Facilitators

District trainers trained in TOT

MO-PHI as training coordinator

STS and STLS

RNTCP-MO/ADMO/CDMO (any one)

Process

CDMO to send an official letter with training guidelines and funds to MO-PHI to

conduct the training.

Session content

TB as a disease, its cause, mode of transmission, type, magnitude of problem,

etc.

RNTCP

Treatment formalities under RNTCP, including diagnostic procedures and

intake of medicines

Filling-up of treatment card

Counselling and health education for TB patients

Role and responsibilities of DOT provider

Gender disparities and IEC in RNTCP




Lectures, reading of modules, participatory discussions, questions and answers,

role-plays, quizzes, demonstrations, ice-breakers, sputum collection procedures

and experience-sharing by cured patients.

Health communication materialsBanners, posters, flipbooks, leaflets, booklets, success stories and snakes and

ladders .



CD.

Outcome

The DOT provider (DP) has first-hand knowledge about RNTCP.

DP is confident of referring suspected cases for sputum microscopy and togive DOTS.

DP is aware about the seriousness of irregular/default treatment and the

follow-up sputum tests.

DP is able to fill the treatment card and keep the medicine packet intact.

DP is able to give proper and right health education to the patient and the

community.

Evaluation



Follow-up

The DP is enabled to

motivate the suspected TB patient to get his sputum examined, explain

treatment requirements and expected duration of treatment with advice on

regular follow-up of sputum examinations;

ensure that every patient diagnosed as a case of TB is registered and treated

for the full term;

fix the time and place for DOT, keeping in mind the patient’s convenience

and operational feasibility;

maintain the treatment card up-to-date and ensure that the patient is allotted

a TB number;

ensure immediate defaulter retrieval and impart health education to the

patient, the family and the community.



Involvement of cured patients as DOT providers

Introduction

It is mainly health staff, anganwadi workers and volunteers from some NGOs

who have been identified as DOT providers.

Rationale

It is well-known that satisfied users are the best motivators. One who has

undergone the process himself and has gained experiences, both positive and

negative, can share his views with others more convincingly than others.

Objective

To facilitate and enable cured TB patients to provide DOTS, counsel patients,

refer suspected cases and disseminate RNTCP information.

ParticipantsCured patients of both sexes who are literate or semi-literate.

Process

A list of participants using the above-mentioned criteria is prepared by laboratory

technicians/STS from the patient register of PHI/TB register of a TU. The patients

are then contacted to assess their willingness to take part in the training and to

act as DOT providers. After a batch of 10-15 participants are enlisted, the training

date is decided by the MO-TU and the DTO. The participants are intimated

personally by the LT/concerned health worker of the date, time and venue of the

training.

Venue

TU headquarter/any other convenient place for the participants to attend.

Duration

One day.

Resource persons

MO-TU/MO-PHI/STS/STLS/LT/BEE

CDMO/DTO/SDMO may also attend the training programme.

Session content

Theory—Technical aspects of TB such as cause, mode of spread, type, categori-

sation of treatment, diet, sputum follow-up and principles of counselling.

Practical—Filling of patient cards.



Training methodology

Discussions, sharing of experiences, group work/individual assignments, role-

plays, demonstrations and quizzes.


Flipbooks and/or flashcards, medicine boxes and treatment cards.



CD.

Evaluation

Questionnaire and quiz given by trainer.

Ongoing supervision in the field by STS/MO-PHI to assess and support their

performance in providing DOTS, filling of treatment cards and counselling.

Follow-up

Once the participants start their work, MO-PHI, STS and health workers of that

area to keep contact with them and guide them regularly.

1.3.5 Strengthening the state IEC organisationTraining for BEEs on community-based health communicationactivities

Health communication activities are the key to success for all health programmes.Such activities have better success rate when organised by the communities

themselves instead of being planned and organised from outside. All health

communication functionaries need to be trained on community-based health

communication activities so that they can play their roles successfully.

Objectives

On completion of the training, the participants (BEEs) would be able to

implement successful community-based health communication programmes in

their respective areas with the help of new communication technologies.

Specific objectives

Utilise their knowledge and skill on recent communication technologies

Use PRA technique to identify health-seeking behaviour of the community

and the lacunae between knowledge and practice

Organise effective trialogue approach sessions to sort out problems and

improve programme performances

Develop and use low-cost media to provide health communication support

for the programme



Duration

Two days

Venue

Conference hall of the SIH&FW or in a hotel in the state capital

Participants

CDMOs, ADMOs, BEEs and RNTCP MOs. Ideally, 30 participants per batch.

Facilitators

Director, (Health Services), Jt. Director (TB), Dy. Director TB

RNTCP trainer from State TB Demonstration and Training Centre

Communication specialists

Process

An official letter is issued from the Government/Director of Health Services toCDMO informing him/her to participate in the programme. The CDMO, in turn,

will arrange for the BEEs to participate.

Session content

Introductory session

The TB scenario

Communication basics and its relevance in RNTCP

Community-based health communication and media

PRA exercise and its relevance

Social mobilisation and partnership development Assignments on media production

Field visit—trialogue approach

Presentation of field experiences

Presentation of assignments

Preparation and presentation of activity plan

Evaluation


Lecture, presentation, participatory process, group discussion, demonstration,

ice-breakers, field visits, audio-visual etc.

Communication materials

Banners, posters, leaflets, handouts

Evaluation

At the end of the workshop, an evaluation is carried out using evaluation formats

to assess whether the objective of the training has been achieved.



Training of Mass Education and Information Officer (MEIO) anddistrict-level media officers

Objective

Capacity-building of media officers in planning and implementing media

activities towards creation of awareness for promotion of RNTCP.

Duration

Two and a half days

Venue

State/zonal headquarters

Participants

MEIO, DHRO

MEIO (H&FW) District Information and Public Relations Officer (PR Department)

Field Publicity Officers

Programme Executives (Health) (Doordarshan and AIR)

Resource persons

State trainer on RNTCP

Director/Dy. Director from SIH&FW

MO-TU/MO-PHI

Process of organisationSIH&FW, PR Department, Field Publicity Department and AIR/DD decides

a suitable date and venue. Request letters are issued to concerned district

authorities/officials from their respective heads of department to relieve the

participants for the training programme.

Session content

1st day

Brief introduction on RNTCP and the DOTS strategy

Technical aspects of TB

Role of IEC for promotion of RNTCP

Introduction on gender disparities in health with special reference to TB

Media and materials for community education, including community

media

2nd day

Field visits to observe interaction meeting of patients and DP as an effective

community medium.



Street theatre

Presentation of field observations

Review of media and materials, suggestions for improvement and developing

new ones

3rd day Presentation of new ideas for media materials

Prepare and present need of action plan for the district for next six months


Lecture discussion

RNTCP and DOTS strategy


Gender

Demonstration Street theatre

Involving TB patients, showing medicines, technical aspects of TB

Media materials

Observation

Interaction meeting

Street theatre

Group work

Review of media materials

Plan of action


OHP, flip chart/blackboard, posters, flip book , banners, video/audio cassette, TV

and VCR.



CD.

Training state IEC staff

Objective

To enhance professional competency in the production of IEC materials,

organisation of training programmes for block- and district-level media officers

and reviewing district-level health communication activities related to RNTCP.



Duration

One day

Venue

State headquarters (SIH&FW)

Participants

Deputy Director, IEC

Health Education Officer

Production Officer

Health Educators

Artists-cum-photographers

Resource Persons

Director, SIH&FW

DHS/Jt. DHS


Director Health Services (DHS) and the Director of SIH&FW, Orissa, decide a

convenient date for the training.

Session content

Brief introduction on RNTCP and DOTS strategy


Media production—some basic points

Role of IEC cell officers in the production of IEC materials, organisation of training and review of health communication activities related to RNTCP.


Lecture-discussions, video presentations and demonstrations.


OHP, video/audio cassette , posters, production of posters, final products selected

for printing, pretesting and handouts.

1.4 IEC Material Development1.4.1 Poster development workshopIn print/display media, posters are considered to be one of

the important means for disseminating information to literate

and semi-literate groups. Posters are developed for RNTCP in a

systematic manner during a workshop.



Objective

To facilitate the participants to design posters with important messages on TB for

creating awareness among different target groups, suitable to their culture and

language.

VenueSuitable location at district headquarters.

Duration

Three days (residential).

Participants

Local artists, artist-cum-photographer from the Department of Health and

Family Welfare and other departments.

Process of organisationCDMOs/DTOs are informed regarding the workshop and are requested to select

participants from their districts and obtain their willingness. After a list of 10-12

participants is finalised, a request letter is sent to them through their department

heads to attend the workshop.

Session content

Brief introduction of RNTCP


Target group and message development

Principles of poster development Individual assignments on poster development

Presentation of final products


Posters, flipbooks and/or leaflets


While planning your activity view the ‘Types of IEC material and their use’ module


Facilitators

TB and Chest specialist of the district headquarter hospital

Dy. Director/Director of SIH&FW

Selection of posters for pre-test

At the final presentation, posters are selected by the Directorate of SIH&FW (State

IEC cell) for pre-testing.



Responsibility of pre-testing and printing

The State IEC cell takes the responsibility to pre-test the posters in the field

among the respective target groups and, after necessary changes, the printing

process is started.

1.4.2 Development of other display materialDisplay materials need to be attractively presented in order to help viewers retain

what they have visualised. Display materials commonly used are:

Exhibits

Models

Tin plates

Banners

Hoardings

Wall-paintings

Display boards

Posters (see section 4.1)

Photographs

Objective

To disseminate important messages on RNTCP to the community.

Target groups

All community members.

Deciding on format

The overall appearance of the materials should never distract viewers from thelesson in hand. The format chosen should

be clear

have a pleasing layout

use appropriate colours and illustrations and

promote a desire to learn.

When deciding on the appropriate format, imagine that you are assembling a

picture that consists of different parts—all needing to fit together harmoniously.

The type of format chosen should depend upon the materials being developed.

Consider the following aspects:

Purpose

Be clear about what you want to achieve. Take into account the type of material

being used and the messages you want to convey. This is essential if you are

to know how to lay your materials out, what to include and where to position

photographs, sketches and other illustrations.



Experimentation

Ideas for layout come from experimenting and brainstorming. Try out different

ideas by sketching them on a piece of paper to see what they look like. You do not

have to go into any detail at this stage—just make a rough sketch.

Relevance All the elements in your design should be relevant to your objectives and the target

audience. They should help the viewers understand and retain the messages

being conveyed.

Proportion

The size of the elements that make up your material should be determined by

their importance (the use of headlines, illustrations etc.).

Direction

Effective design (exhibit) should direct the audience, making it easy for them tomove around and find the information they require.

Contrast

Building visual contrast into your materials makes the information more eye-

catching and interesting. You may want to make your titles (in a flip-book) larger

than the text, or present figures and percentages as a graph or chart.

Simplicity

Decide which design most effortlessly enhances the message you want to convey

and meets the objectives.

Finally, pre-test the display material and make necessary additions and

changes.

1.4.3 Development of radio spots

Objective

To disseminate important messages to the community on a wide basis.

Target groups

All radio listeners, especially adult women and men, and adolescents.

Points to be considered while developing radio spots:

Present only one idea

Begin with an attention-getter

Be very explicit

Ask listeners to take action



Make the audience feel the importance of the tuberculosis situation and

adopt the DOTS strategy

Repeat the key idea two to three times

Process

The group that develops the radio spots, comprises members from the IEC cell, TBcell, staff of AIR and DANTB staff. This group develops and finalises the concept,

message and the format (jingles, music, drama) and determines the length of

the spots (one to three minutes). The time for broadcast is planned—prime time

before and after news is preferable in accordance with the budget allocation.

