Professional Documents
Culture Documents
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 RNTCP
Published by
Central TB Division
Directorate General of Health Services
Ministry of Health and Family Welfare
Government 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 6
3. 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
Contents | III
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 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
Foreword | V
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 between
strong 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
Abbreviation | VII
ESI Employees’ State Insurance
FW Family welfare
GoI Government of India
HIV Human Immunodeficiency Virus
HSR Health systems research
HW 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 organisation
NTI 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
Abbreviation | IX
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:
The document is divided into two parts. Part I provides a framework for designing
and planning a communication programme for RNTCP.
Executive Summary | XI
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.
1. Treatment-seeking
2. Timely detection
3. Completion of treatment
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.
Strategic Framework | 1
2 | A Health Communication Strategy for RNTCP
Contents
1. Introduction 5
4.2 Monitoring 33
4.3 Evaluation 33
Strategic Framework | 3
5. Capacity-building 37
5.3 District-level 38
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 taken
to make this strategy relevant and applicable to all states of India.
Strategic Framework | 5
2
Communication in a
TB Control Programme
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.
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.
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.
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 2000
onwards, 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:
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.
Strategic Framework | 7
The IEC strategy will be guided by the following principles:
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).
Strategic Framework | 9
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.
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 more
frequent 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.
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 in
society. 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 and
gender among the general population without tuberculosis in rural Maharashtra, India. Trop Med
Int Health. 2004 Nov. 9 (11):1228-38.
Strategic Framework | 11
Behavioural Change
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 several
phases of implementation and scaling up of the TB control programme in
Orissa, a model of communication has emerged, which is characterised by seven
elements:
Cultural Sensitivity
Right to Know
Gender Sensitivity
Appropriate
Media Mix
TB
Control
Elements of Orissa
Communication Model
Research, Monitoring
and Evaluation
Participation
Community
Multi-level Partnership
Strategic Framework | 13
2.5.5 Multi-level partnership
It 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 different
people 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).
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).
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.
Strategic Framework | 15
friendly service, to improve provider attitude and skills and to encourage
patients and their families to become advocates for the programme.
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.
1. treatment-seeking,
2. timely detection and
3. completion of treatment. Ti
m
ely
1. Treatment-seeking t
Treatmen
ti
on
2. Timely detection
C
om
f
Strategic Framework | 17
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 treatment
The 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 this
often 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.
Health 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.
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.
1
Health-Seeking Behaviour of Tribal Communities for TB: Perceptions and Practices — a study in
three districts of Orissa, October, 2000, DANTB, Orissa. www.dantb.org
Given these goals, the primary and secondary target groups for the communication
strategy include (but is not limited to):
TB patients/potential TB patients
Families/neighbours/general public
DOT providers
Local leaders
ANMs/AWWs
SHGs/CBOs/NGOs/PRIs
Strategic Framework | 19
Often, intermediate agents, such as media and influential community members,
play an important role in reaching both primary and secondary target groups.
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.
2. Taking care of self and family members 2. Increasing capacity for providing care
and making services more accessible
3. Reducing stigma and discrimination
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:
Strategic Framework | 21
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.
1. The target behaviour exists but Patients do not approach a health facility for Early symptoms are not
not to an adequate degree or with investigation after the onset of TB symptoms for more considered serious.
sufficient frequency. than three weeks.
2. The target behaviour exists but not Patients do not complete treatment but stop when the Implications of
for sufficient duration. symptoms disappear. stopping treatment are
not understood.
3 The target behaviour exists but not The DOT provider visits the patient for follow-up but The DP has been
in the form desired. gives information in a patronising manner and does insufficiently trained
not provide support for completing the treatment. and/or supervised.
4 The target behaviour exists but not The patient is not taken for sputum test and treatment Importance of
at the right time. until a late stage where chances of cure are small. early treatment not
understood. Services
are not trusted.
5 The social and cultural aspects of Stigmatisation may effectively block timely detection DOTS and/or curability
the disease in question may block of TB for particular groups, e.g. women. of TB is not accepted.
the desired practice.
