Has India's TB Programme Undermined TB Advocacy?

Advocacy, communication and social mobilisation is an integral part of any national TB programme. To achieve the global targets of 70% case detection rate and 85% cure rate among TB patients, the countries are guided by the Global Plan to Stop TB which provides a roadmap for the fight against TB for a 10-year period (2006-2015).1 WHO recommends an ACSM framework for national TB programmes that aims to address four key challenges: (1) case detection and treatment adherence, (2) stigma and discrimination, (3) empowering affected people and (4) mobilising political commitment and resources necessary for TB control.2 In India, although the national TB programme has been implementing the global plan in totality since 2006 onwards, the ACSM component has taken a backseat in terms of creating awareness among the public and the involvement of community and non-governmental organisations to garner the momentum to fight TB at local levels.There is a profound lacuna in implementing the globally advocated ACSM strategies. The shortcomings in implementation could be due to sub-optimal political and administrative commitment, lagged health systems and biased mindsets of health workers. The gaps and the pragmatic solutions for better ACSM implementation in the programme are enumerated below.In India, health is a state subject and the centre provides technical guidelines and a major share of funds for the programme implementation through the general health system. Currently, the ACSM component under the programme is plagued with limited capacity to plan and execute it with precision. Unavailability of desired funds and continued shrunken allocations is a vicious cycle harboured within states; the country spends a meagre 2% of the total Revised National Tuberculosis Control Programme (RNTCP) budget on ACSM.3At the state level, the programme has provided a contractual position of an Information, Education and Communication (IEC) officer to facilitate and co-ordinate with its districts for effective implementation of ACSM activities. However, the activities of the IEC officer become more distinct only in the month of March, when world TB day is celebrated. Most of the times, they are engaged in activities like procurement, compilation of reports and assisting the state TB officer with their routine which are completely out of their core remit. The state- and district-level programme managers are not specially trained in ACSM and they have a blurred vision on the magnitude of dividends fetched on the time and money invested on ACSM activities. This mistrust on the potential of ACSM is completely due to a lack of convincing models and measures to demonstrate the impact of the activities.Surprisingly, the programme managers are convinced that wall paintings, hoardings, audio-visual announcements and printing pamphlets are the only ACSM components and restrict themselves to these activities. Even though these activities are implemented, they are not uniform throughout the district, state or country. Activities initiated at national level, such as pulsatile mass media campaigns, are not financially sustainable. …