The staff of AIR, along with artists, develops the lyrics and music and makes the

spot, which is pre-tested prior to final production. The final product is screened

by the group and used for broadcasting.

Full details of the number of broadcasts, the time span and the time and dates of broadcasting are to be well-maintained to record the outcome of the programme.

The Audience Research wing of All India Radio or any other research institution

can be requested to evaluate the outcome of such programmes and provide

suggestions.

1.4.4 Development of TV spotsTV spots provide a useful way of reaching large-scale communities with health

education messages.

Objective

To disseminate information about RNTCP and TB to a wider range of people in a

quick, entertaining and comprehensible manner.

Target groups

All sections of the community including influential groups in the private/public

sectors who watch TV.

Points to be considered while making TV spots:

Be brief

Assume the viewer gets bored easily and can ‘switch off’ mentally/physically at

any time.

Be entertaining

The viewer needs to be entertained by the telecast. Make it as lively and interesting

as possible. Try to make the message more acceptable by use of music/comedy/

drama. Do not lecture.



Be clear

It is no use burying the message too far in the entertainment or making it obscure.

Be simple, use straight-forward ordinary language (local dialect). Speak clearly

and do not rush.

Aim for maximum impact Always try to start a spot with something that catches attention—music, jingle or

a striking word/question. End with something that people will remember.

Dialogue or discussion

Dialogue or discussion is always more interesting than one person talking. It is

very difficult to hold attention with one voice.

Aim for variety

Do not put in too much speech or too long pieces of music. Try putting a music

background to the speech, use different voices, ask questions, keep the viewersguessing—try not to be predictable.

Process

The group that develops the TV spot comprises the TV staff, state IEC cell,

state TB cell and DANTB staff.

The message concept and the format (jingles, music, drama, script) is then

finalised.

Time span of spot is determined (one to three minutes).

Time of broadcast—prime time before and after news is preferable in

accordance with budget allocation. The TV staff along with other artists develop the lyrics, music and dialogue

and produce the spot, which is pre-tested prior to final production.

Final product is screened by the group and used for telecasting.

Full details of the number of telecasts, the time span and the time and dates of

telecast are to be well-maintained to record the outcome of the programme.

The audience research wing of Doordarshan or any other research institution

can be requested to evaluate the outcome of such programmes and give

suggestions.



1.4.5 Development of cinema slides

Objective

To disseminate messages on TB and RNTCP through screening of slides at

different cinema halls in the state.

Target group

Cinema theatre audiences.

Important messages for slides

Early signs and symptoms of TB

Place of availability of free diagnosis and treatment facilities

Importance of regular intake of drugs

Process

Development of messages and selection of photographs to be done ina brainstorming session. In this session, the Project Officer of DANTB,

representatives from the State IEC Cell/TB Cell and IEC Advisor would suggest

different important messages. One/two messages for use will be selected and

finalised. Relevant pictures will be placed with the message.

The slides are pre-tested.

After messages and pictures are finalised an advertising firm with expertise in

preparing cinema slides is identified and given orders. The IEC Advisor and the

Dy. Director, IEC, both work with the firm to finalise the preparation of slides.

The slides are then handed over to the Mass Education and Information Officer

of the district for distribution at cinema halls, with a letter from the Collector to

screen them free of cost.

1.4.6 Development of music cassette

Objective

To disseminate RNTCP and TB messages in an entertaining way in the local

dialect with local music.

Target group

Adult men, women, adolescents and school/college students.

Process

A group of local artistes are identified and sensitized for three to four hours

on RNTCP and TB. The social aspects are fully discussed. They are encouraged



to develop lyrics with important messages on TB and RNTCP. These lyrics

are examined by a group of IEC and TB experts and necessary alterations/

improvements are made.

Composition of music

The composition of music and identification of local singers then takes place.Once the lyrics are finalised, music is composed with the help of local music

experts and singers. Importance is given to traditional music and instruments.

After a number of rehearsals, songs are recorded in a well-equipped professional

studio.

Important messages

Cause of TB, mode of spread

Early signs and symptoms

Procedure of diagnosis and treatment

Availability of facilities, free of cost

Importance of regularity of treatment and timely sputum follow-up

Cassettes are distributed to MOs/BEEs of each PHI for use at

interaction meetings amongst DPs, patients and programme personnel,

exhibitions,

melas /festivals and

interactive stalls at haats .

1.4.7 Development of role-plays A role-play is a type of drama where trainees/participants act out real-life

situations relating to a chosen issue in front of their colleagues/peers.

Objectives

To enable trainees/participants to explore issues/events from different points

of view and develop empathy for patients/communities.

To enable use of available intellectual and emotional faculties and existing

experience for problem-solving.

To enable participants to practise counselling skills and making difficult

decisions in a realistic situation.

Purpose

Role-plays can help a group

get to know one another,

think about a particular problem/issue,

be more sympathetic to others’ point of view and

strengthen communication and counselling problem-solving skills.



Use a role-play

to help trainees/participants realise that others, too, have situations/

problems similar to their’s,

where active involvement can produce a sound basis for discussion and

to demonstrate different ways of dealing with a problem/situation.

Organisation of process

The facilitator

decides on the learning objective and chooses a problem (Ram Babu, Cat-I

patient, aged 40 years, a labourer, has stopped taking DOTS after six doses.

He is an alcoholic and does not listen to the TB staff);

describes the situation for the role-play to all present;

explains the role of actors (patients can also be actors) and observers;

explains to observers that acting skills are not being evaluated; rather, they

must observe the reasoning, attitudes and responses to the issue;

lets the role-play continue till its logical conclusion (10—15 minutes).

Target audience

Trainees, participants in meetings/workshops (interactive meetings of patients

and DOT providers); also trainees in relation to supportive supervision.

Venue

Orientation training of medical/non-medical staff

Training workshop of health staff

Interactive meeting of patients and DOT providers

Facilitators

Trainers

Resource persons at different meetings

MEIO/BEE/principals of HW training centre

STS/STLS

Review

Ask actors to share their feelings while enacting their roles

Ask observers for comments and questions

How can the role-play help them in their work?

Evaluation

Listen carefully to points made in response to questions.

Note the perception and values that emerge which will help trainees/

participants in future activities.

Ask trainees/participants on ways to improve the role-play.



Methodology

Participatory training method

Advantages

Focuses directly on the problem.

Helps trainees/participants to deal with it through direct/indirectinvolvement.

Does not require monetary or material support.

Exposes an individual to various points of view.

Disadvantages

If trainees/participants are not fully involved, the session may only be of

entertainment value.

Roles can be exaggerated and distorted.

Learning can be hampered if the discussion group focuses on unimportant

aspects while ignoring important/relevant ones.

Therefore, facilitators have to take meticulous care to avoid such unwanted

situations.

1.4.8 Training on street theatre technique

Objective

To enhance skills on development of street theatre scripts for RNTCP.

DurationSeven days residential training

Venue

A suitable place, preferably a big hall, youth club, community centre or an NGO

office building. The concerned cultural/street play/NGO groups who organise

the training programme select the venue for the participants.

Participants

Those with a cultural background, a flair for acting and an interest to perform

before the community are selected. The group size is 10–12 persons including

males and females; two groups of NGOs are trained in one batch.

Resource person

External persons who have teaching experience with street theatre technique,

scriptwriting and acting. He/she usually holds a degree from Sangeet Sahitya

(Kala) Academy, Orissa.



For technical session

MO-PHI, STS, BEE


CDMO discusses with ADMO/MO-TU/MO-PHI/STS/BEEs during monthly

meetings or RMS meetings to identify potential cultural groups; BEE/STScontacts cultural/street play group leaders and discusses about street theatre

workshop. The district authority selects two active groups at sub-district and

district levels, and informs them accordingly. CDMO/ADMO is responsible for

the training and sends a letter to the cultural groups regarding a suitable date

and venue for the training programme. BEE contacts concerned NGO/cultural/

street-play groups for selection of the training venue and boarding and food

arrangements. District authority contacts resource persons for the training

programme.

Content Technical knowledge on TB and programme implementation.

Basic concept and principles of street theatre technique.

Scriptwriting

At the end of the closing day, the troupes demonstrate a street theatre show for

the public in the presence of health personnel and resource persons. After the

performance, technical errors are rectified by the resource persons.


Discussions, group work, lectures, role-plays, demonstrations, re-demonstrations.


Banner, posters, flipbooks, folders and leaflets .


While planning your activity view the ‘Advocacy and Social Mobilisation’ module


Outcome

Capacity to develop and perform high-quality street theatre on RNTCP is

enhanced.

Follow-up

After returning to their community the participants are selected. The script may

be modified as per local needs. At this time they are provided technical guidance

and programme expertise from the theatre. After a number of rehearsals they are

ready for the field performance.



Report-writing

Consultants in street theatre, and health personnel.

1.4.9 Pre-testing IEC materialsPre-testing means field-testing communication materials before they are

produced or printed.

By interviewing the target audience the materials are made for, it is assessed

whether they are well understood and appreciated by the audience.

Posters, flip charts, flash cards, leaflets, pamphlets, storybooks, booklets and

video programmes are some of the materials than can be pre-tested.

Why pre-testing?

Communication materials are most often developed by urban, educated, modern,

comparatively well-off and healthy men surrounded by visual stimulation, butare most often meant for rural, illiterate, conservative, comparatively poor and

relatively unhealthy people – including women – who live in villages with limited

exposure to pictures, posters or other visual aids. There is a gap between these

two groups and the planners must verify their visuals with the target groups to

ensure effective communication. Pre-testing is a cost-effective mechanism to

prevent expensive mistakes.

Process

Preparation before going to the field include research on the communication

material, the target audience, objective of the material and the questions to beaddressed.

In the field, local leaders are contacted and explained about the pre-test. Explain

that you are testing the materials and not the villagers, and that you want the

villagers’ suggestions for improving the materials.

Interview techniques

Establish a social setting—a place where there will be no disturbance.

Establish rapport. The introduction is important; respondents should be

encouraged to give time and suggestions.

Let people touch and hold the material.

Encourage people to talk freely.

Put different types of questions (open-ended and close ended) and listen

carefully.

Probing and follow-up questions should be asked.

Thank the respondents for their time. Always let them know that they were

of great help and that the information gathered will be used to improve the

material.



Recording

Pre-testers should work in pairs if possible. One should conduct the interview,

while the other writes down the questions and answers.

Analysing the results of pre-testing

Today, computers can be used to analyse the results. Normally, the material ispre-tested with 30-50 people which is usually sufficient to assess the materials.

Final production

After making necessary changes, the final product is ready for printing.

Care has to be taken to use materials (paper, cloth, colour etc.) that are

durable for a long period.

1.5 Involvement of Partners in HealthCommunication for RNTCP

1.5.1 Use of street theatreOpen-air shows like yatra, theatre, pala, dance, drama and puppet show and

other folk forms of communication have widespread popularity. A story is

presented in combination with dance, music and humour through these genres

and entertains the community.

Based on the principles of forms of folk communication, street theatre is

considered an effective medium for educating the community. Street theatre has

come to be widely used in socio-development programmes in diverse areas such

as education, health, agriculture, social forestry, prevention of dowry, prohibition

and labour exploitation. Street theatre was first adopted in Orissa by DANLEP topromote early diagnosis and regular treatment of leprosy by reducing the social

stigma and was proved to be very effective. Based on this experience, street

theatre was also utilised in RNTCP.

