Rationale of the Practice: The learning corner is more of an approach, than a modality and is designed based on the adult learning principles of internal motivation, self-direction and is experience oriented and relevancy oriented. Training using multiple modalities and application of this knowledge for cadre-specific exercises and problem solving, are the highlights of this approach. 

Implementation Strategy: Implemented from 2019 onwards, the learning corner was conceptualized by the then STDC Director Dr N D Deshmukh and supported by Training Coordinator Dr Asha Telang and team.

“The learning corner includes display of conceptualized material backed up with audiovisual aids in combination with other teaching modalities for effective learning. I would call these learning corners as teaching/speaking walls. My vision for a training programme is to benefit its participants in acquiring knowledge and bring about a positive change in their attitude and practice after the training. This is one of the successful experiments we have done in STDC Pune.” 

DR NANDAKUMAR D DESHMUKH, FORMER DIRECTOR, STDC PUNE

The translation of standardized curriculum into Tamil was a comprehensive process undertaken to ensure effective dissemination of critical healthcare content in Tamil Nadu. This section outlines the systematic steps involved in the translation endeavour. 

Image

Figure 1 process followed for Translating the standardized Material into Tamil and Implementation strategy at the State and District level

1.Initial meeting and discussion:
State TB Cell and STDC (State TB Training and Demonstration Centre) Tamil Nadu conducted the initial meeting and discussion involving key stakeholders to plan the translation process.

2.Expert Committee Formation:
Established a state-level Expert Committee chaired by the State Tuberculosis Officer (STO) of Tamil Nadu and the Director of State TB Training and Demonstration Centre (STDC) to oversee the translation process, ensuring linguistic accuracy and cultural relevance. Committee included 8 other representatives who know programme very well and are fluent in Tamil.

3.Translation of Content:
The Training curriculum was translated into Tamil by a team led State IEC officer. The translated contents were submitted on a timely basis to the expert committee for the review and feedback. The question bank for pre-test and post test questions attached to each chapter were also translated.

4.Expert Committee Review and Feedback Integration:
Expert committee members read the entire content together in physical mode and provided feedbacks on timely basis.  The content creation team incorporated the suggestions and resubmitted it for approval. The expert committee had a total of 5 in-person meeting and one virtual meeting to finalize the content

5.Configuration of training curriculum on Knowledge Base:
After approval, the final version of the translated content was configured into the Knowledge Base (Kbase). Home | Knowledge Base (ntep.in). NTEP Knowledge base is the subsystem of the modernized training system is the machinery to develop translatable multi-media training material

6.Review by the State Training division:    
The Training Division of the Department of Public Health (DPH) and the National Health Mission (NHM) in Tamil Nadu conducted a detailed review  of the content focusing on cultural appropriateness and any potential conflicts with state norms.

7.Launch of the Course for Health Volunteers and Treatment supporters in Tamil Nadu :
The Modernized Training System for health volunteers was officially inaugurated in Tamil Nadu on March 13, 2023. The launch event, presided over by the Honourable Director of Public Health and Preventive Medicine DPH, marked a significant milestone in healthcare training initiatives.

8.Training of Trainers:
With the help of DTO, 2 Senior Women Health Volunteers and 1 DTTMO (District Training Medical Officer) from every district of Tamil Nadu were identified as Trainers. Entire pool of trainers were divided into two batches and  6 Hours ToT was conducted in two batches at state level on March 14th and 15th 2023. 

9.District-Wise Roll-Out:    
People to be trained were identified district wise, Training batches were created and scheduled through Learning Management System (WHO Swasth-E-Gurukkul) .In Phase -1, 5 districts have conducted trainings for Women Health Volunteers 

 

