A health communication strategy for RNTCP

The Danish assistance to the Revised National Tuberculosis Control Programme in India, DANTB, was established in 1997. In addition to the financial and technical support to establishing the necessary infrastructure for RNTCP, the project made Orissa special compared to other states of India by the development of two specific components dedicated to work with TB-related information, education and communication (IEC) and health systems research (HSR) by DANTB.

The development of IEC in Orissa took place in a continuous dialogue with both GoO and GoI. f Danida and DANTB  ensured that, whenever possible, successful approaches, activities and materials were considered for large-scale adoption at the national level. An example of this 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 for RNTCP , which was circulated and discussed on that occasion, is a logical outcome of this long-standing collaboration between strong partners on IEC for RNTCP

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:

• Central level decision-makers/planners
• State-level decision-makers/planners
• District-level managers and implementers
• Service providers (public and private)
• NGOs/CBOs

The communication strategy framework for RNTCP draws on the experiences of communication in RNTCP in the various states as well as the experiences in other health programmes such as the National Leprosy Eradication Programme (NLEP), Reproductive and Child Health Programme (RCH) and the National AIDS Control Programme (NACP). It builds on the Orissa model of communication in RNTCP developed by the Danish Assistance to the Revised National Tuberculosis National Programme (DANTB) and also draws pertinent lessons from the health systems research conducted by DANTB in Orissa.

The Orissa model of communication involved seven strategic elements:

1. Universal right to know
2. Cultural sensitivity
3. Gender sensitivity
4. Community participation
5. Multi-level partnership
6. Appropriate media mix
7. Research, monitoring and evaluation

The document is divided into two parts. Part I provides a framework for designing and planning a communication programme for RNTCP. While the implementation of directly observed treatment, short-course (DOTS) in India is beginning to bear fruit in terms of decreased morbidity and mortality, TB is still the leading cause of death among adults. 

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. Building on Phase I, the communication component of RNTCP in Phase II has three main objectives:

1. Awareness-raising for behaviour change to increase understanding about TB and the use of RNTCP services and preventive action among

• the public, so that they make use of DOTS and
• medical practitioners across the country, so that they know about correct TB diagnosis and treatment and they refer symptomatic cases for sputum test, or become DOT providers themselves.

2. Advocacy to create, facilitate, develop and forge political, administrative and community-level commitment to TB control in India.

3. Patient-provider communication and counselling to help ensure patient compliance with the treatment regimen, enhance the reputation of a patientfriendly service, improve provider-attitude and skills, and encourage patients and their families to become advocates for the programme.

The communication strategy is guided by the following principles:

• The communication approach is people-centred and client-friendly.
• Communication efforts and initiatives are process- rather than productoriented.
• Detailed planning, choice of communication channels and monitoring are decentralized
• Communication strategies address social and cultural issues related to TB

In resonance with the three objectives of communication in the TB-control programme, three basic essential behavioural goals are critical for success, viz.

1. Treatment-seeking

2. Timely detection

3. Completion of treatment

New Concept revised the existing DANTB IEC Strategy for Orissa in close collaboration with the DANTB IEC unit & Chief Technical Adviser, and other relevant DANTB staff and produce d the national-level Health Communication Strategy for RNTCP. Layout and printing of the publication was also carried out by New Concept.