SESSION 8

REFERRAL AND LINKAGES

At the end of this session, participants will be able to:

 Understand various types of referrals required for patients so that their needs will
be addressed.
 Describe various challenges while developing programmatic linkages and making
referrals.
 List and discuss reasons why some patients do not access services.
 List the strategies to address the challenges in referrals and linkages.
 Discuss the advantages of creating an effective system of referral and linkages.
 Discuss the benefits of this system for patients as well as for the effective
implementation of the national programme.
 Develop the ability to make use of knowledge from this session, in the setting of
counselling.
Programmatic Linkages for the RNTCP

The TB counselor under RNTCP must establish the following programmatic linkages with
other health services.

Figure 8.1: Programmatic Linkages for the RNTCP

Participant Handout: Care and Support for TB Patients (Manual for

1 Counsellors) /Saksham, TISS/2014
Care and Support services:

Maternal and Child Health:

Linkages with Maternal and Child Health services are not just for those counsellors who are
attached to Antenatal or Gynaecology units in the hospital. Every counsellor should know
their services and how to link to them effectively:

 Essential antenatal care.

 Family planning services.
 Safer delivery practices.
 Counselling and support for the infant feeding method opted by the woman.
 Maternal Care: MCH postpartum care services help protect the mother‘s health by
providing medical and psychosocial supportive care.
 Infant care: MCH postnatal care services offer assessment of infant growth and
development, nutritional support, immunisations, and early HIV testing.
 Family care: MCH services provide social support, testing and counselling for family
members; referrals to community-based support programmes; and assistance in
dealing with stigma.

Positive people’s network:

Positive people’s networks offer -

 Psycho-social support.
 Support groups.
 Legal support.
 Socio-economic support.
 Nutritional support.

RNTCP and social Linkages

The TB counsellor must link patients appropriately with the Care and Treatment services they
need.

Role of TB counsellor in ensuring Social linkages

The Counsellor should try to address these barriers during counselling and ensure that patient
reach the at the referral centre.

Counsellors may also use contact telephone numbers to contact patients who have not
reached the referred service centre. Of course, for this, counsellors should seek permission to
contact the patient over the telephone and should be very discreet while making the telephone
call.
Participant Handout: Care and Support for TB Patients (Manual for
2 Counsellors) /Saksham, TISS/2014
Assistance schemes for TB Patients:

As a counsellor, you may not always find it possible to address all the needs of your patients
within the health system. The Care and Support Programme has made provisions for free
treatment. But TB patients have other needs as well. Besides failing health, they face two
problems: First, their health problems often disrupt their employment leading to breakdown
in family finances. Second, they are often marginalised due to the stigma associated with TB.
Hence there is a need to develop linkages with other government departments, NGOs and the
public sectors.

Types of schemes:

 TB affects people of all walks of life. But its impact is greatest on members of the
lower socio-economic classes. With TB, the demand for living a healthier life is more
important than ever and the additional economic burden is the biggest barrier to
accessing the free care and support services.
 There are various government schemes which a TB patient can avail. These schemes
differ from state to state and sometimes from district to district. A partial list is
provided here.

Social Security schemes:

Examples of such schemes are:
 Widow pension scheme.
 Special pension schemes
 Old age pension scheme.
 Employment guarantee schemes.

a. Nutritional support for MDR/XDR-TB patients:

In Mumbai in collaboration with IDBI bank , free nutrition is being provided to all
MDR/XDR-TB patients through RNTCP .

Role of the counsellor:

 Referral
 Managing Barriers
 Enhancing Linkages

Referral:

An effective counsellor will gather information on the locally available schemes and seek to
link people to the right resource.

Participant Handout: Care and Support for TB Patients (Manual for

3 Counsellors) /Saksham, TISS/2014
Managing barriers:

As a counsellor, you should be aware of the barriers that a TB patient can face while trying to
avail a package of services. Based on experience you should explore solutions to these
barriers on a case-to case basis. Hence it is extremely important to obtain feedback from
patients for whom you have already made referrals. Providing information that is as accurate
as possible is critical. For instance, tell them how to reach there, draw a small map, etc.

Further, prepare your patients as to what to expect when they go to a particular office to
register for the scheme/ service. This is the skill of anticipatory guidance. Remember it takes
time for people to feel comfortable. Therefore, work with them at their pace.

Prepare your patients as to what to expect when they go to a particular office to

register for the scheme/ service. This is the skill of anticipatory guidance.

