Competencies of the Senior Treatment Supervisor (STS)

• Identify individuals vulnerable to develop TB disease.
• Identify individuals eligible for TPT/ testing for TBI - Screen for TB using 4 symptom complex and identify presumptive TB.
• Prescribe appropriate diagnostic test to diagnose TB, DR-TB and TB Infection to the eligible based on NTEP guidelines.
• Enroll a person in Ni-kshay and request for Test through Ni-kshay 

1. Verification of case records in Ni-kshay to check whether correct tests are prescribed and the diagnosis is complete including testing for drug resistance 
2. Interview with STS to understand his/her practice in relation to diagnosis of TB 
3. Interviews with people affected with TB/TBI under care of the STS to check whether they are diagnosed completely.

• Check the reports of various laboratory investigations and coordinate with medical officer to establish the diagnosis of TB/ TB Infection .
• Classify the TB disease based on site of disease, DST results and history of ant-TB treatment..
• Co-ordinate to identify an appropriate treatment supporter and health facility in consultation with the medical officer, field staff and beneficiary.
• Document the treatment initiation and details of prescription in Ni-kshay -To conduct home visit for initial counselling

1. Verification of case records in Ni-kshay to check whether correct regimens are prescribed 
2. Interview with patients under care of STS to check whether treatment initiation is as per NTEP guidelines 

• Counsel the people with presumptive TB/ people affected with TB/TBI on: Early and complete Diagnosis of TB, correct and complete Treatment of TB, Treatment Adherence, Air borne Infection Control, Contact Investigation, TB Preventive Therapy, Co-morbidity management, Adverse Drug Reactions and Social welfare measures

1. Interview with people affected with TB/TBI to check STS's ability to counsel

• Successfully refer out a person with TB to higher center/ nearest health facility for ensuring continuum of care -Accept the referred in patients and co-ordinate to provide care.
• Request for transfer in of treatment records for ensuring continuum of care when ever required -Document the referral in Ni-kshay.
• Coordinate with respective program staff for continuation of treatment post referral out

1. Verify Transfer Module in Ni-kshay to check success of referrals

• Maintain the list of treatment supporters in Ni-kshay -Train- the health volunteers and treatment supporters using the cadre wise training course 

1. Interview with treatment supporters to check STS'S ability to train

• Co-ordinate to Feed bank details of benificiaries for Ni-Kshay Poshan Yojana, Incentives to informers and private providers, treatment supporters and tribal TUs.
• Verify bank details and initiate payment process.
• Trouble shoot any issues at maker level related to non-payment of benifits to the eligible.
• Monitor DBT using dashboard and registers, identify the list of people for which the benefits were not paid and thrive to process the payment timely

1. Review of DBT indicators in Ni-kshay

• Perform vulnerability mapping to identify vulnerable populations/ individuals
  - Identify and train pool of community volunteers, ASHAs, on active TB case finding campaign
• Prepare team wise daily micro-plan/ calendar of ACF activities including plan for door to door visit, sample collection and transportation to linked TB laboratories
• Monitor the process and provide supportive supervision to ensure quality of services and prevent leaks in cascade of care -Coordinate for reporting the data on Ni-Kshay on ACF modules

1. Review Ni-kshay ACF data, review micro plans and ACF documents
    

• Coordinate with persons affected by TB and concerned field staff (TB-Health Visitor, ASHA, ANM, etc.) for identification of the nearest health facility and arranging a treatment supporter
• Identify, train and maintain a pool of treatment supporters
• Counsel people affected with TB about various choices of directly observed treatment (DOT) options - like treatment supporter, 99DOTS, MERM, etc. and arrange for option of patients choice as per feasibility
• Co-ordinate for recording of Realtime adherence either by treatment supporter or MPHW/CHO in Ni-kshay or by the beneficiary directly through 'Arogya Sathi App' 
• Link the eligible beneficiaries with Ni-kshay Mitra for addressing the essential unmet needs including nutrition, co-morbidity management, infection control, rehabilitation and palliative care  

1. Interview with people affected with TB regarding the support received

• Monitor treatment adherence records on Ni-ksay on a day to day basis -Identify people who have missed doses
• Investigate reasons for missed doses and trouble shoot -Initiate timely retrieval actions wherever required  

1. Review Ni-kshay adherence calendars
2. Interview with treatment supporters and patients who missed doses

• Co-ordinate with the primary health care team and treatment supporters to ensure that the people affected with TB and their families are offered all public health actions including contact investigations, TB Preventive Therapy, Infection control counselling, treatment adherence support, linkages to social welfare schemes and universal drug susceptibility testing and post treatment follow up
• Record the details of public health action in Ni-kshay

1. Review of Ni-kshay records to check timeliness and completeness of Public health actions
2. Interviews with people affected with TB to check about public health actions

• Identify local issues (community & health facility level) affecting TB care efforts -Maintain list of key people to target for political advocacy (PRI leaders) and list of prominent key opinion leaders (KOL), Ni-kshay Mitras, Private Providers - Identify and engage Ni-Kshay Mitra and link the to program and beneficiaries
• Identify and train local TB Champions, Ni-Kshay Mitra, etc.
   

1. Check for any results of advocacy in terms of commitment from Local Government, engagement of private providers, engagement of community 
    

• Maintain a database of TB Champions
• Train TB Champions 
• Ensure their voices are heard in all important meetings 
• Discuss TB in meetings like Jan Arogya Samiti (JAS), Mahila Arogya Samiti (MAS), Village Health Sanitation, Nutrition Committee (VHSNC), etc. and appeal for inclusion of TB case finding and stigma alleviation activities to be integrated in general health related outreach activities
• Organize community meetings and patient provider meetings 
• Organise activities at schools, workplaces to mobilize community for health behaviour
• Conduct awareness about TB in community  

1. Interview with PRI leaders, civil society leaders, TB Champions and the staff.
2. Review of documents of community engagement activities

• Identify and map key providers (private hospitals, practitioners, AYUSH, chemists, traditional healers, laboratories)
• Advocate with key players for following Standards of TB Care in India
• Support the providers in ensuring STCI to their clients by providing information, providing drugs diagnostics and public health actions based on need
• Strengthen surveillance by ensuring timely notification and outcome data from private sector
• Identify patients not notified and their providers through information from Schedule H1
• Co-ordinate with agencies working for private sector engagement to achieve the expected outcome
• Liase with professional organizations like IMA, IAP, AHPI ect for engaging their members in NTEP activities

• To update Ni-kshay profile section of all health facilities in allocated geographical territory (services, GIS location, contact details, names, bank details, etc.)
• To identify new health facility and register as new health facility (public sector & private sector) on Nikshay, as per classification and programme guidance
   

To monitor adherence to stocking norms and identify health facility for impending stockouts or with drug stock nearing expiry and assist respective PHI drug store to raise refill request.

Coordinate with TU/ DTC drug store pharmacist for issuance of relevant drug stock as per request

• Use Ni-kshay dashboards and other program records, and interpret key performance indicators of NTEP in the facility/geography -Perform time, place, person analysis and identify areas for improvement `
• Assist MO in Monitoring the input and process indicators related to the output/outcome indicator and suggest corrective actions - Conduct supportive supervision and help in building capacity of treatment supporters with an intention to improve quality of services. 
• Assist Medical Officer in providing timely and actionable feedback to health sub-centers and reporting field staff (ANM, ASHA, TB-HV, STS, STLS, MPW, HA, etc.)
• Support the staff in taking the corrective actions leading to an improvement in quality of services"