Objective

To create awareness in order to enhance timely case-detection, treatment

adherence and generate knowledge about TB and RNTCP.

Target audience

Community, patients and service providers of all age groups.


After a formal five-day training, the teams contact the CDMO/DTO of a district,

who sends them to the MO-PHI with an official letter regarding performance of

street theatre.



Planning at PHC-level

The team meets the MO-PHC and the BEE to prepare a calendar for shows at the

sub-centre level, indicating the date, place and time of each show. A maximum

of two shows are planned in a day. The calendar is sent to health workers of all

sub-centres well in advance with instructions for their presence at the show. The

time of performance is chosen to suit local communities.

Performance in the field

The team proceeds to different sub-centres and contacts health workers for

selection of a suitable venue. Once the venue is selected, the troupe moves

around the village playing music to make people aware of the show. Once the

audience is gathered, the play is started.

Content

The show is presented in a story form with all necessary messages on TB and

RNTCP, including cause, mode of spread, signs and symptoms, availability of diagnostic and treatment facilities, importance of regular treatment and timely

sputum follow-up. Usually, the script is developed based on one of the local issues

related to RNTCP. The audience enjoys the story with music, humour, dance and

song. The show continues for 45 minutes to one hour.

In most of the shows cured TB patients are involved to narrate their experiences,

which attracts and encourages symptomatic cases to come forward to report.

Also, the general public is convinced that TB is curable and treatment is available

free of cost.

Question-answer session

At the end of the show, the health worker asks the audience about the message

they have received. He/she also answers questions asked by the audience to

address their doubts.

Reporting of suspects

It has been experienced that a number of chest symptomatics from among the

audience report to the team on the spot, who, in turn, advise them to get their

sputum examined at the nearest PHI. They also prepare a list of such cases and

hand it over to the health staff, and send a copy to the medical officer of PHI.

Distribution of IEC materials

At the end of the show leaflets and handbills are also distributed to the audience

to enable them to know more about the disease and the programme.



Record-keeping

A format containing the date, time and place of the show, the number of people

present, (both male and female), influential persons/leaders of the locality

present and the names of the symptomatics reported is filled up by the troupe

and submitted to the concerned district authorities.

Follow-up

The symptomatics reported during the show are followed up and necessary

action is taken by the STS, the MO-PHI and the DOT provider.

Evaluation

Usually the performance is evaluated by the following indicators in respective

PHIs:

Increase of information on TB and RNTCP at the community

Increase of chest symptomatic cases reporting to PHIs

Increase in drug compliance

Reduction in defaulter rate

1.5.2 PuppetsPuppets are a form of drama with considerable potential for IEC. They are part of

a tradition of folk-media used in many parts of Orissa.

Objectives

To disseminate messages on TB that are easily absorbed.

To spread awareness on DOTS to all segments of the community.

Target audience

Children and women and men of all age groups. Many people see puppets as

being relevant only for children and are surprised when they realise how useful

they can be with adults.

Duration

30 – 45 minutes.

Venue

School premises, village haats /festivals, community halls or a central, open space

in a village.

Resource persons

Skilled persons practising puppetry are given an orientation on RNTCP and the

first performance is supervised by the media/TB staff.



Process

Different types of puppets according to the characters are made and

portrayed:

Glove puppets, with heads made of papier-mâché/clay.

Rod puppets, with figures on wooden rods.

Jointed puppets, moved by strings.

Do not wave the puppets around. Make them active—dance, chase, fight, hit

and even hug.

Give the puppets names, special clothing and personalities.

Include humour, music and songs to entertain.

Keep it simple. Do not try to cover too much.

Make a stage that can be easily put up and taken down for transportation. A

wall or a curtain to stand behind is required.

Choose the timing of the performance carefully. Find out when the children,

women and men are free.

Make sure the performances are well-publicised in advance.

Impact

Puppets have maximum impact when the community participates in the

preparation of the programme, in performing the show and discusses it

afterwards.

1.5.3 Patient-DP-community interaction meeting

Objectives

To develop a good rapport and reduce social distance between DOT providers,patients and other programme personnel.

To review the knowledge and activities of DOT providers and patients

regarding TB as a disease and provision under RNTCP.

To interact with irregular and defaulter cases and identify their problems and

needs for counselling towards retrieval.

To promote sharing of experiences between DOT providers and patients on

their problems and success and agree on action for improvement, keeping

the gender component in view.

To maintain and promote the motivation level of DOT providers.

To facilitate the practice of good counselling and communication skills.

Process

A meeting is likely to be held in a PHI twice a year. A calendar is prepared by

the DTO for every round of the meeting. Once the calendar is circulated by

the CDMO/DTO to all PHCs, it is the responsibility of the concerned MO-PHI

to intimate the DOT providers to attend the meeting.



The BEE is the convenor of the meeting and will assist the MO PHI in

organising and conducting the meeting.

Venue

PHI/PHC headquarters or any other suitable central place convenient to all

participants.

Sitting arrangement

The meeting preferably takes place under a tree, except in the rainy season. All

participants should sit on a common mat on the floor in a circle/semi-circle.

Duration

One day.

Participants

DOT providers, both medical and non-medical

Patients under treatment (male/female)

Cured former TB patients (male/female)

Defaulters, all

Other programme personnel like BEE, MO-PHI, LT, STS, STLS, MO-TU and

ICDS supervisor

Selection of patients and DOT providers

To ensure better participation and interaction, patients and providers are limited

to a total of 40-50. Preference is given to all smear positive and defaulter patients,

both male and female, to motivate them for regular treatment. Similarly, DOT

providers who need orientation are called in on a priority basis.

Agenda of discussion

Re-orientation of knowledge component in RNTCP

Introduction of gender components

Review of the activities of each DOT provider

Interaction with each patient

Review points of patient counselling which includes diet and regular sputum

follow-up

Experience of DOT provider and suggestion for improvement

Narration of experience by patients

Patient awareness regarding the disease

Patient as educator/motivator in referred cases

Interaction with defaulters

Cross-checking and updating patient cards

Role-play



Method

Mainly participatory through discussion

Sharing of experiences

Role-play

Quiz

Evaluation and follow-up

The meeting is evaluated at the end of the session through a developed format in

terms of participation, food, venue, defaulter retrieval etc. In the field, DOT providers

and STSs monitor the regularity of the treatment among patients, and STSs monitors

improvement of knowledge on the programme and fills the treatment cards.

1.5.4 Trialogue approachSuccess of any health communication strategy depends largely on the close

interaction and coordination between stakeholders. In RNTCP, this can be done

through the trialogue approach. This is a community-based activity. In thisapproach there are three ‘p’s—the patients, the providers and the people. In this

meeting the participants spend a whole day together, siting on a mat and eating

from a common plates. This meeting gives an opportunity for people to air their

feelings. It also provides an excellent opportunity for women to participate.

Irregular and defaulter cases are specially addressed to identify their problems

and needs, for counselling. Influential people from the community such as

panchayati raj members are encouraged to actively participate in spreading

awareness about TB diagnosis and DOTS.

The trialogue approach reduces the gap between patients, providers and the

community through informal, interactive meetings.

Objectives

To develop a good rapport and reduce social distance between DOT providers,

patients and other programme personnel

To review the knowledge and activities of DOT providers and patients

regarding TB as a disease and provision under RNTCP

To interact with irregular and defaulter cases, identify their problems and

needs for counselling towards retrieval

To promote sharing of experiences between DOT providers and patients on

their problems and success and agree on action for improvement, keeping

the gender component in view

To maintain and promote the motivation level of DOT providers

To facilitate the practice of good counselling and communication skills



Process

A meeting is likely to be held in a PHI twice a year. A calendar is prepared by

the DTO for every round of the meeting. Once the calendar is circulated by

the CDMO/DTO to all PHCs, it is the responsibility of the concerned MO-PHI

to intimate the DOT providers to attend the meeting.

The BEE is the convenor of the meeting and will assist the MO-PHI inorganising and conducting the meeting.

Venue

PHI/PHC headquarters or any other suitable central place convenient to all

participants.

Sitting arrangement

The meeting preferably takes place under a tree, except in the rainy season. All

participants should sit on a mat on the floor in a circle/semi-circle.

Duration

One day.

Participants

DOT providers, both medical and non-medical

Patients under treatment (male/female)

Cured former TB patients (male/female)

Defaulters, all

Other programme personnel like BEE, MO-PHI, LT, STS, STLS, MO-TU and

ICDS supervisor

Selection of patients and DOT providers

To ensure better participation and interaction, patients and providers are limited

to a total of 40-50. Preference is given to all smear positive and defaulter patients,

both male and female, to motivate them for regular treatment. Similarly, DOT

providers who need orientation are called in on a priority basis.

Agenda of discussion

Re-orientation of knowledge component in RNTCP.

Introduction of gender components.

Review of the activities of each DOT provider.

Interaction with each patient.

Review points of patient counselling which includes diet and regular sputum

follow-up.

Experience of DOT provider and suggestion for improvement.

Narration of experience by patients.

Patient awareness regarding the disease.



Patient as educator/motivator in referred cases.

Interaction with defaulters.

Cross-checking and updating patient cards.

Role-play.

Method Mainly participatory through discussion.

Sharing of experiences.

Role-play.

Quiz.

Evaluation and follow-up

The meeting is evaluated at the end of the session through a developed format

in terms of participation, food, venue, defaulter retrieval etc. In the field, DOT

providers and STSs monitor the regularity of the treatment among patients

and STSs monitors improvement of knowledge on the programme and fills thetreatment cards.

1.5.5 Orientation of tribal link workers

Objectives

To improve timely diagnosis and regular treatment of TB cases through a

coordinated effort by involving all partners in community development blocks.

Specific objectives

To improve awareness regarding TB and RNTCP in the entire block area.

To identify and extend block-level partnership for mobilising resources and

for accelerating awareness activities on RNTCP.

Capacity-building of different partners/stakeholders.

To improve the quality of RNTCP services.

To improve the case detection and cure rates.

Target group

All sarpanches , samiti members, zila parishad members.

Selected health workers from different sub-centres (4-5).

Selected AWWs from the block (4-5).

Selected traditional healers (3-4).

NGO/CBO representatives (3-4).

One male and one female volunteer from each gram panchayat .

Venue

Generally, an open-air venue under a tree at the block headquarters is selected

for the training programme. In special circumstances, like rainy weather, the

venue is shifted to a big well-ventilated room, if possible.



Sitting arrangement

All participants, observers and resource persons sit on the floor on a mat in a

circle/semi-circle.


First, district health authorities like the CDMO and DTO are contacted andrequested to organise the orientation programme in a particular block. A request

letter is then issued to the BDO for arranging the activity under intimation to the

concerned PHC MO and SDMO.

A formal meeting is convened of the stakeholders listed below to decide the date

and develop a plan for implementing the orientation programme.

SDMO

MO-PHC

BEE

BDO

Chairman, panchayat samiti

Representatives of one or two active NGOs

CDPO

Two or three sarpanches , if possible.

In the presence of all the above stakeholders, the purpose of the orientation,

selection of participants, logistic arrangements, distribution of responsibility,

selection of date and the venue are discussed. A formal letter mentioning the

date, time and venue of the orientation meeting is issued by the BDO to all

participants and observers.

Resource persons

CDMO/DTO/SDMO

MO-PHC/sector

STS/LT/BEE

CDPO/supervisors

Training session

At the outset, a brief introduction about the orientation session is given by the

CDMO/DTO or SDMO, highlighting the necessity of such orientation, followed by

self-introduction of participants, resource persons and observers. The technical

session then follows.