The state had witnessed the growth of the NTEP program from being a pilot project in two districts to an expanded program covering all districts by 2004. Important activities like undertaking testing and imitating patients on early treatment was being undertaken by the state with the objective of increasing case detection and improving treatment completion rates in the state. It was at this stage of the program progress in the state that under the leadership and close supervision of the Joint Director, TB and Director of National Programes and Principal Secretary, a proposal was initiated by the State TB Officer (STO) to have an independent infrastructure for the STDC, Bhopal. The process of establishing an independent building as the State Training and Demonstration Centre (STDC), Bhopal was initiated in 2006. The proposal was accepted by the state NHM office and an initial amount of Rupees 80 Lakh and subsequently an additional amount of 80 lakhs was allocated for construction of the STDC building and hostel accommodation. An additional amount of 2 crores was sanctioned in the year 2022 to complete the entire infrastructure of the STDC. Two medical officers from the State TB cell were given additional charge to ensure that the proposal was approved successfully within the given time through repeated and timely follow up including site visits Etc.  The construction was done by the Public Works Department (PWD) in the state.  The STDC, Bhopal is constructed on approximately 42 acres of land which also has the state TB hospital, the Intermediate Reference laboratory (IRL), a cancer hospital and the Food and Drugs office within this land. The land is owned by the state NHM. 
 

The task of training 1017 Senior Treatment Supervisors (STS) across the state demanded a well-coordinated and strategic approach from STDC Agra. To meet this challenge, the team developed a robust and comprehensive plan that laid the groundwork for successful implementation. This roadmap focused on gathering detailed trainee data, scheduling training batches, and ensuring timely communication and resource allocation. The planning phase set the stage for a seamless execution of the training program, ensuring every STS received the necessary knowledge, skills and support to contribute to the programme.

1. Planning

For ensuring uniform training of 1017 STS in the state, STDC Agra resorted to robust planning.

The first step was to create a comprehensive roadmap inclusive of following steps:
•Collection of Trainee information: The team meticulously crafted a detailed list of all STS personnel across the state, categorized by district. This was done based on the training planning tool prepared by Central TB Division (https://ntep.in/node/3614/BookPage/25-planning-tool) in collaboration with USAID supported The Union led iDEFEAT TB Project. This served as the denominator.
•Create Batches as per the resources available: Based on the infrastructure, dates and resource persons available, STDC Agra created batches for imparting the trainings.
•Assign Trainees to the various Batches: They assigned trainees to the various batches. Each training batch was scheduled perfectly to ensure the participation of every STS. Batches were created keeping in mind that the work on the ground is not to be affected. At the same time, STDC team ensured that no one was left behind. 
•Communication/ Invitation to Trainees: Requisite and timely communication was sent out to the trainees allowing sufficient time to be prepared for taking the batches. 
•Identification of the resources required for training:  Medical Officers of the STDCs and WHO-consultants served as the resource persons for these training sessions. Resource persons were meticulously mapped against each batches to ensure their availability. Funds for the trainings were budgeted in Program Implementation Plan (PIP).¹
•Localized Learning: Course for STS on NTEP approved by Central TB Division was a 40-hour curriculum including 11 modules and 43 chapters (https://ntep.in/node/3408). To enhance the understanding, STDC translated training materials into Hindi, making the content accessible for participants from diverse educational backgrounds.

2. Operationalizing:

STDC organized 32 training sessions for covering 1017 STS over two years, from August 2022 to April 2024. Out of these, 8 batches were undertaken using the modernized training system. The Modernized Training system entailed use of blended mode of classroom training such that the training was imparted using virtual technological mechanisms.

•Role of Training Co-ordinator: A dedicated training coordinator was appointed to oversee the entire process from start to finish. Their responsibilities included meticulously planning the training schedules in close collaboration with the State TB Cell and STDC, selecting and assigning facilitators, and ensuring the necessary resources—such as training venues—were in place. Additionally, the coordinator was tasked with organizing training batches, scheduling courses within the Learning Management Information System, monitoring the progress of the trainings, and keeping all key stakeholders regularly updated. This comprehensive role ensured smooth and efficient execution of the training program.
•Practical learning: The training was highly practical and immersive, featuring six-day induction sessions complemented by two-day refresher courses. Emphasis was placed on real-world applications, allowing participants to actively engage with the material. This hands-on approach not only deepened their understanding but also boosted their confidence in effectively applying newly acquired skills within their respective districts.
•Continuous Monitoring: The STDC assessed the effectiveness of the training by conducting pre- and post-tests through the Learning Management System (LMS), allowing for data-driven insights. Feedback was actively incorporated, enabling session adjustments to ensure continuous improvement and enhanced learning outcomes.
•Inclusivity at Its Core:  The STDC created an accessible and supportive training environment by providing accommodations, meals, and logistical assistance for all participants, including individuals with disabilities. These efforts ensured an inclusive atmosphere, allowing everyone to fully engage in the learning experience
•Collaboration:  The trainings were undertaken in collaboration with WHO NTEP Technical Support Network and The Union led iDEFEAT TB Project. 
•Team Work: Under the chairpersonship of Director, STDC staff coordinated and implemented the training activities with a clear roles and responsibilities.
 

