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A Health Communication Strategy for RNTCP

A Health Communication Strategy


for RNTCP

Published by
Central TB Division
Directorate General of Health Services
Ministry of Health and Family Welfare
Government of India

in collaboration with
DANTB
A Health Communication Strategy
for RNTCP

Published by
Central TB Division
Directorate General of Health Services
Ministry of Health and Family Welfare
Government of India

in collaboration with
DANTB
Contents

Foreword v
Abbreviations vii
Executive Summary xi

Part 1
Strategic Planning Framework 1

1. Introduction 5
2. Communication in a TB Control Programme 6
3. Communication Strategy for TB Control Programme 15
4. Monitoring and Evaluation of Communication in RNTCP 33
5. Capacity-building 37
6. Special IEC Needs in RNTCP Phase II 40

Part 2
Planning and Implementing a Health Communication Strategy of
RNTCP – A Practical Guide

1. Introduction 47
2. Implementation of the Strategy 59

Annexures
1. Implementation Guide to Health Communication Activities 73
2. IEC Resource Centre of Central TB Division User Guidelines 145
3. Index of Materials Available in the Central TB Division’s 149
Web-based IEC Resource Centre
4. Index of Health Communication Materials Used in Orissa 156
5. User Guidelines for the Health Communication Video Modules CD 173
6. Suggested Format for Planning IEC Activities at State and District 175
7. IEC Reporting Formats 176

Contents | III
Foreword
India has the largest number of tuberculosis (TB) cases in the world, accounting
for more than one-third of the global burden, and TB is the leading cause of
death among adults in the country. With this background, the Governments of
Denmark and India agreed in 1996 that the Danish development cooperation in
India should be further expanded to include the fight against TB. This happened
at a time when India was playing a pivotal role in developing and testing the
DOTS strategy (Directly Observed Treatment, Short-course) for TB control—a
strategy that was subsequently globally recommended by WHO. There was a need
to establish solid experiences in implementing DOTS in different parts of India.
In agreement between Danida, Government of India (GoI) and Government of
Orissa (GoO), the State of Orissa was selected as a relevant and important locus
for the Danish support, being one of the poorest states of India, with a large tribal
population and high TB prevalence.

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. DANTB has been fortunate to have highly creative and dedicated staff
working with IEC throughout the project and while HSR provided input for
IEC in terms of formative and problem-based research, the IEC activities were
also set to develop innovative approaches and strategies as well as making use
of successful experiences with health communication from other projects. The
project attracted substantial additional funding for IEC in Orissa in comparison
with other states of India, and examples of innovations include: patient-
provider interaction meetings; interactive stalls at weekly markets; a wide range
of folk media; involvement of panchayati raj institutions, self-help groups and
community-based organisations; as well as locally-designed IEC materials. Orissa
became an IEC laboratory with involvement of villagers, DOT Providers, former
patients, health staff at all levels and NGOs and voluntary organisations as lab
technicians. When all the districts were covered by the end of 2004, the project
set focus on mass media in support of IEC, and the trialogue approach, originally
developed by the Danida-supported leprosy programme, was introduced.

The development of IEC in Orissa has taken place in a continuous dialogue with
both GoO and GoI. It has always been the aim of Danida and DANTB to ensure
that, whenever possible, successful approaches, activities and materials should
be considered for large-scale adoption at the national level. An example of this

Foreword | V
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, which was circulated and discussed on
that occasion, is a logical outcome of this long-standing collaboration between
strong partners on IEC for RNTCP.

As Danida is phasing out development activities by the end of 2005, DANTB will
also cease its operations. It is indeed positive that the project leaves behind an
IEC heritage that is well appreciated by GoI and that will continue to live at the
national level in RNTCP II. It is hoped that the present volume will be helpful to
planners at state- and district-levels in the implementation of the IEC component
of RNTCP II, and that it will be widely used and disseminated.

Mariann Lyby
Development Counsellor for Health
Royal Danish Embassy
New Delhi
November 2005

VI | A Health Communication Strategy for RNTCP


Abbreviations
ADMO Assistant District Medical Officer
AIDS Acquired Immunodeficiency Syndrome
AIR All India Radio
ANM Auxiliary Nurse Midwife
ATD&TC Anti-Tuberculosis Demonstration and Training
Centre
AWW Anganwadi Worker
BCC Behaviour change communication
BDO Block Development Officer
BEE Block Extension Educator
BPL Below poverty line
Cat I, II & III Category I, II & III (anti-tuberculosis drug
treatment classification)
CBO Community-based organisation
CDMO Chief District Medical Officer
CDPO Child Development Project Officer
CHW Community Health Worker
CII Confederation of Indian Industry
CME Continuing medical education
CTD Central Tuberculosis Division
Danida Danish International Development Assistance
DANLEP Danish Assistance to the National Leprosy
Eradication Programme
DANTB Danish Assistance to the Revised National
Tuberculosis Control Programme
DD Doordarshan (Indian national television network)
DDG Deputy Director General
DfID Department for International Development (UK)
DHS Director of Health Services
DMET Director of Medical Education and Training
DOTS Directly observed treatment, short-course
DP DOT provider
DTC District Tuberculosis Centre
DTO District Tuberculosis Officer

Abbreviation | VII
ESI Employees’ State Insurance
FW Family welfare
GoI Government of India
HIV Human Immunodeficiency Virus
HSR Health systems research
HW Health worker
ICDS Integrated Child Development Services
IEC Information, education and communication
IMA Indian Medical Association
IPC Inter-personal communication
LHV Lady Health Visitor
LT Laboratory Technician
MC Microscopy Centre
MCI Medical Council of India
MDR-TB Multi-drug resistant-TB
MEIO Mass Education and Information Officer
MO Medical Officer
MO-PHI Medical Officer of the peripheral health institution
MO-TU Medical Officer, Tuberculosis Unit (sub-district)
MoH&FW Ministry of Health and Family Welfare
MPHS Multi-purpose Health Supervisor
NGO Non-governmental organisation
NTI National Tuberculosis Institute
NTP National Tuberculosis Programme
NYK Nehru Yuva Kendra
NSS National Service Scheme
OHP Overhead Projector
OPD Outpatient department
PHC Primary Health Centre
PHI Peripheral health institution
PIP Project Implementation Plan
PMOE Participatory monitoring and ongoing evaluation
PRA Participatory rapid appraisal
PRI Panchayati raj institution
RD Rural Development
RMP Registered Medical Practitioner

VIII | A Health Communication Strategy for RNTCP


RMS Review, monitoring and supervision
RNTCP Revised National Tuberculosis Control Programme
SC Scheduled Caste
SDTU Sub-district Tuberculosis Unit
SHG Self-help Group
SIH&FW State Institute for Health and Family Welfare
SSC State Steering Committee
ST Scheduled Tribe
STD Sexually transmitted diseases
STDC State Tuberculosis Demonstration Centre
STI State Tuberculosis Institute
STLS Senior Tuberculosis Laboratory Supervisor
STO State Tuberculosis Officer
STS Senior Treatment Supervisor
TAI Tuberculosis Association of India
TB Tuberculosis
TBA Traditional Birth Attendant (trained)
TOT Training of trainers
TRC Tuberculosis Research Centre
TU Tuberculosis Unit
VHG Village Health Guide
WB World Bank
WCD Women and Child Development
WHO World Health Organization

Abbreviation | IX
Executive Summary
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. From an estimated one TB
death per minute in India in 1999, the death rate has decreased to an estimated
two deaths every three minutes in 2004.

Executive Summary | XI
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 patient-
friendly 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 product-
oriented.
 Detailed planning, choice of communication channels and monitoring are
decentralised
 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

XII | A Health Communication Strategy for RNTCP


The target groups for the communication strategy are:

Primary target group


1. TB patients/potential TB patients
2. Families/neighbours/general public

Secondary target group


1. Doctors/RMPs/clinic operators/medical students
2. DOT providers
3. Local leaders
4. ANMs/AWWs
5. SHGs/CBOs/NGOs/PRIs

The strategic communication framework identifies target behaviour and


barriers and suggests a set of key messages and support services to be used for
communicating to the group. The framework also suggests channels to reach the
target group.

Of particular importance to inter-personal communication (IPC) is the trialogue


approach. Trialogue is a strategy that which aims at changing community attitudes
and behaviour through active participation in caring for persons affected by the
disease as well as open and honest discussions regarding fears, prejudice and
problems concerning TB.

The framework encourages the use of participatory techniques such as


participatory rapid appraisal (PRA), for assessing group and community resources,
identifying and prioritising problems and appraising strategies for solving them.

Monitoring and ongoing evaluation are essential components of the


communication framework.

Planning for ongoing communication capacity-building is essential in


implementing an information, education and communication (IEC) strategy,
whether in regard to formative IEC assessment, design, communication product
development, pre-testing, monitoring or evaluation. The framework takes
cognizance of this.

In order for the Government of India (GoI) to meet the challenge of coming up
with an effective response to the TB situation, the involvement and reach of
partners such as NGOs and CBOs is very important.

Part II of this document provides detailed steps in designing and implementation


of the activities, events and materials at the central, state-, district- and PHI-

Executive Summary | XIII


levels. This part, along with the Annexures, is particularly relevant for micro-
planning and may guide implementers of IEC in the adoption of a wide range of
IEC activities to address specific needs and target audiences.

The steps and processes are supported by a list of suggested communication


activities and communication materials. In addition, a set of video modules is
enclosed with the book on a VCD. They demonstrate a number of IEC activities,
taking RNTCP in Orissa as an example. Also, the Annexures provide an overview
of and guidelines for the web-based RNTCP IEC Resource Centre set up by the
Central TB Division in collaboration with DANTB.

XIV | A Health Communication Strategy for RNTCP


Part 1
Strategic Planning Framework

Strategic Framework | 1
2 | A Health Communication Strategy for RNTCP
Contents

1. Introduction 5

2. Communication in a TB Control Programme 6

2.1 TB control programme in India 6

2.2 Communication in RNTCP 7

2.3 Key concepts 8

2.4 Knowledge and behavioural change 9

2.5 The Orissa IEC model—an example 12

3. Communication Strategy for TB Control Programme 15

3.1 Objectives and focus of communication in RNTCP Phase II 15

3.2 Strategic framework 16

3.3 Guiding principles for IEC in TB control programme 16

3.4 Behavioural goals for IEC strategy 17

3.5 Health systems research for IEC 18

3.6 Defining behavioural change objectives 19

3.7 Planning at state and district level 30

3.8 Checklist for strategic planning framework 31

4. Monitoring and Evaluation of Communication 33


in RNTCP

4.1 What is monitoring and evaluation? 33

4.2 Monitoring 33

4.3 Evaluation 33

4.4 Monitoring and evaluation in RNTCP Phase II 34

4.5 An example: IEC and acceptability of DOTS 35

Strategic Framework | 3
5. Capacity-building 37

5.1 Central level: advocacy and IEC unit 37

5.2 State-level capacity for IEC 37

5.3 District-level 38

6. Special IEC needs in RNTCP Phase II 40


6.1 Improving access to hand to reach people 40

4 | A Health Communication Strategy for RNTCP


1
Introduction
The purpose of this planning and implementation strategy is to provide a
framework for planning, designing, implementing and supporting strategic
health communication activities for the Revised National Tuberculosis Control
Programme (RNTCP).

The first part of the communication strategy provides a conceptual framework


and is particularly intended for state-level decision-makers and planners,
district-level managers and non-governmental organisations (NGOs) in charge
of implementing information, education and communication (IEC) activities.

The second part of this volume focuses on planning and implementing the
strategy. It is particularly relevant for district- and block-level managers and
implementers and for NGOs working with IEC activities.

During RNTCP Phase I, IEC activities were given particular attention in the state
of Orissa, where special funding and technical assistance was made available for
the development of IEC activities and materials through the Danish Assistance to
the Revised National Tuberculosis Programme (DANTB) project funded by Danish
International Development Assistance (Danida). While the comparatively high
level of IEC activities in Orissa has provided important input for the development
of the present strategy, which is developed by the Central TB Division of the
Directorate General of Health Services, under the Ministry of Health and Family
Welfare of the Government of India, in collaboration with DANTB, it is important
to point out that IEC activities have taken place in most other states in India as
well, and that the present strategy is intended for a national programme. Actual
implementation at state- and district-levels should take place through flexible
adaptation in view of local needs and constraints; however, care has been taken
to make this strategy relevant and applicable to all states of India.

Strategic Framework | 5
2
Communication in a
TB Control Programme
Tuberculosis (TB) is an infectious disease caused by a bacillus, Mycobacterium
tuberculosis. Nearly two billion people around the world are infected with the
bacillus that causes TB. Each year, about 8.4 million people develop active, or
infectious, TB and about two million deaths are related to TB.

TB is the world’s biggest single infectious cause of death among adults. India
accounts for one-fifth of the global TB incidence and is estimated to have the
highest number of active TB cases amongst the countries of the world. Nearly
1.8 million new cases occur each year. TB has killed more people than any other
infectious disease in India.

2.1 TB Control Programme in India

The National Tuberculosis Control Programme (NTCP), established in 1962,


created an infrastructure for TB-control throughout the country and was
integrated with the general health services. The programme provided free service
to the community. There was no specific focus on health communication.

The NTCP was reviewed during 1992 by a panel of experts. Based on the findings
and recommendations of the review, the Government of India (GoI) evolved a
Revised National Tuberculosis Control Programme (RNTCP) on the basis of the
strategy of directly observed treatment, short course (DOTS) recommended by
the World Health Organization (WHO). Objectives of RNTCP included achieving
a 70 percent case detection rate and a treatment success rate of 85 percent of new
smear-positive cases.

This strategy was pilot-tested in 1993-94 in five sites covering a population of


2.35 million, and thereafter expanded to 17 project sites covering a population
of 13.85 million, to assess technical and operational feasibility. Encouraged by
the results of the pilot studies, the GoI decided to expand the programme in a
phased manner to cover the entire population of India by the end of 2005 with
assistance from the World Bank. Danida supported the programme in Orissa, and

6 | A Health Communication Strategy for RNTCP


the Department for International Development (DfID) in Andhra Pradesh, Global
Fund to Fight AIDS, TB, and Malaria (GFATM) in Bihar, Chhattisgarh, Jharkhand,
Uttaranchal and Uttar Pradesh and the United States Agency for International
Development (USAID) in Haryana.

An estimated one billion people in India were covered under the DOTS strategy
for TB control and more than four million people were treated as of March
2005. However, TB control in India still faces many challenges and health
communication is seen as an essential component to ensure a growing public
demand for RNTCP services.

2.2 Communication in RNTCP

Health communication activities for RNTCP presuppose that free quality services
are in place for the target group. Accordingly, the initial emphasis in RNTCP has
been on establishing and maintaining the required quality of services. From 2000
onwards, once quality services were established and their availability ensured,
IEC played a more prominent role in the programme. DOTS services are now
available to more than one billion people and the Centre, states and districts have
realised the importance of communication to reach the vast number of people in
a country characterised by tremendous diversity.

Several states have taken up IEC for RNTCP using new and innovative ways.
Orissa, Tamil Nadu, Gujarat, Delhi, Rajasthan and Maharashtra have tried several
initiatives and developed strategies that have proved very successful.

In RNTCP Phase II, the IEC component has three main objectives:

1. Awareness-raising to increase understanding about TB amongst:

 the public, so that they make use of RNTCP services and

 medical practitioners across the country, so that they know about correct
TB diagnosis and treatment and they refer patients to DOTS services, or
become DOT providers themselves.

2. Advocacy to develop 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, to enhance the reputation of a
patient-friendly service, and to encourage patients and their families become
advocates for the programme.

Strategic Framework | 7
The IEC strategy will be guided by the following principles:

1. IEC should be process-rather than product-oriented. This has two dimensions.


TB-control requires a long-term commitment from patients, providers, policy-
makers and communities; this commitment is built through interaction
and partnerships, not by simply transmitting information. Communication
strategies for TB-control therefore need to maximise opportunities for
interactive communication, such as engaging cured patients to convince
and support others, group meetings to discuss all aspects of TB-control,
including social aspects. The other dimension of the concept of process
rather than product is the list of steps required to plan IEC within a national
disease control programme. To avoid over-reliance on media and materials,
overall IEC planning should be based on an analysis of the needs and include
a package of three components (formative research, strategy to address the
needs and monitoring).

2. Detailed planning, choice of communication channels and monitoring


should be decentralised to ensure local relevance and wide reach of
information. The Centre will provide leadership and develop core messages,
mass media and advocacy events. The states and districts will base their
specific strategies on the core framework and messages, and will encourage
local adaptation and innovation to reach all possible groups with the most
appropriate communication tools.

3. Strategies should address social issues related to TB such as stigma and


gender.

2.3 Key Concepts

In the field of communication, a number of different terms are currently in use, with
different meanings and emphases, leading at times to a narrow focus on method
rather than purpose. In this document the concept of ‘health communication’ is
used as a generic term, whereas ‘information, education and communication’
(IEC) has been preferred over more recent terminology that stressed this or
that specific aspect of health communication. For the sake of clarity, we wish to
emphasise that IEC is used here as a broad category, including, for example, inter-
personal communication (IPC) and behaviour change communication (BCC).

 Behaviour change communication (BCC) – An approach that is specifically


designed to change or sustain the behaviour of individuals or social groups,
using a variety of communication techniques.

8 | A Health Communication Strategy for RNTCP


 Information and communication technologies (ICT) – A broad concept
describing a range of communication and computing media that includes
e-mail, the Internet, satellite and digital communication as well as television,
radio, film and video.

 Information, education and communication (IEC) – IEC can be defined as


‘a public health approach aiming at changing or reinforcing health-related
behaviours in a target audience, concerning a specific problem and within a
pre-defined period of time, through communication methods and principles’
(WHO).

 Social mobilisation – This is an approach that empowers people to actively


participate in the development process actively through local initiatives and
well-informed dialogue.

 Social marketing – A market-oriented strategy that seeks to utilise


commercially-developed marketing techniques for public health purposes
by promoting and selling products, ideas, or services that are considered to
have social value, using a variety of outlets and marketing approaches. Often,
goods are made available at subsidised prices.

2.4 Knowledge and Behavioural Change

The concept of knowledge


In the past, health communication activities assumed that if medically-based
information was disseminated in the public, this would be sufficient to lead
people to change their behaviour to optimise their health. An obvious example of
the failure of this assumption is smoking. If knowledge about the negative impact
of smoking on health would in itself be sufficient to achieve healthy behaviour
change, no medical doctors would be smokers. Human Immunodeficiency Virus-
(HIV) prevention campaigns during the 1980s and 1990s showed that human
behaviour is, at best, only partially guided by ‘textbook knowledge’ about risky
behaviour. In terms of sexual behaviour, emotions obviously constitute a very
important motive; in certain situations, this is further modified by other factors,
such as financial circumstances, use of substances like alcohol and drugs,
inter-personal power relations, access to prevention, positive values associated
with risky behaviour etc. Knowledge about transmission of infection and how
to protect oneself against it is a necessary, but not sufficient, pre-condition.
Therefore, health communication with the objective of HIV-prevention through
the promotion of safe practices needs to be based on an analysis of human
behaviour of relevance to the issue at hand. The lessons from HIV prevention
are also relevant for TB: it is equally true, that merely providing factual messages
like ‘Go for sputum test if coughing persists for more than three weeks’ may

Strategic Framework | 9
be insufficient to stimulate people to follow the advice. This is so because the
message competes with local knowledge, e.g. about common cold which may be
perceived as both non-serious and long-term. Therefore, the message must be
packaged in such a way that it challenges this perception. Programmes, which
take into account local realities when identifying key behavioural determinants,
are much more likely to be effective.

Examples of contextual factors that influence behaviour change


For IEC to lead to the desired objective, contextual factors play a significant role.

 Stigma
Tuberculosis is very unevenly stigmatised. Experiences
in India indicate that TB patients are more frequently
stigmatised in urban than in rural and tribal areas.
Stigmatisation cannot generally be seen as associated
with lack of knowledge about tuberculosis, and it is more
frequent among more educated groups than among
uneducated or illiterate people. Stigma is known to be closely related to fear,
and fear in relation to TB is associated with the disease being potentially fatal
and infectious. Therefore, information in itself is not sufficient to de-stigmatise
TB. Specific IEC activities must address the emotional aspects of stigma at the
community-level. This can be done by showing carefully how care of and support
to TB patients at the same time can protect the community from infection. In
urban areas, mass media and involvement of role models should be utilised
to address stigma. In rural areas, the trialogue approach (see below) has been
developed with this purpose in mind.

 Gender
There is a gender imbalance in TB case detection. Proportionally
however female cases are detected and treated. The reasons
for this are not clearly understood yet and both biological and
social determinants may be involved. In terms of IEC, gender
as a social determinant for TB infection needs to be addressed.
A special concern is delay of diagnosis among women due to
limitations in access to diagnostic services. A study in Orissa1
found substantial gender differences when it came to action taken in response to
the symptoms. Fifteen percent of women took no action when having symptoms
as compared to eight percent of men. Fifty percent of women did not go to a
peripheral health institution (PHI) as the first point of treatment, as compared to

1
DANTB and New Concept Information Systems: Low Utilisation of TB Services by Women. New
Delhi, 2002.

10 | A Health Communication Strategy for RNTCP


41 percent of men. Nearly a third of the female respondents who did not go first
to the PHI waited anywhere between one and four months before they took any
action. Another study in rural Maharashtra2 queried respondents without active
disease about vignettes depicting a man and a woman with typical features of
TB. Emotional and social symptoms were frequently reported for both vignettes,
but more often considered most distressing for the female vignette; specified
problems included arranging marriages, social isolation, and inability to care for
children and family. Job loss and reduced income were regarded most troubling
for the male vignette. Men and women typically identified sexual experience
as the cause of TB for opposite-sex vignettes. With wider access to information
about TB, male respondents more frequently recommended allopathic doctors
and specialty services.

The planning of IEC activities must take gender aspects into account to reach
women effectively both in terms of ensuring that IEC reaches women and that
IEC messages are relevant in view of the constraints that women may face in
society. But gender issues also include attention to health issues that are specific
to men; an example in some communities could be the problem use of alcohol
being more common among men and requiring special attention to increase
completion of treatment.

 Poverty
The epidemiological pattern of tuberculosis follows income
patterns and the disease is closely linked to poverty, poor
housing conditions and poor hygiene. It follows that TB
patients are more likely to be poor and illiterate than the
average population. Accordingly, a variety of means and
media must be used to reach the target groups. Furthermore,
it must be acknowledged that poverty itself drastically decreases the freedom to
make choices in life. Hence, it may be very difficult for patients to give priority
to treatment over work, once they feel better. The IEC strategy must take into
account the living conditions of the target groups and the limited possibilities for
poor people to follow advice provided from a public health perspective.

2
Atre SR, Kudale AM, Morankar SN, Rangan SG, Weiss MG. Cultural concepts of tuberculosis and
gender among the general population without tuberculosis in rural Maharashtra, India. Trop Med
Int Health. 2004 Nov. 9 (11):1228-38.

Strategic Framework | 11
 Behavioural Change

A Basic Model of Communication for Behavioural Change can be Summarised as Follows:

Accurate and timely information is a necessary, but not


sufficient, prerequisite to behavioural development and
change. Information alone seldom leads to behavioural
change.

Communicating information through appropriate channels


in motivating formats is one essential component of
successful programmes.

People need to be empowered to make basic everyday


decisions about their own lives in order for them to act on
the information received, no matter how motivated they
are.

Their wider environment must support and facilitate change


for the effect of the programme to be sustained.

2.5 The Orissa IEC Model—An Example

From the outset, communication activities have been a major part of the RNTCP/
DANTB partnership in Orissa. While many new and innovative communication
activities have been tried in various states, the Orissa experience was a well-
documented one. Based on the experience and learning over the years in several
phases of implementation and scaling up of the TB control programme in
Orissa, a model of communication has emerged, which is characterised by seven
elements:

Cultural Sensitivity
Right to Know
Gender Sensitivity
Appropriate
Media Mix

TB
Control

Elements of Orissa
Communication Model
Research, Monitoring
and Evaluation
Participation
Community

Multi-level Partnership

12 | A Health Communication Strategy for RNTCP


2.5.1 Universal right to know
The over-riding principle of the strategy is that every person
has a right to essential health information, including the basics
about DOTS. It is the responsibility of the government at all
levels to ensure that this information is made available to all
people, irrespective of their social and economic status, level of
education, gender, religion or any other specific individual or
group characteristics.

2.5.2 Cultural sensitivity


It has been characteristic of the development of IEC activities
for RNTCP in Orissa that communities have been involved in
a bottom-up approach. This has been guided by a systematic
effort to challenge the marginalisation of certain groups and
individuals at the community-level, and which has worked
to reduce the distance between service providers, patients and communities.
For example, special initiatives have been designed to decrease social distance
between tribal communities and non-tribal service provides, targeting the latter
to increase their understanding and tolerance of cultural variation.

2.5.3 Gender sensitivity


Gender issues influence timely detection and treatment
completion for both men and women. The communication
strategy needs to address gender through special gender
sensitisation initiatives and through mainstreaming gender
in the planning, development and implementation of any
communication activity.

2.5.4 Community participation


Community involvement in planning and implementation of
IEC activities foster a sense of ownership of the programme
at the local level. Social mobilisation is based on direct
dialogue with the community to understand and explore
existing concerns and possible social conflicts with relevance
to diagnosis and treatment. Potential or actual processes of
social marginalisation need to be identified and addressed. Ideally, this will create
a self-supporting and sustainable system for voluntary reporting of people with
TB symptoms. Only by creating a shared understanding that DOTS is possible in
spite of these factors, and that cure of TB is necessary for individuals, the active
involvement of communities in demanding RNTCP services can be ensured.

Strategic Framework | 13
2.5.5 Multi-level partnership
It requires the involvement and multi-level partnership of
a broad range of people to support large-scale adoption
of health practices that can bring down TB morbidity and
mortality. It is a strategic aim to involve relevant partners
in IEC activities as the patient may come into contact with a range of different
people and institutions in connection with diagnosis and treatment. Partners may
include private practitioners, NGOs at local, state and national levels, corporate
bodies and commercial establishments including pharmaceutical companies;
community groups (in particular women’s groups); local government and
panchayati raj institutions (PRI); self-help groups (SHG) and other community-
based organisations (CBO).

2.5.6 Appropriate media mix


TB Different media have different qualities of communication and
Control
they carry different aspects (intellectual, emotional etc.) of a
message. In addition, different target groups may have different
degrees of access to different media. Importantly, illiteracy is a
barrier for some people in accessing any written IEC. Material
development is an essential component of any IEC programme. It is necessary to
develop different types of materials for different types of audiences with focused,
targeted messages. Professional designers may often belong to the middle class
and employ middle class aesthetics. In Orissa, the use of drawings made by
artists from tribal communities proved highly successful both in terms of the key
audience’s ability to understand the messages and of increased ownership of the
programme.