Content

Highlighting of RNTCP, TB, its cause, mode of spread, signs and symptoms,

categories of treatment, availability of diagnostic and treatment facilities and the

role of link workers. This session is continued till lunch break.



It is conducted through question-answer sessions, discussions, sharing of

experiences, demonstrations (patient, medicine box, sputum container) and

quizzes.

Initially, a number of questions written on a piece of paper are distributed among

the participants. They are encouraged to answer those questions serially, whichare then summarised by the resource person. Likewise, all the topics are covered

by answering all questions, followed by a quiz among the participants, and a

street theatre performance.

After lunch, the participants and the resource person plan the orientation session

at the gram panchayat (GP) level and dissemination of information to every

household through IPC. Dates are finalised among the participating sarpanches

for the training and conduction of IPC. Resource persons like MO-PHC, DTO,

SDMO and DANTB personnel share the responsibility to facilitate the training

camp at gram panchayat level. A detailed calendar of the gram panchayat levelorientation activities is finalized on that day.

Writing and IEC materials used

Writing pads, pens, folders, leaflets, pamphlets, booklets and posters are

distributed among the participants for future reference. Posters, banners,

flipbooks and OHPs are used for training purposes.



CD.

Outcome

Increase of awareness on RNTCP in the community

Involvement of people’s representatives in RNTCP

Increase in the utilisation of RNTCP services

1.5.6 Orientation of cured, former patients as RNTCP advocates

Objective

Capacity-building of cured TB patients to disseminate appropriate information

for better utilisation of RNTCP services in the community.

Duration

One day.



Venue

Block headquarters or any other suitable place that is centrally-located

Participants

Cured, former TB patients, both male and female.

Facilitators

MO-PHI, BEE, STS and LT.


BEE, STS and LT prepare a list of participants in consultation with the MO-PHI

and fix a suitable date for the orientation. A letter is then issued to all participants

requesting them to attend the programme.

Session content

Objective of orientation.

Brief introduction on technical aspects of TB.

Target groups in RNTCP.

Important talking points for different target groups.

Scope of disseminating information.

Use of different IEC materials.

Use of NLDP card.

Aids to be used

Banners, posters, pictorial folder, booklets, pictorial pamphlet and pocket

folders.



CD.

Outcome

Increase of awareness about TB and RNTCP in the community.

Reporting of suspected TB cases increased at outpatient departments

(OPDs).

Reduction of defaulters.

Increase of cure rate.

1.5.7 Orientation for NGOs at district-level

Objective

To apprise NGOs about RNTCP and help them identify their partnership role in

performing specific activities for the promotion of the programme.



Venue

District headquarters/conference hall/community hall.

Duration

One day.

Participants

President and secretary from each NGO.

Resource person

CDMO/DTO/MO-PHI/STS/BEE


Collect the list of NGOs from the CDMO office and compile a profile of NGOs

who are working in the field of health with the government sector. CDMO/DTO

and DANTB staff make the selection of NGOs to be invited. Date, time and venueare decided by CDMO in consultation with DTO, MO-TU, MO-PHI, STS, BEE and

DANTB staff. CDMO then invites the participants (NGO secretary and president)

by a letter to the orientation meeting.

Session content

RNTCP as a programme

Achievements of the RNTCP district

Technical aspects of TB such as its cause, mode of spread, signs and

symptoms, diagnosis and treatment, diet pattern of TB patient, side-effect

of the medicines, availability of treatment facilities and IEC on the gendercomponent


Discussion

Group work

Demonstration

Quiz

Role-play

Snakes and ladders game


OHP, slides, folder, leaflets, booklets, posters, banners and games.



CD.



Follow-up

DTO/MO-PHI contacts the presidents/secretaries of the NGOs who attended

the orientation. A date is decided by DTO/MO-PHI in consultation with the

NGO secretary who selects a suitable venue and informs the participants for

orientation at grassroots level.

Evaluation

After six months, MO-PHI, STS and BEE evaluate the orientation of NGO members

in terms of

no. of NGOs involved in RNTCP activities,

no. of NGOs providing DOT,

no. of NGOs carrying out awareness activities and

no. of NGOs referring suspects.

Documentation

A report on NGO activities is prepared by BEEs

Outcome

Increase of symptomatic cases reporting to nearest PHI.

Increased awareness about TB among community.

Reduced number of defaulters.

Increase in number of NGO DOT providers.

Increase in cure rate.

1.5.8 Sensitisation meeting for PRI members

Objective

To ensure the support of panchayati raj institution (PRI) members for the

successful implementation of RNTCP in their area.

Duration

Half day

Venue

Block headquarters

Participants

Chairman, panchayat samiti

Samiti members

Sarpanches

BDO and other extension officers

DOT providers, patients



Facilitators

MO-PHI/PHC

BEE

STS

Process of organisationMO-PHI discusses with BDO and Chairman of panchayat samiti and fixes a

suitable date. The Chairman of the panchayat samiti informs all participants to

attend the meeting.

Session content

Objective of the meeting


Facilities under RNTCP

Status of TB in the block

Role of PRI members in the promotion of RNTCP


Banners, posters, flipbooks, folders and pictorial pamphlets .

Outcome

Discussion about RNTCP in monthly gram panchayat meetings

Involvement of PRI members in referring suspects and motivating

defaulters.

Follow-upBEEs and DPs attend gram panchayat -level monthly meetings and discuss TB

problems there.

1.5.9 Orientation of SHGs

Objectives

To ensure involvement of SHGs in the dissemination of

information on RNTCP to the community.

To enable SHGs to refer symptomatic cases for sputum

examination.

To enable SHGs to motivate defaulter patients for regular

treatment.

Venue

School building/AWW/community centre/under a tree or any other suitable

place



Duration

Half day

Participants

Two to three representatives from each SHG (50 to 60 participants).

Resource persons

MO-PHI/STS/BEE


CDMO to contact CDPO to discuss the orientation meeting for SHG members

and fix a date.

CDPO to discuss with supervisor in the monthly meeting and select the venue

and time for the orientation.

Supervisor selects the most active presidents and secretaries of SHGs.

Supervisor informs the participants about the orientation meeting or asks AWWs to do so.

Session content

Session starts with success story

Discussion of roles and responsibilities of SHG members towards the

programme, such as

creating awareness about TB/RNTCP during monthly meetings,

organise meetings for women’s groups,

refer chest symptomatic cases to PHI,

be active in defaulter retrieval and if necessary, act as a DOT provider.

Teaching contents

TB as a disease, cause, mode of spread, signs and symptoms, diagnosis

and treatment availability, DOTS strategy, diet of patient and side-effects of

medicines.


Story-telling, discussions, role-plays and demonstrations.


Folders, leaflets , booklets, posters, banners, flipbooks, flash cards and cassette

player with a cassette.



CD.



Outcome

Increase of symptomatic cases reporting to the PHI

Increased awareness on TB among SHG members

Reduced number of defaulters

Examination of sputum at regular intervals

Follow-up

Review activities and re-orientation of knowledge during monthly meetings by

HWs (male/female), AWWs and BEEs.

Evaluation

Responsibility of HW (male/female), AWW and BEE to evaluate every half year:

How many symptomatic cases referred to PHI?

How many TB patients cured?

How many defaulter patients motivated for regular treatment?

How many patients died of TB?

How many TB patients under treatment in their respective places (category-

wise male/female)?

1.5.10 Orientation of volunteers, teachers, students and religiousorganisations

Objective

To ensure the support of NSS/NYK volunteers in disseminating RNTCP messages

in the community.

Duration

Half a day to one day

Participants

NYK/NSS volunteers

Venue

NYK office/college campus/any other suitable place.

Group size

40–50 participants.

Resource persons

MO-TU/MO-PHI/STS/STLS/BEE/Dy. MEIO


CDMO/DTO to discuss with youth coordinator of NYK and MO-PHI to discuss

with NSS programme officer of college for organising the sensitisation meeting.



Session content

Morning session

Assess knowledge of participants about TB

Discuss objectives of meeting

Present status of TB in Orissa and districts What is TB, cause, mode of spread

Signs and symptoms of TB

Diagnosis procedure

Duration of treatment, DOTS strategy, dangers in interruption of medicine

Importance of the follow-up sputum test

Prevention of TB

Review of knowledge by quizzes

Post-lunch session

DOTS implementation in the district Availability of free treatment at nearest PHC/CHC

Discuss role of NSS/NYK volunteers towards RNTCP

Possible role and responsibility

To disseminate messages through IPC/group discussions/camps/village

meetings.

Refer chest symptomatic cases to nearest PHI.

Motivate defaulters for regular drug intake and regular sputum follow-up

examinations.


Lectures, discussions, success stories, role-play, group discussions, snakes and

ladders game and outdoor games (kabaddi)


Banners, folders , flipbooks , exhibition sets, leaflets and booklets



CD.

Outcome

Increased awareness on TB in the community.

Increased chest symptomatic cases reporting to nearest PHI.

Reduced number of defaulters in their respective areas.

Participants interested to act as DOT providers.

Participants involved in various health communication activities organised

by PHI and district-level RNTCP staff.



Follow-up

Monitoring chest symptomatic cases referred by participants.

Technical/programme guidance provided to participants by concerned PHI

personnel.

Involved NYK/NSS volunteers in RNTCP activities whenever necessary in

their PHI. Review activities and re-orient participants at suitable intervals.

All activities to be documented by concerned PHI and programme

personnel.

1.5.11 Orientation of traditional healers, traditional birth attendantsand other indigenous practitioners

Objectives

To enhance knowledge on TB and RNTCP.

To ensure support of participants in the referring of chest symptomatics.

To enable participants to motivate defaulters for regular drug intake.

Duration

Half day.

Venue

PHC/CHC building/school building/NGO office.

Resource persons

MO-TU/MO-PHI/BEE/STS/LT.

Participants

Traditional healers and indigenous practitioners/VHGs/TBAs.


Health workers send a list of traditional healers in their respective areas to the

MO-PHC. The BEE prepares a consolidated list of traditional healers in the block.

The lists of VHGs and TBAs are usually available at the primary health centre.

The MO-PHC decides the date of the sensitisation meeting in consultation with

the DTO/ADMO incharge of TB. The participants are then informed through the

health workers about the date, time and venue of the meeting.

Session content

Facts about TB like cause, mode of spread and signs and symptoms of TB.

Diagnostic procedures, importance of regular treatment and timely sputum

follow-up under DOTS strategy.



Roles and responsibilities of traditional healers/VHGs TBAs in RNTCP such

as

disseminating messages in the community,

referring chest symptomatic cases to the nearest PHI and

counselling patients for regular anti-TB drug intake.

Review of knowledge by quiz.


Discussions, role-plays, live success stories and snakes and ladder game.


Banners , posters , flipbooks, folders, leaflets, booklets and games (indoor and

outdoor)


While planning your activity view the ‘Orientation’ module in the accompanying CD.

Follow-up

Chest symptomatic cases referred by traditional healers to be recorded by

BEE.

Monitoring the number of defaulter/irregular cases counselled by traditional

healer.

Problems associated with TB and programme to be clarified by HW/AWW/

BEE.

After six months, review the activities and re-orientate about knowledge

component.

Outcome

Chest symptomatic cases increased in their respective area.

Reduced defaulter and irregular patients.

Responsibility

Organising meeting and follow-up action by MO-PHI.

Recording and report-writing by BEE.