6 The life conditions of the target A woman may not be allowed to leave the house at the Gender discrimination
population block them from time of an interaction meeting because no man will blocks women’s access
accessing either IEC information or accompany her. to services.
services or both.
7 The target behaviour has a The opportunity cost for continuing treatment or the Poverty affects choices
competing priority behaviour. need to resume work after the relief of symptoms may of patient.
affect treatment completion.
8 Desirable health practices are Taking seven pills every alternate day for two to three As provided above.
frequently more complex than they months, followed by a sputum examination, followed
may appear to be. by three to four months of continued medication,
may appear simple on paper, but practising it may be
difficult for a variety of reasons as mentioned above.
Primary target Low awareness about TB A cough that lasts for Provision of and access
group Low risk-perception more than three weeks to user-friendly health
TB patients could be TB services
Misconceptions about cure and
Potential TB treatment There is a sure cure for Counselling services
patients TB through DOTS Testing facilities
Fear of TB
Availability of free Treatment facilities
Stigma and discrimination diagnosis and treatment
Accessibility to services through PHCs
Cost of services and treatment
Attitude of service providers
Treatment process and time taken
Primary target Low awareness about TB There is a sure cure for Provision and access to
group Low risk-perception TB through DOTS health services
Families Misconceptions about cure and Counselling services
Neighbours treatment Save somebody’s life by Information services
General public convincing them to take
Fear of TB
the full treatment for TB
Stigma and discrimination
Accessibility to services
Cost of services and treatment
Strategic Framework | 23
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.
In short, the creative brief serves as a map or guidebook for the IEC material
development team and the creative designers.
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.
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.
Strategic Framework | 25
Hoardings High visibility if well-placed Easily removed
One-way communication
Stationary
Bus panels High visibility if well-placed Requires writing/reading skills (does
Mobile not reach illiterate people)
Outdoor Wall paintings High visibility if well-placed One-way communication
Can be used in relevant context (i.e,
PHI walls)
Exhibitions Can combine numerous materials and Expensive
media Requires staff
Can be interactive
Street plays Focuses directly on real-life issues and Requires troupe of actors
provides a platform for solutions Requires travel from village to village
Puppets Flexible infotainment method for
Requires puppet theatre
educating communities
Requires travel from village to village
Can effectively reach illiterate
Song and communities Requires singing and dancing
Folk Media Dance Can be combined with counselling troupe
Is liked by all age groups (including Requires travel from village to village
children)
Haats Interactive method to address Requires skilled persons for
questions from target audience communicating
Weekly market setting reaches both Requires travel from village to village
men and women
Community Can generate vivid local-level Women may not attend
Communi-
radio discussion
cation
Media Particularly useful at village clubs/
gatherings
Rally Large-scale participation Short-lived
Events World TB Day Strong coordination of activities at all Requires organising capacity
levels simultaneously
Patient- Decreases social distance Requires good communication skills
provider Creates mutual confidence between
interaction patients and providers
meetings
Trialogue Establishes community support for Requires good communication and
IPC
patient facilitation skills
Addresses stigma
Peer education Critical-awareness-building Requires careful selection and
training of peer educators
Group Can create critical mass of change Effect depends on social
meetings agents at community-level cohesiveness of group outside the
Interactive and participatory activity
communication process
Community Can create critical mass of change Requires good communication skills
meetings agents at community-level
Interactive and participatory
communication process
IEC Strategic Framework, Goals, Objectives, Audience, Themes, Activity and Indicators
Treatment-seeking Behaviour
Patient- Patients with TB Previous bad experience Good provider IPC Decreased rejection
provider symptoms and with health services behaviour Role play by community and
Communication their families Poor communication Importance of family
Street theatre
Staff of PHI skills friendly and No. of people with TB
Games
informative symptoms seen by
communication Display/print media medical doctors
with patients Interaction in groups Increased voluntary
testing
Strategic Framework
| 27
2. Timely Detection
Goals Objectives Audience Key Barriers Themes/Message Activities/Channels/ Indicators
Focus Media
Awareness Community Insufficient attention Role models Mass media Increased demand for
members importance being given Perception Print media diagnostic services
Community to TB symptoms among —right, respect, Increase in correct and
Folk media
health staff
Timely Detection
TB Increased media coverage
CONTROL Information on Intersectoral
of TB
DOTS strategy partnership with
NGOs/ PRIs/SHGs/
teaching institutions
Treatment Completion
Intersectoral
partnership with
NGOs
Patient- Patients Competing priorities for Proper counselling IPC Increased use of
provider Family members patient/family Role play DOTS services
Communication of TB patients Inability to take medicines/ Increased support
Street theatre
go for sputum test for patient
Games
Distance between DP and to complete
Display/print media treatment
patient
Interaction in groups Increased
Lack of counselling skills
regularity of
treatments
Strategic Framework
| 29
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/ Budget
Events
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
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
Strategic Framework | 31
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 Do the communication activities fit
implementation well with other programme functions
such as service delivery, logistics,
policies and staffing?