2.5.7 Research, monitoring and evaluation


Research is required to assess communication needs and to
understand barriers to the desired health-related behaviour in
order to develop an optimal communication strategy and design. Particularly
for needs assessment and impact evaluation, and to address identified problems
and bottlenecks, participatory research methods should be used to involve
communities in analysing inputs and outcomes.

Monitoring and evaluation are separate from research and should be built into
the IEC activities as a routine component. Monitoring and evaluation help to
identify problems, measure progress towards achievement of objectives and
assess results in order to correct the problems identified. In addition, a routine
monitoring system with standard formats to document all IEC activities needs to
be in place (see Annexure 7 for monitoring formats).

14 | A Health Communication Strategy for RNTCP


3
Communication Strategy for TB
Control Programme

While the implementation of the DOTS strategy in India is beginning to bear fruit
in terms of decreased morbidity and mortality, TB is still the leading cause of
death among adults. From an estimated one TB death per minute in India in
1999, the rate has come down to an estimated two deaths every three minutes in
2004.

During Phase I, the Centre, states and districts 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.

3.1 Objectives and Focus of Communication in


RNTCP Phase II

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 DOTS services and
preventive action among:
 the public, so that they make use of RNTCP services and
 medical practitioners across the country, so that they
know about correct TB diagnosis and treatment and
they refer patients to DOTS services, 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, to enhance the reputation of a patient-

Strategic Framework | 15
friendly service, to improve provider attitude and skills and to encourage
patients and their families to become advocates for the programme.

3.2 Strategic Framework

The aim of developing a strategic framework for IEC is to identify the


communication need (objectives), communication players/audience (target
groups) and communication tools (channels, activities and materials). This
framework will build on the work already undertaken within RNTCP in Phase I.
It will be further modified to encourage a needs-based approach and will include
aspects of monitoring and assessment.

The focus in RNTCP Phase II is on a combination of Centrally-produced core


messages and media, and needs-based planning to develop state-and district-
specific strategies, with local innovations to reach all possible groups through the
most appropriate channels, materials and activities. The Central core framework
provides the general outline, and each state will come up with a more detailed
strategy based on their own needs, analysis of the problem and the target groups,
so that IEC activities are tailored to address local needs, and reflect local culture.

The framework has six components: objectives, target groups, messages,


channels, activities/materials and research and monitoring. These are applied to
each of the three objectives or IEC components. All IEC sub-components will be
analysed qualitatively to assess the needs, correct and refine the programme as it
evolves and help in gauging programme success in real-time.

The core strategic framework has been developed for use across the programme
to ensure a clear and unified strategic direction for IEC throughout RNTCP. Core
messages for the broad categories of target groups for each of the three objectives
will be standardised at the Central level to ensure that the accuracy of messages
is not compromised or diverted from the national programme’s key objectives.
The framework’s contents may be modified over time.

More detailed segmentation of audiences at the state and district levels will help
to formulate more specific and targeted messages, identify appropriate channels
and to develop context-specific activities and materials.

3.3 Guiding Principles for IEC in TB Control Programme

The over-riding principle of a communication strategy in the TB control


programme is that every person has a right to essential health information,
including the basics about DOTS, which involves timely diagnosis and necessary
treatment.

16 | A Health Communication Strategy for RNTCP


The communication strategy is guided by the following principles:

1. The communication approach is people-centred and client-friendly. This


means understanding the audience, their context, their perceptions and their
beliefs, and that too from their perspective, by learning from them, listening
to them and working with them.

2. Communication efforts and initiatives are process- rather than product-


oriented. TB control requires a long-term commitment from providers, policy-
makers and communities; this commitment is built through interaction and
partnerships, not simply by transmitting information. A systematic analysis
of needs and ongoing monitoring and evaluation are required to continuously
guide this process.

3. Detailed planning, choice of communication channels and monitoring are


decentralised to ensure contextual relevance and a wide reach of information.
The Centre provides leadership, develops core messages and mass media and
advocacy events but otherwise supports a decentralised approach. The states
and districts base their local strategies on the core framework and messages
and promote local adaptation and innovation to reach all possible groups
with the most appropriate communication tools.

4. Communication strategies address social and cultural issues related to TB


such as stigma, social distance between patients and providers, poverty,
illiteracy and gender. Addressing socio-cultural issues has a positive impact
on treatment-seeking and -completion.

3.4 Behavioural Goals for IEC Strategy

In RNTCP, three basic essential behavioural goals are


t Seeki
critical for success, viz. en n
m
g
t
Trea

1. treatment-seeking,
2. timely detection and
3. completion of treatment. Ti
m
ely

1. Treatment-seeking t
Treatmen

General awareness of TB symptoms forms a necessary


Det

backdrop for treatment-seeking behaviour during the


early stages of disease.
ec

ti
on
2. Timely detection
C

om
f

Treatment-seeking leads the person with symptoms pletion o


into contact with the health system, where diagnosis

Strategic Framework | 17
can be performed. The earlier the correct diagnosis is established, the sooner the
treatment can begin and the patient cease to be a potential source of infection.

3. Completion of treatment
The treatment for TB is long and must be completed for a patient to be cured.
After one or two months of treatment, the symptoms of TB subside and this
often leads to a shift in the patient’s priorities. Patients may live in circumstances
where earning a living, family responsibilities or job compulsions are seen as
more compelling than going to the DOT provider or the health centre. Since it
has proved impossible to predict risk of defaulting, it is critical that the patient is
given unremitting support and counselling.

We shall consider treatment-seeking, timely detection and completion of


treatment as our strategic behavioural goals.

3.5 Health Systems Research for IEC

Health systems research (HSR) can provide essential input for IEC. HSR is an
umbrella concept for multidisciplinary research on identified health system-
related problems. Complementary research methods are selected accordingly.

3.5.1 Utilisation of research for IEC development: an example


Prior to the development of the Orissa IEC model for RNTCP, an HSR project was
undertaken with the objective of determining the knowledge, perceptions and
health-seeking behaviour of three tribal districts of Orissa with regard to chest
symptoms and to assess local sources of information on health and disease.1

The findings of this study revealed that blood in sputum was perceived as the main
distinctive symptom of TB and was also seen by villagers as leading inevitably to
the death of the victim. The causes of TB were perceived to be alcohol, tobacco
and hereditary disposition, while at the same time TB could spread through direct
social interaction. The first point of contact for people with TB symptoms was
the traditional healer. Half the population knew that TB treatment was now free,
but most knew patients who had spent lots of money on treatment. The defaulter
rate was as high as 15 per cent, and the average minimum delay in diagnosis was
111 days for men and 146 days for women.

These results pointed to the need to develop new kinds of communication


activities that could effectively make appropriate TB information available
to largely illiterate populations, including the tribal communities. With the

1
Health-Seeking Behaviour of Tribal Communities for TB: Perceptions and Practices — a study in
three districts of Orissa, October, 2000, DANTB, Orissa. www.dantb.org

18 | A Health Communication Strategy for RNTCP


expansion of RNTCP coverage beyond the initial districts, the communication
activities also expanded, and, in 2003, a comprehensive IEC strategy for RNTCP
in Orissa was developed on the basis of the experiences gained.

The ultimate goal of health research is to contribute to the solution of priority


health problems. However, the purpose is to produce research results of sufficient
quality to inform and guide policy decisions. The above example illustrates how
research, when integrated into health programme planning and implementation,
can play an important role in improving the utilisation and coverage of health
services by creating a dialogue between programme staff, policy-makers and
researchers.

3.6 Defining Behavioural Change Objectives

Whether the target population is a particular group or the general public, it


is important first to refer to the TB control programme’s behavioural change
objectives. What changes in behaviour does the programme intend to achieve?

3.6.1 Understanding audience and target behaviour


While selecting and addressing the target groups we need to consider that the
ultimate goal is to promote behavioural change among potential and current
patients so that they seek treatment, get diagnosed and complete treatment.

Given these goals, the primary and secondary target groups for the communication
strategy include (but is not limited to):

Primary Target Group

 TB patients/potential TB patients

 Families/neighbours/general public

Secondary Target Group

 Doctors/RMPs/clinic operators/medical students

 DOT providers

 Local leaders

 ANMs/AWWs

 SHGs/CBOs/NGOs/PRIs

Strategic Framework | 19
Often, intermediate agents, such as media and influential community members,
play an important role in reaching both primary and secondary target groups.

3.6.2 Defining the communication objectives for the target


audience

Once local needs have been assessed, a matrix is developed to identify the
objectives for each target group. Below is given an example for illustration.

Primary target group Secondary target group

1. TB patients/potential TB patients 1. Doctors/RMPs/clinic operators/


2. Families/neighbours/general public medical students
2. DOT providers
3. Local leaders
4. ANMs/AWWs
5. SHGs/CBOs/NGOs
6. PRIs

Raising awareness about TB 1. Equipping with information to


1. Seeking timely treatment communicate better

2. Taking care of self and family members 2. Increasing capacity for providing care
and making services more accessible
3. Reducing stigma and discrimination

3.6.3 Identifying and defining barriers


Having defined the primary and secondary target audiences and the
communication objectives, the next step is to use the available knowledge and/
or findings of the needs assessment to identify barriers and means to overcome
them. It must be noted that not all barriers can be addressed by communication
alone. The table below shows possible barriers that could emerge in such an
exercise:

Target audience Barriers

Primary target group


TB patients/potential TB patients Low awareness about TB
Low risk perception
Misconceptions about cure and treatment
Fear of TB
Stigma and discrimination
Accessibility to services
Cost of services and treatment
Attitudes of service providers
Treatments process and time taken
Low awareness about TB

20 | A Health Communication Strategy for RNTCP


Primary target group
Families/neighbours/general Low risk perception
public Misconceptions about cure and treatment
Fear of TB
Stigma and discrimination
Accessibility to services
Cost of services and treatment

Secondary target group


1. Doctors/RMPs/clinic Inability to communicate effectively
operators/medical students Lack of relevant information
2. DOT providers Lack of counselling skills
3. Local leaders
4. ANMs/AWWs
5. SHGs/CBOs
6. PRIs

3.6.4 Understanding barriers and target behaviour


A participatory communication strategy with emphasis on community
participation needs to have a bottom-up approach, which systematically seeks
to challenge the dynamics that marginalise certain groups and individuals at
the community level. A key concern is to overcome communication gaps and
social distance between service providers, patients and communities. A small
but symbolically very important example of this is to insist that all participants
sit at the same level during meetings, irrespective of their status outside. An anti-
hierarchical approach establishes a context in which it is seen as meaningful for
people to change their behaviour actively and participate in the implementation
of the DOTS programme for themselves as patients and for other patients in their
community. In order to involve all members in group activities, participatory
learning methods are required.

Participatory learning
Participatory learning is a creative problem-solving method in which every
member participates actively. In the participatory approach, the learning process
is just as important as the subject of learning.

Participatory learning:

 focuses on the needs and problems of group members,


 uses each group member’s knowledge, experience and skills,
 considers every participant a trainee and a trainer,
 uses practical real-life activities so participants learn by doing and
 takes place at a location and in a setting where participants feel at ease.

Strategic Framework | 21
Participatory learning increases group members’ understanding of their situation
and makes them more aware of their own values, attitudes, skills and knowledge.
It allows them to discover their hidden talents and capacities and strengthens
democratic community-level problem-solving and decision-making processes.

One of the well-established forms of participatory learning is participatory rapid


appraisal (PRA). Individuals with PRA experience should be involved and/or
specific literature be consulted when adopting PRA techniques.

An illustrative list of behavioural barriers is provided below that may be identified


through participatory learning processes.

Illustrative List of Behavioural Barriers with Examples

S No. Behaviour Example Reason

1. The target behaviour exists but Patients do not approach a health facility for Early symptoms are not
not to an adequate degree or with investigation after the onset of TB symptoms for more considered serious.
sufficient frequency. than three weeks.

2. The target behaviour exists but not Patients do not complete treatment but stop when the Implications of
for sufficient duration. symptoms disappear. stopping treatment are
not understood.

3 The target behaviour exists but not The DOT provider visits the patient for follow-up but The DP has been
in the form desired. gives information in a patronising manner and does insufficiently trained
not provide support for completing the treatment. and/or supervised.

4 The target behaviour exists but not The patient is not taken for sputum test and treatment Importance of
at the right time. until a late stage where chances of cure are small. early treatment not
understood. Services
are not trusted.

5 The social and cultural aspects of Stigmatisation may effectively block timely detection DOTS and/or curability
the disease in question may block of TB for particular groups, e.g. women. of TB is not accepted.
the desired practice.

6 The life conditions of the target A woman may not be allowed to leave the house at the Gender discrimination
population block them from time of an interaction meeting because no man will blocks women’s access
accessing either IEC information or accompany her. to services.
services or both.

7 The target behaviour has a The opportunity cost for continuing treatment or the Poverty affects choices
competing priority behaviour. need to resume work after the relief of symptoms may of patient.
affect treatment completion.

8 Desirable health practices are Taking seven pills every alternate day for two to three As provided above.
frequently more complex than they months, followed by a sputum examination, followed
may appear to be. by three to four months of continued medication,
may appear simple on paper, but practising it may be
difficult for a variety of reasons as mentioned above.

22 | A Health Communication Strategy for RNTCP


3.6.5 Developing approaches to address the barriers
After having defined the barriers to be addressed, the next step is to identify the
relevant communication approaches. The matrix below provides an example with
target groups to be addressed, barriers, key messages that will be communicated
and support services that would be needed to achieve these changes.

Target groups Barriers Key Messages Support Services

Primary target  Low awareness about TB  A cough that lasts for  Provision of and access
group  Low risk-perception more than three weeks to user-friendly health
 TB patients could be TB services
 Misconceptions about cure and
 Potential TB treatment  There is a sure cure for  Counselling services
patients TB through DOTS  Testing facilities
 Fear of TB
 Availability of free  Treatment facilities
 Stigma and discrimination diagnosis and treatment
 Accessibility to services through PHCs
 Cost of services and treatment
 Attitude of service providers
 Treatment process and time taken

Primary target  Low awareness about TB  There is a sure cure for  Provision and access to
group  Low risk-perception TB through DOTS health services
 Families  Misconceptions about cure and  Counselling services
 Neighbours treatment  Save somebody’s life by  Information services
 General public convincing them to take
 Fear of TB
the full treatment for TB
 Stigma and discrimination
 Accessibility to services
 Cost of services and treatment

Secondary target  Inability to communicate  Today there is a sure  Provision or access to


group effectively cure for TB but your health services
 Doctors  Lack of relevant information support is needed to  Education services
 RMPs make it fully effective
 Clinic operators  Lack of counselling skills  Counselling services
 Medical students  Information services
 DOT providers
 Local leaders
 ANMs/AWWs
 SHGs/CBOs
 NGOs

3.6.6 Develop themes and messages


While the strategy puts emphasis on understanding the local needs, state-
and district-level implementers need not re-invent the wheel. The online IEC
Resource Centre should be consulted to assess whether suitable materials exist
that can be adapted to the local needs.

Strategic Framework | 23
When a new campaign is developed, it should have an overall theme that will
appeal to and attract the target populations. The theme should stem from the
BCC formative assessment and further consultation. It should provide overall
guidance for the development of messages, which should therefore be consistent
with the theme.

The theme should be positive. It is now commonly understood that fear campaigns
and campaigns blaming particular groups are ineffective. Most experts agree that
fear tends to focus an audience’s attention on what not to do, or what to avoid,
and they may increase victim-blaming and stigma that in turn cause people to
avoid services that may benefit them. Approaches are more effective when they
promote positive messages that state clearly what audiences can and should do.

The theme should be catchy and devised in such a way that all target populations
can relate to it and identify with it. People who see different messages for different
audiences should be able to link any of these diverse elements with the theme of
the campaign.

3.6.7 Developing a creative brief


After collecting information on the target audience and determining the best
communication materials to be used, and before beginning the actual design
of communication materials, the material development team should prepare a
‘creative brief’ for each material to be prepared. The creative brief serves as a
guide, assisting those who carry out actual material design and production. The
creative brief should define the objectives of the IEC material, identify obstacles
to be expected in its use or acceptance, develop draft messages or advice and
support statements, define the tone of the messages and list any other necessary
creative considerations such as different language versions or social conditions.

In short, the creative brief serves as a map or guidebook for the IEC material
development team and the creative designers.

3.6.8 Designing messages


A message is a short phrase or sentence that summarises an idea in a simple,
attractive and understandable term. It is the ‘take-away’ information that is
repeated to friends, colleagues and other interested parties. A good message is
short and to the point and answers to the hopes and aspirations of the target
population: ‘If I do X (get information, go for diagnosis), I will benefit by Y’ (not
get very ill and lose income, protect my family, be completely cured). Whatever
the benefit, it will have to outweigh any disadvantage or ‘cost’ the audiences
might perceive. People may also need messages that help them feel they can
succeed. This may be accomplished through messages that model success and
positive outcomes.

24 | A Health Communication Strategy for RNTCP


3.6.9 Pre-testing materials
The pre-testing of IEC materials is an important step in the development
process. Without pre-testing, IEC materials stand the risk of becoming inefficient
and detached from the needs of the target audience. Such IEC materials may
be neutralised, transmit useless information, not motivate, or not build upon
existing positive practices.

Pre-testing draft materials can help determine whether the materials and
messages are acceptable to the intended target audience and the individuals
charged with using or distributing the material. Pre-testing of draft IEC material
ensures that the material is ‘right’ from the audience’s perspective.

3.6.10 Selecting suitable channels


Communication channels are used to access the target groups with the intended
messages. While the profiles of target groups are indicative of how they can be
reached, it is important to understand and clarify the main mechanisms to be
adopted for reaching each target group.

Typology of media (interpersonal/mass media) (one way/two way, advocacy)

 Folk media/street theatre


 Interactive/IPC
 Events/exhibition/World TB Day rallies
 Mass media—electronic, broadcast, print, outdoor
 Advocacy
 Capacity-building

For each type of media, there can be a number of specific forms of implementation.
To choose the best mix for a particular target audience and communication
purpose, the advantages and disadvantages of the different types and forms
should be carefully considered. The table below provides a sample analysis of
this.

Media Type Advantages Disadvantages/Special Requirements


Main television  Reaches communities on a large scale  Does not reach the poorest and
channels most disadvantaged groups
 Expensive to produce
Local television  Reaches communities through their  Reach is limited
channels dialects  Expensive to produce
Mass Media
Film  Information/education through  One-way communication
entertainment  Expensive to produce
Print  Can use the material more than once  Requires writing/reading skills (does
 Can mobilise public opinion not reach illiterate people)
 Can contain more detailed information

Strategic Framework | 25
Hoardings  High visibility if well-placed  Easily removed
 One-way communication
 Stationary
Bus panels  High visibility if well-placed  Requires writing/reading skills (does
 Mobile not reach illiterate people)
Outdoor Wall paintings  High visibility if well-placed  One-way communication
 Can be used in relevant context (i.e,
PHI walls)
Exhibitions  Can combine numerous materials and  Expensive
media  Requires staff
 Can be interactive
Street plays  Focuses directly on real-life issues and  Requires troupe of actors
provides a platform for solutions  Requires travel from village to village
Puppets  Flexible infotainment method for
 Requires puppet theatre
educating communities
 Requires travel from village to village
 Can effectively reach illiterate
Song and communities  Requires singing and dancing
Folk Media Dance  Can be combined with counselling troupe
 Is liked by all age groups (including  Requires travel from village to village
children)
Haats  Interactive method to address  Requires skilled persons for
questions from target audience communicating
 Weekly market setting reaches both  Requires travel from village to village
men and women
Community  Can generate vivid local-level  Women may not attend
Communi-
radio discussion
cation
Media  Particularly useful at village clubs/
gatherings
Rally  Large-scale participation  Short-lived
Events World TB Day  Strong coordination of activities at all  Requires organising capacity
levels simultaneously
Patient-  Decreases social distance  Requires good communication skills
provider  Creates mutual confidence between
interaction patients and providers
meetings
Trialogue  Establishes community support for  Requires good communication and
IPC
patient facilitation skills
 Addresses stigma
Peer education  Critical-awareness-building  Requires careful selection and
training of peer educators
Group  Can create critical mass of change  Effect depends on social
meetings agents at community-level cohesiveness of group outside the
 Interactive and participatory activity
communication process
Community  Can create critical mass of change  Requires good communication skills
meetings agents at community-level
 Interactive and participatory
communication process

26 | A Health Communication Strategy for RNTCP


1. Treatment-seeking Behaviour

IEC Strategic Framework, Goals, Objectives, Audience, Themes, Activity and Indicators

Goals Objectives Audience Key Barriers Themes/Message Activities/ Channels/ Indicators


Focus Media
Awareness  Community groups  General mistrust due to  Role models  Mass media  Positive reports in
 Local community previous bad experiences  Perception  IPC media
leaders with health services —right, respect,  Decrease of delay in
 Folk media
 Opinion leaders  Unauthorised TB responsibility diagnosis
 Advocacy
treatment exists  Concept of DOTS  Decreased fear of TB
 Social mobilisation
 Low awareness about TB diagnosis
 Intersectoral
 Low risk-perception  Increased support
partnership with NGOs/
 Misconceptions about to people with TB
PRIs/SHGs/teaching
cure and treatment symptoms to go for
institutions
diagnosis
 Fear of TB
Advocacy  Community groups  Stigma and discrimination  Importance of  Mass media  Increased uptake of
 Formal/informal  Accessibility of services early detection  IPC services
community and effects  Increased community
 Cost of services and  Folk media
organisations of complete support from PRIs
treatment  Advocacy
treatment
TB
 PRI members  Negative attitude of
CONTROL
 Social mobilisation
service providers  Intersectoral
partnership with NGOs

Treatment-seeking Behaviour
Patient-  Patients with TB  Previous bad experience  Good provider  IPC  Decreased rejection
provider symptoms and with health services behaviour  Role play by community and
Communication their families  Poor communication  Importance of family
 Street theatre
 Staff of PHI skills friendly and  No. of people with TB
 Games
informative symptoms seen by
communication  Display/print media medical doctors
with patients  Interaction in groups  Increased voluntary
testing

Strategic Framework
| 27
2. Timely Detection
Goals Objectives Audience Key Barriers Themes/Message Activities/Channels/ Indicators
Focus Media
Awareness  Community  Insufficient attention  Role models  Mass media  Increased demand for
members importance being given  Perception  Print media diagnostic services
 Community to TB symptoms among —right, respect,  Increase in correct and
 Folk media
health staff

28 | A Health Communication Strategy for RNTCP


groups responsibility complete information
 Display media
 Community  Low risk-perception  Knowledge of  Decrease in stigma and
 Advocacy
leaders  Misconceptions about cure  Timely discrimination
and treatment  Social mobilisation
 Political detection  Increased community
representatives  Fear of TB  Intersectoral support for diagnosis
 Availability of
partnership with
 Health system  Stigma and discrimination free drugs
NGOs/ PRIs/SHGs/
staff  Accessibility to services  DOTS strategy teaching institutions.
 NGOs/PRIs/  Negative attitudes of
SHGs service providers
 Illiteracy
Advocacy  Opinion leaders  Competing interests and  Knowledge  Mass media  Increased support for DOTS
 Political priorities about TB,  IPC  Increased demand for
representatives  Competing demands for symptoms, diagnostic services
 Folk media
attention mode of
 Media  Advocacy  Increased support from
infection and
representatives PRIs and other institutions
treatment  Social mobilisation

Timely Detection
TB  Increased media coverage
CONTROL  Information on  Intersectoral
of TB
DOTS strategy partnership with
NGOs/ PRIs/SHGs/
teaching institutions

Patient-  Patients  Insufficient attention/  Role models  IPC  Increased support to


provider  Family members importance being given  Perception  Role play patients with TB or TB
Communication of affected to TB symptoms among – right, respect, symptoms
 Games
people with TB health staff responsibility  Increased trust between
 Display/print media
 Staff of PHI  Lack of counselling skills  Knowledge of patients, families and
 Interaction in groups providers
 Poor communication skills DOTS strategy
 Communication  Decrease of both diagnosis
strengthening activities and treatment delay
 Increased voluntary testing
3. Treatment Completion

Goals Objectives Audience Key Barriers Themes/Messages Activities/Channels/ Indicators


Focus Media
Awareness  TB patients  Low risk-perception  Proper counseling  Mass media  Increase in
 Community  Misconceptions about cure on routes of  IPC correct and
and treatment transmission, complete
 General public  Folk media
methods of treatment
 Adverse effects of treatment  Advocacy
prevention  Decrease in
 Difficulty in swallowing  Social mobilisation
 Role models defaulting
many tablets
 Perception  Intersectoral
 Accessibility to services partnership with
 Effects of correct,
 Attitude of service providers NGOs/PRIs/SHGs
complete treatment
 Treatment process and time and regular sputum  Games
taken check-up
 Financial constraints  Implications of not
completing treatment
Advocacy  Community  Lack of relevant  Importance of correct,  Mass media  Increased support
groups information complete treatment  IPC for DOTS
 Formal/informal  Lack of communication and regular sputum
 Folk media
community skills check-up
TB  Advocacy
CONTROL
organisations  Poor communication skills
 Social mobilisation

Treatment Completion
 Intersectoral
partnership with
NGOs

Patient-  Patients  Competing priorities for  Proper counselling  IPC  Increased use of
provider  Family members patient/family  Role play DOTS services
Communication of TB patients  Inability to take medicines/  Increased support
 Street theatre
go for sputum test for patient
 Games
 Distance between DP and to complete
 Display/print media treatment
patient
 Interaction in groups  Increased
 Lack of counselling skills
regularity of
treatments

Strategic Framework
| 29
3.7 Planning at State- and District-level

It has been described above that a plan of action should be based on audience
needs, putting objectives and goals first. This could be filled in a matrix, as given
below.

Action Plan
S.No. Goal Objective Audience Activity/Materials/ Budget
Events

1 Awareness

2 Advocacy

3 PP
Communication

The next step is to develop a media plan of how the activities and materials will
flow over the months in the year. This should ensure that activities and materials
are taking place in the planned manner. It should also help to synchronise
activities for maximum benefit. This requires knowledge of media habits and the
differential reach of various media and their relevance to the target audience. A
planning matrix has been given below that can be used to get an overview of the
media mix over a period of 12 months.

Media Plan
TV Radio Press Outdoor

Jan

Feb

Mar

Apl

May

Jun

Jul
Aug
Sep
Oct
Nov
Dec

30 | A Health Communication Strategy for RNTCP


3.8 Checklist for Strategic Planning Framework

1. Analysis of the situation


1. Purpose (health situation that the programme is trying to improve)
2. Key health issue (behaviour or change that needs to occur to improve the
health situation)
3. Context (wtrengths, weaknesses, opportunities and threats (SWOT) that
affects the health situation)
4. Gaps in information available to the programme planners and to the audience
that limit the programme’s ability to develop sound strategy. These gaps will
be addressed through research in preparation for executing the strategy
5. Formative research (new information that will address the gaps identified
above)

2. Communication strategy
1. Audiences (primary, secondary and/or influencing audiences)
2. Objectives
3. Positioning and long-term identity
4. Strategic approach
5. Key message points
6. Channels and tools

3. Management considerations
1. Partner roles and responsibilities
2. Timeline for strategy implementation
3. Budget
4. Monitoring plan

4. Evaluation—tracking progress and evaluating impact strategy


review checklist
The table below is a checklist to help you ensure that the communication strategy
is completely integrated into the RNTCP. As mentioned at the beginning of the
book, strategic communication is the steering wheel that guides the rest of the
programme. This checklist helps to ensure that the steering wheel is working
successfully.