1. In the context of public health programs in India, especially under schemes like the National Health Mission (NHM), a PIP refers to a detailed annual plan that outlines the activities, interventions, budgetary allocations, and goals for implementing specific health programs at the state or district level.

1.Human Resource: STDC Delhi developed its full-fledged sections in epidemiological, public health, statistical and administrative wing. The STDC director provides leadership and guidance to opportunities for conducting research. The Epidemiologist at STDC serves as the nodal officer for implementation of research. He is supported by a microbiologist and a biostatistician for monitoring collection and analysis of research data.

2.Capacity Building on OR: The key staff along with STDC Director completed their formal training in research methodology in 1990 and ‘How to do Operational Research?’ in 2005 at National Tuberculosis Institute, Bangalore.

3.Financial Resources: Along with funds earmarked for operational research in State NTEP funds, STDC Delhi shares experience of trying odds with every opportunity to fund its research. In last 10 years, more than 50% of the total researches were funded by State Operational Research Committee. In addition, some research projects are funded by ICMR or external agencies like MRC London, Corporates like Sandoz under corporate social responsibility (CSR).  Funds earmarked for research studies are restricted to use under the same functional component.

4.Infrastructural capacity: Accredited with National Accreditation Board for Testing and Calibration Laboratories (NABL), the Intermediate reference laboratory (IRL) at STDC Delhi is equipped with Biosafety Level-3, Whole Genome Sequencing (WGS), second-line Line Probe Assay (LPA) and Liquid culture DST (drug-susceptibility testing) facilities.  These make STDC Delhi a preferred site for research projects meant for multi-centric clinical trials, kit validation or validation of new diagnostic modalities4 in collaboration with RBIPMT (The Rajan Babu Institute of Pulmonary Medicine and TB), NITRD (the National Institute of TB and Respiratory diseases) or NIRT (National Institute for research in Tuberculosis, Chennai).

5.Orientation to potential researchers: STDC Delhi regularly conducts orientation workshops for potential researchers (DTO), faculty from various medical and nursing colleges, development agencies and corporate entities to sensitize on potential areas for operational research.  Guidance on research tools to support good quality data collection is circulated.

6.Institutional mechanisms: STDC Delhi has established an institution level 7-member Scientific Advisory Committee, that reviews and finalizes the research proposals to be submitted to Operational research committee on behalf of STDC Delhi.

STDC Delhi has its own Institution Level Ethics Committee4 with members represented from TB Association of India, Delhi TB Association, State level Legal advisor, Community member, STDC itself and chaired by a Medical College faculty. The committee reviews the submitted protocols and provides ethical clearance based on the type of research involved.  

7.Collaboration with State OR mechanism: STDC Delhi remains the focal point for organizing state task force meetings. The State Operational Research committee meets at STDC Delhi regularly to review and finalize the submitted proposals. Hence, any upcoming/ ongoing research is informed to STDC Delhi and priorities for conducting the same is facilitated. The State Task force also advocates for one thesis per medical college in a year to be undertaken by postgraduates.

8.Collaboration with TB Association of India (TAI): The staff of STDC Delhi provides managerial support to TB Association of India. They support the publication of the quarterly journal of TAI as members of editorial board4. Also, the faculty actively participates in annual conferences organized by TAI and supports in finalizing the scientific program and participating in the sessions. This provides an opportunity for STDC Delhi to create more awareness in their staff regarding current priorities of the national program, learnings from other states and dissemination of their research findings.

9.Maintaining a database of research studies: STDC Delhi documents the database (offline & online) of TB related (past and ongoing) research activity conducted in state. It is maintained as a part of the program annual report documented by STDC. It helps in wide dissemination of undergoing projects and provides an opportunity for collaboration, cross-learning or enhancement of research. Details of the research projects taken up in 2022-23 are listed in the annexure.

10.Dissemination of findings: STDC Delhi encourages use of various media to disseminate their research findings to the community at large. Around two-thirds of the total publication (71) is disseminated each through research publication or review article in past 6 years. This helps to keep the team motivated and continue to uptake further research projects.