Message Are the communication messages
integration consistent with availability, access and
cost (financial and psychological) of
the service?
Communication Are the tools and channels being used
mix integration to guide the audience through the steps
to behaviour change?
Message design Is the message design consistent with
integration the positioning of the product, service
or behaviour?
Management Are all internal and partner
integration organisations working together in
accordance with an agreed upon plan
and strategy with regular progress
meetings?
Financial Is the budget being used in the most
integration efficient and effective way to ensure
that the economies of scale are
achieved?
Level of integration (total)
(Total possible score=70)
4.2 Monitoring
Documentation 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.
4.3 Evaluation
Evaluation 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
Strategic Framework | 33
evaluation may often use both qualitative and quantitative methods and will
assess whether the objectives of the activity were achieved.
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.
Study profile of initial defaulters and analyse barriers to their access to DOT
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.
Strategic Framework | 35
the community-level were conducted to assess the awareness and acceptability
of DOTS. In addition, available RNTCP statistics were analysed.
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.
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.
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:
Strategic Framework | 37
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) specific
training 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.
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.
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.
A detailed guide for implementation with special attention to district and sub-
district level activities is provided in Part 2 of this document.
Strategic Framework | 39
6
Special IEC Needs in RNTCP
Phase II
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 populations
The 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:
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.
Strategic Framework | 41
IEC for non-public providers
This target group can be further segmented into
private providers,
practitioners of other health systems and
traditional health providers
1.1 Goal and essential elements of the health communication strategy for RNTCP 47
1.3 Messages 49
1.4 Channels 51
Annexures 69
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.
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.
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
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.
3. The benefit or gain aspect for the patients instead of the provider needs
additional emphasis in message selection and design.
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.
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.
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.
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- and
block-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 conducted
at state-level)
• Patient group meeting at PHI-level
• (Re)orientation of jail inmates and employees
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.
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.
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 not
directly 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.
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
Source: Draft PIP of TB-2, CTD
1
** Each state will have additional budget for engaging agencies/NGOs to work as communication
facilitators for the state and districts. (The proposed budget is approximately Rs.20,000 per
district per year, or about Rs.1,600 per district per month). This budget would be over and above
the state and district allocation for health communication activities.
In addition, Rs 25,000 per million population is available for NGOs for IEC at the
district-level under schemes for NGOs.
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
At the state level, the strategic communication responsibility within the State TB
Cell rests with the STO who is assisted by an IEC Officer.
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.
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
It is at the district- and local levels that the challenge of reaching the ‘interior
pockets’ 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.
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.
The health communication activities have been broadly grouped into the
following types:
Policy support
Media support
Capacity-building
Communication material development
Involvement of partners in communication activities
Involvement of other organisations and individuals
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.