Enhancing linkages:

Developing linkages with the various government departments is extremely important for the
benefit of your patient. A good rapport with your counterparts in these departments will
ensure timely and hassle-free services to your patients.
A “Thank You” note to the concerned officer will take you a long way ahead.

Participant Handout: Care and Support for TB Patients (Manual for

4 Counsellors) /Saksham, TISS/2014
Key messages:

 Be aware of the services available at the referral units (care and support
services, ICTC, Maternal and Child Health, positive people’s Network) as also
the schemes, and guide patients appropriately.
 Role of the counsellor:
 Referral: An effective counsellor gathers information on the locally
available schemes and seeks to link people to the right resource.
 Managing Barriers: As a counsellor, you must be aware of the barriers
that a TB patient can face while trying to avail a package of services.
Based on experience, you need to explore solutions to these barriers on a
case-to case basis. Remember it takes time for people to feel comfortable.
Therefore, work with them at their pace.
 Enhancing Linkages: Develop linkages with the various government
departments as it is extremely important for the benefit of your patient. A
good rapport with your counterparts in these departments will ensure
timely and hassle-free services to your patients.
 Prepare your patients on what they should expect when they go to a
particular office to register for the scheme/ service. This is the skill of
anticipatory guidance.
 Ensure that each and every one of your TB patients has reached the ICTC
and all HIV-TB co-infected patients have registered at the ART centre.

Participant Handout: Care and Support for TB Patients (Manual for

5 Counsellors) /Saksham, TISS/2014
ANNEXURE 2: Social Benefit Schemes

1) Sanjay Gandhi Niradhar Yojana:

Objective: The Sanjay Gandhi NiradharAnudanYojna is a Socio- Economic Assistance

Scheme of the State Govt. for financial aid to the destitute or very poor persons of the society
to increase their financial income to some extent.

Eligibility Criteria:

Categor Beneficiary Benefit/Amount Paid   Total

y From  State Govt From Amount
Central  Paid per
Govt month
Male Members above 65   Rs. 175/- per month  Rs. 75/- Rs. 250/-
a)
years
b) Women above 65 years         Rs. 250/- per month  - Rs.  250/-
Widows below 60 years with Rs. 250/- per month for  -  Rs.250/-
no children self till she is not
c) remarried.

Widows below 60 years with Rs. 250/- for self per  - Rs. 500/-
one minor child month and Rs 250/- for
the child  per
month subject to the
d)
condition that she is not
remarried & till her
minor attains age of 18
years
Widows below 60 years  with Rs.  625/-  per  - Rs. 625/-
two or more minor children month subject to the
condition that she is not
e)
remarried & till her
minors attain age of 18
years 
Females below 60 years &  Rs. 250/ per month  Rs. 250/-
Males below 65 years who
are suffering from Leprosy &
f) AIDS or other type of
sickness/Mental disability and
there by unable to Service /
Maintain their livelihood.  

Participant Handout: Care and Support for TB Patients (Manual for

6 Counsellors) /Saksham, TISS/2014
2) Antoyodaya Anna Yojana (AAY):

Objective: To provide food security to the poorest of the poor. The selected families are given
a special Antyodaya card, with which they can claim grain from the fair price shops (FPS) or
ration shops, the local outlet of the public distribution system (PDS). This card entitles the
selected family to 35 kgs of grains each month at Rs 2/kg for wheat and Rs 3/kg for rice.

Concerned Authority

 Consumer Affairs, Food and Civil Supplies (CS-I) Department

3) Balsangopan Yojana:

 Objective: A Child Welfare Service that provides substitute family care for a planned
period for a child, when his/her own family cannot care for him/her, for a temporary
or extended period

Concerned Authority

 Women and Child Development Department

4) Indira Awaas Yojana:

 Objective: To construct houses for those who lost houses due to fire accidents, floods
etc

 Eligibility: Victims of fire accidents, floods, bonded labourers, disabled persons,

widows (SC, STand BC) belonging to BPL

 Benefits: Financial assistance of Rs. 20,000/- under 100% subsidy scheme for
construction of houses

Concerned Authority

 District Rural Development Agencies DRDAs/ ZillaParishads

5) Indira Gandhi National Old Age Pension Scheme (IGNOAPS):

 Objective: Destitute aged 65 years or more and does not have any source of regular
income/financial support from his family members or others & is living alone or has
children below 18 years of age.

