Role of Peripheral Health Care workers around a DMC in TB Care

Peripheral Health Care Workers (PHWs) including Community Health Officer (CHO), Auxiliary Nurse Midwife (ANM) and Multi-purpose health worker (MPHW) are central to primary health care and service delivery. They play important an role in TB care at Peripheral Health Institutes (PHIs) and Designated Microscopy Centres (DMCs).

Their responsibilities include:

1. Vulnerable population mapping: vulnerability assessment and mapping of vulnerable population (diabetic patients, patients on immunosuppressants, alcoholics and smokers etc) in communities is done by PHWs.

2. Screening and referral for testing:

PHWs are involved in:

- screening of household/workplace contact persons and other contact persons of TB patients as eligible in the local context

- periodic active case finding among identified vulnerable population for TB/Latent TB Infection

- referring presumptive TB patients promptly to the nearest microscopy or molecular laboratory through laboratory request forms

- registration of referred cases in Nikshay as presumptive TB patient

- providing sputum container to persons with symptoms of TB and counselling for collection of good quality sputum in the morning

- sample packaging and transport to TB laboratories for testing

- follow-up sputum examination

CHO is responsible to ensure availability of adequate sputum collection containers (sputum cups and falcon tubes), logistics for sample packaging and transportation.

3. Treatment initiation: It is the responsibility of the PHWs in coordination with NTEP staff to organize and ensure treatment initiation for the patient. They decide upon a convenient location for drug administration, identification of treatment supporter and supply of drugs to treatment supporter

4. Coordinating treatment support:

- PHWs act as a treatment supporter or identify treatment supporter who is accessible and acceptable to the patient to provide TB treatment

- support for adherence to treatment and monitoring of TB patients at the community level

- update the original treatment card at the PHI on a fortnightly basis and Nikshay entries in coordination with NTEP staff

5. Ensuring public health action: 

The PHW visits the house of the patient within a week of TB diagnosis to:

- verify the residential address so that in case of interruption, retrieval action can be taken

- counsel the patient and family members regarding the disease, treatment and its adherence

- screening of contact persons, providing TB Preventive Therapy (TPT) to all eligible

- advise patient on balanced diet, taking the food they can afford and also about nutritional support systems available for the eligible patients

- collect the bank account number of the patient or one of the household members; or facilitate getting the bank account opened, if not having one

- mobilize/refer for HIV testing

- sample collection and transportation for Dug Susceptibility Testing 

6. Awareness generation/advocacy in community

PHWs generate awareness/advocacy in the community. The activities include:

- awareness on health promotion and health seeking behaviour

- awareness on symptoms of TB, good cough etiquettes, available services for screening, diagnosis and treatment of TB

- awareness on patient support and benefit schemes including Nikshay Poshan Yojana

- mobilize community, community leaders (religious leaders, school principals, women’s Self-Help Groups, etc) and Panchayati Raj Institution (PRI) members for TB sensitization activities

- identify TB survivors to volunteer for the community engagement activities 

Resource

Training Modules for Programme Managers and Medical Officers, Central TB Division, MoHFW 2020

Assessment