Annexure 1 | 69
Contents
1. Implementation Guide to Health Communication Activities 73
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 80
1.2.3 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 102
1.4.3 Development of radio spots 103
1.4.4 Development of TV spots 104
1.4.5 Development of cinema slides 106
1.4.6 Development of music cassette 106
1.4.7 Development of role-play 107
1.4.8 Training on street theatre technique 109
1.4.9 Pre-testing of IEC material 111
1.5 Involvement of partners in IEC for RNTCP 112
1.5.1 Use of street theatre 112
1.5.2 Puppets 114
1.5.3 Patient-DP-community interaction meeting 115
1.5.4 Trialogue approach 117
1.5.5 Orientation of tribal link workers 119
1.5.6 Orientation of cured, former patients as RNTCP advocates 121
1.5.7 Orientation of NGOs 122
1.5.8 Sensitisation meeting for PRI members 124
1.5.9 Orientation of SHGs 125
1.5.10 Orientation of volunteers, teachers, students and 127
religious organisations
Annexure 1 | 71
1.5.11 Orientation of traditional healers, traditional birth 129
attendants and other indigenous practitioners
1.5.12 Orientation of members of CBOs 130
1.5.13 Training/workshop for CDPOs/supervisors at district level 132
1.5.14 Group discussion 134
1.5.15 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 138
1.6.2 Orientation of jail immates and employees 139
1.6.3 Sensitisation workshop for journalists 141
1.7 Monitoring, evaluation and research 143
1.7.1 RNTCP programme documentation 143
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 | 73
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
Outcome
Regular meetings at gram panchayat-level/community-level to discuss RNTCP
by HWs/BEE
Objective
To disseminate TB messages to the public
Participants
School 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)
Process of organisation
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
Outcome
Increased awareness of TB among the public.
Symptomatic case reporting increases at PHI-level.
Report-writing
DIPRO/Dy. MEIO
Objective
MARCH To create large-scale awareness in the community
24 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
Process of organisation
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
Annexure 1 | 75
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.
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 Exhibition
Exhibition 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.
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.
Process of organisation
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 the
occasion. After the decision is taken, a suitable place is identified in consultation
with the local organiser of the festival/mela.
Annexure 1 | 77
1.2 Media Advocacy
TB 1.2.1 Print media
Control
Print 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.
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
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.
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
Annexure 1 | 79
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
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
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
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.
Annexure 1 | 81
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 for
IEC because the audience can identify with the characters and their problems
(patients/traditional healers/providers). Dramas are expensive to produce.
All these activities are jointly taken up with the State Institute of Health and
Family Welfare (IEC Cell).
Objective
To disseminate messages to create awareness amongst the community
People are more likely to believe something if they can see, feel and touch it for
themselves.
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
Annexure 1 | 83
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 one
batch (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.
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
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
Annexure 1 | 85
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
Teaching methodology
Reading the modules, lecture, participatory discussion, doing exercises, quiz,
question answer, ice-breaker and demonstration (medicine, sputum container,
TB register, forms etc.).
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
At the end of the training, an evaluation is carried out using developed question
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 materials
and 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.
Annexure 1 | 87
1.3.2 RNTCP training of TB programme staff
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
Teaching methodology
Lectures, readings, presentations, participatory processes, questions and
answers, demonstrations, practical exercises, audio-visuals etc.
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
At the end of the training, an evaluation is carried out using developed question
formats to assess whether the objectives of the training have been achieved.
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.
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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 in
order 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
Teaching methodology
Lectures, readings, demonstrations, participatory processes, questions and
answers, audio-visual presentations, practical exercises etc.
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
At the end of the training, an evaluation is carried out using developed question
formats to assess whether the objectives of the training have been achieved.
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.
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
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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.
Teaching methodology
Lectures/discussions/demonstrations.
Training materials
OHP, handouts, writing materials.
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.
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.
Date
Once 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
Annexure 1 | 93
Teaching methodology
Lectures, reading of modules, participatory discussions, questions and answers,
role-plays, quizzes, demonstrations, ice-breakers, sputum collection procedures
and experience-sharing by cured patients.
Outcome
The DOT provider (DP) has first-hand knowledge about RNTCP.