Strategic Framework | 31
Review Checklist
Subject Key Question Degree of
integration
(Score)
(1-lowest,
10-highest)
Objectives Do the behaviour change objectives fit
with the programme objectives?
Programme Do the communication activities fit
implementation well with other programme functions
such as service delivery, logistics,
policies and staffing?
Message Are the communication messages
integration consistent with availability, access and
cost (financial and psychological) of
the service?
Communication Are the tools and channels being used
mix integration to guide the audience through the steps
to behaviour change?
Message design Is the message design consistent with
integration the positioning of the product, service
or behaviour?
Management Are all internal and partner
integration organisations working together in
accordance with an agreed upon plan
and strategy with regular progress
meetings?
Financial Is the budget being used in the most
integration efficient and effective way to ensure
that the economies of scale are
achieved?
Level of integration (total)
(Total possible score=70)

32 | A Health Communication Strategy for RNTCP


4
Monitoring and Evaluation of
Communication in RNTCP
The design of any health communication campaign needs to include monitoring
and evaluation activities to be complete. Monitoring and evaluation help to
identify problems, measure progress toward objectives and assess results.

4.1 What is Monitoring and Evaluation?


 Monitoring is a regular assessment of routine records of decisions, activities,
expenditures and, if possible, outcome indicators to ensure that actions are
taken according to plan and that the expected outcome is achieved.
 Evaluation is an analysis of activities and outcomes relative to project or
programme objectives.

4.2 Monitoring
Documentation of activities is a necessary pre-condition for ongoing monitoring.
Therefore, standard formats need to be used. Sample formats have been annexed
in this book, but additional formats will have to be developed according to the
specific needs and further development of the IEC component.

Monitoring is particularly useful in two areas:

1. Monitoring for management: Careful monitoring is essential throughout


implementation to be able to identify bottlenecks and critical barriers that
may otherwise derail the programme.

2. Monitoring for accountability: Monitoring enables the state and funding


agencies to assess the value of the programme and demonstrates appropriate
use of funds.

4.3 Evaluation
Evaluation questions are formulated by using the behavioural objectives as
criteria after the media are finalised, reproduced and put to use.

Evaluation may look at processes and/or outcomes. Process evaluation will often
be qualitative in nature and analyse organisational, managerial, administrative
and technical aspects of a programme, a project or an intervention. Outcome

Strategic Framework | 33
evaluation may often use both qualitative and quantitative methods and will
assess whether the objectives of the activity were achieved.

While outcome indicators seem straightforward in terms of IEC activities for


RNTCP, in practice they are not. Even though it is known that IEC will certainly
strengthen both case-detection and case-holding, it is difficult to know what
is the contribution of IEC is in a particular case, compared to other factors
(such as vacancies at PHI level, personal relationship between DP and patient,
role of private practitioners in community etc.). Because of the many possible
compounding factors the success of IEC activities cannot simply be read from
the standard quantitative IEC indicators. What can be assessed are qualitative
indicators such as general awareness of signs and symptoms at the community-
level, reasons for preferring a particular first-line treatment option, and
community-level acceptability of DOTS.

4.4 Monitoring and Evaluation in RNTCP Phase II


At the Central level, monitoring and evaluation has been the policy of the
programme and will be continued. An end-term impact assessment of the Phase
I media activities would be the basis for developing a media plan for the Phase
II project. At least one mid-term review/impact assessment will be conducted
to help in fine-tuning the media campaign during the project period, and one
detailed end-term impact assessment will be carried out. Opportunities for
feedback on IEC activities would be found during routine meetings, such as the
weekly meetings of PHIs and designated MCs, fortnightly reviews of the STS/
STLS by the MO-TC, monthly district-level review meetings between the DTO
and staff, state-level review meetings held at the end of each quarter and CTD
review meetings of STOs twice a year. These review meetings are useful tools for
monitoring the implementation of the IEC components.

Focused qualitative studies would be encouraged to be undertaken by some


states. These would be useful both in designing and refining IEC strategies. These
could be outsourced to local institutes or NGOs. Larger studies would fall under
the operational research agenda.

Process indicators for monitoring state capacity to formulate and implement


needs-based IEC activities will be developed over the course of the first year,
and used for monitoring the decentralisation of IEC activities. An appropriate
checklist designed by the programme would be used as a standard tool for
monitoring state level activities.

State annual action plans would be monitored against achievements at the state-
level, and IEC would be included in the periodic internal evaluations conducted
by states and CTDs.

34 | A Health Communication Strategy for RNTCP


The following issues are some examples included in the National Operational
Research Agenda:

 Study profile of initial defaulters and analyse barriers to their access to DOT

 Qualitative studies to document the impact of stigma on access to and


utilisation of RNTCP services

 Qualitative assessment of effectiveness of patient information leaflets and


other materials

 Qualitative assessment of impact of IPC training on sensitivity of providers to


socio-economic needs of patients

 Qualitative study to understand the barriers to utilisation of RNTCP services


in tribal areas

 Evaluation of IEC messages prepared in locally relevant tribal


dialects/languages

4.5 An Example: IEC and Acceptability of DOTS


A study was carried out in 2005 to assess the impact of IEC/BCC activities
in RNTCP, with special attention to the issue of acceptability of DOTS at the
community-level in selected districts of Orissa.3

Of the 30 districts of Orissa, 14 districts with RNTCP implementation


before 1 January 2003, were included and stratified according to the year of
implementation of the RNTCP. One district from each stratum was randomly
selected for the study and IEC activities mapped and ranked under a three-
pronged classification according to direction and purpose:
1. One-way communication (IEC)
2. Two-way communication (IPC/BCC)
3. Advocacy

Based on the calculated intensity of IEC activities, MCs were sorted into quartiles.
Two MCs, one with high and one with low intensity of IEC activities, were selected
in each of the four districts. Two villages for each of these MCs were selected
randomly for in-depth study. In addition, six villages were included where street
theatre performances (which is a key tool for community-level IEC) about TB had
taken place. In all villages, group discussions and semi-structured interviews at

3
A detailed study report will be published at www.dantb.org by the end of 2005.

Strategic Framework | 35
the community-level were conducted to assess the awareness and acceptability
of DOTS. In addition, available RNTCP statistics were analysed.

In one district, the qualitative study showed that knowledge about TB as an


infectious disease that could be cured by DOTS after diagnosis on the basis of a
sputum test (and X-ray) was substantially more consolidated in villages of the MC
with high IEC-intensity than in the MC with low IEC-intensity. The information
about TB was more coherent, and more people were able to volunteer information
about signs and symptoms, treatment and curability. The study also showed that
in both areas, there was cause for some concern about indirect cost of treatment
and/or travel to the health facility. Perhaps most importantly in terms of IEC and
acceptability of DOTS, it was clear that health communication is perceived in a
context of :

1. what is already known,


2. competing interests of various actors (including, for example, traditional
healers, drug vendors and private practitioners),
3. the quality and accessibility of health services in the community, and
4. prior experiences in the community with TB in particular and with various
practitioners and services offering treatment in general.

It was also found that the RNTCP indicators were not sufficiently sensitive to
assess IEC impact directly.

One of the main conclusions of the study is that former patients play an essential
role as RNTCP advocates and sources of knowledge. This implies that patient-
provider interaction meetings and the trialogue approach should be given high
priority in the future.

36 | A Health Communication Strategy for RNTCP


5
Capacity-building
5.1 Central Level: Advocacy and IEC Unit

An Advocacy and IEC unit within the CTD will be established to provide overall
leadership for the IEC component, to procure services of the IEC agency at the
central level and coordinate activities, to manage the mass media component
at the national level, and to provide oversight, assess capacity and ensure
consolidation of further development of IEC materials.

During Phase I, the programme took advantage of expertise from outside sources.
For example, deciding on indicators for the baseline studies and tracking, and
the review of IEC materials for developing the web-based Resource Centre
(December 2002 to December 2003), the CTD IEC team was assisted by a number
of institutions such as WHO, the World Bank, Danida, media and social research
agencies and NGOs. In RNTCP Phase II, this concept of profiting from outside
advice is formalised in the form of an IEC advisory group for infusion of ideas
and sharing of experience.

WHO consultants provide technical assistance to districts, states and the


Centre. They assist districts and states in developing action plans including IEC
activities.

5.2 State-level Capacity for IEC

At the state-level, responsibility for IEC activities within the State TB Cell rests
with the STO who is assisted by an IEC officer. Responsibilities include:

 Vision for communication aspects in RNTCP


 Planning of IEC activities
 Monitoring of IEC activities
 Tapping resources for IEC activities
 Supervision of IEC activities
 Support to districts
 Developing material in local languages
 Organising events for advocacy

Strategic Framework | 37
 Supervision by IEC officer
 Capacity building of the districts for implementing activities for awareness
generation and social mobilisation.

Training for the IEC officers will be provided in two stages: 1) induction training
when they first join, which will introduce them to the RNTCP; and 2) specific
training in IEC for RNTCP will be conducted in batches by the CTD with the
support of Danida in Orissa. The curriculum developed with the support of
Danida would be used for subsequent training and retraining of IEC Officers at
the national/regional institutes. Inter-state visits will provide opportunities for
IEC officers to learn from others and share ideas.

A communication facilitator who may be an individual or a group/institution/


NGO will work with the state TB Cell to facilitate activities across about five
districts to address a felt need that experienced and helping hands are needed at
the district level to support the medical officers to organise and implement social
mobilisation activities.

5.3 District-level

Districts will have an active role in developing plans for IEC activities with
sufficient flexibility to allow for local initiatives and variations. IEC activities at
the district-level would use the appropriate local medium for dissemination of
information. IEC activities at the district-level would involve local organisations,
leaders, panchayats and NGOs for IEC.

Each district will organise a certain minimum number of minimum activities,


such as community meetings, mike publicity, display of posters at each PHI,
interaction meetings, trialogue meetings, wall paintings and puppet shows and
street plays. Each PHI will have one such activity organised at the village-level in
a year. Wall writings are proposed in each village. Facilitation of IEC activities will
be by the newly-created level of Communication Facilitator from the state who
will support in planning and organising social mobilisation activities at district
and sub-district level.

In addition, support from outside the formal health system would be sought. The
wide range of players such as gram panchayats, NGOs, mahila mandals, youth
groups, and schools along with support and resources from state and district
administration, such as information/ education officer would be co-opted.

Capacity-building would also include sharing of material and innovations across


districts and states. While the Centre takes the leadership, states and districts will
plan and implement need based health communication activities. There would

38 | A Health Communication Strategy for RNTCP


be a two-way flow of information from and to the Centre and the states. The
establishment of a web-based IEC Resource Centre at the official website is the
first step in this direction. This would be strengthened further with the regular
addition of new material.

The local communication teams at the district-and sub-district-levels are


recommended to try different approaches and resources in view of the different
local resources in terms of leadership and groups. For example, in one district the
team might revolve around PRIs and in another a local NGO might take the lead.
States and districts would be encouraged to explore innovative approaches in
communication, particularly for hard-to-reach groups. The lessons learnt from
these approaches could be disseminated widely across districts and states.

A detailed guide for implementation with special attention to district and sub-
district level activities is provided in Part 2 of this document.

Strategic Framework | 39
6
Special IEC Needs in RNTCP
Phase II
6.1 Improving Access to Hard-to-Reach Populations

During Phase II, RNTCP has prioritised hard-to-reach groups and IEC will play an
important role. The following groups have been identified for special attention:

 Tribal populations
 Marginalised populations in urban slums
 Other marginalised and vulnerable sections of the community

Tribal populations
The studies done in the first phase of the project, i.e. studies on accessibility
and utilisation of RNTCP services by the marginalised sections, along with field
experience, have identified specific areas for IEC attention. These studies have
made the following suggestions for promoting community participation and
intersectoral coordination:

 Involvement of NGOs, traditional healers, private practitioners, AWWs,


community health workers (CHWs), cured patients, tribal youth and other
community based volunteers in IEC activities and to provide DOT, using
local (tribal) origin as a selection criterion
 Developing locally relevant IEC messages and patient education material
using local vocabulary, prepared by taking help of local primary school
teachers and members of PRIs
 Using local chemists, grocery shops and other places frequently visited by
tribals to disseminate information on RNTCP and DOTS
 Using the opportunity offered by village fairs and festivals as well as weekly
market days to inform the tribal population about DOT
 Link IEC in RNTCP with the social mobilisation campaigns held in other
disease control programmes
 Decrease communication gaps and social distance between non-
tribal service providers and tribal communities through culture and
communication sensitisation workshops and other similar activities

40 | A Health Communication Strategy for RNTCP


Marginalised populations in urban slums
Evidence from studies suggest that special efforts are needed to increase access
to DOT for the marginalised population in urban areas – the poor, homeless and
migrants – and for patients who are under-represented in RNTCP, like working
and elderly males and males and females of marriageable age. IEC interventions
to reach these groups would include:

 Involvement of cured patients, student and community volunteers to


motivate patients, provide DOT and trace defaulters
 Involvement of NGOs and support groups working with alcoholics and
drug addicts in counselling and DOT provision
 Involving support groups for migrants working in cities such as social
networks in the city encompassing relatives and friends extending from the
places of origin of migrants to help in case detection, patient motivation
and DOT
 Providing workplace information about TB and DOTS, particularly in sites
where male representation in the programme is poor and in cities where
migrant populations are engaged in specific activities (hotel workers,
taxi and rickshaw drivers and daily wage labourers engaged in loading
and unloading activities in ports, railway stations etc) by sensitising and
involving employers and contractors as DOT providers

IEC for people living with HIV


Opportunities for reaching HIV-positive patients with information about TB, and
for reaching TB patients with information about the possible link with HIV, will
be found through strengthening the links between TB and HIV programmes. TB–
HIV coordination has been initiated in the first phase of the project, and includes
IEC activities.

Measures to synergise efforts for IEC would be taken in future for the benefit
of patients. Both the programmes will ensure availability of health education
material to the other programme. RNTCP believes that the most useful channel is
interpersonal communication, and there is an existing infrastructure of services
and NGOs to facilitate this.

While TB is stigmatised to some degree and among some populations, HIV/AIDS


is much more so. While de-stigmatisation of both HIV/AIDS and TB should be
pursued as a high priority, IEC activities addressing the co-infection of TB and
HIV should seek to avoid the inadvertent message that all TB patients are believed
to have HIV/AIDS, since this could inadvertently jeopardise the gains that have
been achieved by RNTCP.

Strategic Framework | 41
IEC for non-public providers
This target group can be further segmented into

 private providers,
 practitioners of other health systems and
 traditional health providers

Data from available studies suggests that a neighbourhood private provider


continues to be the people’s first port of call for TB in urban and semi-urban
areas. The involvement of private practitioners and NGOs is a crucial component
of the IEC strategy. The IEC activities to address this groups would include:

 A sensitisation package for healthcare providers as well as for the


beneficiaries will be developed and disseminated by the CTD. This will
contain a guide to RNTCP for medical practitioners, PowerPoint and OHP
slides presentations, a booklet on frequently-asked questions, desktop
reference material, posters, provider-specific definitions, diagnostic
algorithms, treatment regimes and DOTS directory of MCs and DOT
providers.
 Advocacy of the RNTCP amongst health providers by sensitisation and
training through the Indian Medical Association and other professional
bodies
 Workshops and continuing medical education (CME) programmes for
medical colleges and the private sector
 Use of newsletters, the press and other media to spread the RNTCP
message to a wider audience

Enhancing patient-provider communication


Interpersonal communication builds trust with patients, their families and
their social networks. RNTCP aims to create and maintain good interpersonal
communication and counselling skills among the programme staff, bridge the
gap between patients and providers, and provide support to patients during
the course of treatment so that they complete treatment and continue to be
advocates for DOTS.

Interpersonal communication skills and counselling are important at all levels


of the programme. Communication pervades diagnostic services, treatment
administration and patient supervision. A module on improving interpersonal
communication skills in RNTCP training was introduced in the training
curriculum of all key TB personnel and is implemented as part of the overall
training package. The module, in the form of a book, contains role-plays that
enable trainees to experience field situations in the classroom. The training and
associated curricula are research-based.

42 | A Health Communication Strategy for RNTCP


Part 2
Planning and Implementing a Health
Communication Strategy for RNTCP –
A Practical Guide

Planning and Implementing a Health Communication Strategy for RNTCP | 43


44 | A Health Communication Strategy for RNTCP
Contents
1. Introduction 47

1.1 Goal and essential elements of the health communication strategy for RNTCP 47

1.2 Target audiences 48

1.3 Messages 49

1.4 Channels 51

1.5 Main objectives of the health communication strategy 51

1.6 Health communication strategy framework 53

1.7 Involving partners 54

1.8 Timeframe for health communication activities 54

1.9 Development of health communication materials and pre-testing 57

1.10 Monitoring, evaluation and research 58

2. Implementation of the Health Communication Strategy 59

2.1 Implementation at the central level 60

2.2 Implementation at the state-level 61

2.3 Implementation at the district-level 63

2.4 Implementation at the PHI-level 64

2.5 Health communication activity implementation matrix 65

Annexures 69

1. Implementation Guide to Health Communication Activities 73


2. IEC Resource Centre of Central TB Division User Guidelines 145
3. Index of Materials Available in the Central TB Division’s 149
Web-based IEC Resource Centre
4. Index of Health Communication Materials Used in Orissa 156
5. User Guidelines for the Health Communication Video Modules CD 173
6. Suggested Format for Planning IEC Activities at State and District 175
7. IEC Reporting Formats 176

Planning and Implementing a Health Communication Strategy for RNTCP | 45


46 | A Health Communication Strategy for RNTCP
1
Introduction
This part of the document provides information to facilitate
the implementation of the health communication strategy
for RNTCP at the central, state-, district- and PHI/MC-
levels.

It provides information on how to implement a range of


health communication activities covering:
1. Support for policy implementation and RNTCP
2. Media advocacy
3. Health communication activities for capacity-
building
4. Health communication material development
5. Involvement of partners in BCC for RNTCP
6. Involvement of other organisations and individuals in
BCC
7. Monitoring, evaluation and research

The Annexures give detailed instructions on the use of the web-based IEC
Resource Centre set up by the CTD as well as the video-based modules on health
communication activities produced by DANTB.

The document is accompanied by two compact disks (CD). The first CD contains
the video-based modules on health communication activities that can be viewed
on a desktop computer or shown to an audience using a projector. The second
CD contains resource material for the communicator, including an index of
communication materials developed by DANTB for RNTCP in Orissa that can
be adapted and used for various communication activities suggested in the
document.

1.1 Goal and Essential Elements of the Health


Communication Strategy for RNTCP

Large-scale adoption of health practices by the people, resulting in lower


TB morbidity and mortality rates, requires appropriate behaviour change

Planning and Implementing a Health Communication Strategy for RNTCP | 47


tools and techniques throughout the planning, design and implementation
of communication activities. A necessary pre-condition is to learn the most
appropriate ways to communicate desirable behavioural change and convert this
information into effective health messages for IPC, broadcast media and print
materials to provide skills-based training and implement programmes to support
health practices over time. This process pre-supposes a thorough understanding
of RNTCP and of working with stakeholders in applying an appropriate health
communication methodology.

The goal of such a communication strategy for RNTCP can be defined as


follows:

To facilitate and enable clients, service providers and the community at large to
engage themselves in informed and supportive counselling, interaction and action
at all levels and at all stages of tuberculosis detection, diagnosis and treatment,
thereby empowering individuals, families and communities to be responsible for
behavioural change to achieve the cure of people infected and infectious with
tuberculosis.

The strategy to achieve this goal is built on three essential elements of the
successful cure of a potential TB case: timely detection, treatment seeking and
completion of treatment.

1.2 Target Audiences

Following the importance of timely detection, treatment-seeking


and completion of treatment, the primary audiences for health
communication activities for the TB programme are:

Primary Target Group


 TB patients/potential TB patients
 Families/neighbours/general public

Secondary Target Group


 Doctors/RMPs/clinic operators/medical students
 DOT providers
 Local leaders
 ANMs/AWWs
 SHGs/CBOs
 PRIs

48 | A Health Communication Strategy for RNTCP


The following secondary audiences are equally important from a communication
perspective:

Centre, State, Central TB Division (CTD), National Tuberculosis Institute (NTI),


District Tuberculosis Research Centre (TRC), State TB Institute (STI), State
Steering Committee (SSC)

Professional Indian Medical Association (IMA), Tuberculosis Association of India


Bodies (TAI), Medical Council of India (MCI), Nursing Council of India (NCI)

Development Bilateral and multilateral agencies, e.g. Danish International


Partners Development Assistance (Danida) Department for International
Development (UK) (DfID), World Bank (WB), World Health Organization
(WHO)

Mass Media Press, radio, television

Corporate Confederation of Indian Industries (CII), Employees' State Insurance


Bodies (ESI), Indian Railways, industrial houses, pharmaceutical companies

Intersectoral Departments of Women and Child Development (WCD), Rural


Linkages Development (RD), Integrated Child Development Services (ICDS),
Family Welfare (FW)

It is important to assess the needs of these audiences at state-, district- and sub-
district levels and to map or otherwise assess their demographic and geographical
distribution. Providers need training in IPC and management of IEC programmes.
Community-members and families obviously constitute a primary target group
and should be involved in health communication activities. The need to involve
the community and educate them to support symptomatic persons for early
diagnosis and registering for treatment or to act as DOTS providers implies
participatory education and information activities. The involvement of other
audience segments like drug companies, local leaders and the media helps to
create a supporting environment.

1.3 Messages

Messages should be tailor-made for the target audience. These messages


should be pre-tested at various levels so that they conform to the
contextual variables and may be suitably modified for a given local setting. Health
communication messages can be generic or specific. Some of the messages
would be of a generic type to create an enabling environment. This could be
handled by the state and central agencies. Along with generic messages there
would be development and utilisation of specific messages related to access and
quality treatment. Message design should take into consideration factors like
gender, rural-urban population ratios, socioeconomic status, literacy and media
exposure.

Planning and Implementing a Health Communication Strategy for RNTCP | 49


For analytical purposes the dimensions of a message are defined as follows:
 Appeal
 Approach
 Content
 Text or image
 Context
 Source
 Recipient

These dimensions help to decide the message and to design it appropriately.

Some of the standard messages in RNTCP are as follows:


“If you have cough for three weeks or more go to the nearest health centre to get
your sputum checked.”
"TB is curable."
"Diagnosis and treatment is available free of cost."
"If you stop the treatment in-between, it has dangerous consequences."
"Take DOTS and you will be free of TB."
"We have a cure for TB—we have to tell the people about it."

The importance of these simple messages rests in their ability to convey the ideas
behind them and thus have an impact on timely detection, treatment seeking and
completion of treatment. For example, is the universal World TB Day 2003 message
`DOTS cured me—it will cure you too' understandable for a patient in a village? Will
it help a person to approach the health centre or seek treatment? Is it clear to the
patient what DOTS refers to? Is the message placed in the context of the patient?
One needs to break the apparently simple messages carefully into understandable
information that would prompt the desired health behaviour.

The key issues for message development are the following:


1. Message selection needs a careful and systematic analysis. Seemingly simple
messages need to be looked at closely for their meaning, comprehension,
effect and adequacy.

2. Messages need to be creatively designed and tested methodically. Different


evaluation designs for different messages for different audiences may be
required.

3. The benefit or gain aspect for the patients instead of the provider needs
additional emphasis in message selection and design.

4. The elements of message selection and design should be incorporated in the


standard RNTCP training modules.

50 | A Health Communication Strategy for RNTCP


1.4 Channels

A number of channels can be used effectively to disseminate health communi-


cation messages. These are:
1. Folk media
2. Melas/festivals
3. Interpersonal communication
4. Trialogue approach
5. Sensitisation meetings for PRIs
6. Print media
7. Electronic media
8. Broadcast media
9. Workshops and seminars
10. Health camps
11. Other innovative channels

Using an appropriate multimedia mix enhances the reach and impact of health
communication messages. The point of contact for interaction with patients at
the health facility or the DOTS centre can be effectively used for patient education
and information. However, this calls for skills in IPC. Supportive supervision as
part of monitoring can be used to address misinformation and misunderstandings
concerning TB. Other channels that can be used are exhibitions, camps, radio,
television shows, public service announcements, panel discussions, print
advertisements, workshops and seminars.

As certain mass media activities are expensive, intersectoral and cross-provider


systems and private donors should be tapped to sponsor media space and
time, and appropriate links with commercial agencies and NGOs should be
explored and their experiences and expertise adopted. Within the RNTCP set-up,
competent and responsible personnel at the state- and district-levels are trained
to manage a media plan.

1.5 Main Objectives of the Health Communication


Strategy

The health communication component in RNTCP has three main


objectives:

1. Awareness-raising and capacity-building to increase understanding about


TB amongst

 the public, so that they make use of RNTCP services and


 practitioners across the country, so that they know about correct TB
diagnosis and treatment and they refer patients to DOTS services, or
become DOT providers themselves.

Planning and Implementing a Health Communication Strategy for RNTCP | 51


2. Advocacy and social mobilisation to develop 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, to enhance the reputation of a
patient-friendly service, and to encourage patients and their families to
become advocates for the programme.

1.5.1 Awareness-raising and capacity-building


While the dissemination of necessary information on TB is
an essential element for achieving this goal, and indeed is
a right of the community, it is not a sufficient factor. The community will also
discuss issues of poverty, access, availability, fear of stigma, illiteracy problems,
competing health beliefs and barriers for motivation (such as alcoholism, work
routines, etc.) with the facilitator. Only by creating a shared understanding that
DOTS is possible in spite of these factors, and that cure of TB patients will help to
overcome such barriers, the involvement of communities be ensured.

Training activities form a very important part of the health communication


strategy. Training focuses primarily on three levels: 1) training of health workers
2) training of DOT providers and 3) training of IEC staff as well as training of
trainers for all three levels. All training consists essentially of two components:
1) TB-specific information concerning all stages of TB management and 2)
communication skills concerning different types of health communication
activities. The training should involve hands-on use of IEC materials by relevant
audiences as well as mutual assessment of IEC implementation practices.
Modules for medical officers, senior treatment supervisors and other health
workers should be suitably modified to incorporate IPC and counselling, dynamic
and participatory group interaction and use of available IEC materials. These
exercises should take into account male/female differentials in behaviour and
treatment-seeking patterns and social dynamics, and particular emphasis should
be placed on role-plays and similar activities whereby providers can experience
the patient's point of perspective.

