BRAC - BANGLADESH

Peri-urban TB control in Banglasesh - phase II.

Despite having very effective treatment modality TB remains the first killer disease of adults, Around 70,000 people die because of TB every year in Bangladesh. BRAC has been implementing a tuberculosis programme in Bangladesh since 1984 which started with the rural settings. BRAC is also implementing a TB control programme in the urban setting. BRAC replicated the same model that was initiated in rural settings where Shastho Sebika (Community Health Volunteers) were at the core of programmes. However, the context is different in urban settings.

Fragmented services and absence of coordination between these providers, lack of documentation and insufficient coverage in the private and corporate areas increase the risk of drop out and fuel the condition in these areas. Besides this, the Public Health Watch on TB Policy has shown that NTP lacks operational structure in the urban areas. Moreover, there has been very little information about urban DOTS program in terms of its success, failures, specific strategy and guidelines and community perspectives regarding TB.

To address this constraint, three consecutive phases of operational research have been initiated in the district towns and peri-urban areas of BRAC TB Control Programme. The first phase of the study was an exploratory study to investigate the possible factors and potentialities from both providers and patients perceptive to identify the hurdles in these areas and recommend possible solution in the peri-urban areas and district towns. Based on the recommendations of the first phase of the study, a strategy for peri-urban areas and district towns is developed for piloting.

The main objective of this phase is to pilot a new strategy for peri-urban and district town areas using a segmented approach under which different strategies will be intervened in three selected areas. The specific objectives are: to document the existing services in the peri-urban and district town areas, to implement the different strategies in the intervention sites, to evaluate the strategies in the intervention and control areas based on certain indicators and to assess the cost effectiveness of the proposed strategy. One baseline survey before the commencement of the piloting and one after the piloting phase will be carried out to evaluate the proposed interventions. The study will review and revise training and communication materials, develop counselling training material, strengthen communication and mobilization activity and orient community stakeholders and other alternative providers in the pilot areas. The study will also develop and test a network of communication/linkage and follow-up between the providers, stakeholders and communities with BRAC.