DP is confident of referring suspected cases for sputum microscopy and to
give 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
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
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.
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.
Participants
Cured 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.
Annexure 1 | 95
Training methodology
Discussions, sharing of experiences, group work/individual assignments, role-
plays, demonstrations and quizzes.
Evaluation
Questionnaire and quiz given by trainer.
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.
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
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 to
CDMO 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
Teaching methodology
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.
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Training of Mass Education and Information Officer (MEIO) and
district-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 organisation
SIH&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.
3rd day
Presentation of new ideas for media materials
Prepare and present need of action plan for the district for next six months
Training methodology
Lecture discussion
RNTCP and DOTS strategy
Technical aspects of TB
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
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.
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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
Process of organisation
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
Technical aspects of TB
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.
Training methodology
Lecture-discussions, video presentations and demonstrations.
Venue
Suitable 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 organisation
CDMOs/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
Technical aspects of TB
Target group and message development
Principles of poster development
Individual assignments on poster development
Presentation of final products
Facilitators
TB and Chest specialist of the district headquarter hospital
Dy. Director/Director of SIH&FW
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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.
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 the
lesson 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.
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.
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 to
move 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.
Objective
To disseminate important messages to the community on a wide basis.
Target groups
All radio listeners, especially adult women and men, and adolescents.
Annexure 1 | 103
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, TB
cell, 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.
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.
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.
Dialogue or discussion
Dialogue or discussion is always more interesting than one person talking. It is
very difficult to hold attention with one voice.
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.
Annexure 1 | 105
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.
Process
Development of messages and selection of photographs to be done in
a 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.
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.
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
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
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.
Annexure 1 | 107
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.
Advantages
Focuses directly on the problem.
Helps trainees/participants to deal with it through direct/indirect
involvement.
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.
Objective
To enhance skills on development of street theatre scripts for RNTCP.
Duration
Seven 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.
Annexure 1 | 109
For technical session
MO-PHI, STS, BEE
Process of organisation
CDMO discusses with ADMO/MO-TU/MO-PHI/STS/BEEs during monthly
meetings or RMS meetings to identify potential cultural groups; BEE/STS
contacts 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.
Teaching methodology
Discussions, group work, lectures, role-plays, demonstrations, re-
demonstrations.
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.
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, but
are 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 be
addressed.
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.
Annexure 1 | 111
Recording
Pre-testers should work in pairs if possible. One should conduct the interview,
while the other writes down the questions and answers.
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.
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.
Process of organisation
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.
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.
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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 Puppets
Puppets 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.
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.
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.
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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
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
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
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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 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
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.
Method
Mainly participatory through discussion.
Sharing of experiences.
Role-play.
Quiz.
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.
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Sitting arrangement
All participants, observers and resource persons sit on the floor on a mat in a
circle/semi-circle.
Process of organisation
First, district health authorities like the CDMO and DTO are contacted and
requested 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.
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 level
orientation activities is finalized on that day.
Outcome
Increase of awareness on RNTCP in the community
Involvement of people’s representatives in RNTCP
Increase in the utilisation of RNTCP services
Objective
Capacity-building of cured TB patients to disseminate appropriate information
for better utilisation of RNTCP services in the community.
Duration
One day.
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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.
Process of organisation
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.
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.
Objective
To apprise NGOs about RNTCP and help them identify their partnership role in
performing specific activities for the promotion of the programme.
Duration
One day.
Participants
President and secretary from each NGO.
Resource person
CDMO/DTO/MO-PHI/STS/BEE
Process of organisation
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 venue
are 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 gender
component
Teaching methodology
Discussion
Group work
Demonstration
Quiz
Role-play
Snakes and ladders game
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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.
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
Process of organisation
MO-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
Technical aspects of TB
Facilities under RNTCP
Status of TB in the block
Role of PRI members in the promotion of RNTCP
Outcome
Discussion about RNTCP in monthly gram panchayat meetings
Involvement of PRI members in referring suspects and motivating
defaulters.
Follow-up
BEEs and DPs attend gram panchayat-level monthly meetings and discuss TB
problems there.