1.5.2 Advocacy and social mobilisation


Advocacy is done to win the support of key decision-makers in order
TB
CONTROL
to influence policies and ensure financial and other resources,
and to promote a conducive environment for the implementation
and sustainability of the programme. It is necessary to identify the
target group and how to access and communicate with them. It can be useful to
organise a network and establish strategic coalitions to create a support base that
can convey persuasive arguments to key decision-makers. The media constitute
one such strategic partner. Advocacy works differently at different levels and with

52 | A Health Communication Strategy for RNTCP


different players. Advocacy at higher levels may facilitate behaviour change at
lower levels by offering a behaviour model and affirming community norms.

Social mobilisation is a type of grass-roots level advocacy whereby the collective


force of a community is mobilised for a cause. It is necessary to meet people at
their own level of understanding and to explore existing concerns and possible
social conflicts in the community with relevance to the RNTCP agenda, including
in particular, gender issues and other potential or actual processes of social
marginalisation. The entire community must participate in decision-making in a
way that reinforces the common interest in the objectives of developing a network
of community members who will work actively for timely detection and support
treatment-seeking behaviour and completion of treatment, and thereby create a
self-supporting and sustainable system for voluntary reporting of suspected TB
cases.

1.5.3 Patient-provider communication and


counselling (trialogue approach)
Success of any health communication strategy depends largely on
the close interaction and coordination between stakeholders. In
RNTCP, this can be done through the trialogue approach. This is
a community-based activity. In this approach there are three ‘p’s: the patients,
the providers and the people. In this meeting the participants spend a whole day
together, siting on a common mat and eating from a common plate. This meeting
gives an opportunity for people to air their feelings. It also provides an excellent
opportunity for women to participate.

Irregular and defaulter cases are specially addressed to identify their problems
and needs for counseling. Influential people from the community such as
panchayati raj members are encouraged to participate actively in spreading
awareness about TB diagnosis and DOTS.

The trialogue approach reduces the gap between patients, providers and
community through informal, interactive meetings.

1.6 Health Communication Strategy Framework

The matrix shown in page 29 depicts the health communication


strategy framework for RNTCP. Based on this framework, the state-
level and district level implementers can develop detailed needs-
based framework and action plans.

Planning and Implementing a Health Communication Strategy for RNTCP | 53


1.7 Involving Partners

The patient comes across and uses many systems for services and is
influenced by many different systems—public, private, NGOs and
community among others. The strategy should take cognisance of
the importance of these players:
 Private medical practitioners should be educated in the proper diagnosis and
treatment of TB, as well as on important messages to be given to the public.

 NGOs, whether grass-roots, state-wide or national, should be involved by


appropriate training in participatory and interactive techniques so that they
can organise and carry out education and community awareness, as also in
service delivery by way of working as DOTS providers.

 Corporate or commercial companies, particularly pharmaceutical firms,


can play an important role in influencing the outcome of the programme by
providing appropriate information as well as involving private providers for
using the standard regimens for the revised strategy.

 Local self-government agencies and community groups have many roles to


play. Through community participation they can help reduce stigma, facilitate
the selection of DOT providers and help in organising health or TB melas.
A sustained interest of the community in the TB control programme will
depend upon the information and benefits provided by the programme and
the sympathetic attitude of public sector providers. Lastly, the involvement of
PRIs would provide an opportunity for coordination among various sectors
and personnel working for rural development such as the ICDS, AWWs, BDOs,
SHGs and ANMs which can have a positive bearing on health programmes.

1.8 Timeframe for Health Communication Activities

There are important differences between communication activities in connection


with the initial phase of implementing RNTCP in a new area and the ongoing
communication activities.

1.8.1 Initiating RNTCP in a new area


6-9 months before launch:
 Training of trainers in IEC, counselling and communication skills.

3-6 months before launch:


 Training of medical officers, DOT providers, laboratory technicians, senior
treatment supervisors and senior tuberculosis laboratory supervisors in IEC
and counselling.

54 | A Health Communication Strategy for RNTCP


1-3 months before launch:
 Development and production of banners, posters and other IEC materials
on
 signs and symptoms of TB
 availability of free diagnosis and treatment
 central slogans of the campaign
 Advocacy activities involving central stakeholders and the media

At the time of launch of RNTCP in an area:


 Conduct campaigns at each primary health centre involving
 District Collector/zila parishad Chairman
 Panchayat
 Health system leaders
 Block development staff
 Women and youth groups
 ICDS
Using
 Folk media
 Exhibition stalls
 Mela kits for demonstration
 Demonstration of medicines, given by popular leaders to
patients
 Launch area-wide media campaign involving:
 Local and area-wide newspaper coverage
 Radio and TV coverage
 Cable operators, district publicity staff and other available
media systems
Using
 Regular news coverage
 Ads, jingles
 Educational and entertaining dramas adapted for radio and TV

1.8.2 Ongoing communication activities throughout


RNTCP
The table in the following page 56 indicate the frequency of ongoing
health communication activities to be carried out on a continuous
basis upon the initial launch of RNTCP in a district, as seen in a
yearly and a three-monthly (13 weeks) perspective. Hence, the timeframes do
not indicate how often one single person/group/institution should be involved
in the same IEC activity, but provide an experience-based indication of the
frequency of communication activities at the district level required to ensure the
successful implementation of RNTCP. However, for a few activities, state-level
implementation has been specifically indicated.

Planning and Implementing a Health Communication Strategy for RNTCP | 55


Health Communication Activities Throughout the Year
Fortnightly
• Patient-provider interaction meetings

Monthly
• (Re)orientation training of ICDS officers and supervisors (different blocks)
• Orientation of PRI members (different blocks)
• Interactive stalls in weekly markets
• Interaction meetings with SHGs and women's groups

Quarterly
• (Re)orientation training for NGOs and CBOs
• (Re)orientation of tribal link workers (in tribal districts/blocks)
• (Re)orientation of traditional healers, TBAs, VHGs

Half-yearly
• Workshop for media personnel (AIR, DD, DIPRO, field publicity officers)
• (Re)orientation of NSS volunteers
• (Re)training of cured former TB patients as DOT providers
• (Re)orientation of industrial workers, union leaders and representatives
• (Re)orientation of members of NYK
• (Re) orientation of SHG groups at district- and block-level
• Workshop to develop posters and other printed materials
• Workshop on the role of media for increasing visibility of RNTCP at state-, district- and
block-levels
• Street theatre technique and script writing workshop

Yearly
• CME programmes at medical colleges and nursing institutions
• (Re)orientation of NGOs at district- and state-level
• Audio-visual material development with tribal and other unreached communities
• (Re)orientation of PRI members at block-level
• Trialogue approach with patient group; interaction with people at PHI level
• Workshop on script writing of TB-related dramas for professional writers (usually conducted
at state-level)
• Patient group meeting at PHI-level
• (Re)orientation of jail inmates and employees

Special IEC Activities


• Leading up to and on World TB Day, 24 March
In contrast to the planning of communication activities prior to the launch of
RNTCP, where the sequence is to be followed strictly, planning for ongoing districts
should be kept flexible according to need-based and practical circumstances.
Hence, the tables are primarily intended to communicate the relative frequency
of the various activities. Training of regular staff involved in IEC activities has not
been included in the figures and should be dealt with separately.

1.9 Health Communication Material Development


and Pre-testing

Material development is an essential component of any health communication


programme. It is necessary to develop different types of materials for different types
of audiences with focused, targeted messages. An index to the communication
material available in the web-based IEC Resource Centre of the CTD has been
provided in Annexure 3. An index to the communication materials developed in
Orissa by DANTB is given in Annexure 4.

While professional designs may suit the aesthetics of the producer who may
often belong to the middle class, they are no guarantee for high quality products.
In the Orissa experience, through the PRA technique, the use of drawings made
by members of tribal communities proved highly successful both in terms of
the key audience's ability to understand the messages as well as increased
ownership of the programme. One needs to conduct assessments for different
products—pamphlets, posters, radio announcements, TV spots, wall paintings,
handouts, press advertisements and exhibitions. Whether conceptualised in-
house or contracted to NGOs or professional agencies for development and pre-
testing, the products should be grounded in local perceptions of the problems
pertaining to DOTS implementation and should preferably include input from
target audiences. Periodic reviews should be carried out for continued validation
and updating of the information contained in the materials produced.

Pre-testing of health communication materials is a necessary tool to avoid


spending of resources on communication activities that do not achieve the
desired objectives or that can be directly counter-productive. Pre-testing should
take place with a representative sample of the target audience.

The need and methodology to pre-test varies widely according to the type
of communication activity and the costs involved. In relatively inexpensive
communication interventions, one would be reluctant to spend more
resources on pre-testing than the intervention costs, whereas in very expensive
interventions like TV productions, the resources spent for pre-testing to ensure
benefits from large investments would be more. In such cases, the use of focus
groups for previewing the product can often be a useful and effective pre-testing
methodology.

Planning and Implementing a Health Communication Strategy for RNTCP | 57


Certain types of communication activities cannot be pre-tested effectively
because they are interactive in a way that pre-supposes the involvement of a real
target audience. Such activities include folk media like street theatre, interaction
meetings and interaction stalls at melas (fairs) and haats (village markets). In such
cases, it is essential to systematically evaluate the activity and feed the results
back to the active IEC agents who then should modify the activity according to
the feedback.

1.10 Monitoring, Evaluation and Research

The response from the field is critical for the successful adoption
and modification of IEC components. Periodic reviews should be
conducted to assess the value and utility of the campaign or its
message. A positive impact of an IEC activity on TB control can be maintained
by refining the message or design as required. Systematic research should be
conducted periodically, preferably by independent agencies and/or persons not
directly involved in the communication activities, to monitor and evaluate the
IEC programme and the activities undertaken. The process, outcome and impact
parameters should be defined at the outset and the findings utilised to bring
about improvements in the programme.

Monitoring would be particularly useful in three areas:


1. Management: Careful monitoring is essential at the early-implementation or
the pilot-testing stage of the programme.
2. Evaluation: Proper monitoring enables accurate interpretation of final
evaluation results.
3. Accountability: Monitoring enables the state and funding agencies to assess
the value of the programme and demonstrates appropriate use of funds.

58 | A Health Communication Strategy for RNTCP


2
Implementation of the Strategy
This strategic framework for communication identifies the communication
need (objectives), communication players/audience (target groups), and
communication tools (channels, activities and materials). This framework will
build on the work already undertaken within RNTCP Phase I.

The focus of this framework is on a combination of centrally produced core


messages and media, and needs-based planning and IEC development to
develop state and district specific strategies, with local innovations to reach all
possible groups through the most appropriate channels, materials and activities.
The Central core framework provides the general outline, and each state will
come up with a locally-adapted strategy based on their own needs, analysis of
the problem and the target groups, so that communication activities are tailored
to address local needs, and reflect local culture. A suggested list of activities and
details of implementation have been provided in the following pages.

Financial Provisions for Communication


The Project Implementation Plan (PIP) for RNTCP Phase II has recommended
the following budgets for activities at various levels.

State-level
Population Budget** (Rs)
Small States Up to 10 million 500,000
Medium-size States 10-30 million 700,000
Large States 30-50 million 1,200,000
50 million and above 1,700,000
Source: Draft PIP of TB-2, CTD
1

** Each state will have additional budget for engaging agencies/NGOs to work as communication
facilitators for the state and districts. (The proposed budget is approximately Rs.20,000 per
district per year, or about Rs.1,600 per district per month). This budget would be over and above
the state and district allocation for health communication activities.

Planning and Implementing a Health Communication Strategy for RNTCP | 59


District-level
Budget allocation at the district levels would be Rs 75,000 per million population
per year. Sixteen urban centres (already identified in the previous project) with
populations of more than one million will have Rs 150,000 lakh per million
populations per year. All other urban cities with a populations of more than one
million will have a budget of Rs 100,000 per year. The district level budget would
be over and above the state budget for IEC mentioned above.

In addition, Rs 25,000 per million population is available for NGOs for IEC at the
district-level under schemes for NGOs.

2.1 Implementation at the Central Level

2.1.1 Roles and responsibilities


At this level, the CTD is the principal advocate for RNTCP.

As far as implementation of BCC activities is concerned, the CTD provides


leadership and support to the state and district levels.

An advocacy and strategic communication unit within the CTD


 provides overall leadership for the IEC component,
 procures services of the comunication agency at the central level and
coordinate activities,
 manages the mass media component at the national level,
 provides oversight of the national level communication strategy, assessing
capacity for strategic communication at the state-level, and providing
support where necessary and
 ensures that achievements and lessons learnt in RNTCP Phase I are
consolidated and used for further IEC development.

The CTD involves national bodies like the IMA and the TAI and national-level
NGOs to take responsibility to involve their members throughout the state. It
involves the MCI and other bodies to recommend appropriate changes to policies
and curricula with respect to the control of TB. It also reviews the capacity and
competency of the central training institutes with respect to BCC activities.

The media campaign can be effectively and economically handled from the central
level. Given its nature, where media cannot be segmented by states, the Centre
would handle the national media campaign. A media agency would assist the
CTD in planning and executing media activities based on the studies conducted
for RNTCP and the viewership survey and media research. State-specific popular

60 | A Health Communication Strategy for RNTCP


channels could be included in the media planning and execution. Options for
the careful use of ‘free media’ will also be considered.

2.1.2 Target audience


At this level, the target audience consists of:
 National-level institutes and bodies such as National Tuberculosis Institute
(NTI), Tuberculosis Research Centre (TRC), etc.
 Professional bodies such as Indian Medical Association (IMA), Tuberculosis
Association of India (TAI), Medical Council of India (MCI), Nursing Council
of India (NCI), etc.
 Development partners such as bilateral and multilateral agencies, e.g.,
Danida, Department of International Development (UK) (DfID) and World
Bank (WB), World Health Organization
 Mass media—national-level television, radio and press
 Corporate bodies such as Confederation of Indian Industries (CII),
Employees’ State Insurance (ESI), railways, industrial houses, pharmaceutical
companies
 Ministries, and departments such as the Departments of Women and
Child Development (WCD), Rural Development (RD), Integrated Child
Development Services (ICDS), Family Welfare (FW) at the state-level
 Opinion-leaders and politicians—ministers, eminent personalities, religious
leaders etc.

2.2 Implementation at the State-level

2.2.1 Roles and responsibilities


The state government is the key operating agency for RNTCP. It has ownership of
communication activities at all levels of the health care system. It makes adequate
budgetary allocations for communication programmes, based on inputs from
the District TB Centres (DTCs). It advocates the use of communication activities
in RNTCP and takes steps to build public-private partnerships at the state level,
by involving NGOs, private practitioners and pharmaceutical and other relevant
industries.

At the state level, the strategic communication responsibility within the State TB
Cell rests with the STO who is assisted by an IEC Officer.

The role of the State TB Cell in strategic communication is as follows:


 Vision for communication aspects in RNTCP
 Planning of health communication activities
 Monitoring of health communication activities
 Tapping resources for health communication activities

Planning and Implementing a Health Communication Strategy for RNTCP | 61


 Supervision of health communication activities
 Support to districts
 Developing materials in local languages
 Organising events for advocacy
 Supervision by IEC officer
 Capacity-building of the districts for implementing activities for awareness
generation and social mobilisation.

The state government develops generic communication materials in close


collaboration with the district and peripheral TB staff and IEC officers.

The State Tuberculosis Officer (STO) is responsible for planning, coordinating


and monitoring the implementation of all communication training activities
through the State Institute of Health and Family Welfare (SIH&FW) and outlines
the personnel requirements for training needs in communication. The state
government is responsible for the initiation and appropriate utilisation of
operational research and monitoring evaluation to assess the impact of health
communication activities and to modify them, if required.

The STO is actively assisted in developing and coordinating the communication


activities by the SIH&FW or a designated IEC officer, who is capable of involving
the media and PRIs for disseminating the central messages for TB control. Once
RNTCP services are available in all districts, the programme will embark on mass
media campaign which are envisaged to be powerful in reaching all urban and
peri-urban areas.

The states have a role in mass media as follows:


 Pre-testing materials intended for nation-wide use, and in providing feedback
 Dissemination of centrally produced media materials
 Providing feedback on how national level campaigns are being received
 Adapting centrally produced materials to ensure contextual relevance
 Sharing media successes with the central level

2.2.2 Target audience/players/partners


At this level, the target audience consists of:
 Health service providers
 Community
 State-level institutes and bodies such as state TB institutes, state steering
committees
 Professional bodies such as the state-level branches of the Indian Medical
Association (IMA), Tuberculosis Association of India (TAI), Medical Council
of India (MCI), Nursing Council of India (NCI) etc.

62 | A Health Communication Strategy for RNTCP


 Development partners such as state-level offices of bilateral and multi-lateral
agencies, e.g., Danish International Development Assistance (Danida),
Department of International Development (UK) (DfID), World Bank (WB),
World Health Organisation (WHO) etc.
 Mass media.
 Corporate bodies at the state-level such as industry and business associations,
Employees’ State Insurance (ESI), Indian Railways, industrial houses,
pharmaceutical companies, etc.
 Ministries and departments at the state-level such as the departments of
Women and Child Development (WCD), Rural Development, Integrated
Child Development Scheme (ICDS), Family Welfare (FW), etc.
 Opinion leaders, politicians and administrators at the state-level—MPs,
MLAs, eminent personalities, religious leaders etc.

2.3 Implementation at the District-level

2.3.1 Roles and responsibilities


The district is the link between the state and PHIs in terms of training and
dissemination of IEC materials. The district TB society is responsible for planning,
implementing and monitoring RNTCP communication activities at the district
level with the DTO/ADMO being the responsible officer. The DTO is responsible
for involvement of PRIs, NGOs and other relevant district-level organisations in
health communication activities. The CDMO is responsible for actively obtaining
the necessary information from the DTO/MEIO/BEEs in order to ensure the
implementation of the communication strategy.

In addition, the support from the outside the formal health system would be drawn.
A wide range of players such as gram panchayats, NGOs, mahila mandals, youth
groups and schools along with support and resources from the state and district
administrations such as information/education officers would be co-opted.

Capacity-building would also include sharing of material and innovations across


districts and states. While the Centre takes the leadership, the state and districts
will plan and implement need-based health communication activities. There
would be a two-way flow of information from and to the Centre and the states.
The establishment of a web-based IEC Resource Centre at the official website is
the first step in this direction. This would be strengthened further with regular
addition of new material.

The local communication teams at the district- and sub-district levels are
encouraged to try different approaches and resources, keeping in mind the
different local resources in terms of leadership and groups. For example, in one
district the team might revolve around PRI and in another a local NGO may

Planning and Implementing a Health Communication Strategy for RNTCP | 63


take the lead. States and districts would be encouraged to explore innovative
approaches in communication, particularly for hard-to-reach groups. The lessons
learnt from these approaches could be disseminated widely across districts and
states.

It is at the district- and local levels that the challenge of reaching the ‘interior
pockets’ and engaging hard-to-reach populations becomes relevant. Districts
will bear the responsibility of reaching those who may not be exposed to mass
media campaigns, and for complementing the information that is received from
national and state sources with locally relevant activities. Adapting RNTCP’s core
messages will rely on the locally available talent to adapt messages using the
local language and reflecting local interests and concerns. Districts will therefore
have flexibility in planning and implementation to meet the specific needs of the
populations in those areas.

2.3.2 Target audience


At this level, the target audience consists of:
 Health service providers, CDPOs, MEIO, BEEs
 Community
 District-level institutes and bodies
 Professional bodies at the district-level
 Mass media—district-level television, radio and press
 Corporate bodies at the district level
 Opinion leaders, politicians and administrators at the district-level
 NGOs

2.4. Implementation at the PHI-level

2.4.1 Roles and responsibilities


PRIMARY HEALTH CENTRE

The PHI is the community-level centre for health


communication activities. This facility has an active role to
play in timely detection, treatment and promotion of the adoption of DOTS by
patients and the community. The entire staff at a PHI should be specially trained
in IPC and counselling. IEC materials should be easily available and adequately
displayed and used regularly.

The PHC level should explore the possibilities of increasingly utilising the
‘cured person’ for IEC purposes, and should promote local ownership of the TB
programme.

64 | A Health Communication Strategy for RNTCP


2.4.2 Target audience
 Women and men, rural and urban, hard-to-reach groups such as tribals,
marginalised populations in slums etc.
 Patients
 Private providers, practitioners of other health systems, traditional health
providers
 School children, teachers, NGOs, CBOs, SHGs, PRI members, etc
 Media

2.5 Health Communication Activity Implementation Matrix

The matrix in the following page suggests a comprehensive list of health


communication activities for RNTCP and the levels at which they are
appropriate.

The health communication activities have been broadly grouped into the
following types:

 Policy support
 Media support
 Capacity-building
 Communication material development
 Involvement of partners in communication activities
 Involvement of other organisations and individuals

Detailed guidelines for the planning and implementation of each health


communication activity are given In the following pages.

Each activity should be understood in the context of the overall strategic health
communication framework for RNTCP. The activities should be timed at intervals
as described earlier. For each activity, a list of health communication material
has been suggested. Samples of the health communication material that can
be adapted to the requirements at the local level have been provided in the
annexures.

Planning and Implementing a Health Communication Strategy for RNTCP | 65


Health Communication Activity Implementation Matrix
Ref No Health Communication Activity Central State- District- PHI-
Level level level /MC-
level
3.1 Support for policy implementation and for
RNTCP
3.1.1 Interactive stall at haats   
3.1.2 Organisation of mass rally   
3.1.3 Observation of World TB Day—24 March    
3.1.4 Exhibition   
3.2 Media advocacy
3.2.1 Print media    
3.2.2 Electronic media    
3.2.3 Display media    
3.2.4 Policy support   
3.3 Health communication activities for
capacity-building
3.3.1 Training of health workers   
3.3.2 RNTCP training of TB programme staff   
3.3.3 CME programme for health workers   
3.3.4 Training of DOT providers  
3.3.5 Strengthening the state IEC organisation 
3.4 IEC development material
3.4.1 Poster development workshop  
3.4.2 Other display material development  
3.4.3 Development of radio spots  
3.4.4 Development of TV spots  
3.4.5 Development of cinema slides  
3.4.6 Development of music cassette  
3.4.7 Development of role-play  
3.4.8 Training on street theatre technique   
3.4.9 Pre-testing of IEC material   
3.5 Involvement of parterners in IEC for
RNTCP
3.5.1 Use of street theatre   
3.5.2 Puppets  
3.5.3 Trialogue approach 
3.5.4 Orientation of tribal link workers 
3.5.5 Orientation of cured, former patients as 
RNTCP advocates

66 | A Health Communication Strategy for RNTCP


Health Communication Activity Implementation Matrix
Ref No Health Communication Activity Central State- District- PHI-
Level level level /MC-
level
3.5.6 Orientation of NGOs 
3.5.7 Sensitisation meeting for PRI members  
3.5.8 Orientation of SHGs  
3.5.9 Orientation of volunteers, teachers,  
students and religious organisations
3.5.10 Orientation of traditional healers,  
traditional birth attendants and other
indigenous practitioners
3.5.11 Orientation of members of CBOs  
3.5.12 Training/workshop for CDPOs/supervisors  
at district-level
3.5.13 Group discussion 
3.5.14 Kalyani clubs  
3.5.15 Workshop on culture and communication  
3.6 Involvement of other organisations and
individuals
3.6.1 Orientation of industrial workers 
3.6.2 Orientation of jail immates and employees 
3.6.3 Sensitisation workshop for journalists 
3.7 Monitoring, evaluation and research  
3.7.1 RNTCP programme documentation   

Planning and Implementing a Health Communication Strategy for RNTCP | 67


Annexures

Annexure 1 | 69
Contents
1. Implementation Guide to Health Communication Activities 73
1.1 Support for policy implementation and for RNTCP 73
1.1.1 Interactive stall at haat 73
1.1.2 Organisation of mass rally 74
1.1.3 Observation of World TB Day—24 March 75
1.1.4 Exhibition 76
1.2 Media advocacy 78
1.2.1 Print media 78
1.2.2 Electronic media 80
1.2.3 Display media 82
1.3 Health communication activities for capacity building 83
1.3.1 Training of health workers 83
1.3.2 RNTCP training of TB programme staff 88
1.3.3 CME for health workers 91
1.3.4 Training of DOT providers 92
1.3.5 Strengthening the state IEC organisation 96
1.4 IEC material development 100
1.4.1 Poster development workshop 100
1.4.2 Other display material development 102
1.4.3 Development of radio spots 103
1.4.4 Development of TV spots 104
1.4.5 Development of cinema slides 106
1.4.6 Development of music cassette 106
1.4.7 Development of role-play 107
1.4.8 Training on street theatre technique 109
1.4.9 Pre-testing of IEC material 111
1.5 Involvement of partners in IEC for RNTCP 112
1.5.1 Use of street theatre 112
1.5.2 Puppets 114
1.5.3 Patient-DP-community interaction meeting 115
1.5.4 Trialogue approach 117
1.5.5 Orientation of tribal link workers 119
1.5.6 Orientation of cured, former patients as RNTCP advocates 121
1.5.7 Orientation of NGOs 122
1.5.8 Sensitisation meeting for PRI members 124
1.5.9 Orientation of SHGs 125
1.5.10 Orientation of volunteers, teachers, students and 127
religious organisations

Annexure 1 | 71
1.5.11 Orientation of traditional healers, traditional birth 129
attendants and other indigenous practitioners
1.5.12 Orientation of members of CBOs 130
1.5.13 Training/workshop for CDPOs/supervisors at district level 132
1.5.14 Group discussion 134
1.5.15 Kalyani clubs 136
1.5.16 Workshop on culture and communication 137
1.6 Involvement of other organisations and individuals 138
1.6.1 Orientation of industrial workers 138
1.6.2 Orientation of jail immates and employees 139
1.6.3 Sensitisation workshop for journalists 141
1.7 Monitoring, evaluation and research 143
1.7.1 RNTCP programme documentation 143

2. IEC Resource Centre of Central TB Division User Guidelines 145


3. Index of Materials available in the Central TB Division’s 149
Web-based IEC Resource Centre
4. Index of Health Communication Materials Used in Orissa 156
5. User Guidelines for the Health Communication Video
Modules CD 173
6. Suggested Format for Planning IEC Activities at State and District 175
7. IEC Reporting Formats 176

72 | A Health Communication Strategy for RNTCP


Annexure 1
Implementation Guide to Health
Communication Activities
There are a number of health communication activities that can be implemented
as part of the strategy. Illustrated below are activities designed by DANTB in
Orissa.

1.1 Support for Policy Implementation and for RNTCP


1.1.1 Interactive stall at haats
Objective
To inform the community on different aspects of TB and avail
facilities provided by RNTCP.

Duration
Four hours on weekly market day.

Venue
Suitable open place in the haat.

Participants
Local villagers (male/female/children) and vendors.