Concerned Authority

 Ministry of Rural Development

Participant Handout: Care and Support for TB Patients (Manual for

7 Counsellors) /Saksham, TISS/2014
6) Double Nutrition:

 Supplementary Nutrition (SNP): The nutrition component varies from state to state
but usually consists of a hot meal cooked at the Anganwadi, based on a mix of pulses,
cereals, oil, vegetable, sugar, iodised salt, etc. Sometimes “take-home rations” (THR)
are provided for children under the age of three years.

Concerned Authority

 Women and Child Welfare Department (ICDS)

7) Indira Gandhi National Widow Pension Scheme (IGNWPS):

 Objective: To give financial assistance @ Rs. 400/‐ (Four hundred ) per month to all
the identified pensioners who are widows of the age group of 40 years – 64 years, and
from families which are below the poverty line. The coverage will be universal and
there shall not be any quota at any level.

 Concerned Authority: Ministry of Rural Development, Government of India

8) Rajiv Yuva Shakti (Individual):

 Objective: To provide financial assistance to educated youth to undertake self

employment activities

 Eligibility: Educated unemployed youth possessing a minimum education of 10th

Class (pass or fail) and belonging to families with an annual income of Rs. 50,000/- or
less

 Benefits: Financial assistance in the form of loan up to Rs. 1,00,000/- through banks
with a maximum subsidy of Rs. 30,000/-

 Gram Panchayat Secretary/MPDO/District Youth Welfare Officer.

9) Girl Child Protection Scheme:

 Objective: Promote and protect the rights of girl child and contribute to their
development

 Eligibility: Children (below 3 years) belonging to BPL family with two children.
Orphans, children of Jogins, Basivinis, Devadasi, and Mathamma are given
preference

 Benefit: In case of single girl child, she is entitled to receive Rs. 1,00,000/- after
completion of 20 years of age. In case of two girl children, both of them are entitled to
receive Rs. 30,000 each after completion of 20 years. Scholarship of Rs. 1200/- per
annum from 9th to Intermediate is given. Life Insurance coverage from the age of 3

Participant Handout: Care and Support for TB Patients (Manual for

8 Counsellors) /Saksham, TISS/2014
 years onwards. In the event of accidental death of the girl child, the parent is entitled
to receive full amount

 Anganwadi teacher/ICDS Supervisor/ICDS Project Director/Women & Child Welfare

Officer.

10) Urban Self Employment Program (USEP):

 Objective: To provide financial assistance to unemployed youth to undertake income

generating activities.

 Eligibility: BPL Unemployed youth in the age group of 18-50 years possessing a
minimum academic qualification of 7th standard

 Benefit: Bank loan up to Rs. 50,000 with 15% subsidy

 Contact: Municipal Commissioner/District Collector

11) Annapurna Scheme:

 Objective: To supply 10 Kgs rice per month on free of cost to the senior citizens who
are eligible for old age pension, but not getting pension

 Eligibility: Senior citizens 65 years of age or above who are eligible for old age
pension under the National Old Age Pension Scheme (NOAPS) but not getting
pension( Blue card holders)

 Benefit:10 Kgs. of rice per month on free of cost

 Contact: Gram Panchayat Secretary/Fair Price Shop Dealer/Mandal Revenue

Officer/District Supply Officer

12) Rajiv Gruhakalpa:

 Objective: To improve the quality of urban life by providing houses with improved
infrastructure

 Eligibility: Beneficiary should reside in town/municipality for five years. And Annual
income should be in the range of Rs. 24,000/–36,000/-

 Benefit: Unit cost is Rs. 75,000/- Of which 10% beneficiary contribution and 90%
loan through banks. Infrastructure like land, roads, water supply, sewerage lines and
power supply to the colony are provided free of cost by the Government

 Contact: Municipal Commissioner/District Manager, Housing Corporation

Participant Handout: Care and Support for TB Patients (Manual for

9 Counsellors) /Saksham, TISS/2014
13) Sanjay Gandhi Swavlamban Yojna:

 Objective: This Yojna is to provide financial help unemployed educated or non-

educated  persons for starting self employment

 Unemployed educated or non-educated persons below 40 years who have

registered their name with Employment Exchange.

 Benefit: A short term interest free loan upto Rs 2500/- for purpose of starting self
employment like Tea stall, Carpentry, Sale of Vegetables/Fruits, Selling Clothes etc. 

 Contact: At district level, collector is a controlling officer of the scheme; at Taluka

level, scheme was implemented by Tahsildars.

Participant Handout: Care and Support for TB Patients (Manual for

10 Counsellors) /Saksham, TISS/2014