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
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Duration
Half day
Participants
Two to three representatives from each SHG (50 to 60 participants).
Resource persons
MO-PHI/STS/BEE
Process of organisation
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,
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.
Teaching methodology
Story-telling, discussions, role-plays and demonstrations.
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)?
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
Process of organisation
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.
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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
Teaching methodology
Lectures, discussions, success stories, role-play, group discussions, snakes and
ladders game and outdoor games (kabaddi)
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.
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.
Process of organisation
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.
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Roles and responsibilities of traditional healers/VHGs TBAs in RNTCP such
as
disseminating messages in the community,
Teaching methodology
Discussions, role-plays, live success stories and snakes and ladder game.
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.
Objective
Capacity building of CBOs in organising awareness activities, referring suspects
and retrieving defaulters for promotion of RNTCP.
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. The
president/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.
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.
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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 ICDS
officer 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.
Teaching methodology
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).
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
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
Monthly meeting of ICDS where RNTCP is discussed; health communication
activities planned with responsibility for specific activities shared MO-PHI to
attend the meeting.
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During field visits, interaction with AWWs to assess the planned activities
implemented by STSs and BEEs.
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.
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 to
dominate 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.
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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.
Venue
Generally, 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
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
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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.
Outcome
Increased sensitivity to cultural issues among service providers and programme
staff.
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
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.
Teaching methodology
Discussions
Demonstrations
Quizzes
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
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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
Process of organisation
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.
Teaching methodology
Lectures, participatory discussions, group discussions, role-plays, demonstration
of sputum collection procedure and quizzes
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.
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.
Annexure 1 | 141
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
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
Outcome
Interviews with DPs/patients/programme personnel and other information
and 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.
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
Annexure 1 | 143
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.
Background
The 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 IEC
Resource Centre has been set up by the Central TB Division, Ministry of Health
and Family Welfare with the support of DANTB and Danida.
Highlights
The 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.
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.
Annexure 2 | 145
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.
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 search
The 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 results
The results page will display thumbnail icons of the materials along with titles
Specific results
On 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.
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.
Annexure 2 | 147
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 be
effective, 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.
ID No. 6
Type of Material Flipbook/chart
Material Title Tuberculosis Control
Area of Use Rural, Urban
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
Annexure 3 | 149
ID No. 11, 12-21
Type of Material Poster
Material Title My wife is second to none
Area of Use Rural, Urban
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
Annexure 3 | 151
ID No. 72, 73-82
Type of Material Poster
Material Title TB can be cured with DOTS (Rahul
Dravid)
Area of Use Rural, Urban
Target Audience Patients, General Public
Language English, Hindi, Gujarati, Bengali,
Kannada, Malyalam, Marathi, Oriya,
Punjabi, Tamil, Telugu
Objective To advocate DOTS and that TB is
completely curable with DOTS and
diagnosis and treatment process is
free
ID No. 97-107
Type of Material Poster
Material Title DOTS—sure cure for TB (Rahul
Dravid)
Area of Use Rural, Urban
Target Audience Community, General Public