Facilitators
MO-PHI, Dy. MEIO, BEE, STS, HWs.

Process of organisation
 Planning for interactive stall by ADMO/MO-TU, BEE, STS
 Selection of haats in a block
 Letter to MO-PHI for organising stall
 Arrangement of IEC materials by Dy. MEIO/BEE/STS
 Invite cured male/female patients to participate
 Sharing of responsibility among health personnel and cured patients to
facilitate the process
 Display of IEC materials, and a mobile exhibition unit with captions on TB

Annexure 1 | 73
Messages used
 Cause of TB, how it spreads and signs and symptoms of TB
 Free diagnostic and treatment facilities available at PHIs
 Importance of early reporting

Methodology
 Interaction
 Explaining exhibit materials
 Street play

Health communication materials


Banners (19-23), posters (7-12), exhibition model (32), tent for exhibition stall,
leaflets (5-6), snake and ladder game, tape recorder, mela kits, pocket folders,
register to record comments of audience. While planning your activity view the
‘Advocacy and Social Mobilisation’ module in the accompanying CD.

Outcome
Regular meetings at gram panchayat-level/community-level to discuss RNTCP
by HWs/BEE

1.1.2 Organisation of mass rally


TB
CONTROL

Objective
To disseminate TB messages to the public

Participants
School students/NSS volunteers/PRI members/SHG members/DOT providers
(HW/[male/female], AWW), NGO members/cured patients and public
(participants around 100 to 200, both male and female)

Process of organisation
 CDMO invites DTO, MO-TU, MO-PHI, STS, CDPO, DIPRO, MEIO, BEE,
programme officer of NSS, district coordinator of NYK, BDO, CDPO, local
school headmaster, NGO secretary for planning meeting. They decide the
date, time and area to be covered
 CDMO informs DTO, MO-TU, MO-PHI, STS, DIPRO, Dy. MEIO, BEE,
Programme Officer of NSS, district coordinator of NYK, BDO, headmaster,
NGO secretary by letter
 Programme officer selects the NSS volunteers and informs them about the
rally
 District coordinator selects the NYK volunteers and inform them about the
rally
 BDO informs sarpanches
 Headmaster selects the students and tells them to participate in the rally

74 | A Health Communication Strategy for RNTCP


 NGO secretary selects NGO members and informs them to participate
 CDPO selects the AWWs and informs them to participate
 STS informs the DOT provider and DOT provider informs the cured patients
Caption preparation by MO-PHI, DIPRO/Dy. MEIO/BEE/STS/DOT providers/
NSS volunteers/NYK volunteers
 Arrange ambulance (DTO)
 Arrange drinking water (municipality)
 Arrange media personnel (like press, TV, radio, photographer) by DIPRO

Health communication materials


 Banners (19-23), leaflets (5-6), placards
 Messages for slogans, e.g.
 TB is curable.
 Stop TB—use DOTS.
 DOTS cured me. It will cure you too.

Outcome
 Increased awareness of TB among the public.
 Symptomatic case reporting increases at PHI-level.

Report-writing
DIPRO/Dy. MEIO

1.1.3 Observation of World TB Day—24 march

Objective
MARCH  To create large-scale awareness in the community
24  To motivate and encourage community to avail the facilities
available at the PHI for TB
 To highlight special messages on World TB Day

Target group
General public/patients/providers/peoples’ representatives

Venue
District-/sub-district-/block-/PHI-level, any suitable place

Process of organisation
 CDMO/ADMO invites MO-TU/STS/STLS/MO-PHI/Dy. MEIO/DIPRO/
BEE/NSS/NYK Programme Officer/NGO representative for planning the
observance of World TB Day
 Listing of health communication activities with detailed planning, including
budget, by concerned MO-TU/MO-PHI/BEE/Dy. MEIO and submission to
CDMO

Annexure 1 | 75
 MO-TU/STS/STLS/Dy. MEIO/DIPRO plan to observe World TB Day at district
level
 CDMO releases funds to carry out the activities
 MO-PHI invites all block-level officials/PRI members/cured patients/
active NGOs/teachers/ICDS personnel to participate in the World TB Day
arrangements
 At the district-level, CDMO invites collector/sub-collector/zila parishad
Chairman/PRI members/cured patients/ICDS personnel/DSWO/block
officials/doctors/nurses of district hospital to participate in World TB Day
observance.
 Sharing of responsibility at district-/PHI-level to carry out these activities.
 Procurement of IEC materials for distribution to PHIs by ADMO (Med.)/MO-
TU/Dy. MEIO.
 Emphasis is given to involve cured, former patients to share their experiences
in different activities.

Suggested health communication activities


 Rally by cured and former patients, school students and health personnel
 Orientation of students followed by debate/quiz competition among high
school/college students
 Exhibition on RNTCP at district and PHI levels
 Mass meeting with block officials, PRI members, NGOs and chief functionaries
from colleges and AIR
 Street play in weekly markets in each block to disseminate the messages on
RNTCP
 RNTCP chariot
 Interactive stall at weekly haats
 Talks on TB and RNTCP jingle/spot could be organised for broadcast by local
private channels, All India Radio and Doordarshan stations
 Other innovative activities may be carried out as per need

Health communication materials


Mela kit, banners, posters, leaflet, booklet, pamphlet, exhibition models, mike
set, cassette with player, TV, VCR, placard, folders

Reporting
MO-PHI/MO-TU/DTO are responsible for submitting a detailed report on the
observance of World TB Day to CDMO who reports to Dy. Director of Health
Services

1.1.4 Exhibition
Exhibition is one of the important health communication activities
that meets the information needs of different target groups from
various parts of a district and state.

76 | A Health Communication Strategy for RNTCP


Purpose
To create awareness in the community regarding different technical aspects of
TB and encourage people to avail the services provided under the RNTCP.

Venue
At a suitable place of festival/mela/function.

Target group
General community, patients and service providers.

Duration
Depends upon the length of the festival or function. Usually one day to one week.

Process of organisation
A request letter is written by the MO-PHC to the district authority (CDMO/DTO)
to organise and provide support for such an exhibition sufficiently ahead of the
occasion. After the decision is taken, a suitable place is identified in consultation
with the local organiser of the festival/mela.

Construction of the stall


 In many instances, ready-made stalls are provided by the organiser of the
festival. Otherwise, a contractor is entrusted to erect a stall with the provision
of sufficient lighting arrangements, electricity and cloth decoration.
 Usually the size of the stall is 15’ x 12’ with two gates, i.e. entrance and exit.

Health communication materials


 Exhibits and other display materials pertaining to necessary information on
TB and RNTCP are put up in the stall. These may be models, boards, posters,
banners, equipments, medicines, etc. Sometimes, story boards are put up
to explain to the audience the disease or programme. This is very useful for
practical demonstrations, which are generally appreciated by many people.
 TV, VCR and audiocassettes are played to disseminate information in
an entertaining way. A person is given responsibility to explain about
TB to the audience as well as to answer queries through interpersonal
communication.

Video-based training modules


While planning your activity, view the ‘Advocacy and Social Mobilisation’ module
in the accompanying CD.

Annexure 1 | 77
1.2 Media Advocacy
TB 1.2.1 Print media
Control
Print media can be a useful way of reaching the community with
IEC messages. It will only reach those who can read and can afford
to buy them. The audience will often include opinion leaders and
influential persons.

Newspapers
Can provide detailed information about a topic. It is easy to present technical
data, such as achievements of RNTCP in a clearly-designed text. Important
topics, such as five important components of RNTCP, can be covered in a series
of articles.

Objective
To create awareness and mobilise public opinion on TB/RNTCP.

Formats used in newspaper


News: Description of important, recent events accompanied by photographs (e.g.
launching of RNTCP in a PHI).

Future events: Details of future events, public announcements (mass run on


World TB Day).

Advertisements: These can be of any size from small ads to full-page ads containing
important messages on TB (e.g. ‘Use DOTS, Fight Poverty’).

Features: Features are longer articles describing events or reviewing topics. They
contain items of general interest and short stories. RNTCP can be a subject for
features, such as description of TB as a disease, problems emerging from late
diagnosis and irregular treatment and effects of utilising DOTS.

Letters: There is usually a section with letters from the public responding to
various issues of RNTCP.

Special interest sections: Many newspapers have a health section. Often, this
contains an ‘advice column’ responding to issues raised by readers that can
include TB.

Advantages
 Influential in creating awareness and mobilising public opinion
 Can be used to support radio and TV for educational purposes

78 | A Health Communication Strategy for RNTCP


Disadvantages
 Can be used only for literates
 Can be expensive for the poor
 It is a one-way communication
 Requires special writing and editing skills

Leaflets
 Use of leaflets is most common in health education.
 The simplest leaflet is a single sheet of paper, printed on one/both sides and
folded into half or three parts.
 Leaflets can be larger with two or more sheets of paper (pamphlets/
brochures).

Target audience
All literate women and men.

Objective
To spread mass awareness in the community regarding TB as a disease and the
availability of free treatment.

Preparation and production


 Should be interesting to look at
 Should contain relevant information for target readership (e.g. signs and
symptoms of TB, free diagnosis and treatment, PHIs providing DOTS)
 Language should be easy to read and understand
 Complicated technical words should be avoided
 Should mention place for getting further information

Pre-testing
All leaflets/pamphlets/booklets should be pre-tested and changes made
accordingly before printing.

Distribution
Look out for opportunities to distribute materials, such as:
 Campaigns and rallies
 Group discussions
 Public meetings—World TB Week
 In-service training programmes
 Exhibitions

Advantages
 Excellent format for presentation of technical information
 Can support other media for educational purposes

Annexure 1 | 79
 Useful in individual and group sessions; can serve as a reminder of the main
points made
 Helpful for sensitive subjects like TB and AIDS—when people are too shy to
ask, they can pick up a leaflet and read the information

Disadvantages
 Can be used only by literates
 Can only be effective only if well-designed and appealingly produced

1.2.2 Electronic media


For mass communication of ideas, messages and important events.

Objectives
 To spread mass awareness regarding basic scientific facts about TB
 To bring about a change in the beliefs and attitudes towards TB as a disease
and its curability
 To support parallel initiatives for behavioural change

Target audience
Patients, service providers and the community at large.

Radio
It is the media channel that now reaches the widest audience. Our country still
depends on centralised production of broadcast programmes. However, local
radio stations produce programmes in regional languages with locally-relevant
content that are increasingly common.

Advantages
 Radio technology is available all over the country and can reach mass
audiences cheaply
 Receivers are cheap and are available in the remotest areas (unreachable
areas)
 Messages can be repeated at low cost
 Easy to reach illiterate population
 Is flexible and formats can be of varied types
 Effective in spreading awareness and announcing events (e.g. World TB Day)
 Can mobilise community to participate in public events and projects (e.g.
mass run for ‘Use DOTS, Stop TB’ campaign)

Disadvantages
 One-way channel
 Difficult to assess audience reaction and interest
 Content may not be suitably-tailored for small communities

80 | A Health Communication Strategy for RNTCP


Television
DOTS programmes containing stories and educational elements could be
shown from VCR equipment generating a one-night cinema hall experience at
village-level (using VCR, projector, simple screen, electricity from generator).
The existence of many channels reduces the audience of any one channel and
provides stiff competition for health-related messages on TV.

Advantages
 Its novelty attracts audiences (spots on effective use of DOTS)
 Messages can be repeated and thus reinforced (helps in behavioural
change)
 Suitable for motivation through utilisation of different formats (drama,
music, folk-media, events)
 Can create awareness, even among illiterates

Disadvantages
 Expensive to operate
 One-way method – no audience participation
 Not available among very poor people
 Requires extensive planning and preparation

Formats for radio and TV


 News – An IEC activity mentioned in the news bulletin gives wide coverage
and credibility at no cost (e.g. mass meeting on ‘Use DOTS, Stop TB’ on
Independence Day)
 Spot announcements, for example on the inauguration of RNTCP in a district
with a list of PHIs where DOTS is available. Spot announcements are useful
for quick circulation of messages in the community.

Slogans and jingles


 Slogans are short catchy sentences, designed to attract attention, usually
moulded on well-known sayings or rhymes. They can identify a campaign,
e.g. ‘World TB week’

 Jingles are slogans set to music and are more memorable; set to identify a
programme (RNTCP)

‘Phone-in’ programmmes
Programmes in which listeners ring a studio either ‘live’ or ‘off-air’ and give their
views, ask questions or ask for advice. They are dealt with by an expert, or by a
panel in the studio.

Annexure 1 | 81
Talks and documentaries
Five to ten minute talks by doctor/DOT provider/cured patient are used.
Documentaries explore a single topic and include different effects.

Drama
Long/short plays, soap operas, serials and dramas have enormous potential for
IEC because the audience can identify with the characters and their problems
(patients/traditional healers/providers). Dramas are expensive to produce.

Quizzes and panel games


Quizzes and panel games are popular. Those watching them try to answer
the questions themselves and learn something from the answers. This can be
effectively used for awareness-building on RNTCP.

All these activities are jointly taken up with the State Institute of Health and
Family Welfare (IEC Cell).

Health communication materials


Posters, folders, leaflets, booklets

Video-based training modules


While planning your activity view the ‘Types of IEC Material and their Use’ module
in the accompanying CD.

1.2.3 Display media


Display materials present information and ideas on health and TB
in exciting and challenging ways.

Display materials commonly used are:


 Exhibits
 Models
 Tin plates
 Banners
 Hoardings
 Wall paintings
 Display boards
 Posters
 Photographs

Objective
To disseminate messages to create awareness amongst the community

82 | A Health Communication Strategy for RNTCP


Target group
Patients and their families, service providers and the community at large.

Using display materials as teaching/learning aids can stimulate participatory


teaching, e.g. a model on a TB patient’s experience of diagnosis, treatment and
outcome or an actual demonstration of food to be taken while on treatment for
TB.

People are more likely to believe something if they can see, feel and touch it for
themselves.

Display materials can be used to promote learning and spread awareness.

Well-developed and properly used display materials can


 convey vital information (banners on signs and symptoms of TB);
 show something that people cannot see in real life (positive slide under a
microscope with TB organism);
 provide a substitute for the real thing (pictures/posters of persons suffering
from TB—now and then);
 arouse people’s interest and gain attention (mela kit with key messages);
 help people to remember key points (exhibition set); and
 make difficult ideas easy to understand (wall painting).

1.3 Health Communication Activities for Capacity-


building
Orientation at state-level of CDMOs/ADMOs/DTOs/RNTCP
MOs

1.3.1 Training of health workers

Objective
 To orientate district-level managers on technical, operational and programme
management aspects of the RNTCP and update them
 To involve participants in micro-planning exercises for the selection of PHI/
TU/DTC and personnel identification for DOT providers, STS, STLS, LT, MO-
PHI, MO-TU, etc., and make district resource mapping/identification and
prepare RNTCP District Action Plan
 Review RNTCP performance indicators as per national guidelines and
generate problem-solving discussions

Duration
Two days

Annexure 1 | 83
Venue
Conference hall of the SIH&FW or in a hotel at the state capital

Participants
CDMOs, ADMOs, DTOs and RNTCP MOs. Ideally, 30 participants in each batch; a
total of three batches for the state of Orissa. Participants from 10 districts in one
batch (CDMO, ADMO/DTO, RNTCP MO).

Date
Once every six months. Date is fixed as per the convenience of the participants
and the facilitators. The orientation should be made mandatory before the
RNTCP preparatory work starts for new areas/districts.

Facilitators
 Dy. Director General TB and/or representative from Central TB Division
 Secretary, Health and Family Welfare and/or Dy. Secretary, Health and Family
Welfare
 Director, Health Services, Jt. Director (TB/Leprosy), Dy. Director TB
 RNTCP trainer from State TB Demonstration and Training Centre
 WHO consultant and Danida representatives.

Process
An official letter is issued from the Government/Director of Health Services to
CDMO requesting him/her to participate in the programme and CDMO, in turn,
allowing the other two to join.

CDMOs are asked to bring certain data related to the programme for discussion/
planning.

Session content
 Inaugural formalities, objective of the workshop, key issues and general
address, etc., done by the Secretary, Jt. Director and Director respectively
 Brief introduction on RNTCP, extent of problem of TB and control measures
 Technical and operational aspects of RNTCP
 Assessment of resources at district level as per district-wise information
presented by the participants
 Programme review, micro-planning and action to be taken
 Problems and bottlenecks—an open discussion to sort out issues
 Preparation of district-wise action plans and follow-up action plans

Teaching methodology
Lecture, presentation, participatory process, group discussion, panel discussion,
question and answer, demonstration, audio-visual etc.

84 | A Health Communication Strategy for RNTCP


Health communication materials
Banners, posters, flipbooks, leaflets

Video-based training modules


While planning your activity view the ‘Orientation’ module in the accompanying
CD.

Outcome
 RNTCP information updated and district-level programme managers
orientated
 Problems and difficulties discussed and sorted out to the extent possible
 Review of RNTCP activities done
 District Action Plan and Gannt chart prepared for the next six months

Report writing
Report/proceedings preparation by the ministerial staff of the State TB Cell.

Evaluation
At the end of the training, an evaluation is carried out using developed question
formats to assess whether the objective of the training has been achieved.

Follow-up
 Apprise the District Collector and discuss in the District Health Society
meeting
 Discussion at the district-level monthly meetings and RNTCP in regular
review agenda
 Preparation of Gannt chart and District Action Plan
 Micro-planning exercises at PHC level involving all staff
 Regular organisation of quarterly review, monitoring and supervision
workshops

Modular training for MO-PHI at state level

Objective
 To train the designated medical officers of PHIs in diagnosis and treatment
of TB patients in their respective areas and in overseeing quality control of
microscopy activities and drug distribution
 To enable the designated medical officers to participate in and review all
technical aspects of RNTCP and preparation of monthly and quarterly reports
to be submitted to the TU/district and make supervisory visits
 To be able to act as training coordinator during the DOT providers’ training
and ensure participation of all

Annexure 1 | 85
Duration
Seven days, including one day for field exposure (residential).

Venue
Any of the Chest and TB departments of the three medical colleges in Orissa.

Participants
CDMO selects medical officers of a designated MC who are willing and regular
in service. Ideally, 20–24 medical officers in a batch will be trained in two groups
with three facilitators.

Date
The date is decided by the state based on the training needs and workload. As per
the RNTCP national norm, there should be a trained designated medical officer
in each PHI at any given point of time.

Facilitators
 Professors/assistant professors/lecturers of the Chest and TB and SPM
departments of three medical colleges who are trained as trainers of trainers
(TOT) in RNTCP.
 Other senior medical officers with specialisation in TB and chest diseases
from the districts who are also trained as TOTs in RNTCP.
 Retired professors/assistant professors/DMETs who may have been involved
in the training programmes earlier.

Process
A state-wide training calendar to be prepared by the STO as per the needs and
load of the districts. The professors of the respective medical colleges need to be
consulted and a formal letter from the Director of Health Services, along with
the approved training calendar, to be served to the districts/medical colleges/
facilitators for information and necessary action.

Session content
 All ten modules (1 to 10) of the training course with relevant exercises for
each module
 One-day field visit to a district to experience the practicalities and interaction
with patients and providers

Teaching methodology
Reading the modules, lecture, participatory discussion, doing exercises, quiz,
question answer, ice-breaker and demonstration (medicine, sputum container,
TB register, forms etc.).

86 | A Health Communication Strategy for RNTCP


Health communication materials
Training modules, banners, posters, flipbooks, leaflets and booklets.

Video-based training modules


While planning your activity view the ‘Orientation’ module in the accompanying
CD.

Outcome
The medical officer
 is sound in RNTCP and is updated with the latest information on the disease
and can advise on sputum microscopy examination,
 is confident of diagnosing and treating a TB patient in accordance with
RNTCP guidelines and
 can counsel the TB patients properly and advise the DOT provider on the do’s
and don’ts of treatment.

Evaluation
At the end of the training, an evaluation is carried out using developed question
formats to assess whether the objectives of the training have been achieved.

Follow-up
The medical officer
 ensures identification of TB suspects, collects sputum from them, refers
patients for diagnosis or further examination and advises treatment;
 supports laboratory services, monitors documentation related to microscopy
examinations, maintains an adequate supply of re-agents and other materials
and ensures disposal of contaminated materials;
 communicates with patients, monitors drug administration and administers
preventive treatment;
 ensures that patients brought under treatment are registered, monitors the
regularity of sputum examinations and identifies and records treatment
outcomes; and
 periodically assesses the quality of reports, conducts support supervision
visits, maintains a regular supply of drugs and other materials and participates
in and presents quarterly progress reports in the quarterly review, monitoring
and supervision workshops to be held at the TB Unit-level.

Annexure 1 | 87
1.3.2 RNTCP training of TB programme staff

Training of Senior Treatment Supervisors (STS) at state-level

Objectives
To train and orient key RNTCP personnel in order to
 make them well-acquainted and skilled to perform relevant job responsibilities
under RNTCP,
 ensure proper treatment and
 ensure proper registration and reporting.

Duration
Six days, including two days of field visit.

Venue
The training hall of Anti-tuberculosis Demonstration and Training Centre
(ATD&TC), Cuttack, or in an RNTCP district having conference facilities.

Participants
 Existing supervisory staff at PHC level Multi-purpose Health Supervisor
(MPHS), Sanitary Inspector, Senior Health Worker, Pharmacist, Ophthalmic
Assistant) to be decided by the CDMO/ADMO of the district.
 Contractual personnel (in this case an extensive training plan is needed on
duration, curriculum and module).
 Must know two-wheeler driving and be willing to travel extensively.
 20-24 participants in one batch to be trained in two groups.

Date
As per workload and requirements. One STS to be selected for a TU with 500,000
population. S/he should be trained before the DOT provider training starts at the
PHI level.

Facilitators
 State-level RNTCP (TOT) trainer.

Process
A state-wide training calendar is to be prepared by the STO. A formal letter from
the Director of Health Services to be sent to the CDMOs of the districts where the
training need is assessed along with the calendar.

Session content
 DOT provider training module

88 | A Health Communication Strategy for RNTCP


 STS module 1 and 2
 Dummy TB register
 Training exercise sheet
 Field visit

Teaching methodology
Lectures, readings, presentations, participatory processes, questions and
answers, demonstrations, practical exercises, audio-visuals etc.

Health communication materials


Banners, posters, flipbooks and leaflets

Video-based training modules


While planning your activity view the ‘Orientation’ module in the accompanying
CD.

Outcome
The STS is
 well-acquainted with RNTCP,
 confident of doing the job,
 well-versed with field practicalities and
 able to plan and report independently.

Evaluation
At the end of the training, an evaluation is carried out using developed question
formats to assess whether the objectives of the training have been achieved.

Follow-up
The STS
 ensures identification of TB suspects and proper treatment of patients during
frequent and regular visits to the PHIs;
 records results of follow-up sputum smear examinations till end of
treatment;
 records drug collection (during the continuation phase) and records
remarks;
 communicates with patients and gives health education to community;
 ensures proper drug administration and appropriate preventive treatment
for children;
 maintains the TB register and ensures that all patients under treatment are
given TB numbers; and
 helps prepare the quarterly reports including programme management and
logistics.

Annexure 1 | 89
Training of Senior Tuberculosis Laboratory Supervisor (STLS)
at state-level

Objectives
 To train and orient STLS to perform laboratory quality control in the PHI.
 To plan and make regular supervisory visits to PHIs at least once a month in
order to ensure that all sputum-positive slides and 10-15 percent of negative
slides are cross-checked.
 To ensure that contaminated materials are disposed of safely, and monitor
the maintenance of the TB laboratory register at regular intervals.

Duration
Five days including field visit. In order to be eligible for STLS training, it is a
prerequisite for the participant to first undergo the six-day laboratory technician
training.

Venue
Training hall of the ATD&TC, Cuttack, or in an old RNTCP district.

Participants
Qualified pathology laboratory technicians. Ideally, 20 participants in a batch to
be trained in two groups. Must know two-wheeler driving.

Date
State training calendar to be prepared by the STO. Training to be organised as per
workload assessment and convenience of the facilitator and the participants.

Facilitators
 State RNTCP (TOT) trainer
 Senior Laboratory Technicians of ATD&TC, Cuttack
 Experienced STLS of the old RNTCP districts

Process
A formal letter from the Director of Health Services to be issued to all CDMOs
concerned. The venue details and training schedule is attached to the training
calendar of the STS. Both the STLS and STS visit the same PHI but with different
checklists—the STS on the treatment part and the STLS on laboratory aspects.

Session content
 DOT provider module
 Laboratory technician module
 Module for STLS

90 | A Health Communication Strategy for RNTCP


 Field visit
 Training exercise sheet

Teaching methodology
Lectures, readings, demonstrations, participatory processes, questions and
answers, audio-visual presentations, practical exercises etc.

Health communication materials


Banners, posters, flipbooks and leaflets.

Video-based training modules


While planning your activity view the ‘Orientation’ module in the accompanying
CD.

Outcome
The STLS is
 sensitised on RNTCP,
 sound and confident in laboratory supervision work and
 able to prepare independent travel plans and report back from the field.

Evaluation
At the end of the training, an evaluation is carried out using developed question
formats to assess whether the objectives of the training have been achieved.

Follow-up
The STLS
 conducts visits to microscopy centres;
 performs laboratory quality control;
 ensures that contaminated materials are disposed of safely;
 ensures that treatment cards are correctly filled;
 monitors the maintenance of the TB laboratory register; and
 monitors documentation related to microscopy.

1.3.3 CME for health workers

CME in medical colleges

Objectives
 To update the participants’ knowledge on RNTCP
 To apprise the participants about the objectives and strategies adopted under
RNTCP
 To encourage the participants to follow the principles of diagnosis and
treatment procedures as prescribed under RNTCP

Annexure 1 | 91
Target group
House surgeons, post-graduate students.

Duration
Half day.

Venue
Conference hall of medical college.

Organising process
DANTB issues a request letter to the Principal/Professor and HoD of TB and
Chest Department to organise a CME programme, under intimation to the
Director of Medical Education and Training. A suitable date is decided as per the
convenience of all concerned.

Facilitators
 State trainer on RNTCP
 Director/Jt. Director (TB) of Health Services
 Deputy Director

Session content
 Brief introduction on RNTCP
 Components of DOTS
 Diagnosis and treatment procedures
 Role of doctors in the promotion of RNTCP.

Teaching methodology
Lectures/discussions/demonstrations.

Training materials
OHP, handouts, writing materials.

1.3.4 Training of DOT providers


training and re-training of DOT providers at PHI level

Objectives
 To train and re-orientate DOT providers in basic information about various
aspects of TB; this includes exercises on various activities and skills which the
DOT provider has to perform while implementing RNTCP
 On successful completion of training, DOT providers working at the periphery
will be well-acquainted with and skilled to perform all job requirements
related to RNTCP.

92 | A Health Communication Strategy for RNTCP


 To keep DOT providers abreast and updated about RNTCP in order to treat
and cure TB patients smoothly and effectively.

Duration
One day at the MC.