Supervising the activities of traditional healers by STS/HW worker/AWW.

1.5.12 Orientation of members of CBOsCBOs are usually small voluntary social groups who aim to serve the local

community, especially the under-privileged groups.

Objective

Capacity building of CBOs in organising awareness activities, referring suspects

and retrieving defaulters for promotion of RNTCP.



Duration

One day

Venue

CBO headquarters or any other suitable place decided by them.

Participants

All active members of the CBO.

Facilitators

MO-PHI, BEE, STS

Process of organization

A list of CBOs who are actively involved in other health programmes is available

at the PHC. The BEE/STS, sometimes DANTB personnel, in consultation with

the MO-PHI, contacts concerned CBO and fix a suitable date and place. Thepresident/secretary of concerned CBO informs the members regarding the date,

time and place of such orientation.

Session content

Objective of the orientation.

Technical/social aspects of TB.

Places where diagnosis and treatment facilities are available.

Possible causes of defaulting treatment and ways to retrieve defaulters.

Different types of awareness activities and their scope.

Review of knowledge by quiz.


Banners, posters, flipbooks, pictorial folder and pictorial pamphlet, snakes and

ladders game and outdoor games (kabaddi)



CD.

Outcome

CBOs disseminate information on TB and RNTCP in their locality.

CBOs refer symptomatic cases to PHI.

CBOs retrieve defaulters.

CBOs act as DOT providers.



1.5.13 Training/workshop for CDPOs/supervisors at district-level

Objective

To ensure greater involvement of supervisory staff to encourage and support

AWWs in acting as DOT providers.

Duration

Two days (residential).

Venue

A suitable conference hall/meeting hall.

Participants

CDPO/project officer/supervisors (15 – 20).

Ensure participants from each block by District Social Welfare Officer (DSWO).

Facilitators

Trainer in RNTCP

CDMO/ADMO/DTO/MEIO

STS

Process

A letter is issued by the CDMO/DTO requesting the Collector or DSWO to spare

the ICDS officer and supervisors for the training. After subsequent discussion, a

suitable date and venue is finalised after which DSWO issues a letter to the ICDSofficer and supervisors to attend the training programme.

Session content

Brief introduction of RNTCP.

Status of TB in India, Orissa and concerned districts.

Technical aspects of TB like cause, mode of spread, type of disease, diagnostic

procedure, treatment under DOTS strategy and timely sputum follow-up.

Gender disparities and IEC in RNTCP.

Role of ICDS officials in the promotion of RNTCP.


Lectures, participatory discussions, group discussions, role-plays, quizzes,

demonstrations/return demonstrations, ice-breakers, sputum collection

procedures, medicine strips (no. of days and doses), experience-sharing of cured

patients and follow-up of treatment cards (exercise).



Methodology Contents

Lecture and discussion Introduction of RNTCP


Gender IEC in RNTCP

Demonstration Medicine boxes for treatmentSputum collection procedure

Narration of experiences by patients

Treatment card filling up

Street theatre in IEC

Group work Role of ICDS officials in promotion of

RNTCP

Role-play Counselling of patients for regular anti-TB drug

intakeSupervision of DOT provider

Quiz Assessment of knowledge


Banners, posters, flipbooks, leaflets, booklets, TV, VCR, tape recorder, OHP,

writing materials, folders, mela kits, pocket folders, writing pads, pens, pencils,

erasers, snakes and ladders game, exhibition model.

Outcome Monthly review meeting of AWW at block level.

Routine supervision during field visit of AWWS activities in RNTCP.

Discussion on RNTCP during awareness meeting at project/PHC level.

Involvement in RNTCP activities like workshops/trainings organised by

PHIs.

Report-writing

Report preparation by Dy. MEIO/BEE/MO-TU.

Evaluation



Follow-up

Monthly meeting of ICDS where RNTCP is discussed; health communication

activities planned with responsibility for specific activities shared MO-PHI to

attend the meeting.



During field visits, interaction with AWWs to assess the planned activities

implemented by STSs and BEEs.

1.5.14 Group discussionGroup discussion is a face-to-face interaction between members of a small group

where ideas, thoughts, experiences and feelings are shared.

Participants

Women and men, usually within the reproductive-age-group, who hail from the

same locality and share a common socio-cultural background.

The number of participants usually ranges between 30 and 50. It is a big group for a

short discussion, usually one hour, which is convenient to the group members.

Objective

Objectives will differ from group to group, according to their health-seeking behavioural practices based on their knowledge. One example is to build group

consciousness on a selected topic, e.g. the effects of proper utilisation of RNTCP

health facilities.

Venue

Panchayat office/school/community hall/open-air platform.

Facilitator

BEE/STS/Health Assistant (male/female)/HW (male/female), NGO, volunteers.

Process and Content

The facilitator meets village leaders/PRI members/youth club members/elders

and fixes the date, time and venue for discussion. The topic is also made known

in advance.

Role of the facilitator

Ensure a relaxed and friendly environment for the discussion.

Seating people in a circle in an open-air atmosphere, on the ground is the

best way for discussion. In a circle, there is no ‘head’ and everyone is equal.

Sitting in a ‘U’ shape is the next-best thing.

Tell the group at the outset that each one of them must participate.

Decide on the objective of the discussion in advance and ensure that each

one of the participants understands the issues to be discussed.

Begin with easy questions, with what people will feel free to talk about. This

builds up people’s confidence.

If no one answers a question, ask it again, using slightly different and simpler

language. Give examples.



Do not give up if answers are slow in coming. It will take people time to ‘warm

up’ to this new way of learning.

Always respond politely and with enthusiasm to any answer. Praise

participants when they do respond, even if the answer is wrong:

“Well done.”

“Thank you for your thoughts.”“That’s really interesting.”

Be sure to look at every member in the group. Do not look at only those who

talk - as others will feel discouraged.

If someone puts a question to you, you can direct it to another member by

saying: “That’s an interesting question. Ms. Pushpa, could you respond to Ms.

Leela?”

Help keep the discussion focused on the objective.

Keep and use audio-visual aids whenever required.

Ensure equal participation of all, never allowing one or a few members todominate the discussion.

Encourage members to share opinions (even if wrong), information and

experiences.

From time to time, summarize important points.

The best discussions are those that leave people wishing for more. After an

hour or so, people’s minds begin to wander and not much more learning can

take place.

Complete the process by a quick review of important points and make

someone responsible for a follow-up action.

Evaluation by facilitators and organisers

How well was the group discussion organised?

Attendance (male/female) Nos.

Physical facilitators Good/Adequate/Poor

Was the objective achieved? Yes/No

If No, reasons?

Participation of members – Good/Fair/Poor

If ‘Poor’, reasons?

1.5.15 Kalyani clubsKalyani clubs have been formed under the GoI scheme in nine Doordarshan

kendras all over India. The members of the club watch health programmes

like Kalyani on television and spread health messages amongst people living

in remote areas with no television access. Besides watching these episodes on

television, members of Kalyani clubs are also informed about RNTCP and DOTS,

enhancing their knowledge about TB.



Club members organise dance programmes and plays with TB as the focus. The

performances provide information to patients, providers and the community in

an entertaining way. These performances are telecast on Doordarshan as a part of

the Kalyani episode, spreading awareness about TB amongst a larger audience.

The Kalyani club members are motivated to write about the problems faced by people in remote areas, for telecast through the Kalyani episodes.

Objective

To create awareness among youth to enhance timely detection, treatment

adherence and general knowledge about TB and DOTS.

Target audience

Community—particularly youth.

VenueGenerally, an open air venue near a village is selected for the programme.

Duration

Three to four hours.

Process of organization

District health authorities like the CDMO and DTO are contacted and requested

by Kalyani clubs to organise the programme in a particular block. A request

letter is then issued to the BDO for arranging the activity under intimation to the

concerned MO-PHC Medical Officer and the SDMO. A formal meeting of all these

stakeholders is convened to decide the date and develop a plan for implementing

the programme.

Finally, the Doordarshan officer is informed about the date and venue of the

programme and requested to televise.

Resource persons

CDMO/DTO/SDMO

MO-PHC/sector

STS/LT/BEE


Banners, posters, flipbooks, leaflets, booklets, story boards, tape recorder,

outdoor material.



Follow-up

After the programme, the concerned Kalyani club members are met and their

views ascertained about the success of the programme and possibilities for

organising such events in neighbouring villages.

1.5.16 Workshop on culture and communicationThere are several districts in India where a large section of the population do not

have access to basic RNTCP services in spite of the wide coverage network. The

cure rate in these districts may also be low compared to the national norm of

85 per cent. This could be attributed to varied geographical and ethno-cultural

reasons. In order to motivate patients for continuation of treatment, bridging the

cultural divide is indeed vital.

The workshop on ‘Culture and Communication’ for service providers serves

this purpose. The intent is to make providers internalise the importance of

understanding the culture of the local people and hence to make a consciouseffort for improvement in service delivery.

Objective

Sensitising service providers about geographical and ethno-cultural issues in

order to bridge the cultural divide.

Duration

Two days

Venue A suitable conference hall/meeting hall.

Participants

Traditional healers, STLS, pharmacists, LHV, BEE, MO, ADMO, ADEO, MPHS,

STS, surgeons

Facilitators

Trainers in RNTCP

CDMO/ADMO/DTO

STS

Process

Planning meeting at district level involving CDMO/DTO/Collector for

finalisation of date, venue and participants.

Request letter is issued to all participants to participate in the meeting

CDMO arranges all logistical requirements



Session content

Inauguration

Introductory session where traditional healers introduce themselves

Role play

Lecture on ‘Culture and its Various Connotations’ by a resource person

Training game Group sessions

Presentation of findings by groups

Story exercise and sharing experiences

Concluding session and feedback from participants

Workshop methodology

Lectures, group exercises, training games, role plays, quizzes, ice-breakers,

exercises.

Health communication materialsBanners, posters, tape recorder, register to record comments of participants.

Outcome

Increased sensitivity to cultural issues among service providers and programme

staff.

1.6 Involvement of Other Organisations and Individuals

1.6.1 Orientation of industrial workers

Objective

To ensure early reporting of symptomatic cases by industrial workers and

dissemination of information to other people

Venue

Community hall/club or any other suitable place

Duration

Two to three hours

Participants

Managers/officers/workers

Resource persons

DTO/MO-PHI/STS/BEE and DANTB officer




CDMO/DTO informs the general manager of company.

General manager of company decides the venue, time and date in consultation

with CDMO/DTO.

Company general manager informs the participants about the sensitisation

meeting.

Session content

Technical aspects of TB, its cause, mode of spread, signs and symptoms, diagnosis

and treatment, diet of the patient, side-effects of the medicine and availability of

treatment facility.


Discussions

Demonstrations

Quizzes


Banners, posters, flash cards, flipbooks and leaflets



CD.

Follow-up

MO-PHI/STS to keep regular contact with the MO of the concerned company regarding

referral of chest symptomatic cases and

regular drug intake and timely sputum follow-up where patients are under

DOTS.

Outcome

Increased awareness on TB among industrial workers and their family

members and friends

Increased reporting by suspected cases for sputum examination

1.6.2 Orientation of jail inmates and employeesRNTCP has been implemented in 14 districts of Orissa in a phased manner.

Community awareness and education is one of the important components of

RNTCP. Efforts are on to make every section of the community aware about the

services provided under RNTCP so that it may avail them.



Jail inmates who do not know about the happenings outside the four walls of

the jail need to be sensitised about the new TB programme. Many inmates are

released within a short period of time, either because they committed minor

offences or because they are granted bail. Hospitals/dispensaries have been set

up in district/central jails and designated jail MOs are available in smaller jails to

provide medical care to the inmates.