Language English, Hindi, Gujarati, Bengali,
Kannada, Malyalam, Marathi, Oriya,
Punjabi, Tamil, Telugu
Objective To advocate DOTS as the best system
for treatment
ID No. 119-129
Type of Material Poster
Material Title “I completed TB treatment and gained
a happy life”
Area of Use Rural, Urban
Target Audience Patients, General Public
Language English, Hindi, Gujarati, Bengali,
Kannada, Malyalam, Marathi, Oriya,
Punjabi, Tamil, Telugu
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
Type of Material Poster
Material Title Do’s and Don’ts
Area of Use Rural, Urban
Target Audience General public
Language English, Hindi, Gujarati, Bengali,
Kannada, Malyalam, Marathi, Oriya,
Punjabi, Tamil, Telugu
Objective To spread awareness about TB
Annexure 3 | 153
ID No. 141-151
Type of Material Poster
Material Title Facts about Tuberculosis
Area of Use Rural, Urban
Target Audience General public
Language English, Hindi, Gujarati, Bengali,
Kannada, Malyalam, Marathi, Oriya,
Punjabi, Tamil, Telugu
Objective To spread awareness about TB
ID No. 152-162
Type of Material Poster
Material Title Towards Freedom from TB
Area of Use Rural, Urban
Target Audience Patients, General Public
Language English, Hindi, Gujarati, Bengali,
Kannada, Malyalam, Marathi, Oriya,
Punjabi, Tamil, Telugu
Objective To spread awareness about TB, its
main symptoms, diagnosis, DOTS and
treatment
ID No. 163-173
Type of Material Poster
Material Title Myths and Realities
Area of Use Rural, Urban
Target Audience Community, General Public
Language English, Hindi, Gujarati, Bengali,
Kannada, Malyalam, Marathi, Oriya,
Punjabi, Tamil, Telugu
Objective To dispel myths related to TB
ID No. 174-184
Type of Material Poster
Material Title DOTS system now closer to you
Area of Use Rural, Urban
Target Audience Opinion leaders, General Public
Language English, Hindi, Gujarati, Bengali,
Kannada, Malyalam, Marathi, Oriya,
Punjabi, Tamil, Telugu
Objective To show the rapid increase in DOTS
coverage
ID No. 196-206
Type of Material Balloon
Material Title DOTS—sure cure for TB
Area of Use Rural, Urban
Target Audience Community, General Public
Language English, Hindi, Gujarati, Bengali,
Kannada, Malyalam, Marathi, Oriya,
Punjabi, Tamil, Telugu
Objective To spread awareness about TB and its
cure through DOTS
Annexure 3 | 155
Annexure 4
Index of Health Communication Materials
Used 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 Specially developed for
illiterate audiences
Remarks 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 to
people’s representatives
Content Role of people’s representatives
in the promotion of RNTCP
Language Oriya
Target Audience People’s representatives
No. 4
Type of Material Booklet
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 Oriya
Target 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 curable
Content Symptoms of TB and availability of diagnosis
and treatment
Language Oriya and Alchick
Target Audience General and tribal communities
Remarks Specially developed for IPC
Annexure 4 | 157
No. 7
Type of Material Poster
Title in Oriya Jhara, funka, guni, tuni se yugara katha
Title in Alchick 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
Type of Material Poster
Title in Oriya Heu pachhe ma tara jakhma rogitia sisu pain
ma khira amruta parai
Title in English Encouraging breast-feeding even if mother
is under DOTS
Content Value of breast-feeding during DOTS
Language Oriya
Target Audience Patients and general community
No. 9
Type of Material Poster
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
Target Audience General community
No. 10
Type of Material Poster
Title 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
Target Audience General community
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
Type of Material Poster
Title in English Tre a t m e n t re g i m e n , s p u t u m
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
Type of Material Poster
Title in English Treatment
Content Types of patients under different
treatment categories
Language English
Target Audience Medical officers and laboratory
technicians
Remarks Reproduced from key concept, to
display in OPDs and laboratories
Annexure 4 | 159
No. 15
Type of Material Poster
Title in English Diagnosis
Content Diagnostic procedure
Language English
Target Audience Medical officers and laboratory
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 with
related 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. 20
Type of Material Cloth banner (10’ x 3’)
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
Target Audience Patients and general community
Annexure 4 | 161
No. 21
Type of Material Cloth banner (10’ x 3’)
Title in Oriya Nija ghara rahi adhunika ousad bebahara kari Jakhma rogaru
mukta huantu
Title in English Take drugs at home and be cured
Content TB patients can be treated at home
Language Oriya
Target Audience Patients and general community
No. 22
Type of Material Cloth banner (10’ x 3’)
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
sputum
Language Oriya
Target Audience Patients and general community
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
Target Audience Patients and general community
No. 25
Type of Material Cardboard poster
Title in Oriya Bastabata
Title in English True facts
Content Measures to prevent spread of TB
Language Oriya
Target Audience Patients and general community
No. 26
Type of Material Cardboard poster
Title in Oriya Jani rakhantu
Title in English Remember some inportant facts
Content Preventive measures for TB
Language Oriya
Target Audience Patients and general community
Annexure 4 | 163
No. 27
Type of Material Cardboard poster
Title in Oriya Jani rakhantu
Title in English Remember some important facts
Content Diagnosis of TB
Language Oriya
Target Audience Patients and general community
No. 28
Type of Material Cardboard poster
Title in Oriya Apna kana jananti?