Venue
PHC training/meeting hall, local school premises, meeting hall of the BDO office
or any public place free of outside disturbance.

Participants
Multi-purpose health workers, anganwadi workers, volunteers, village health
guides, NGOs, teachers and cured patients. Ideally, 20-30 participants in a batch
for one facilitator.

Date
Once a year in PHIs. MOs-PHI to send the list of participants; ADMO/RNTCP-
MO to prepare the calendar for the district, and CDMO to issue letters to PHIs
for the training.

Facilitators
 District trainers trained in TOT
 MO-PHI as training coordinator
 STS and STLS
 RNTCP-MO/ADMO/CDMO (any one)

Process
CDMO to send an official letter with training guidelines and funds to MO-PHI to
conduct the training.

Session content
 TB as a disease, its cause, mode of transmission, type, magnitude of problem,
etc.
 RNTCP
 Treatment formalities under RNTCP, including diagnostic procedures and
intake of medicines
 Filling-up of treatment card
 Counselling and health education for TB patients
 Role and responsibilities of DOT provider
 Gender disparities and IEC in RNTCP

Annexure 1 | 93
Teaching methodology
Lectures, reading of modules, participatory discussions, questions and answers,
role-plays, quizzes, demonstrations, ice-breakers, sputum collection procedures
and experience-sharing by cured patients.

Health communication materials


Banners, posters, flipbooks, leaflets, booklets, success stories and snakes and
ladders .

Video-based training modules


While planning your activity view the ‘Orientation’ module in the accompanying
CD.

Outcome
 The DOT provider (DP) has first-hand knowledge about RNTCP.
 DP is confident of referring suspected cases for sputum microscopy and to
give DOTS.
 DP is aware about the seriousness of irregular/default treatment and the
follow-up sputum tests.
 DP is able to fill the treatment card and keep the medicine packet intact.
 DP is able to give proper and right health education to the patient and the
community.

Evaluation
At the end of the training, an evaluation is carried out using developed question
formats to assess whether the objective of the training has been achieved.

Follow-up
The DP is enabled to
 motivate the suspected TB patient to get his sputum examined, explain
treatment requirements and expected duration of treatment with advice on
regular follow-up of sputum examinations;
 ensure that every patient diagnosed as a case of TB is registered and treated
for the full term;
 fix the time and place for DOT, keeping in mind the patient’s convenience
and operational feasibility;
 maintain the treatment card up-to-date and ensure that the patient is allotted
a TB number;
 ensure immediate defaulter retrieval and impart health education to the
patient, the family and the community.

94 | A Health Communication Strategy for RNTCP


Involvement of cured patients as DOT providers

Introduction
It is mainly health staff, anganwadi workers and volunteers from some NGOs
who have been identified as DOT providers.

Rationale
It is well-known that satisfied users are the best motivators. One who has
undergone the process himself and has gained experiences, both positive and
negative, can share his views with others more convincingly than others.

Objective
To facilitate and enable cured TB patients to provide DOTS, counsel patients,
refer suspected cases and disseminate RNTCP information.

Participants
Cured patients of both sexes who are literate or semi-literate.

Process
A list of participants using the above-mentioned criteria is prepared by laboratory
technicians/STS from the patient register of PHI/TB register of a TU. The patients
are then contacted to assess their willingness to take part in the training and to
act as DOT providers. After a batch of 10-15 participants are enlisted, the training
date is decided by the MO-TU and the DTO. The participants are intimated
personally by the LT/concerned health worker of the date, time and venue of the
training.

Venue
TU headquarter/any other convenient place for the participants to attend.

Duration
One day.

Resource persons
 MO-TU/MO-PHI/STS/STLS/LT/BEE
 CDMO/DTO/SDMO may also attend the training programme.

Session content
Theory—Technical aspects of TB such as cause, mode of spread, type, categori-
sation of treatment, diet, sputum follow-up and principles of counselling.
Practical—Filling of patient cards.

Annexure 1 | 95
Training methodology
Discussions, sharing of experiences, group work/individual assignments, role-
plays, demonstrations and quizzes.

Health communication materials


Flipbooks and/or flashcards, medicine boxes and treatment cards.

Video-based training modules


While planning your activity view the ‘Orientation’ module in the accompanying
CD.

Evaluation
Questionnaire and quiz given by trainer.

Ongoing supervision in the field by STS/MO-PHI to assess and support their


performance in providing DOTS, filling of treatment cards and counselling.

Follow-up
Once the participants start their work, MO-PHI, STS and health workers of that
area to keep contact with them and guide them regularly.

1.3.5 Strengthening the state IEC organisation


Training for BEEs on community-based health communication
activities

Health communication activities are the key to success for all health programmes.
Such activities have better success rate when organised by the communities
themselves instead of being planned and organised from outside. All health
communication functionaries need to be trained on community-based health
communication activities so that they can play their roles successfully.

Objectives
On completion of the training, the participants (BEEs) would be able to
implement successful community-based health communication programmes in
their respective areas with the help of new communication technologies.

Specific objectives
 Utilise their knowledge and skill on recent communication technologies
 Use PRA technique to identify health-seeking behaviour of the community
and the lacunae between knowledge and practice
 Organise effective trialogue approach sessions to sort out problems and
improve programme performances
 Develop and use low-cost media to provide health communication support
for the programme

96 | A Health Communication Strategy for RNTCP


Duration
Two days

Venue
Conference hall of the SIH&FW or in a hotel in the state capital

Participants
CDMOs, ADMOs, BEEs and RNTCP MOs. Ideally, 30 participants per batch.

Facilitators
 Director, (Health Services), Jt. Director (TB), Dy. Director TB
 RNTCP trainer from State TB Demonstration and Training Centre
 Communication specialists

Process
An official letter is issued from the Government/Director of Health Services to
CDMO informing him/her to participate in the programme. The CDMO, in turn,
will arrange for the BEEs to participate.

Session content
 Introductory session
 The TB scenario
 Communication basics and its relevance in RNTCP
 Community-based health communication and media
 PRA exercise and its relevance
 Social mobilisation and partnership development
 Assignments on media production
 Field visit—trialogue approach
 Presentation of field experiences
 Presentation of assignments
 Preparation and presentation of activity plan
 Evaluation

Teaching methodology
Lecture, presentation, participatory process, group discussion, demonstration,
ice-breakers, field visits, audio-visual etc.

Communication materials
Banners, posters, leaflets, handouts

Evaluation
At the end of the workshop, an evaluation is carried out using evaluation formats
to assess whether the objective of the training has been achieved.

Annexure 1 | 97
Training of Mass Education and Information Officer (MEIO) and
district-level media officers

Objective
Capacity-building of media officers in planning and implementing media
activities towards creation of awareness for promotion of RNTCP.

Duration
Two and a half days

Venue
State/zonal headquarters

Participants
 MEIO, DHRO
 MEIO (H&FW)
 District Information and Public Relations Officer (PR Department)
 Field Publicity Officers
 Programme Executives (Health) (Doordarshan and AIR)

Resource persons
 State trainer on RNTCP
 Director/Dy. Director from SIH&FW
 MO-TU/MO-PHI

Process of organisation
SIH&FW, PR Department, Field Publicity Department and AIR/DD decides
a suitable date and venue. Request letters are issued to concerned district
authorities/officials from their respective heads of department to relieve the
participants for the training programme.

Session content
1st day
 Brief introduction on RNTCP and the DOTS strategy
 Technical aspects of TB
 Role of IEC for promotion of RNTCP
 Introduction on gender disparities in health with special reference to TB
 Media and materials for community education, including community
media

2nd day
 Field visits to observe interaction meeting of patients and DP as an effective
community medium.

98 | A Health Communication Strategy for RNTCP


 Street theatre
 Presentation of field observations
 Review of media and materials, suggestions for improvement and developing
new ones

3rd day
 Presentation of new ideas for media materials
 Prepare and present need of action plan for the district for next six months

Training methodology
Lecture discussion
 RNTCP and DOTS strategy
 Technical aspects of TB
 Gender

Demonstration
 Street theatre
 Involving TB patients, showing medicines, technical aspects of TB
 Media materials

Observation
 Interaction meeting
 Street theatre

Group work
 Review of media materials
 Plan of action

Health communication materials


OHP, flip chart/blackboard, posters, flip book , banners, video/audio cassette, TV
and VCR.

Video-based training modules


While planning your activity view the ‘Orientation’ module in the accompanying
CD.

Training state IEC staff

Objective
To enhance professional competency in the production of IEC materials,
organisation of training programmes for block- and district-level media officers
and reviewing district-level health communication activities related to RNTCP.

Annexure 1 | 99
Duration
One day

Venue
State headquarters (SIH&FW)

Participants
 Deputy Director, IEC
 Health Education Officer
 Production Officer
 Health Educators
 Artists-cum-photographers

Resource Persons
 Director, SIH&FW
 DHS/Jt. DHS

Process of organisation
Director Health Services (DHS) and the Director of SIH&FW, Orissa, decide a
convenient date for the training.

Session content
 Brief introduction on RNTCP and DOTS strategy
 Technical aspects of TB
 Media production—some basic points
 Role of IEC cell officers in the production of IEC materials, organisation of
training and review of health communication activities related to RNTCP.

Training methodology
Lecture-discussions, video presentations and demonstrations.

Health communication materials


OHP, video/audio cassette , posters, production of posters, final products selected
for printing, pretesting and handouts.

1.4 IEC Material Development


1.4.1 Poster development workshop
In print/display media, posters are considered to be one of
the important means for disseminating information to literate
and semi-literate groups. Posters are developed for RNTCP in a
systematic manner during a workshop.

100 | A Health Communication Strategy for RNTCP


Objective
To facilitate the participants to design posters with important messages on TB for
creating awareness among different target groups, suitable to their culture and
language.

Venue
Suitable location at district headquarters.

Duration
Three days (residential).

Participants
Local artists, artist-cum-photographer from the Department of Health and
Family Welfare and other departments.

Process of organisation
CDMOs/DTOs are informed regarding the workshop and are requested to select
participants from their districts and obtain their willingness. After a list of 10-12
participants is finalised, a request letter is sent to them through their department
heads to attend the workshop.

Session content
 Brief introduction of RNTCP
 Technical aspects of TB
 Target group and message development
 Principles of poster development
 Individual assignments on poster development
 Presentation of final products

Health communication materials


Posters, flipbooks and/or leaflets

Video-based training modules


While planning your activity view the ‘Types of IEC material and their use’ module
in the accompanying CD.

Facilitators
 TB and Chest specialist of the district headquarter hospital
 Dy. Director/Director of SIH&FW

Selection of posters for pre-test


At the final presentation, posters are selected by the Directorate of SIH&FW (State
IEC cell) for pre-testing.

Annexure 1 | 101
Responsibility of pre-testing and printing
The State IEC cell takes the responsibility to pre-test the posters in the field
among the respective target groups and, after necessary changes, the printing
process is started.

1.4.2 Development of other display material


Display materials need to be attractively presented in order to help viewers retain
what they have visualised. Display materials commonly used are:
 Exhibits
 Models
 Tin plates
 Banners
 Hoardings
 Wall-paintings
 Display boards
 Posters (see section 4.1)
 Photographs

Objective
To disseminate important messages on RNTCP to the community.

Target groups
All community members.

Deciding on format
The overall appearance of the materials should never distract viewers from the
lesson in hand. The format chosen should
 be clear
 have a pleasing layout
 use appropriate colours and illustrations and
 promote a desire to learn.

When deciding on the appropriate format, imagine that you are assembling a
picture that consists of different parts—all needing to fit together harmoniously.
The type of format chosen should depend upon the materials being developed.

Consider the following aspects:

Purpose
Be clear about what you want to achieve. Take into account the type of material
being used and the messages you want to convey. This is essential if you are
to know how to lay your materials out, what to include and where to position
photographs, sketches and other illustrations.

102 | A Health Communication Strategy for RNTCP


Experimentation
Ideas for layout come from experimenting and brainstorming. Try out different
ideas by sketching them on a piece of paper to see what they look like. You do not
have to go into any detail at this stage—just make a rough sketch.

Relevance
All the elements in your design should be relevant to your objectives and the target
audience. They should help the viewers understand and retain the messages
being conveyed.

Proportion
The size of the elements that make up your material should be determined by
their importance (the use of headlines, illustrations etc.).

Direction
Effective design (exhibit) should direct the audience, making it easy for them to
move around and find the information they require.

Contrast
Building visual contrast into your materials makes the information more eye-
catching and interesting. You may want to make your titles (in a flip-book) larger
than the text, or present figures and percentages as a graph or chart.

Simplicity
Decide which design most effortlessly enhances the message you want to convey
and meets the objectives.

Finally, pre-test the display material and make necessary additions and
changes.

1.4.3 Development of radio spots

Objective
To disseminate important messages to the community on a wide basis.

Target groups
All radio listeners, especially adult women and men, and adolescents.

Points to be considered while developing radio spots:


 Present only one idea
 Begin with an attention-getter
 Be very explicit
 Ask listeners to take action

Annexure 1 | 103
 Make the audience feel the importance of the tuberculosis situation and
adopt the DOTS strategy
 Repeat the key idea two to three times

Process
The group that develops the radio spots, comprises members from the IEC cell, TB
cell, staff of AIR and DANTB staff. This group develops and finalises the concept,
message and the format (jingles, music, drama) and determines the length of
the spots (one to three minutes). The time for broadcast is planned—prime time
before and after news is preferable in accordance with the budget allocation.

The staff of AIR, along with artists, develops the lyrics and music and makes the
spot, which is pre-tested prior to final production. The final product is screened
by the group and used for broadcasting.

Full details of the number of broadcasts, the time span and the time and dates of
broadcasting are to be well-maintained to record the outcome of the programme.
The Audience Research wing of All India Radio or any other research institution
can be requested to evaluate the outcome of such programmes and provide
suggestions.

1.4.4 Development of TV spots


TV spots provide a useful way of reaching large-scale communities with health
education messages.

Objective
To disseminate information about RNTCP and TB to a wider range of people in a
quick, entertaining and comprehensible manner.

Target groups
All sections of the community including influential groups in the private/public
sectors who watch TV.

Points to be considered while making TV spots:

Be brief
Assume the viewer gets bored easily and can ‘switch off’ mentally/physically at
any time.

Be entertaining
The viewer needs to be entertained by the telecast. Make it as lively and interesting
as possible. Try to make the message more acceptable by use of music/comedy/
drama. Do not lecture.

104 | A Health Communication Strategy for RNTCP


Be clear
It is no use burying the message too far in the entertainment or making it obscure.
Be simple, use straight-forward ordinary language (local dialect). Speak clearly
and do not rush.

Aim for maximum impact


Always try to start a spot with something that catches attention—music, jingle or
a striking word/question. End with something that people will remember.

Dialogue or discussion
Dialogue or discussion is always more interesting than one person talking. It is
very difficult to hold attention with one voice.

Aim for variety


Do not put in too much speech or too long pieces of music. Try putting a music
background to the speech, use different voices, ask questions, keep the viewers
guessing—try not to be predictable.

Process
 The group that develops the TV spot comprises the TV staff, state IEC cell,
state TB cell and DANTB staff.
 The message concept and the format (jingles, music, drama, script) is then
finalised.
 Time span of spot is determined (one to three minutes).
 Time of broadcast—prime time before and after news is preferable in
accordance with budget allocation.
 The TV staff along with other artists develop the lyrics, music and dialogue
and produce the spot, which is pre-tested prior to final production.
 Final product is screened by the group and used for telecasting.
 Full details of the number of telecasts, the time span and the time and dates of
telecast are to be well-maintained to record the outcome of the programme.
The audience research wing of Doordarshan or any other research institution
can be requested to evaluate the outcome of such programmes and give
suggestions.

Annexure 1 | 105
1.4.5 Development of cinema slides

Objective
To disseminate messages on TB and RNTCP through screening of slides at
different cinema halls in the state.

Target group
Cinema theatre audiences.

Important messages for slides


 Early signs and symptoms of TB
 Place of availability of free diagnosis and treatment facilities
 Importance of regular intake of drugs

Process
Development of messages and selection of photographs to be done in
a brainstorming session. In this session, the Project Officer of DANTB,
representatives from the State IEC Cell/TB Cell and IEC Advisor would suggest
different important messages. One/two messages for use will be selected and
finalised. Relevant pictures will be placed with the message.

The slides are pre-tested.

After messages and pictures are finalised an advertising firm with expertise in
preparing cinema slides is identified and given orders. The IEC Advisor and the
Dy. Director, IEC, both work with the firm to finalise the preparation of slides.

The slides are then handed over to the Mass Education and Information Officer
of the district for distribution at cinema halls, with a letter from the Collector to
screen them free of cost.

1.4.6 Development of music cassette

Objective
To disseminate RNTCP and TB messages in an entertaining way in the local
dialect with local music.

Target group
Adult men, women, adolescents and school/college students.

Process
A group of local artistes are identified and sensitized for three to four hours
on RNTCP and TB. The social aspects are fully discussed. They are encouraged

106 | A Health Communication Strategy for RNTCP


to develop lyrics with important messages on TB and RNTCP. These lyrics
are examined by a group of IEC and TB experts and necessary alterations/
improvements are made.

Composition of music
The composition of music and identification of local singers then takes place.
Once the lyrics are finalised, music is composed with the help of local music
experts and singers. Importance is given to traditional music and instruments.
After a number of rehearsals, songs are recorded in a well-equipped professional
studio.

Important messages
 Cause of TB, mode of spread
 Early signs and symptoms
 Procedure of diagnosis and treatment
 Availability of facilities, free of cost
 Importance of regularity of treatment and timely sputum follow-up

Cassettes are distributed to MOs/BEEs of each PHI for use at

 interaction meetings amongst DPs, patients and programme personnel,


 exhibitions,
 melas/festivals and
 interactive stalls at haats.

1.4.7 Development of role-plays


A role-play is a type of drama where trainees/participants act out real-life
situations relating to a chosen issue in front of their colleagues/peers.

Objectives
 To enable trainees/participants to explore issues/events from different points
of view and develop empathy for patients/communities.
 To enable use of available intellectual and emotional faculties and existing
experience for problem-solving.
 To enable participants to practise counselling skills and making difficult
decisions in a realistic situation.

Purpose
Role-plays can help a group
 get to know one another,
 think about a particular problem/issue,
 be more sympathetic to others’ point of view and
 strengthen communication and counselling problem-solving skills.

Annexure 1 | 107
Use a role-play
 to help trainees/participants realise that others, too, have situations/
problems similar to their’s,
 where active involvement can produce a sound basis for discussion and
 to demonstrate different ways of dealing with a problem/situation.

Organisation of process
The facilitator
 decides on the learning objective and chooses a problem (Ram Babu, Cat-I
patient, aged 40 years, a labourer, has stopped taking DOTS after six doses.
He is an alcoholic and does not listen to the TB staff );
 describes the situation for the role-play to all present;
 explains the role of actors (patients can also be actors) and observers;
 explains to observers that acting skills are not being evaluated; rather, they
must observe the reasoning, attitudes and responses to the issue;
 lets the role-play continue till its logical conclusion (10—15 minutes).

Target audience
Trainees, participants in meetings/workshops (interactive meetings of patients
and DOT providers); also trainees in relation to supportive supervision.

Venue
 Orientation training of medical/non-medical staff
 Training workshop of health staff
 Interactive meeting of patients and DOT providers

Facilitators
 Trainers
 Resource persons at different meetings
 MEIO/BEE/principals of HW training centre
 STS/STLS

Review
 Ask actors to share their feelings while enacting their roles
 Ask observers for comments and questions
 How can the role-play help them in their work?

Evaluation
 Listen carefully to points made in response to questions.
 Note the perception and values that emerge which will help trainees/
participants in future activities.
 Ask trainees/participants on ways to improve the role-play.

108 | A Health Communication Strategy for RNTCP


Methodology
Participatory training method

Advantages
 Focuses directly on the problem.
 Helps trainees/participants to deal with it through direct/indirect
involvement.
 Does not require monetary or material support.
 Exposes an individual to various points of view.

Disadvantages
 If trainees/participants are not fully involved, the session may only be of
entertainment value.
 Roles can be exaggerated and distorted.
 Learning can be hampered if the discussion group focuses on unimportant
aspects while ignoring important/relevant ones.

Therefore, facilitators have to take meticulous care to avoid such unwanted


situations.

1.4.8 Training on street theatre technique

Objective
To enhance skills on development of street theatre scripts for RNTCP.

Duration
Seven days residential training

Venue
A suitable place, preferably a big hall, youth club, community centre or an NGO
office building. The concerned cultural/street play/NGO groups who organise
the training programme select the venue for the participants.

Participants
Those with a cultural background, a flair for acting and an interest to perform
before the community are selected. The group size is 10–12 persons including
males and females; two groups of NGOs are trained in one batch.

Resource person
External persons who have teaching experience with street theatre technique,
scriptwriting and acting. He/she usually holds a degree from Sangeet Sahitya
(Kala) Academy, Orissa.

Annexure 1 | 109
For technical session
MO-PHI, STS, BEE

Process of organisation
CDMO discusses with ADMO/MO-TU/MO-PHI/STS/BEEs during monthly
meetings or RMS meetings to identify potential cultural groups; BEE/STS
contacts cultural/street play group leaders and discusses about street theatre
workshop. The district authority selects two active groups at sub-district and
district levels, and informs them accordingly. CDMO/ADMO is responsible for
the training and sends a letter to the cultural groups regarding a suitable date
and venue for the training programme. BEE contacts concerned NGO/cultural/
street-play groups for selection of the training venue and boarding and food
arrangements. District authority contacts resource persons for the training
programme.

Content
 Technical knowledge on TB and programme implementation.
 Basic concept and principles of street theatre technique.

Scriptwriting
At the end of the closing day, the troupes demonstrate a street theatre show for
the public in the presence of health personnel and resource persons. After the
performance, technical errors are rectified by the resource persons.

Teaching methodology
Discussions, group work, lectures, role-plays, demonstrations, re-
demonstrations.

Health communication materials


Banner, posters, flipbooks, folders and leaflets .

Video-based training modules


While planning your activity view the ‘Advocacy and Social Mobilisation’ module
in the accompanying CD.

Outcome
Capacity to develop and perform high-quality street theatre on RNTCP is
enhanced.

Follow-up
After returning to their community the participants are selected. The script may
be modified as per local needs. At this time they are provided technical guidance
and programme expertise from the theatre. After a number of rehearsals they are
ready for the field performance.

110 | A Health Communication Strategy for RNTCP


Report-writing
Consultants in street theatre, and health personnel.

1.4.9 Pre-testing IEC materials


Pre-testing means field-testing communication materials before they are
produced or printed.

By interviewing the target audience the materials are made for, it is assessed
whether they are well understood and appreciated by the audience.

Posters, flip charts, flash cards, leaflets, pamphlets, storybooks, booklets and
video programmes are some of the materials than can be pre-tested.

Why pre-testing?
Communication materials are most often developed by urban, educated, modern,
comparatively well-off and healthy men surrounded by visual stimulation, but
are most often meant for rural, illiterate, conservative, comparatively poor and
relatively unhealthy people – including women – who live in villages with limited
exposure to pictures, posters or other visual aids. There is a gap between these
two groups and the planners must verify their visuals with the target groups to
ensure effective communication. Pre-testing is a cost-effective mechanism to
prevent expensive mistakes.

Process
Preparation before going to the field include research on the communication
material, the target audience, objective of the material and the questions to be
addressed.

In the field, local leaders are contacted and explained about the pre-test. Explain
that you are testing the materials and not the villagers, and that you want the
villagers’ suggestions for improving the materials.

Interview techniques
 Establish a social setting—a place where there will be no disturbance.
 Establish rapport. The introduction is important; respondents should be
encouraged to give time and suggestions.
 Let people touch and hold the material.
 Encourage people to talk freely.
 Put different types of questions (open-ended and close ended) and listen
carefully.
 Probing and follow-up questions should be asked.
 Thank the respondents for their time. Always let them know that they were
of great help and that the information gathered will be used to improve the
material.

Annexure 1 | 111
Recording
Pre-testers should work in pairs if possible. One should conduct the interview,
while the other writes down the questions and answers.

Analysing the results of pre-testing


Today, computers can be used to analyse the results. Normally, the material is
pre-tested with 30-50 people which is usually sufficient to assess the materials.

Final production
 After making necessary changes, the final product is ready for printing.
 Care has to be taken to use materials (paper, cloth, colour etc.) that are
durable for a long period.

1.5 Involvement of Partners in Health


Communication for RNTCP
1.5.1 Use of street theatre
Open-air shows like yatra, theatre, pala, dance, drama and puppet show and
other folk forms of communication have widespread popularity. A story is
presented in combination with dance, music and humour through these genres
and entertains the community.

Based on the principles of forms of folk communication, street theatre is


considered an effective medium for educating the community. Street theatre has
come to be widely used in socio-development programmes in diverse areas such
as education, health, agriculture, social forestry, prevention of dowry, prohibition
and labour exploitation. Street theatre was first adopted in Orissa by DANLEP to
promote early diagnosis and regular treatment of leprosy by reducing the social
stigma and was proved to be very effective. Based on this experience, street
theatre was also utilised in RNTCP.

Objective
To create awareness in order to enhance timely case-detection, treatment
adherence and generate knowledge about TB and RNTCP.

Target audience
Community, patients and service providers of all age groups.

Process of organisation
After a formal five-day training, the teams contact the CDMO/DTO of a district,
who sends them to the MO-PHI with an official letter regarding performance of
street theatre.

112 | A Health Communication Strategy for RNTCP


Planning at PHC-level
The team meets the MO-PHC and the BEE to prepare a calendar for shows at the
sub-centre level, indicating the date, place and time of each show. A maximum
of two shows are planned in a day. The calendar is sent to health workers of all
sub-centres well in advance with instructions for their presence at the show. The
time of performance is chosen to suit local communities.

Performance in the field


The team proceeds to different sub-centres and contacts health workers for
selection of a suitable venue. Once the venue is selected, the troupe moves
around the village playing music to make people aware of the show. Once the
audience is gathered, the play is started.

Content
The show is presented in a story form with all necessary messages on TB and
RNTCP, including cause, mode of spread, signs and symptoms, availability of
diagnostic and treatment facilities, importance of regular treatment and timely
sputum follow-up. Usually, the script is developed based on one of the local issues
related to RNTCP. The audience enjoys the story with music, humour, dance and
song. The show continues for 45 minutes to one hour.

In most of the shows cured TB patients are involved to narrate their experiences,
which attracts and encourages symptomatic cases to come forward to report.
Also, the general public is convinced that TB is curable and treatment is available
free of cost.

Question-answer session
At the end of the show, the health worker asks the audience about the message
they have received. He/she also answers questions asked by the audience to
address their doubts.

Reporting of suspects
It has been experienced that a number of chest symptomatics from among the
audience report to the team on the spot, who, in turn, advise them to get their
sputum examined at the nearest PHI. They also prepare a list of such cases and
hand it over to the health staff, and send a copy to the medical officer of PHI.