Objectives

To sensitise jail inmates regarding the signs and symptoms of TB and the

necessity of early reporting for diagnosis and treatment.

To sensitise jail employees to take timely action in referring chest symptomatic

cases

To persuade patients in jail for regular drug intake and sputum follow-up.

Duration

Half a day.

Venue

District/sub-district jail/under a tree in the jail premises.

Participants

All jail inmates, employees, jail MOs, pharmacists.

Date

A convenient date for participants and facilitators.

Facilitators

District/PHI

District level—MO-TU, STS, Dy. MEIO, STLS, LT

PHI level—MO-PHI, LT, BEE


Planning at district level for finalising date, venue and selection of facilitators

by CDMO

Letter to jail superintendent at district-and sub-district levels by CDMO.

Finalisation of date, time and number of participants to attend by jail

superintendent.

Information to jail employees—Jail Superintendent.

Logistics arrangement for participants—MO-TU, STS, Dy. MEIO, BEE, LT.

Session content

Cause of TB, mode of transmission, symptoms, diagnostic procedure and

treatment facilities available.



Importance of regular medicine intake, sputum follow-up and normal diet.

Identification of defaulter/irregular patient, if any.

Health check-up for symptomatic cases.

Sputum collection.

Role of jail employees for taking timely action in relation to TB.


Lectures, participatory discussions, group discussions, role-plays, demonstration

of sputum collection procedure and quizzes


Banners, posters, flipbooks, leaflets, booklets on RNTCP messages and folders.



CD.

Outcome

Regular discussion on RNTCP among jail inmates and employees, including

jail MO, jail pharmacist and BEE.

Identification of symptomatic cases.

Cases referred for sputum examination.

Report-writing

BEE/Dy. MEIO/MOTU.

1.6.3 Sensitisation workshop for journalists Workshop for journalists can be organised at state, district and block levels.

Objectives

To raise the media’s awareness about issues pertaining to TB.

To enhance the quality of reporting and seek the media’s cooperation in

disseminating news and views on TB and spreading awareness that DOTS is

effective and free.

Participants

Journalists from leading newspapers with an interest in developmental and

health issues.

Programme providers of RNTCP.

Patients who can narrate their experiences or who are DPs.

DOT providers (health and non-health).

NGO representatives.

Key stakeholers such as, Director (IEC)/District MEIO/DIPRO/BDO/zila

parishad chairman/panchayat samiti members.



Venue

Panchayat office/block office/DRDA/Collectorate/SIH&FW

Duration

Half a day to one day

Facilitators

State-level—Director/Dy. Director, IEC, Jt. Dir./Dy. Dir (TB), DANTB staff,

Asst. Prof. ATD&TC, Director, AIR, Director, Doordarshan, zila parishad

Chairman.

District-level—CDMO, MO-TU, ADMO (Med./TB), MEIO, DIPRO, Station

Director (Doordarshan/AIR), DANTB staff, STS.

Block-level—ADMO (Med./TB), MO-TU, MO-PHI, BEE, BDO, Chairman of

panchayat samiti .

Process of organisation Contact the State Press Bureau personally to obtain a list of editors of

important dailies/magazines/news agencies.

Make personal visits to editors/sub-editors after making appointments.

Explain objectives clearly, speak about RNTCP and expectations in the area

of developmental journalism. Request for suitable participants to attend the

workshop. Thank them in anticipation.

Letter of invitation should be sent from the head of the health system:

Dir. of Health Services, State level

CDMO, district-level

MOTU, block-level As part of the media workshop, prepare a written document of RNTCP

activities in the relevant area, with attention-getting headlines. This may be

on different sheets of paper, all put into a folder that will stimulate reading.

Give an address/telephone number of someone who could be contacted if

they need further information.

Session content

Technical and social aspects of TB

Interaction with patients and DPs

Interaction with programme personnel

Street theatre performance

Identify role of journalists in the promotion of RNTCP

Suggestions to be discussed and noted for follow-up.




Mela kits, exhibition models, posters, leaflets, banners, folders and story

book.

Outcome

Interviews with DPs/patients/programme personnel and other informationand news on RNTCP published in newspapers/magazines.

Visits to PHIs/interaction meetings of DPs, patients and providers for regular

press releases.

Meetings at intervals for continuous update of activities.

1.7 Monitoring, Evaluation and Research

1.7.1 RNTCP programme documentationThe successes and failures of a programme must be documented for others to

make use of the experiences gained in other contexts. Innovative approachesand activities which lead a programme to achieve its goal must be shared with

other agencies and possibly replicated in similar programme.

Objective

To present an overview of programme objectives, approaches and achievements

to different stake-holders.

Target audience

Policy-makers

Administrators All health staff in government, private and public sectors

Donor agencies

Format

Publication

Video documentary

Contents

RNTCP background

Extent of TB problem

Process of documentation pertaining to activities in focus

Innovative approaches used

Success in RNTCP



Process of documentation

Relevant operational research, evaluation or documentation techniques

tailor-made to the specific issue/problem.

Consultancy to professional film-maker with adequate experience in video

documentation in government and public sector. Script developed in

collaboration with programme staff.

Issues for documentation

Activities and issues for documentation should be identified through discussions

with DHS, DDHS, DANTB and CDMO/DTOs of the concerned districts. A number

of examples are given below:

Reporting of symptomatic cases and diagnosis of TB

DOTS at grassroots level

Different health communication activities

Monitoring and supervision

Views and perspectives of relevant programme staff



IEC Resource Centre of Central TB DivisionUser Guidelines

Annexure 2

BackgroundThe Government of India and partners supporting TB interventions have long felt

the need for a web-based Resource Centre for IEC material related to TB control

for the benefit of those involved in RNTCP. As a response to this need an IECResource Centre has been set up by the Central TB Division, Ministry of Health

and Family Welfare with the support of DANTB and Danida.

HighlightsThe RNTCP IEC Resource Centre is accessible as a link from the CTD website,

www.tbcindia.org. The Resource Centre houses specifications and digital formats

of representative TB-IEC material being used in the programme. It is a useful tool

in information sharing that is crucial to strengthen IEC activities in TB control

in India. Users (STOs, NGOs, RNTCP staff, researchers, CBOs and others) can

register themselves at the website and access the TB-IEC material database. A search facility has been provided for easy selection of material using a set of

simple criteria. A help link is provided on the website to guide users.

Rationale of the IEC Resource Centre The IEC Resource Centre houses a selection of IEC materials for RNTCP

available online for inspiration and replication at local levels.

Online users will be able to access material produced at national, state- and

district levels for a wide range of different target groups using different types

of media.

The IEC Resource Centre will help to strengthen the capacities of programme

staff in the adaptation and usage of IEC material.

Features of the Resource CentreThe Resource Centre houses specifications and digital formats of representative

TB IEC material. The user can navigate the website, register as a member, view



and search the database of existing materials using keywords and download

images and text.

Users of the Resource Centre are encouraged to submit their e-mail ID while

signing in and registering as members so that they may receive updates on the

Resource Centre as and when such updates are available.

The IEC material database, which is the backbone of the Resource Centre, stores

information about each IEC material, specifying the nature of the IEC material,

languages available, target audience, type of use and other information relevant

to the appropriate use of the material. The material can be downloaded in digital

format in medium resolution (not print quality). All material in regional languages

is accompanied with translations/synopses in English and Hindi. Images of all

print material such as posters, flipbooks and leaflets, are available in portable

digital format. Other non-print material such as audio tapes and video films have

a synopsis of the material.

All IEC materials are uploaded through a single point administrator at the CTD to

maintain the integrity of the Resource Centre.

Using the Resource CentreUsers can search for a particular IEC material by using either the simple or the

advanced search facility. The simple search facility allows the user to search for

IEC material based on media type, target audience and type of material. The

advanced search allows the user to search using other criteria, in addition to the

ones mentioned above, such as title, language, area of use etc.

Simple search An example is search for a poster on symptoms of TB. To find samples of posters

on symptoms of TB, first conduct a simple search. Under ‘Media/Media Type’

click on the ‘Print’ dropdown menu and select ‘Poster’. Under ‘Target Audience’

select ‘General Public’ and then click ‘Submit’. The simple search is generally

very broad and gives search results that will include all print material for general

awareness.

Advanced searchThe advanced search helps in defining the parameters and produces more

focused results. The advanced search has additional parameters that include

type and area of use and language. The ‘Material Title’ and ‘Produced by’ fields

give more precise results.

Search resultsThe results page will display thumbnail icons of the materials along with titles



and brief descriptions. Click on the result that fits the requirements best.

Specific resultsOn clicking the result, a fresh page will open. It will have the title of the material

above the visual. The information matrix gives the details including objectives,

message route format, target group, year of production and the producer.

Modification/Adaptation of Material from Resource CentreUsers who are interested in reproducing the material should check the suggested

modifications/other remarks.

A significant objective of the Resource Centre is to facilitate standardisation of IEC

messages and material across the country without compromising the contextual

and cultural needs of different regions and target groups. Users of the Resource

Centre can freely modify or adapt the material for use in their area.

While modifying or adapting the material, care should be taken to use the

standard RNTCP logo and messages and the latest RNTCP data.

Pre-testing of Material After modifying or adapting material from the IEC Resource Centre, it is strongly

advised that they be pre-tested among the intended target audience.

Pre-testing means field-testing IEC material before they are mass-produced. It is



an important yet often neglected aspect of developing IEC materials. Pre-testing

is a cost-effective mechanism to prevent expensive mistakes. There is often a gap

between the communicators who develop the IEC material and the target groups

for whom the material is intended. Pre-testing helps to assess the effectiveness

and relevance of the material for the target group. The focus on pre-testing should

be on attention, comprehension, relevance, credibility and acceptability. To beeffective, pre-testing must be accurate, well-planned and executed.

The pre-test results should be analysed, assessed and critically reviewed. Based

on the pre-test findings the material should be modified to make it more relevant

and effective to the target group.

Submitting Material to the Resource CentreThe Resource Centre is a dynamic site. The CTD will be reviewing and updating

IEC material produced by different agencies all over the country. If you wish to

submit the IEC material you have produced recently for inclusion, please sendsamples (two copies) to the CTD at the following address. Please also provide the

month/year of production, details of pre-testing and contact address.

Plesae address your mail to

IEC Consultant

Central TB Division


Ministry of Health and Family Welfare

Nirman Bhavan

New Delhie-mail: [email protected]

www.tbcindia.org



Index of Materials Available in the Central TBDivision’s Web-based IEC Resource Centre

Annexure 3

ID No. 1, 3-5

Type of Material Brochure

Material Title TB: A Guide for the Health Provider

Area of Use Rural, Urban

Target Audience Service Providers

Language English, Gujarati, Malyalam, Telugu

Objective To educate health service providers

on TB, types of TB, diagnosis,

treatment process under DOTS,

drug administration and side effects.

