The Ministry of Health and Family Welfare (MoHFW) has recognized the requirement of a multi-sectoral response to address the social determinants like nutritional support, living and working conditions, and increase in access to diagnostic and treatment services. For effective engagement of the community in the path towards ending TB in India, MoHFW is implementing the Community Support to TB patients – “Pradhan Mantri TB Mukt Bharat Abhiyaan”.

1. Nikshay Mitra
Initiative: three-
pronged strategy
for Community
support to TB
Dr. Sandeep Das
Junior Resident (Academic)
Centre for Community Medicine
All India Institute of Medical Sciences, New Delhi
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2. Outline
• Importance of community support for tuberculosis
• Types of community support
• Pradhan Mantri TB Mukt Bharat Abhiyan – Synopsis
• Nikshay Mitra Initiative
• Stakeholders
• Scope of the initiative
• Details of the components of the support
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3. Importance of community support for tuberculosis
• Tuberculosis hinders socioeconomic development: Most people with
tuberculosis are in the economically productive age group of 15–54
years.1
• Although the “direct” costs of diagnosis and treatment are significant
for poor families, the greatest economic loss occurs as a result of
“indirect” costs, such as loss of employment, travel to health facilities,
sale of assets to pay for treatment-related costs, funeral expenses,
and particularly lost productivity from illness and premature death.2
1. Knight L, Initiative ST, Ministerial Conference on Tuberculosis and Sustainable Development (2000 : Amsterdam N. Tuberculosis and sustainable development : the
Stop TB Initiative 2000 report [Internet]. World Health Organization; 2000 [cited 2023 Apr 21]. Report No.: WHO/CDS/STB/2000.4. Available from:
https://apps.who.int/iris/handle/10665/66239
2. Chandra A, Kumar R, Kant S, Parthasarathy R, Krishnan A. Direct and indirect patient costs of tuberculosis care in India. Trop Med Int Health. 2020 Jul;25(7):803–12.
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4. Types of community support1
Community support
Formal
Raising community
awareness of TB and TB
treatment
Case detection and
referral for diagnosis
Providing access to
drugs
Raising awareness to
encourage compliance
Addressing stigma
Direct approach
Indirect approach
Recognition of adverse
effects and tracing of
patients who interrupt
treatment
Documentation of
progress and outcome
Informal
General support
Psychological support
Assistance in diagnostic
testing
Vocational support
Nutritional support
Direct observation of
treatment
1. Hadley M, Maher D. Community involvement in tuberculosis control: lessons from other health care programmes. The International Journal of Tuberculosis and
Lung Disease. 2000 May 1;4(5):401–8.
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5. Pradhan Mantri TB Mukt Bharat Abhiyan
• The Ministry of Health and Family Welfare (MoHFW) has recognized
the requirement of a multi-sectoral response to address the social
determinants like
• nutritional support,
• living and working conditions, and
• increase in access to diagnostic and treatment services.
• For effective engagement of the community in the path towards
ending TB in India, MoHFW is implementing the Community Support
to TB patients – “Pradhan Mantri TB Mukt Bharat Abhiyaan”
1. Central TB Division. Pradhan Mantri TB Mukt Bharat Abhiyan - Guidance Booklet [Internet]. 2022 Feb. Available from:
https://tbcindia.gov.in/WriteReadData/1583929709Guidance%20Booklet_02-08-2022.pdf
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6. Nikshay Mitra Initiative
Stakeholders of this initiative
• TB Patient
• Community
• Nikshay Mitra - Co-operative
societies / Corporates / Elected
Representatives / Individuals /
Institutions / NGOs / Political
Parties
• State & District Administration
• Central TB Division, MoHFW, GoI
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7. Scope of the initiative
Nikshay Mitras
Individuals
They can choose a
patient from a health
facility
Rest all
They must choose the
entire geographical
unit (blocks/urban
wards/districts/states)
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8. Components of the support
The additional assistance from the
Nikshay Mitra to on-treatment TB
patients will be three-pronged:
A. Nutritional support and/or
additional nutritional
supplements
B. Additional investigations for
the diagnosed TB patients
C. Vocational support
Three-
pronged
support
system from
Nikshay Mitra
Nutritional
support
Additional
investigations
for the
diagnosed TB
patients
Vocational
support
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9. Guidelines for Nutritional support to TB
patients
• For micronutrients adequacy, patients
may be encouraged to consume locally
available fresh vegetables, beans and
fruits every day.
• In addition, a supplement containing
one Recommended Dietary Allowance
(RDA) of B complex vitamins,
especially Pyridoxin (B6) and vitamin C
may be provided as long as the patient
receives treatment.
• One RDA of other vitamins and
minerals may be supplemented during
active TB disease.
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Food
basket
2
Food groups For adults For children
Cereals & millets 3 kg 2 kg
Pulses 1.5 kg 1 kg
Vegetable cooking oil 250 g 150 g
Eggs 30 nos. 30 nos.
Milk powder/milk 1 kg/6000 ml 750 g
Food
basket
1
Food groups For adults For children
Cereals & millets 3 kg 2 kg
Pulses 1.5 kg 1 kg
Vegetable cooking oil 250 g 150 g
Milk powder/milk 1 kg/6000 ml 750 g

10. Thank you
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