Distribution of IEC materials


At the end of the show leaflets and handbills are also distributed to the audience
to enable them to know more about the disease and the programme.

Annexure 1 | 113
Record-keeping
A format containing the date, time and place of the show, the number of people
present, (both male and female), influential persons/leaders of the locality
present and the names of the symptomatics reported is filled up by the troupe
and submitted to the concerned district authorities.

Follow-up
The symptomatics reported during the show are followed up and necessary
action is taken by the STS, the MO-PHI and the DOT provider.

Evaluation
Usually the performance is evaluated by the following indicators in respective
PHIs:
 Increase of information on TB and RNTCP at the community
 Increase of chest symptomatic cases reporting to PHIs
 Increase in drug compliance
 Reduction in defaulter rate

1.5.2 Puppets
Puppets are a form of drama with considerable potential for IEC. They are part of
a tradition of folk-media used in many parts of Orissa.

Objectives
 To disseminate messages on TB that are easily absorbed.
 To spread awareness on DOTS to all segments of the community.

Target audience
Children and women and men of all age groups. Many people see puppets as
being relevant only for children and are surprised when they realise how useful
they can be with adults.

Duration
30 – 45 minutes.

Venue
School premises, village haats/festivals, community halls or a central, open space
in a village.

Resource persons
Skilled persons practising puppetry are given an orientation on RNTCP and the
first performance is supervised by the media/TB staff.

114 | A Health Communication Strategy for RNTCP


Process
 Different types of puppets according to the characters are made and
portrayed:
 Glove puppets, with heads made of papier-mâché/clay.

 Rod puppets, with figures on wooden rods.

 Jointed puppets, moved by strings.

 Do not wave the puppets around. Make them active—dance, chase, fight, hit
and even hug.
 Give the puppets names, special clothing and personalities.
 Include humour, music and songs to entertain.
 Keep it simple. Do not try to cover too much.
 Make a stage that can be easily put up and taken down for transportation. A
wall or a curtain to stand behind is required.
 Choose the timing of the performance carefully. Find out when the children,
women and men are free.
 Make sure the performances are well-publicised in advance.

Impact
Puppets have maximum impact when the community participates in the
preparation of the programme, in performing the show and discusses it
afterwards.

1.5.3 Patient-DP-community interaction meeting

Objectives
 To develop a good rapport and reduce social distance between DOT providers,
patients and other programme personnel.
 To review the knowledge and activities of DOT providers and patients
regarding TB as a disease and provision under RNTCP.
 To interact with irregular and defaulter cases and identify their problems and
needs for counselling towards retrieval.
 To promote sharing of experiences between DOT providers and patients on
their problems and success and agree on action for improvement, keeping
the gender component in view.
 To maintain and promote the motivation level of DOT providers.
 To facilitate the practice of good counselling and communication skills.

Process
 A meeting is likely to be held in a PHI twice a year. A calendar is prepared by
the DTO for every round of the meeting. Once the calendar is circulated by
the CDMO/DTO to all PHCs, it is the responsibility of the concerned MO-PHI
to intimate the DOT providers to attend the meeting.

Annexure 1 | 115
 The BEE is the convenor of the meeting and will assist the MO PHI in
organising and conducting the meeting.

Venue
PHI/PHC headquarters or any other suitable central place convenient to all
participants.

Sitting arrangement
The meeting preferably takes place under a tree, except in the rainy season. All
participants should sit on a common mat on the floor in a circle/semi-circle.

Duration
One day.

Participants
 DOT providers, both medical and non-medical
 Patients under treatment (male/female)
 Cured former TB patients (male/female)
 Defaulters, all
 Other programme personnel like BEE, MO-PHI, LT, STS, STLS, MO-TU and
ICDS supervisor

Selection of patients and DOT providers


To ensure better participation and interaction, patients and providers are limited
to a total of 40-50. Preference is given to all smear positive and defaulter patients,
both male and female, to motivate them for regular treatment. Similarly, DOT
providers who need orientation are called in on a priority basis.

Agenda of discussion
 Re-orientation of knowledge component in RNTCP
 Introduction of gender components
 Review of the activities of each DOT provider
 Interaction with each patient
 Review points of patient counselling which includes diet and regular sputum
follow-up
 Experience of DOT provider and suggestion for improvement
 Narration of experience by patients
 Patient awareness regarding the disease
 Patient as educator/motivator in referred cases
 Interaction with defaulters
 Cross-checking and updating patient cards
 Role-play

116 | A Health Communication Strategy for RNTCP


Method
 Mainly participatory through discussion
 Sharing of experiences
 Role-play
 Quiz

Evaluation and follow-up


The meeting is evaluated at the end of the session through a developed format in
terms of participation, food, venue, defaulter retrieval etc. In the field, DOT providers
and STSs monitor the regularity of the treatment among patients, and STSs monitors
improvement of knowledge on the programme and fills the treatment cards.

1.5.4 Trialogue approach


Success of any health communication strategy depends largely on the close
interaction and coordination between stakeholders. In RNTCP, this can be done
through the trialogue approach. This is a community-based activity. In this
approach there are three ‘p’s—the patients, the providers and the people. In this
meeting the participants spend a whole day together, siting on a mat and eating
from a common plates. This meeting gives an opportunity for people to air their
feelings. It also provides an excellent opportunity for women to participate.

Irregular and defaulter cases are specially addressed to identify their problems
and needs, for counselling. Influential people from the community such as
panchayati raj members are encouraged to actively participate in spreading
awareness about TB diagnosis and DOTS.

The trialogue approach reduces the gap between patients, providers and the
community through informal, interactive meetings.

Objectives
 To develop a good rapport and reduce social distance between DOT providers,
patients and other programme personnel
 To review the knowledge and activities of DOT providers and patients
regarding TB as a disease and provision under RNTCP
 To interact with irregular and defaulter cases, identify their problems and
needs for counselling towards retrieval
 To promote sharing of experiences between DOT providers and patients on
their problems and success and agree on action for improvement, keeping
the gender component in view
 To maintain and promote the motivation level of DOT providers
 To facilitate the practice of good counselling and communication skills

Annexure 1 | 117
Process
 A meeting is likely to be held in a PHI twice a year. A calendar is prepared by
the DTO for every round of the meeting. Once the calendar is circulated by
the CDMO/DTO to all PHCs, it is the responsibility of the concerned MO-PHI
to intimate the DOT providers to attend the meeting.
 The BEE is the convenor of the meeting and will assist the MO-PHI in
organising and conducting the meeting.

Venue
PHI/PHC headquarters or any other suitable central place convenient to all
participants.

Sitting arrangement
The meeting preferably takes place under a tree, except in the rainy season. All
participants should sit on a mat on the floor in a circle/semi-circle.

Duration
One day.

Participants
 DOT providers, both medical and non-medical
 Patients under treatment (male/female)
 Cured former TB patients (male/female)
 Defaulters, all
 Other programme personnel like BEE, MO-PHI, LT, STS, STLS, MO-TU and
ICDS supervisor

Selection of patients and DOT providers


To ensure better participation and interaction, patients and providers are limited
to a total of 40-50. Preference is given to all smear positive and defaulter patients,
both male and female, to motivate them for regular treatment. Similarly, DOT
providers who need orientation are called in on a priority basis.

Agenda of discussion
 Re-orientation of knowledge component in RNTCP.
 Introduction of gender components.
 Review of the activities of each DOT provider.
 Interaction with each patient.
 Review points of patient counselling which includes diet and regular sputum
follow-up.
 Experience of DOT provider and suggestion for improvement.
 Narration of experience by patients.
 Patient awareness regarding the disease.

118 | A Health Communication Strategy for RNTCP


 Patient as educator/motivator in referred cases.
 Interaction with defaulters.
 Cross-checking and updating patient cards.
 Role-play.

Method
 Mainly participatory through discussion.
 Sharing of experiences.
 Role-play.
 Quiz.

Evaluation and follow-up


The meeting is evaluated at the end of the session through a developed format
in terms of participation, food, venue, defaulter retrieval etc. In the field, DOT
providers and STSs monitor the regularity of the treatment among patients
and STSs monitors improvement of knowledge on the programme and fills the
treatment cards.

1.5.5 Orientation of tribal link workers

Objectives
To improve timely diagnosis and regular treatment of TB cases through a
coordinated effort by involving all partners in community development blocks.

Specific objectives
 To improve awareness regarding TB and RNTCP in the entire block area.
 To identify and extend block-level partnership for mobilising resources and
for accelerating awareness activities on RNTCP.
 Capacity-building of different partners/stakeholders.
 To improve the quality of RNTCP services.
 To improve the case detection and cure rates.

Target group
 All sarpanches, samiti members, zila parishad members.
 Selected health workers from different sub-centres (4-5).
 Selected AWWs from the block (4-5).
 Selected traditional healers (3-4).
 NGO/CBO representatives (3-4).
 One male and one female volunteer from each gram panchayat.

Venue
Generally, an open-air venue under a tree at the block headquarters is selected
for the training programme. In special circumstances, like rainy weather, the
venue is shifted to a big well-ventilated room, if possible.

Annexure 1 | 119
Sitting arrangement
All participants, observers and resource persons sit on the floor on a mat in a
circle/semi-circle.

Process of organisation
First, district health authorities like the CDMO and DTO are contacted and
requested to organise the orientation programme in a particular block. A request
letter is then issued to the BDO for arranging the activity under intimation to the
concerned PHC MO and SDMO.

A formal meeting is convened of the stakeholders listed below to decide the date
and develop a plan for implementing the orientation programme.
 SDMO
 MO-PHC
 BEE
 BDO
 Chairman, panchayat samiti
 Representatives of one or two active NGOs
 CDPO
 Two or three sarpanches, if possible.

In the presence of all the above stakeholders, the purpose of the orientation,
selection of participants, logistic arrangements, distribution of responsibility,
selection of date and the venue are discussed. A formal letter mentioning the
date, time and venue of the orientation meeting is issued by the BDO to all
participants and observers.

Resource persons
 CDMO/DTO/SDMO
 MO-PHC/sector
 STS/LT/BEE
 CDPO/supervisors
Training session
At the outset, a brief introduction about the orientation session is given by the
CDMO/DTO or SDMO, highlighting the necessity of such orientation, followed by
self-introduction of participants, resource persons and observers. The technical
session then follows.

Content
Highlighting of RNTCP, TB, its cause, mode of spread, signs and symptoms,
categories of treatment, availability of diagnostic and treatment facilities and the
role of link workers. This session is continued till lunch break.

120 | A Health Communication Strategy for RNTCP


It is conducted through question-answer sessions, discussions, sharing of
experiences, demonstrations (patient, medicine box, sputum container) and
quizzes.

Initially, a number of questions written on a piece of paper are distributed among


the participants. They are encouraged to answer those questions serially, which
are then summarised by the resource person. Likewise, all the topics are covered
by answering all questions, followed by a quiz among the participants, and a
street theatre performance.

After lunch, the participants and the resource person plan the orientation session
at the gram panchayat (GP) level and dissemination of information to every
household through IPC. Dates are finalised among the participating sarpanches
for the training and conduction of IPC. Resource persons like MO-PHC, DTO,
SDMO and DANTB personnel share the responsibility to facilitate the training
camp at gram panchayat level. A detailed calendar of the gram panchayat level
orientation activities is finalized on that day.

Writing and IEC materials used


Writing pads, pens, folders, leaflets, pamphlets, booklets and posters are
distributed among the participants for future reference. Posters, banners,
flipbooks and OHPs are used for training purposes.

Video-based training modules


While planning your activity view the ‘Orientation’ module in the accompanying
CD.

Outcome
 Increase of awareness on RNTCP in the community
 Involvement of people’s representatives in RNTCP
 Increase in the utilisation of RNTCP services

1.5.6 Orientation of cured, former patients as RNTCP advocates

Objective
Capacity-building of cured TB patients to disseminate appropriate information
for better utilisation of RNTCP services in the community.

Duration
One day.

Annexure 1 | 121
Venue
Block headquarters or any other suitable place that is centrally-located

Participants
Cured, former TB patients, both male and female.

Facilitators
MO-PHI, BEE, STS and LT.

Process of organisation
BEE, STS and LT prepare a list of participants in consultation with the MO-PHI
and fix a suitable date for the orientation. A letter is then issued to all participants
requesting them to attend the programme.

Session content
 Objective of orientation.
 Brief introduction on technical aspects of TB.
 Target groups in RNTCP.
 Important talking points for different target groups.
 Scope of disseminating information.
 Use of different IEC materials.
 Use of NLDP card.

Aids to be used
Banners, posters, pictorial folder, booklets, pictorial pamphlet and pocket
folders.

Video-based training modules


While planning your activity view the ‘Orientation’ module in the accompanying
CD.

Outcome
 Increase of awareness about TB and RNTCP in the community.
 Reporting of suspected TB cases increased at outpatient departments
(OPDs).
 Reduction of defaulters.
 Increase of cure rate.

1.5.7 Orientation for NGOs at district-level

Objective
To apprise NGOs about RNTCP and help them identify their partnership role in
performing specific activities for the promotion of the programme.

122 | A Health Communication Strategy for RNTCP


Venue
District headquarters/conference hall/community hall.

Duration
One day.

Participants
President and secretary from each NGO.

Resource person
CDMO/DTO/MO-PHI/STS/BEE

Process of organisation
Collect the list of NGOs from the CDMO office and compile a profile of NGOs
who are working in the field of health with the government sector. CDMO/DTO
and DANTB staff make the selection of NGOs to be invited. Date, time and venue
are decided by CDMO in consultation with DTO, MO-TU, MO-PHI, STS, BEE and
DANTB staff. CDMO then invites the participants (NGO secretary and president)
by a letter to the orientation meeting.

Session content
 RNTCP as a programme
 Achievements of the RNTCP district
 Technical aspects of TB such as its cause, mode of spread, signs and
symptoms, diagnosis and treatment, diet pattern of TB patient, side-effect
of the medicines, availability of treatment facilities and IEC on the gender
component

Teaching methodology
 Discussion
 Group work
 Demonstration
 Quiz
 Role-play
 Snakes and ladders game

Health communication materials


OHP, slides, folder, leaflets, booklets, posters, banners and games.

Video-based training modules


While planning your activity view the ‘Orientation’ module in the accompanying
CD.

Annexure 1 | 123
Follow-up
DTO/MO-PHI contacts the presidents/secretaries of the NGOs who attended
the orientation. A date is decided by DTO/MO-PHI in consultation with the
NGO secretary who selects a suitable venue and informs the participants for
orientation at grassroots level.

Evaluation
After six months, MO-PHI, STS and BEE evaluate the orientation of NGO members
in terms of
 no. of NGOs involved in RNTCP activities,
 no. of NGOs providing DOT,
 no. of NGOs carrying out awareness activities and
 no. of NGOs referring suspects.

Documentation
A report on NGO activities is prepared by BEEs

Outcome
 Increase of symptomatic cases reporting to nearest PHI.
 Increased awareness about TB among community.
 Reduced number of defaulters.
 Increase in number of NGO DOT providers.
 Increase in cure rate.

1.5.8 Sensitisation meeting for PRI members

Objective
To ensure the support of panchayati raj institution (PRI) members for the
successful implementation of RNTCP in their area.

Duration
Half day

Venue
Block headquarters

Participants
 Chairman, panchayat samiti
 Samiti members
 Sarpanches
 BDO and other extension officers
 DOT providers, patients

124 | A Health Communication Strategy for RNTCP


Facilitators
 MO-PHI/PHC
 BEE
 STS

Process of organisation
MO-PHI discusses with BDO and Chairman of panchayat samiti and fixes a
suitable date. The Chairman of the panchayat samiti informs all participants to
attend the meeting.

Session content
 Objective of the meeting
 Technical aspects of TB
 Facilities under RNTCP
 Status of TB in the block
 Role of PRI members in the promotion of RNTCP

Health communication materials


Banners, posters, flipbooks, folders and pictorial pamphlets .

Outcome
 Discussion about RNTCP in monthly gram panchayat meetings
 Involvement of PRI members in referring suspects and motivating
defaulters.

Follow-up
BEEs and DPs attend gram panchayat-level monthly meetings and discuss TB
problems there.

1.5.9 Orientation of SHGs

Objectives
 To ensure involvement of SHGs in the dissemination of
information on RNTCP to the community.
 To enable SHGs to refer symptomatic cases for sputum
examination.
 To enable SHGs to motivate defaulter patients for regular
treatment.

Venue
School building/AWW/community centre/under a tree or any other suitable
place

Annexure 1 | 125
Duration
Half day

Participants
Two to three representatives from each SHG (50 to 60 participants).

Resource persons
MO-PHI/STS/BEE

Process of organisation
 CDMO to contact CDPO to discuss the orientation meeting for SHG members
and fix a date.
 CDPO to discuss with supervisor in the monthly meeting and select the venue
and time for the orientation.
 Supervisor selects the most active presidents and secretaries of SHGs.
 Supervisor informs the participants about the orientation meeting or asks
AWWs to do so.

Session content
 Session starts with success story
 Discussion of roles and responsibilities of SHG members towards the
programme, such as
 creating awareness about TB/RNTCP during monthly meetings,

 organise meetings for women’s groups,

 refer chest symptomatic cases to PHI,

 be active in defaulter retrieval and

 if necessary, act as a DOT provider.

Teaching contents
TB as a disease, cause, mode of spread, signs and symptoms, diagnosis
and treatment availability, DOTS strategy, diet of patient and side-effects of
medicines.

Teaching methodology
Story-telling, discussions, role-plays and demonstrations.

Health communication materials


Folders, leaflets , booklets, posters, banners, flipbooks, flash cards and cassette
player with a cassette.

Video-based training modules


While planning your activity view the ‘Orientation’ module in the accompanying
CD.

126 | A Health Communication Strategy for RNTCP


Outcome
 Increase of symptomatic cases reporting to the PHI
 Increased awareness on TB among SHG members
 Reduced number of defaulters
 Examination of sputum at regular intervals

Follow-up
Review activities and re-orientation of knowledge during monthly meetings by
HWs (male/female), AWWs and BEEs.

Evaluation
Responsibility of HW (male/female), AWW and BEE to evaluate every half year:
 How many symptomatic cases referred to PHI?
 How many TB patients cured?
 How many defaulter patients motivated for regular treatment?
 How many patients died of TB?
 How many TB patients under treatment in their respective places (category-
wise male/female)?

1.5.10 Orientation of volunteers, teachers, students and religious


organisations

Objective
To ensure the support of NSS/NYK volunteers in disseminating RNTCP messages
in the community.

Duration
Half a day to one day

Participants
NYK/NSS volunteers

Venue
NYK office/college campus/any other suitable place.

Group size
40–50 participants.

Resource persons
MO-TU/MO-PHI/STS/STLS/BEE/Dy. MEIO

Process of organisation
CDMO/DTO to discuss with youth coordinator of NYK and MO-PHI to discuss
with NSS programme officer of college for organising the sensitisation meeting.

Annexure 1 | 127
Session content

Morning session
 Assess knowledge of participants about TB
 Discuss objectives of meeting
 Present status of TB in Orissa and districts
 What is TB, cause, mode of spread
 Signs and symptoms of TB
 Diagnosis procedure
 Duration of treatment, DOTS strategy, dangers in interruption of medicine
 Importance of the follow-up sputum test
 Prevention of TB
 Review of knowledge by quizzes

Post-lunch session
 DOTS implementation in the district
 Availability of free treatment at nearest PHC/CHC
 Discuss role of NSS/NYK volunteers towards RNTCP

Possible role and responsibility


 To disseminate messages through IPC/group discussions/camps/village
meetings.
 Refer chest symptomatic cases to nearest PHI.
 Motivate defaulters for regular drug intake and regular sputum follow-up
examinations.

Teaching methodology
Lectures, discussions, success stories, role-play, group discussions, snakes and
ladders game and outdoor games (kabaddi)

Health communication materials


Banners, folders , flipbooks , exhibition sets, leaflets and booklets

Video-based training modules


While planning your activity view the ‘Orientation’ module in the accompanying
CD.

Outcome
 Increased awareness on TB in the community.
 Increased chest symptomatic cases reporting to nearest PHI.
 Reduced number of defaulters in their respective areas.
 Participants interested to act as DOT providers.
 Participants involved in various health communication activities organised
by PHI and district-level RNTCP staff.

128 | A Health Communication Strategy for RNTCP


Follow-up
 Monitoring chest symptomatic cases referred by participants.
 Technical/programme guidance provided to participants by concerned PHI
personnel.
 Involved NYK/NSS volunteers in RNTCP activities whenever necessary in
their PHI.
 Review activities and re-orient participants at suitable intervals.
 All activities to be documented by concerned PHI and programme
personnel.

1.5.11 Orientation of traditional healers, traditional birth attendants


and other indigenous practitioners

Objectives
 To enhance knowledge on TB and RNTCP.
 To ensure support of participants in the referring of chest symptomatics.
 To enable participants to motivate defaulters for regular drug intake.

Duration
Half day.

Venue
PHC/CHC building/school building/NGO office.

Resource persons
MO-TU/MO-PHI/BEE/STS/LT.

Participants
Traditional healers and indigenous practitioners/VHGs/TBAs.

Process of organisation
Health workers send a list of traditional healers in their respective areas to the
MO-PHC. The BEE prepares a consolidated list of traditional healers in the block.
The lists of VHGs and TBAs are usually available at the primary health centre.

The MO-PHC decides the date of the sensitisation meeting in consultation with
the DTO/ADMO incharge of TB. The participants are then informed through the
health workers about the date, time and venue of the meeting.

Session content
 Facts about TB like cause, mode of spread and signs and symptoms of TB.
 Diagnostic procedures, importance of regular treatment and timely sputum
follow-up under DOTS strategy.

Annexure 1 | 129
 Roles and responsibilities of traditional healers/VHGs TBAs in RNTCP such
as
 disseminating messages in the community,

 referring chest symptomatic cases to the nearest PHI and

 counselling patients for regular anti-TB drug intake.

 Review of knowledge by quiz.

Teaching methodology
Discussions, role-plays, live success stories and snakes and ladder game.

Health communication materials


Banners , posters , flipbooks, folders, leaflets, booklets and games (indoor and
outdoor)

Video-based training modules


While planning your activity view the ‘Orientation’ module in the accompanying
CD.

Follow-up
 Chest symptomatic cases referred by traditional healers to be recorded by
BEE.
 Monitoring the number of defaulter/irregular cases counselled by traditional
healer.
 Problems associated with TB and programme to be clarified by HW/AWW/
BEE.
 After six months, review the activities and re-orientate about knowledge
component.

Outcome
 Chest symptomatic cases increased in their respective area.
 Reduced defaulter and irregular patients.

Responsibility
 Organising meeting and follow-up action by MO-PHI.
 Recording and report-writing by BEE.
 Supervising the activities of traditional healers by STS/HW worker/AWW.

1.5.12 Orientation of members of CBOs


CBOs are usually small voluntary social groups who aim to serve the local
community, especially the under-privileged groups.

Objective
Capacity building of CBOs in organising awareness activities, referring suspects
and retrieving defaulters for promotion of RNTCP.

130 | A Health Communication Strategy for RNTCP


Duration
One day

Venue
CBO headquarters or any other suitable place decided by them.

Participants
All active members of the CBO.

Facilitators
MO-PHI, BEE, STS

Process of organization
A list of CBOs who are actively involved in other health programmes is available
at the PHC. The BEE/STS, sometimes DANTB personnel, in consultation with
the MO-PHI, contacts concerned CBO and fix a suitable date and place. The
president/secretary of concerned CBO informs the members regarding the date,
time and place of such orientation.

Session content
 Objective of the orientation.
 Technical/social aspects of TB.
 Places where diagnosis and treatment facilities are available.
 Possible causes of defaulting treatment and ways to retrieve defaulters.
 Different types of awareness activities and their scope.
 Review of knowledge by quiz.

Health communication materials


Banners, posters, flipbooks, pictorial folder and pictorial pamphlet, snakes and
ladders game and outdoor games (kabaddi)

Video-based training modules


While planning your activity view the ‘Orientation’ module in the accompanying
CD.

Outcome
 CBOs disseminate information on TB and RNTCP in their locality.
 CBOs refer symptomatic cases to PHI.
 CBOs retrieve defaulters.
 CBOs act as DOT providers.

Annexure 1 | 131
1.5.13 Training/workshop for CDPOs/supervisors at district-level

Objective
To ensure greater involvement of supervisory staff to encourage and support
AWWs in acting as DOT providers.

Duration
Two days (residential).

Venue
A suitable conference hall/meeting hall.

Participants
CDPO/project officer/supervisors (15 – 20).

Ensure participants from each block by District Social Welfare Officer (DSWO).

Facilitators
 Trainer in RNTCP
 CDMO/ADMO/DTO/MEIO
 STS

Process
A letter is issued by the CDMO/DTO requesting the Collector or DSWO to spare
the ICDS officer and supervisors for the training. After subsequent discussion, a
suitable date and venue is finalised after which DSWO issues a letter to the ICDS
officer and supervisors to attend the training programme.

Session content
 Brief introduction of RNTCP.
 Status of TB in India, Orissa and concerned districts.
 Technical aspects of TB like cause, mode of spread, type of disease, diagnostic
procedure, treatment under DOTS strategy and timely sputum follow-up.
 Gender disparities and IEC in RNTCP.
 Role of ICDS officials in the promotion of RNTCP.

Teaching methodology
Lectures, participatory discussions, group discussions, role-plays, quizzes,
demonstrations/return demonstrations, ice-breakers, sputum collection
procedures, medicine strips (no. of days and doses), experience-sharing of cured
patients and follow-up of treatment cards (exercise).

132 | A Health Communication Strategy for RNTCP


Methodology Contents
Lecture and discussion Introduction of RNTCP
Technical aspects of TB
Gender IEC in RNTCP

Demonstration Medicine boxes for treatment


Sputum collection procedure
Narration of experiences by patients
Treatment card filling up
Street theatre in IEC

Group work Role of ICDS officials in promotion of


RNTCP

Role-play Counselling of patients for regular anti-TB drug


intake
Supervision of DOT provider

Quiz Assessment of knowledge

Health communication materials


Banners, posters, flipbooks, leaflets, booklets, TV, VCR, tape recorder, OHP,
writing materials, folders, mela kits, pocket folders, writing pads, pens, pencils,
erasers, snakes and ladders game, exhibition model.

Outcome
 Monthly review meeting of AWW at block level.
 Routine supervision during field visit of AWWS activities in RNTCP.
 Discussion on RNTCP during awareness meeting at project/PHC level.
 Involvement in RNTCP activities like workshops/trainings organised by
PHIs.

Report-writing
Report preparation by Dy. MEIO/BEE/MO-TU.

Evaluation
At the end of the training, an evaluation is carried out using developed question
formats to assess whether the objective of the training has been achieved.

Follow-up
 Monthly meeting of ICDS where RNTCP is discussed; health communication
activities planned with responsibility for specific activities shared MO-PHI to
attend the meeting.