To guide health service providers

on messages to be conveyed to the

patients

ID No. 6Type of Material Flipbook/chart

Material Title Tuberculosis Control


Target Audience Patients, Community, Service Providers

Language English

Objective Spread awareness about TB and DOTS

ID No. 8, 9-10

Type of Material Booklet Material Title Use DOTS, Stop TB

Area of Use Urban

Target Audience Patients

Language English, Hindi, Marathi

Objective Provide complete information about

DOTS and encourage the patient to

complete treatment



ID No. 11, 12-21

Type of Material Poster

Material Title My wife is second to none


Target Audience Community, General Public

Language English, Hindi, Gujarati, Bengali,Kannada, Malyalam, Marathi, Oriya,

Punjabi, Tamil, Telugu

Objective To spread the message that women TB

patients should not be discriminated

against

ID No. 22, 23-32


Material Title DOTS System

Area of Use Rural, UrbanTarget Audience Patients, General Public

Language English, Hindi, Gujarati, Bengali,

Kannada, Malyalam, Marathi, Oriya,


Objective DOTS services are available free at your

nearest health centre for free

ID No. 33, 34-43

Type of Material Banners

Material Title Adopt DOTS if test confirms TB






Objective To spread awareness about TB and its

cure through DOTS

ID No. 44, 45-54

Type of Material Sticker

Material Title DOTS System


Target Audience Patients, General Public




Objective To spread awareness about DOTS

strategy



ID No. 55, 56-57

Type of Material Booklet

Material Title Now Free TB Treatment Through Your

Own Doctor!

Area of Use Urban

Target Audience Patients, General PublicLanguage English, Hindi, Marathi

Objective To inform potential patients about

DOTS and free treatment

ID No. 58, 59-60

Type of Material Flipbook/chart

Material Title TB: A Communication Aid for Health

Providers

Area of Use Urban

Target Audience PatientsLanguage English, Hindi, Tamil

Objective To help health service provider in

communicating effectively with the

patient

ID No. 61, 62-71


Material Title “Towards Freedom from TB…” series

(Zaheer Khan)






Objective To spread the message that TB is a

widespread disease but is completely

curable with DOTS—diagnosis and

treatment process is free



ID No. 72, 73-82


Material Title TB can be cured with DOTS (Rahul

Dravid)


Target Audience Patients, General PublicLanguage English, Hindi, Gujarati, Bengali,



Objective To advocate DOTS and that TB is

completely curable with DOTS and

diagnosis and treatment process is

free

ID No. 83-84, 88-96Type of Material Poster

Material Title Leaving TB treatment incomplete

can…






Objective To spread awareness about dangers of

incomplete treatment

ID No. 97-107


Material Title DOTS—sure cure for TB (Rahul

Dravid)






Objective To advocate DOTS as the best system

for treatment



ID No. 108-118


Material Title “We adopted DOTS and lost nothing”





Objective To spread the message that DOTS is

the best strategy for sure cure of TB

ID No. 119-129


Material Title “I completed TB treatment and gained

a happy life” Area of Use Rural, Urban





Objectives To spread the message that

completing the treatment is very

important and DOTS is the best

strategy for sure cure of TB

ID No. 130-140


Material Title Do’s and Don’ts


Target Audience General public




Objective To spread awareness about TB



ID No. 141-151


Material Title Facts about Tuberculosis


Target Audience General public



Objective To spread awareness about TB

ID No. 152-162


Material Title Towards Freedom from TB


Target Audience Patients, General PublicLanguage English, Hindi, Gujarati, Bengali,



Objective To spread awareness about TB, its

main symptoms, diagnosis, DOTS and

treatment

ID No. 163-173


Material Title Myths and Realities






Objective To dispel myths related to TB

ID No. 174-184


Material Title DOTS system now closer to you


Target Audience Opinion leaders, General Public




Objective To show the rapid increase in DOTS

coverage



ID No. 185-195


Material Title Service to you is our responsibility





Objective To convey that health service

providers in RNTCP are approachable

ID No. 196-206

Type of Material Balloon

Material Title DOTS—sure cure for TB

Area of Use Rural, UrbanTarget Audience Community, General Public




Objective To spread awareness about TB and its

cure through DOTS



Index of Health Communication MaterialsUsed in Orissa

Annexure 2 provides further details about each IEC material developed for

RNTCP Orissa. It is hoped that this would facilitate the replication of materials

elsewhere. Please note that Annexure 1 refers to the numbered items of Annexure

2, so that it can easily be inferred which IEC activities need which IEC materials.

No. 1

Type of Material Pictorial folder

Title in Oriya Chabitia Katha Tia

Title in English One Picture —One Message

Content Cause, mode of spread, signs

and symptoms of TB

Language Oriya

Target Audience Special ly developed for

illiterate audiencesRemarks Developed by a tribal group

and based on the perception

of tribals

No. 2

Type of Material Folder

Title in Oriya Jakhma Rogamukta Samaj

Gathana Pain Eka Nibadana

Title in English Appeal for control of TB topeople’s representatives

Content Role of people’s representatives

in the promotion of RNTCP

Language Oriya

Target Audience People’s representatives

Annexure 4



No. 3


Title in Oriya Saria Deichi Chithi

Title in English Saria writes a letter

Content RNTCP and TB messages in story form

Language OriyaTarget Audience Neoliterate groups

No. 4


Title in Oriya Jakhma Roga Bhala Hoi Paruchi Ma

Title in English TB is now curable

Content All facts on TB including symptoms,

diagnosis and treatment procedure

Language OriyaTarget Audience Patients and general community

Remarks Mainly for patient education

No. 5

Type of Material Leaflet

Title in Oriya Jakhma Roga Samparkare Keteka Janib a

Katha

Title in English Some important information about TB

Content Facts on TB, availability of diagnosis and

treatment under RNTCP

Language Oriya

Target Audience General community

No. 6

Type of Material Pictorial pamphlet

Title in Oriya Jakhma roga arogya sadhya

Title in English TB is curableContent Symptoms of TB and availability of diagnosis

and treatment

Language Oriya and Alchick

Target Audience General and tribal communities

Remarks Specially developed for IPC



No. 7

Type of Materi al Poster

Title in Oriya Jhara, funka, guni, tuni se yugara katha

Title in Alchi ck Ran murgan omkhari agli halflam ktha

Title in English DOTS cures TB

Content To undertake DOTS for TB

Language Oriya and Alchick

Target Audience Patients and general/tribal community

No. 8


Title in Oriya Heu pachhe ma tara jakhma rogitia sisu pain

ma khira amruta parai

Title in English Encouraging breast-feeding even if motheris under DOTS

Content Value of breast-feeding during DOTS

Language Oriya

Target Audience Patients and general community

No. 9


Title in Oriya Tinee hapta dahari jadi lagirahe kasa kapha

parakhiba jai dakatar pase

Title in English Get your sputum examined if you are

coughing for three weeks

Content Symptoms of TB

Language Oriya


No. 10

Type of Material PosterTitle in Oriya Tinee hapta hela na chhade kasa ebe jiba

dakatar pase

Title in English Go to the doctor if cough persists for three

weeks

Content Encouraging early diagnosis of TB

Language Oriya




No. 11


Title in Oriya Enetene chepa pakantu nahin

Title in English Do not spit any- and everywhere

Content Precaution for sputum disposal

Language OriyaTarget Audience Patients and family members

No. 12

Type of material Poster

Title in Oriya Amara lakhya ati kaamre 85 vage jakhma

roginku rogamukta ariba

Title in English Our objective is to cure at least 85% TB

cases

Content Objective of RNTCP

Language Oriya

Target Audience Health personnel

No. 13


Title in English Tr e a t me nt r e gi me n, sput um

examination

Content Treatment category and sputum

follow-up

Language English

Target Audience Medical officers and laboratory

technicians

Remarks Reproduced from key concept, to

display in OPDs and laboratories

No. 14


Title in English Treatment

Content Types of patients under differenttreatment categories

Language English


technicians

Remarks Reproduced from key concept, to

display in OPDs and laboratories



No. 15


Title in English Diagnosis

Content Diagnostic procedure

Language English


technicians

Remarks Reproduced from key concept, to display

in OPDs and laboratories

No. 16

Type of Material Game

Title in Oriya Sapa and Sidi

Title in English Snakes and Ladders

Content Right answers go up the ladder, wrong answers fall into the mouth of the snake

Target Audience For SHGs, youth groups and mahila

mandals

No. 17

Type of Material Flipbook (two types)

Title in Oriya TB/jakhma roga bisayare kichi

jani ba katha

Title in English Facts about TB

Content Different aspects of TB withrelated pictures

Language Oriya

Target Audience Health workers and trainees

No. 18

Type of Material Flash card

Title in Oriya Training Guide

Content Different aspects of TB

with related pictures

Language Oriya

Target Audience Health workers and

trainees



No. 19

Type of Material Cloth banner (10’ x 3’)

Title in Oriya Apana Janichhanti ke? Jakhma roga arogya sadhya

Title in English Do you know? TB is curable

Content Curability of TB

Language Oriya


Remarks One set containing 10 pieces used during group discussions

and other small training programmes.

No. 20


Title in Oriya Mane rakhantu - Chikicha majhir jadi Apana ousda sabana

banda karanti, tebe rogo sangatik akara dharana karipara

Title in English Please remember - if you stop treatment the consequences

can be dangerous

Content Danger of irregular treatment

Language Oriya




No. 21


Title in Oriya Nija ghara rahi adhunika ousad bebahara kari Jakhma rogaru

mukta huantu

Title in English Take drugs at home and be curedContent TB patients can be treated at home

Language Oriya


No. 22


Title in Oriya Jdi apanku kramagata bhabe tinee hapta kasa lagi rahithya

ba jyar hoithya, sanga sanga dakatarnka sa paramrsa karntu

o kapha ra tinoti namuna parikhya karai niontu

Title in English If you are coughing for three weeks, get three specimens of

sputum examined

Content Symptoms of TB and examination of three samples of

sputumLanguage Oriya




No. 23


Title in Oriya Jani rakhantu - Jakma rogara niyamita chikicha samatha

sarakari swasthya kendrare bina mulyare karajeithya

Title in English Free diagnosis and treatment of TB is provided at all PHIsContent Diagnosis and treatment of TB available free of cost in health

institutions

Language Oriya


No. 26Type of Material Cardboard poster

Title in Oriya Jani rakhantu

Title in English Remember some inportant facts

Content Preventive measures for TB

Language Oriya


No. 24

Type of Material Cardboard poster

Title in Oriya Eha gurutua purna

Title in English This is really important

Content Regularity of treatment

Language Oriya


No. 25


Title in Oriya Bastabata

Title in English True facts

Content Measures to prevent spread of TB

Language Oriya




No. 27


Title in Oriya Jani rakhantu

Title in English Remember some important facts

Content Diagnosis of TBLanguage Oriya


No. 28


Title in Oriya Apna kana jananti?

Title in English What do you know?

Content Problem of TBLanguage Oriya


No. 29

Type of Material Cinema slide

Title in Oriya Apananku tini saptaha kasa

heuchiki?

Title in English Are you coughing for three

weeks?

Content How to suspect TB and what to

do

Language Oriya




No. 30

Type of Material Video cassette

Title in Oriya Sabitri

Title in English Sabitri

Content A film about a TB patient who died due to negligenceLanguage Oriya


No. 31

Type of Material Audiocassette (rural)

Title in Oriya No title

Title in English No title

Content Songs about TB symptoms, diagnostic procedure, importance

of regular treatment etc.

Language Oriya


No. 32

Type of Material Exhibition set (wooden)

Title in Oriya Raimani takes DOTS and is cured

Title in English A Success Story

Content Songs about TB symptoms, diagnostic

procedure, importance of regular treatment,

etc.Language Oriya, English


Remarks One set containing 15 storyboards

No. 33

Type of Material Mela kit

Title in English Mobile exhibition unitContent Various information materials on

different aspects of TB

Language Oriya

Target Audience Patients and general

community

Remarks Folding stall with information on TB



No. 34

Type of Material Bounded cloth board

Title in English World – India Statistics of TB

Content Statistical information on TB in

IndiaLanguage English/Oriya

Target Audience Health personnel/trainers/NGOs

No. 35

Type of Material Folding cloth banner

Title in Oriya Adharu ausadha band karaktu nahin

Title in English Do not stop treatment in the middle

of a course

Content Symptoms, diagnostic procedure,

importance of regular treatment etc.

