‘LHWs’ engagement resulted in notification of more TB cases in Sindh’

Pakistan has the fifth highest tuberculosis (TB) burden amongst the 30 high burden countries of the world. Each year more than half a million people develop TB in the country; of these more than 50 per cent are bacteriologically positive.

With 70 per cent of the estimated TB cases being notified, there is still an estimated annual around 145,000 cases which are not noticed by the national notification system. In addition, there are possibly an additional 30 per cent (153,000) undetected prevalent cases. It is estimated that around 156,103 cases are not detected.

A high proportion of missing TB cases in Pakistan resides in the rural areas. The TB prevalence survey of 2011 showed that the prevalence of the disease was higher in rural than in urban areas.

The TB response remains focused on addressing quality of diagnosis and care with little emphasis on community engagement especially in the rural areas. Mercy Corps, jointly with the Sindh LHW Program and Provincial TB Control Program (PTP), piloted a one-year project titled ‘TEAM’ (train, empower and mobilise communities) to end TB. The project engaged more than 800 lady health workers (LHWs) in three districts of rural Sindh. LHWs are the frontline community health workers having deep reach especially in rural populations.

During the project close out ceremony in Karachi, Dr Muhammad Usman Chachar, additional chief secretary health, Sindh, while addressing the participants, spoke of the government’s full commitment to eradicate TB from the country.

He congratulated Mercy Corps, Provincial TB Control Programme and Sindh LHW programme on successfully implementing the project and said that engagement of LHWs in TB prevention and control can make a big impact. The representatives from Department of Health, Sindh LHWs Programme, Provincial TB Control Programmes, WHO, Stop TB Partnership and other organisations also participated in the event.

Dr Arif Noor, country director, Mercy Corps, shared that the purpose of engaging LHWs was to target the rural communities where accessing TB services was challenging for both men and women due to various factors, including stigma, lack of decision-making power among women, and lack of access to health services.

He further added that the aim of the project was to reach to the “missing TB cases” that remained undiagnosed and untreated every year. He added that we need to ensure frequent data review for timely decision-making.

Aamna Rashid, programme manager health programmes, Mercy Corps, shared that between October 2017 and June 2018, a total of 468,454 persons were verbally screened by LHWs during their routine household visits of their catchment population. Of these 3,987 TB presumptive cases were referred to public and private health facilities, out of which 77 per cent cases got tested. Since the inception of the project, total 884 all forms TB cases were registered.

She added that the project had also demonstrated that the engagement of LHWs results in early diagnosis of TB cases.

Dr Abdul Khalique Domki, additional director, PTP Sindh, said that it was for the first time that LHWs were formally engaged in TB prevention and control and the project had been successful in demonstrating that engaging LHWs could help in finding missing TB cases, especially in rural areas.

Dr Ghulam Hussain Sheikh, director, Sindh LHW programme, remarked that LHWs could make a difference as they had reach in their communities as well as the respect that they had gained due to their work. He said people trust them and listen to them, adding that although TB was part of LHWs’ routine work, but this project provided them an opportunity to enhance their capacity in identifying TB presumptive cases and referring them to the health facility in an organised manner.

Dr Waqar Memon, additional director public health, Sindh, said that TB was a global health problem and also a big challenge for Pakistan. He said that in order to address this issue, commitment from all sectors of life was extremely important.

Dr Younis Sheikh, deputy director, DG Office, while giving the vote of thanks, congratulated Mercy Corps, PLYC, the Provincial TB Control Programme and Lady Health Workers Programme for successfully completing the TEAM to finish the project. He also acknowledged the efforts of LHWs who contributed to efforts for TB prevention and control.

Social recognition, appreciation from the community and awards in front of peers or supervisors were found to be strong drivers of motivation for LHWs through operations research conducted under the project.