Title in English What do you know?
Content Problem of TB
Language Oriya
Target Audience Patients and general community
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
Target Audience Patients and general community
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
Target Audience Patients and general community
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
Target Audience Patients and general community
Remarks One set containing 15 storyboards
No. 33
Type of Material Mela kit
Title in English Mobile exhibition unit
Content Various information materials on
different aspects of TB
Language Oriya
Target Audience Patients and general
community
Remarks Folding stall with information on TB
Annexure 4 | 165
No. 34
Type of Material Bounded cloth board
Title in English World – India Statistics of TB
Content Statistical information on TB in
India
Language English/Oriya
Target Audience Health personnel/trainers/NGOs
No. 35
No. 36
Type of Material Video cassette
Title in English Shanta – Model Community
Mobiliser
Content IEC activities in RNTCP
Language English
Target Audience Community health providers, IEC
staff
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
Annexure 4 | 167
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 English
Target 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 traditional
healers and the other side representing
DOT provider)
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
Type of Material Poster
Title in Oriya Laboratory technician kaan pain keteka
manerakhiba katha
Title in English Few things for the Laboratory Technicians
to remember
Content Information on sputum microscopy
Language Oriya
Target Audience Laboratory technicians
Annexure 4 | 169
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
Type of Material Booklet
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
Target Audience General community
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
Target Audience General community
No. 50
Type of Material Poster
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
Target Audience General community
No. 51
Type 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
Target Audience General community
Annexure 4 | 171
No. 52
Type of Material Poster
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
Target Audience General community
No. 53
Type of Material TV spots (two)
Title in English DANTB DOTS
Content Messages on DOTS and TB
Language Oriya
Target Audience General community
No. 54
Type of Material Badge
Title in English DOTS—sure cure for TB
Language English
Target Audience General community
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.
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 SHGs
2. 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
Annexure 5 | 173
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
Posters
Storyboards
Pamphlets, booklets, folders
Banners
Audio/video cassettes
Games, quizzes
Flipbooks, flash cards
Mela kits
Exhibition sets
Annexure 6 | 175
Annexure 7
IEC Reporting Formats
Reporting Format of DOT Patient-provider Interaction
Meeting
Patients
Category I
Category II
Category III
Cured/treatment completed
Irregulars/defaulters
Relatives of patients
DOT providers (DPs)
Laboratory technicians
Pharmacists
Anganwadi workers
NGO workers
Cured patients working as DPs
Teachers
Others (specify)
Annexure 7 | 177
Problems in getting support
from supervisors
Others (specify)
Sharing of patient’s experiences
Problems encountered in
accessing RNTCP services
Benefits from regular treatment
Others (specify)
Name and address of defaulter Who will visit? When? What action was taken? What was the Patient resumed
Patient counselling outcome? treatment
Patient refused
Family counselling
Involved village leaders
Involved cured patient
If ‘Yes’, why?
Why?
Quality of food
Transport arrangements
4.1 Did patients, DPs and supervisory staff eat together? Yes/No
5. Do you have any other comments regarding this interaction meeting? Please
mention positive and negative observations.
Annexure 7 | 179
Reporting Format on Street Theatre Performance
1. Date and time of performance
2. Place of performance
Village
Sub-centre/gram panchayat
District
Male
Female
Children
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 and
addresses.
Name
Designation
Signature of reporter
Published by
Central TB Division
Directorate General of Health Services
Ministry of Health and Family Welfare
Government of India
in collaboration with
DANTB