Language Oriya

Target Audience Patients

Remarks One set five

No. 36


Title in English Shanta – Model Community

Mobiliser

Content IEC activities in RNTCP

Language English

Target Audience Community health providers, IEC

staff



No. 37


Title in Oriya Jakhma - prana binasakari hele madhya arogyo sadhya

Title in English Tuberculosis—A curable killer

Content Introduction of RNTCP and DOTS strategy in Orissa

Language English

Target Audience Health administrators/donor agencies/trainers

No. 38

Type of Material Pocket folder

Title in Oriya Paribartita jatiya jakhma niantran karyakram

(sankhipta suchana)

Title in English Revised National TB Control Programme

Content Basic information on TB

Language Oriya

Target Audience Political representatives PRI members NGOs

teachers

No. 39

Type of Material Audiocassette for the Santhal tribe

Content Songs about TB symptoms, diagnosis procedure, importance

of regular treatment etc.

Language Alchick Target Audience Patients and general community



No. 40

Type of Material Folder with success stories

Title in Oriya Sabo muhon re hasso

Jhauli lata re phoolo

Moo Ethiru kano pauchi tume kano

bujhibo

Ghanti phuni bajilani

Ae kano sathore kimia na kano

Tanka gudiko panire pakai dele sinna…

Koti kare gotia

Nijo jibho nijo hato re kati deli

Sato kahibaku kiyan daribi

Mu para eveready battery

Title in English To be happy and make others happy

Happiness regained

Noble investment

Preaching DOTS

DOTS - the saviour

Paid a price to learn a lesson

One in a million

Duped by a quack

Want to hear my story?

Yours always

Content Small case narratives of patients who

suffered from TB

Language Oriya and EnglishTarget Audience Providers and patients

No. 41

Type of Material Paper belts

Title in Oriya Baidya/DP

Title in English Traditional Healer/DOT Provider

Language Oriya

Target Audience General community (this belt is used

by participants in a mock kabaddi

game, one side representing traditionalhealers and the other side representing

DOT provider)



No. 42

Type of Material Apron

Title in Oriya Pratyakha tattwabadhanare ausadha khai

mun Jakhama rogoru arogya hoichi

Title in English I was cured of TB by taking the medicines

under direct observation

Content Used by participants in rallies

Language Oriya


No. 43

Type of Material Cap

Title in Oriya TB safala chikitsha ra sathika jawab

DOTS

Title in English DOTS—sure cure for TB

Language Oriya

Target Audience General Community

No. 44

Type of Material Pocket Folder

Title in Oriya DOTS subidha apanantu, Jakhma rogoru

mukti huantu

Title in English Adopt DOTS and get rid of TB

Content A brief outline of DOTS and precautions

to be taken during treatment

Language Oriya

Target Audience Patient

No. 45


Title in Oriya Laboratory technician kaan pain keteka

manerakhiba katha

Title in English Few things for the Laboratory Technicians

to rememberContent Information on sputum microscopy

Language Oriya

Target Audience Laboratory technicians



No. 46

Type of Material Certificate of recognition

Title in Oriya Priya DOT Provider

Title in English Dear DOT Provider

Content This is given to DOT providers in

recognition of their work

Language Oriya

Target Audience DOT providers

No. 47


Title in Oriya Chaalo aabe aame gaaonku jiba,

Jakhma rogo katha bujhai deba

Title in English Come lets go to our village and give the

message about TB to everybody Content Description of signs and symptoms

of TB the importance of DOTS and

RNTCP in a nutshell.

Language Oriya


No. 48

Type of Material Flipbook

Title in Oriya DOT Provider kaan pain sankhipta

talim pathyakrama

Title in English A brief curriculum for the DOT

Providers

Content Detailed description of the symptoms

of TB, the role of DOT providers and

the importance of adopting DOTS.

Language Oriya




No. 49

Type of Material Banner

Title in Oriya Aangyan tike sunantu

Title in English Kindly listen

Content This pictorial banner aptly describes how a person is curedof TB, in the words of the cured patient

Language Oriya


No. 50


Title in Oriya DOTS pradanakari kaan pain ketoti

suchana

Title in English Some information for the DOT Provider

Content Brief information about the role of DOT

providers.

Language Oriya


No. 51Type of Material Poster

Title in Oriya DOTS pradatire hin Jakhma arogya

sadhya

Title in English The only cure for TB is DOTS

Content Adopt DOTS under the supervision of one

person

Language Oriya




No. 52


Title in Oriya TB parikhya abang chikitsha saamasta

sarakari swastya kendra re maaganare

mile

Title in English Free treatment for TB is available in all

government medical centres

Content Signs and symptoms of TB and the importance of DOTS

Language Oriya


No. 53

Type of Material TV spots (two)

Title in English DANTB DOTSContent Messages on DOTS and TB

Language Oriya


No. 54

Type of Material Badge

Title in English DOTS—sure cure for TB

Language English




User Guidelines for the HealthCommunication Video Modules CD

Annexure 5

Learning from past experience, the RNTCP is currently engaged in strengthening

IEC activities and institutionalising successful models through further training

and dissemination of the communication strategy, and developing mass media

campaigns for the entire country. This series of IEC video modules has been

developed with this requirement in focus.

The modules are in VCD and VCR format. So, they are appropriate for viewing

by small audiences consisting of about 20 members. They can be viewed on a

television or on a computer screen.

The modules capture the essential elements of implementing a particular

communication activity in RNTCP.

The modules are organised as follows:

Module 1 – Introduction

1. RNTCP-DOTS

2. TB situation in Orissa

3. IEC strategy—goals, target, audiences, components, responsibilities

4. The trialogue approach

Module 2 – Orientation

1. Orientation of SHGs2. Orientation of traditional healers

3. Orientation of students and teachers

4. Orientation of PRIs

5. Orientation of cured patients

6. Orientation of NGOs

7. Orientation of industrial workers

8. Orientation of jail inmates



Module 3 – Advocacy and Social Mobilisation

1. Exhibitions

2. Mass rallies

3. Interactive stalls

4. Puppet show 5. Training on street theatre technique

6. Performances of street theatre groups

7. Group discussions

Module 4 – Types of Health Communication Material andTheir Use

1. IEC material development workshop

2. Pre-testing of IEC material

3. Media workshop4. Use of IEC material

Posters

Storyboards

Pamphlets, booklets, folders

Banners

Audio/video cassettes

Games, quizzes

Flipbooks, flash cards

Mela kits Exhibition sets



Permissible Budget as per NormsTargetGroup/Objective

Activities Planned at District-/State-level ResponsibleOfficerfor These Activities

Estimated Costper Activity Unit

Activity (all activities tobe planned as per localneeds, catering to thetarget groups specified)

No. of ActivitiesHeld inLast FourQuarters

No. of Activities Proposed inthe Next Financial Year,

Quarter-wise

Apr-Jun

July-Sep

Oct-Dec

Jan-Mar

Patients andGeneral Public/For awarenessgenerationand social

mobilisation

Outdoors• Wall paintings• Hoardings• Tin plates• Banners

• OthersOutreach activities• Patient-provider

interaction meetings• Community meetings• Mike publicity • Others

Puppet shows/streetplays etc.

School activities

Print publicity • Posters• Pamphlets• Others

Media activities on cable/local channels/radio

Any other activity

Opinionleaders/NGOsfor advocacy

Sensitisation meetings

Media activities

PowerPoint presentations/one-to-one interaction

Information booklets/brochures

World TB Day activities

Any other public event

Healthcareproviders• Public and

private

• CME programmes• Interaction meetings• One-to-one interaction

meetings

• Information booklets• Any other

Any otheractivitiesproposed

Total Budget

Suggested Format for PlanningActivities at State and Dis

Annexu



IEC Reporting Formats

Annexure 7

Reporting Format of DOT Patient-provider InteractionMeeting

Name of the PHI

1. Date of Meeting 2. Place

3. Time Started 4. Time Ended

1. Attendance ( please write the number of persons attending)

Type of Participant Female Male

Patients

Category I

Category II

Category III

Cured/treatment completed

Irregulars/defaulters

Relatives of patients

DOT providers (DPs)

Multi-purpose Health Workers

Laboratory technicians

Pharmacists

Anganwadi workers

Balwadi workers/balwadi teachers

Village Health Guides

Panchayat members

NGO workers

Cured patients working as DPs Teachers

Others (specify)



Supervisory Staff/Health Authorities Present Not present

DTO

MO-PHI

STS

STLS

MPHS

CDPO, Anganwadi supervisor

Others (please specify)

2. Activities Conducted (please tick the appropriate columns) YES

Activities Lecture GroupDiscussion

Role-play Quiz Individual Counselli

Updating knowledge regarding:

Different categories of patientsand associated treatment

How TB is caused and spread

Number and timings of sputumexaminations required andreason

Dangers associated withdefaulting

Diet

Maintenance of cards

How to handle side-effects

Responsibilities of DPs

Other (specify)

Raising gender issues

Delay in diagnosis

Stigma/fear of rejection

Other (specify)

Cross-checking of patient cards

Review of each DP’s activities

Individual interaction between

DP and her/his patients

Sharing of DP’s experiences

How to ensure timely sputumexamination

How to ensure timely drug pouch collection for new patients

How to promote regular drug intake



Problems in getting supportfrom supervisors

Others (specify)

Sharing of patient’s experiences

Problems encountered in

accessing RNTCP services

Benefits from regular treatment

Others (specify)

3. Problems, Solutions and Responsibilities3.1 Defaulter retrieval

(to be carried out within seven days of meeting)

Fill in these three columns during the meeting Fill these two columns after visit to patient (enter code no.)

Name and address of defaulter Who will visit? When? What action was taken?

Patient counselling

Family counselling

Involved village leaders

Involved cured patient

What was theoutcome?

Patient resumedtreatment

Patient refused

3.2 DOT providers1. Is there a need for a special refresher course for this PHIs’ DOT providers? Yes/No

If ‘Yes’, why?

When should it be held?

Who should conduct it?

2. Is there a need to train additional DPs for this PHI? Yes/No

If ‘Yes’, how many?

Why?



4. Please comment on the following aspects of the meeting.Good Average P

Attendance

Participation by patients in activities

Participation by DPs in activitiesPunctuality, keeping to time schedule

Meeting hall arrangements

Drinking water arrangements

Quality of food

Transport arrangements

4.1 Did patients, DPs and supervisory staff eat together? Y

5. Do you have any other comments regarding this interaction meetingmention positive and negative observations.

6. Please give suggestions for improving theinteraction meetings.

Name, designation and signature of the reporter with date:



Reporting Format on Street Theatre Performance

1. Date and time of performance

2. Place of performance

Village

Sub-centre/ gram panchayat

District

3. Approx. no. of audience

Male

Female

Children

4. Name and designation of local health staff present

5. Local popular persons witnessed the show (obtain their signature and comments)

6. No. of symptomatics reported at the end of show (if any). Mention their names andaddresses.

7. Technical queries compiled by

Name

Designation

Signature of reporter

(Street theatre team)

Health Communication Strategy for RNTCP

Documents

Transcript of Health Communication Strategy for RNTCP