Annexure 1 | 133
 During field visits, interaction with AWWs to assess the planned activities
implemented by STSs and BEEs.

1.5.14 Group discussion


Group discussion is a face-to-face interaction between members of a small group
where ideas, thoughts, experiences and feelings are shared.

Participants
Women and men, usually within the reproductive-age-group, who hail from the
same locality and share a common socio-cultural background.

The number of participants usually ranges between 30 and 50. It is a big group for a
short discussion, usually one hour, which is convenient to the group members.

Objective
Objectives will differ from group to group, according to their health-seeking
behavioural practices based on their knowledge. One example is to build group
consciousness on a selected topic, e.g. the effects of proper utilisation of RNTCP
health facilities.

Venue
Panchayat office/school/community hall/open-air platform.

Facilitator
BEE/STS/Health Assistant (male/female)/HW (male/female), NGO, volunteers.

Process and Content


The facilitator meets village leaders/PRI members/youth club members/elders
and fixes the date, time and venue for discussion. The topic is also made known
in advance.

Role of the facilitator


 Ensure a relaxed and friendly environment for the discussion.
 Seating people in a circle in an open-air atmosphere, on the ground is the
best way for discussion. In a circle, there is no ‘head’ and everyone is equal.
Sitting in a ‘U’ shape is the next-best thing.
 Tell the group at the outset that each one of them must participate.
 Decide on the objective of the discussion in advance and ensure that each
one of the participants understands the issues to be discussed.
 Begin with easy questions, with what people will feel free to talk about. This
builds up people’s confidence.
 If no one answers a question, ask it again, using slightly different and simpler
language. Give examples.

134 | A Health Communication Strategy for RNTCP


 Do not give up if answers are slow in coming. It will take people time to ‘warm
up’ to this new way of learning.
 Always respond politely and with enthusiasm to any answer. Praise
participants when they do respond, even if the answer is wrong:
“Well done.”
“Thank you for your thoughts.”
“That’s really interesting.”

 Be sure to look at every member in the group. Do not look at only those who
talk - as others will feel discouraged.
 If someone puts a question to you, you can direct it to another member by
saying: “That’s an interesting question. Ms. Pushpa, could you respond to Ms.
Leela?”
 Help keep the discussion focused on the objective.
 Keep and use audio-visual aids whenever required.
 Ensure equal participation of all, never allowing one or a few members to
dominate the discussion.
 Encourage members to share opinions (even if wrong), information and
experiences.
 From time to time, summarize important points.
 The best discussions are those that leave people wishing for more. After an
hour or so, people’s minds begin to wander and not much more learning can
take place.
 Complete the process by a quick review of important points and make
someone responsible for a follow-up action.

Evaluation by facilitators and organisers


 How well was the group discussion organised?
 Attendance (male/female) Nos.
 Physical facilitators Good/Adequate/Poor
 Was the objective achieved? Yes/No
 If No, reasons?
 Participation of members – Good/Fair/Poor
 If ‘Poor’, reasons?

1.5.15 Kalyani clubs


Kalyani clubs have been formed under the GoI scheme in nine Doordarshan
kendras all over India. The members of the club watch health programmes
like Kalyani on television and spread health messages amongst people living
in remote areas with no television access. Besides watching these episodes on
television, members of Kalyani clubs are also informed about RNTCP and DOTS,
enhancing their knowledge about TB.

Annexure 1 | 135
Club members organise dance programmes and plays with TB as the focus. The
performances provide information to patients, providers and the community in
an entertaining way. These performances are telecast on Doordarshan as a part of
the Kalyani episode, spreading awareness about TB amongst a larger audience.

The Kalyani club members are motivated to write about the problems faced by
people in remote areas, for telecast through the Kalyani episodes.

Objective
To create awareness among youth to enhance timely detection, treatment
adherence and general knowledge about TB and DOTS.

Target audience
Community—particularly youth.

Venue
Generally, an open air venue near a village is selected for the programme.

Duration
Three to four hours.

Process of organization
District health authorities like the CDMO and DTO are contacted and requested
by Kalyani clubs to organise the programme in a particular block. A request
letter is then issued to the BDO for arranging the activity under intimation to the
concerned MO-PHC Medical Officer and the SDMO. A formal meeting of all these
stakeholders is convened to decide the date and develop a plan for implementing
the programme.

Finally, the Doordarshan officer is informed about the date and venue of the
programme and requested to televise.

Resource persons
 CDMO/DTO/SDMO
 MO-PHC/sector
 STS/LT/BEE

Health communication materials


Banners, posters, flipbooks, leaflets, booklets, story boards, tape recorder,
outdoor material.

136 | A Health Communication Strategy for RNTCP


Follow-up
After the programme, the concerned Kalyani club members are met and their
views ascertained about the success of the programme and possibilities for
organising such events in neighbouring villages.

1.5.16 Workshop on culture and communication


There are several districts in India where a large section of the population do not
have access to basic RNTCP services in spite of the wide coverage network. The
cure rate in these districts may also be low compared to the national norm of
85 per cent. This could be attributed to varied geographical and ethno-cultural
reasons. In order to motivate patients for continuation of treatment, bridging the
cultural divide is indeed vital.

The workshop on ‘Culture and Communication’ for service providers serves


this purpose. The intent is to make providers internalise the importance of
understanding the culture of the local people and hence to make a conscious
effort for improvement in service delivery.

Objective
Sensitising service providers about geographical and ethno-cultural issues in
order to bridge the cultural divide.

Duration
Two days

Venue
A suitable conference hall/meeting hall.

Participants
Traditional healers, STLS, pharmacists, LHV, BEE, MO, ADMO, ADEO, MPHS,
STS, surgeons

Facilitators
 Trainers in RNTCP
 CDMO/ADMO/DTO
 STS

Process
 Planning meeting at district level involving CDMO/DTO/Collector for
finalisation of date, venue and participants.
 Request letter is issued to all participants to participate in the meeting
 CDMO arranges all logistical requirements

Annexure 1 | 137
Session content
 Inauguration
 Introductory session where traditional healers introduce themselves
 Role play
 Lecture on ‘Culture and its Various Connotations’ by a resource person
 Training game
 Group sessions
 Presentation of findings by groups
 Story exercise and sharing experiences
 Concluding session and feedback from participants

Workshop methodology
Lectures, group exercises, training games, role plays, quizzes, ice-breakers,
exercises.

Health communication materials


Banners, posters, tape recorder, register to record comments of participants.

Outcome
Increased sensitivity to cultural issues among service providers and programme
staff.

1.6 Involvement of Other Organisations and Individuals


1.6.1 Orientation of industrial workers

Objective
To ensure early reporting of symptomatic cases by industrial workers and
dissemination of information to other people

Venue
Community hall/club or any other suitable place

Duration
Two to three hours

Participants
Managers/officers/workers

Resource persons
DTO/MO-PHI/STS/BEE and DANTB officer

138 | A Health Communication Strategy for RNTCP


Process of organisation
 CDMO/DTO informs the general manager of company.
 General manager of company decides the venue, time and date in consultation
with CDMO/DTO.
 Company general manager informs the participants about the sensitisation
meeting.

Session content
Technical aspects of TB, its cause, mode of spread, signs and symptoms, diagnosis
and treatment, diet of the patient, side-effects of the medicine and availability of
treatment facility.

Teaching methodology
 Discussions
 Demonstrations
 Quizzes

Health communication materials


Banners, posters, flash cards, flipbooks and leaflets

Video-based training modules


While planning your activity view the ‘Orientation’ module in the accompanying
CD.

Follow-up
MO-PHI/STS to keep regular contact with the MO of the concerned company
regarding
 referral of chest symptomatic cases and
 regular drug intake and timely sputum follow-up where patients are under
DOTS.

Outcome
 Increased awareness on TB among industrial workers and their family
members and friends
 Increased reporting by suspected cases for sputum examination

1.6.2 Orientation of jail inmates and employees


RNTCP has been implemented in 14 districts of Orissa in a phased manner.
Community awareness and education is one of the important components of
RNTCP. Efforts are on to make every section of the community aware about the
services provided under RNTCP so that it may avail them.

Annexure 1 | 139
Jail inmates who do not know about the happenings outside the four walls of
the jail need to be sensitised about the new TB programme. Many inmates are
released within a short period of time, either because they committed minor
offences or because they are granted bail. Hospitals/dispensaries have been set
up in district/central jails and designated jail MOs are available in smaller jails to
provide medical care to the inmates.

Objectives
 To sensitise jail inmates regarding the signs and symptoms of TB and the
necessity of early reporting for diagnosis and treatment.
 To sensitise jail employees to take timely action in referring chest symptomatic
cases
 To persuade patients in jail for regular drug intake and sputum follow-up.

Duration
Half a day.

Venue
District/sub-district jail/under a tree in the jail premises.

Participants
All jail inmates, employees, jail MOs, pharmacists.

Date
A convenient date for participants and facilitators.

Facilitators
 District/PHI
 District level—MO-TU, STS, Dy. MEIO, STLS, LT
 PHI level—MO-PHI, LT, BEE

Process of organisation
 Planning at district level for finalising date, venue and selection of facilitators
by CDMO
 Letter to jail superintendent at district-and sub-district levels by CDMO.
 Finalisation of date, time and number of participants to attend by jail
superintendent.
 Information to jail employees—Jail Superintendent.
 Logistics arrangement for participants—MO-TU, STS, Dy. MEIO, BEE, LT.

Session content
 Cause of TB, mode of transmission, symptoms, diagnostic procedure and
treatment facilities available.

140 | A Health Communication Strategy for RNTCP


 Importance of regular medicine intake, sputum follow-up and normal diet.
 Identification of defaulter/irregular patient, if any.
 Health check-up for symptomatic cases.
 Sputum collection.
 Role of jail employees for taking timely action in relation to TB.

Teaching methodology
Lectures, participatory discussions, group discussions, role-plays, demonstration
of sputum collection procedure and quizzes

Health communication materials


Banners, posters, flipbooks, leaflets, booklets on RNTCP messages and folders.

Video-based training modules


While planning your activity view the ‘Orientation’ module in the accompanying
CD.

Outcome
 Regular discussion on RNTCP among jail inmates and employees, including
jail MO, jail pharmacist and BEE.
 Identification of symptomatic cases.
 Cases referred for sputum examination.

Report-writing
BEE/Dy. MEIO/MOTU.

1.6.3 Sensitisation workshop for journalists


Workshop for journalists can be organised at state, district and block levels.

Objectives
 To raise the media’s awareness about issues pertaining to TB.
 To enhance the quality of reporting and seek the media’s cooperation in
disseminating news and views on TB and spreading awareness that DOTS is
effective and free.

Participants
 Journalists from leading newspapers with an interest in developmental and
health issues.
 Programme providers of RNTCP.
 Patients who can narrate their experiences or who are DPs.
 DOT providers (health and non-health).
 NGO representatives.
 Key stakeholers such as, Director (IEC)/District MEIO/DIPRO/BDO/zila
parishad chairman/panchayat samiti members.

Annexure 1 | 141
Venue
Panchayat office/block office/DRDA/Collectorate/SIH&FW

Duration
Half a day to one day

Facilitators
 State-level—Director/Dy. Director, IEC, Jt. Dir./Dy. Dir (TB), DANTB staff,
Asst. Prof. ATD&TC, Director, AIR, Director, Doordarshan, zila parishad
Chairman.
 District-level—CDMO, MO-TU, ADMO (Med./TB), MEIO, DIPRO, Station
Director (Doordarshan/AIR), DANTB staff, STS.
 Block-level—ADMO (Med./TB), MO-TU, MO-PHI, BEE, BDO, Chairman of
panchayat samiti.

Process of organisation
 Contact the State Press Bureau personally to obtain a list of editors of
important dailies/magazines/news agencies.
 Make personal visits to editors/sub-editors after making appointments.
Explain objectives clearly, speak about RNTCP and expectations in the area
of developmental journalism. Request for suitable participants to attend the
workshop. Thank them in anticipation.
 Letter of invitation should be sent from the head of the health system:
 Dir. of Health Services, State level

 CDMO, district-level

 MOTU, block-level

 As part of the media workshop, prepare a written document of RNTCP


activities in the relevant area, with attention-getting headlines. This may be
on different sheets of paper, all put into a folder that will stimulate reading.
 Give an address/telephone number of someone who could be contacted if
they need further information.

Session content
 Technical and social aspects of TB
 Interaction with patients and DPs
 Interaction with programme personnel
 Street theatre performance
 Identify role of journalists in the promotion of RNTCP

Suggestions to be discussed and noted for follow-up.

142 | A Health Communication Strategy for RNTCP


Health communication materials
 Mela kits, exhibition models, posters, leaflets, banners, folders and story
book.

Outcome
 Interviews with DPs/patients/programme personnel and other information
and news on RNTCP published in newspapers/magazines.
 Visits to PHIs/interaction meetings of DPs, patients and providers for regular
press releases.
 Meetings at intervals for continuous update of activities.

1.7 Monitoring, Evaluation and Research


1.7.1 RNTCP programme documentation
The successes and failures of a programme must be documented for others to
make use of the experiences gained in other contexts. Innovative approaches
and activities which lead a programme to achieve its goal must be shared with
other agencies and possibly replicated in similar programme.

Objective
To present an overview of programme objectives, approaches and achievements
to different stake-holders.

Target audience
 Policy-makers
 Administrators
 All health staff in government, private and public sectors
 Donor agencies

Format
 Publication
 Video documentary

Contents
 RNTCP background
 Extent of TB problem
 Process of documentation pertaining to activities in focus
 Innovative approaches used
 Success in RNTCP

Annexure 1 | 143
Process of documentation
 Relevant operational research, evaluation or documentation techniques
tailor-made to the specific issue/problem.
 Consultancy to professional film-maker with adequate experience in video
documentation in government and public sector. Script developed in
collaboration with programme staff.

Issues for documentation


Activities and issues for documentation should be identified through discussions
with DHS, DDHS, DANTB and CDMO/DTOs of the concerned districts. A number
of examples are given below:
 Reporting of symptomatic cases and diagnosis of TB
 DOTS at grassroots level
 Different health communication activities
 Monitoring and supervision
 Views and perspectives of relevant programme staff

144 | A Health Communication Strategy for RNTCP


Annexure 2
IEC Resource Centre of Central TB Division
User Guidelines

Background
The Government of India and partners supporting TB interventions have long felt
the need for a web-based Resource Centre for IEC material related to TB control
for the benefit of those involved in RNTCP. As a response to this need an IEC
Resource Centre has been set up by the Central TB Division, Ministry of Health
and Family Welfare with the support of DANTB and Danida.

Highlights
The RNTCP IEC Resource Centre is accessible as a link from the CTD website,
www.tbcindia.org. The Resource Centre houses specifications and digital formats
of representative TB-IEC material being used in the programme. It is a useful tool
in information sharing that is crucial to strengthen IEC activities in TB control
in India. Users (STOs, NGOs, RNTCP staff, researchers, CBOs and others) can
register themselves at the website and access the TB-IEC material database. A
search facility has been provided for easy selection of material using a set of
simple criteria. A help link is provided on the website to guide users.

Rationale of the IEC Resource Centre


 The IEC Resource Centre houses a selection of IEC materials for RNTCP
available online for inspiration and replication at local levels.

 Online users will be able to access material produced at national, state- and
district levels for a wide range of different target groups using different types
of media.

 The IEC Resource Centre will help to strengthen the capacities of programme
staff in the adaptation and usage of IEC material.

Features of the Resource Centre


The Resource Centre houses specifications and digital formats of representative
TB IEC material. The user can navigate the website, register as a member, view

Annexure 2 | 145
and search the database of existing materials using keywords and download
images and text.

Users of the Resource Centre are encouraged to submit their e-mail ID while
signing in and registering as members so that they may receive updates on the
Resource Centre as and when such updates are available.

The IEC material database, which is the backbone of the Resource Centre, stores
information about each IEC material, specifying the nature of the IEC material,
languages available, target audience, type of use and other information relevant
to the appropriate use of the material. The material can be downloaded in digital
format in medium resolution (not print quality). All material in regional languages
is accompanied with translations/synopses in English and Hindi. Images of all
print material such as posters, flipbooks and leaflets, are available in portable
digital format. Other non-print material such as audio tapes and video films have
a synopsis of the material.

All IEC materials are uploaded through a single point administrator at the CTD to
maintain the integrity of the Resource Centre.

Using the Resource Centre


Users can search for a particular IEC material by using either the simple or the
advanced search facility. The simple search facility allows the user to search for
IEC material based on media type, target audience and type of material. The
advanced search allows the user to search using other criteria, in addition to the
ones mentioned above, such as title, language, area of use etc.

Simple search
An example is search for a poster on symptoms of TB. To find samples of posters
on symptoms of TB, first conduct a simple search. Under ‘Media/Media Type’
click on the ‘Print’ dropdown menu and select ‘Poster’. Under ‘Target Audience’
select ‘General Public’ and then click ‘Submit’. The simple search is generally
very broad and gives search results that will include all print material for general
awareness.

Advanced search
The advanced search helps in defining the parameters and produces more
focused results. The advanced search has additional parameters that include
type and area of use and language. The ‘Material Title’ and ‘Produced by’ fields
give more precise results.

Search results
The results page will display thumbnail icons of the materials along with titles

146 | A Health Communication Strategy for RNTCP


and brief descriptions. Click on the result that fits the requirements best.

Specific results
On clicking the result, a fresh page will open. It will have the title of the material
above the visual. The information matrix gives the details including objectives,
message route format, target group, year of production and the producer.

Modification/Adaptation of Material from Resource Centre


Users who are interested in reproducing the material should check the suggested
modifications/other remarks.

A significant objective of the Resource Centre is to facilitate standardisation of IEC


messages and material across the country without compromising the contextual
and cultural needs of different regions and target groups. Users of the Resource
Centre can freely modify or adapt the material for use in their area.

While modifying or adapting the material, care should be taken to use the
standard RNTCP logo and messages and the latest RNTCP data.

Pre-testing of Material
After modifying or adapting material from the IEC Resource Centre, it is strongly
advised that they be pre-tested among the intended target audience.

Pre-testing means field-testing IEC material before they are mass-produced. It is

Annexure 2 | 147
an important yet often neglected aspect of developing IEC materials. Pre-testing
is a cost-effective mechanism to prevent expensive mistakes. There is often a gap
between the communicators who develop the IEC material and the target groups
for whom the material is intended. Pre-testing helps to assess the effectiveness
and relevance of the material for the target group. The focus on pre-testing should
be on attention, comprehension, relevance, credibility and acceptability. To be
effective, pre-testing must be accurate, well-planned and executed.

The pre-test results should be analysed, assessed and critically reviewed. Based
on the pre-test findings the material should be modified to make it more relevant
and effective to the target group.

Submitting Material to the Resource Centre


The Resource Centre is a dynamic site. The CTD will be reviewing and updating
IEC material produced by different agencies all over the country. If you wish to
submit the IEC material you have produced recently for inclusion, please send
samples (two copies) to the CTD at the following address. Please also provide the
month/year of production, details of pre-testing and contact address.

Plesae address your mail to


IEC Consultant
Central TB Division
Directorate General of Health Services
Ministry of Health and Family Welfare
Nirman Bhavan
New Delhi
e-mail: postmaster@tbcindia.org
www.tbcindia.org

148 | A Health Communication Strategy for RNTCP


Annexure 3
Index of Materials Available in the Central TB
Division’s Web-based IEC Resource Centre
ID No. 1, 3-5
Type of Material Brochure
Material Title TB: A Guide for the Health Provider
Area of Use Rural, Urban
Target Audience Service Providers
Language English, Gujarati, Malyalam, Telugu
Objective To educate health service providers
on TB, types of TB, diagnosis,
treatment process under DOTS,
drug administration and side effects.
To guide health service providers
on messages to be conveyed to the
patients

ID No. 6
Type of Material Flipbook/chart
Material Title Tuberculosis Control
Area of Use Rural, Urban
Target Audience Patients, Community, Service Providers
Language English
Objective Spread awareness about TB and DOTS

ID No. 8, 9-10
Type of Material Booklet
Material Title Use DOTS, Stop TB
Area of Use Urban
Target Audience Patients
Language English, Hindi, Marathi
Objective Provide complete information about
DOTS and encourage the patient to
complete treatment

Annexure 3 | 149
ID No. 11, 12-21
Type of Material Poster
Material Title My wife is second to none
Area of Use Rural, Urban
Target Audience Community, General Public
Language English, Hindi, Gujarati, Bengali,
Kannada, Malyalam, Marathi, Oriya,
Punjabi, Tamil, Telugu
Objective To spread the message that women TB
patients should not be discriminated
against

ID No. 22, 23-32


Type of Material Poster
Material Title DOTS System
Area of Use Rural, Urban
Target Audience Patients, General Public
Language English, Hindi, Gujarati, Bengali,
Kannada, Malyalam, Marathi, Oriya,
Punjabi, Tamil, Telugu
Objective DOTS services are available free at your
nearest health centre for free

ID No. 33, 34-43


Type of Material Banners
Material Title Adopt DOTS if test confirms TB
Area of Use Rural, Urban
Target Audience Community, General Public
Language English, Hindi, Gujarati, Bengali,
Kannada, Malyalam, Marathi, Oriya,
Punjabi, Tamil, Telugu
Objective To spread awareness about TB and its
cure through DOTS

ID No. 44, 45-54


Type of Material Sticker
Material Title DOTS System
Area of Use Rural, Urban
Target Audience Patients, General Public
Language English, Hindi, Gujarati, Bengali,
Kannada, Malyalam, Marathi, Oriya,
Punjabi, Tamil, Telugu
Objective To spread awareness about DOTS
strategy

150 | A Health Communication Strategy for RNTCP


ID No. 55, 56-57
Type of Material Booklet
Material Title Now Free TB Treatment Through Your
Own Doctor!
Area of Use Urban
Target Audience Patients, General Public
Language English, Hindi, Marathi
Objective To inform potential patients about
DOTS and free treatment

ID No. 58, 59-60


Type of Material Flipbook/chart
Material Title TB: A Communication Aid for Health
Providers
Area of Use Urban
Target Audience Patients
Language English, Hindi, Tamil
Objective To help health service provider in
communicating effectively with the
patient

ID No. 61, 62-71


Type of Material Poster
Material Title “Towards Freedom from TB…” series
(Zaheer Khan)
Area of Use Rural, Urban
Target Audience Patients, General Public
Language English, Hindi, Gujarati, Bengali,
Kannada, Malyalam, Marathi, Oriya,
Punjabi, Tamil, Telugu
Objective To spread the message that TB is a
widespread disease but is completely
curable with DOTS—diagnosis and
treatment process is free

Annexure 3 | 151
ID No. 72, 73-82
Type of Material Poster
Material Title TB can be cured with DOTS (Rahul
Dravid)
Area of Use Rural, Urban
Target Audience Patients, General Public
Language English, Hindi, Gujarati, Bengali,
Kannada, Malyalam, Marathi, Oriya,
Punjabi, Tamil, Telugu
Objective To advocate DOTS and that TB is
completely curable with DOTS and
diagnosis and treatment process is
free

ID No. 83-84, 88-96


Type of Material Poster
Material Title Leaving TB treatment incomplete
can…
Area of Use Rural, Urban
Target Audience Patients, General Public
Language English, Hindi, Gujarati, Bengali,
Kannada, Malyalam, Marathi, Oriya,
Punjabi, Tamil, Telugu
Objective To spread awareness about dangers of
incomplete treatment

ID No. 97-107
Type of Material Poster
Material Title DOTS—sure cure for TB (Rahul
Dravid)
Area of Use Rural, Urban
Target Audience Community, General Public
Language English, Hindi, Gujarati, Bengali,
Kannada, Malyalam, Marathi, Oriya,
Punjabi, Tamil, Telugu
Objective To advocate DOTS as the best system
for treatment

152 | A Health Communication Strategy for RNTCP


ID No. 108-118
Type of Material Poster
Material Title “We adopted DOTS and lost nothing”
Area of Use Rural, Urban
Target Audience Patients, General Public
Language English, Hindi, Gujarati, Bengali,
Kannada, Malyalam, Marathi, Oriya,
Punjabi, Tamil, Telugu
Objective To spread the message that DOTS is
the best strategy for sure cure of TB

ID No. 119-129
Type of Material Poster
Material Title “I completed TB treatment and gained
a happy life”
Area of Use Rural, Urban
Target Audience Patients, General Public
Language English, Hindi, Gujarati, Bengali,
Kannada, Malyalam, Marathi, Oriya,
Punjabi, Tamil, Telugu
Objectives To spread the message that
completing the treatment is very
important and DOTS is the best
strategy for sure cure of TB

ID No. 130-140
Type of Material Poster
Material Title Do’s and Don’ts
Area of Use Rural, Urban
Target Audience General public
Language English, Hindi, Gujarati, Bengali,
Kannada, Malyalam, Marathi, Oriya,
Punjabi, Tamil, Telugu
Objective To spread awareness about TB

Annexure 3 | 153
ID No. 141-151
Type of Material Poster
Material Title Facts about Tuberculosis
Area of Use Rural, Urban
Target Audience General public
Language English, Hindi, Gujarati, Bengali,
Kannada, Malyalam, Marathi, Oriya,
Punjabi, Tamil, Telugu
Objective To spread awareness about TB

ID No. 152-162
Type of Material Poster
Material Title Towards Freedom from TB
Area of Use Rural, Urban
Target Audience Patients, General Public
Language English, Hindi, Gujarati, Bengali,
Kannada, Malyalam, Marathi, Oriya,
Punjabi, Tamil, Telugu
Objective To spread awareness about TB, its
main symptoms, diagnosis, DOTS and
treatment

ID No. 163-173
Type of Material Poster
Material Title Myths and Realities
Area of Use Rural, Urban
Target Audience Community, General Public
Language English, Hindi, Gujarati, Bengali,
Kannada, Malyalam, Marathi, Oriya,
Punjabi, Tamil, Telugu
Objective To dispel myths related to TB

ID No. 174-184
Type of Material Poster
Material Title DOTS system now closer to you
Area of Use Rural, Urban
Target Audience Opinion leaders, General Public
Language English, Hindi, Gujarati, Bengali,
Kannada, Malyalam, Marathi, Oriya,
Punjabi, Tamil, Telugu
Objective To show the rapid increase in DOTS
coverage

154 | A Health Communication Strategy for RNTCP


ID No. 185-195
Type of Material Poster
Material Title Service to you is our responsibility
Area of Use Rural, Urban
Target Audience Patients, General Public
Language English, Hindi, Gujarati, Bengali,
Kannada, Malyalam, Marathi, Oriya,
Punjabi, Tamil, Telugu
Objective To convey that health service
providers in RNTCP are approachable

ID No. 196-206
Type of Material Balloon
Material Title DOTS—sure cure for TB
Area of Use Rural, Urban
Target Audience Community, General Public
Language English, Hindi, Gujarati, Bengali,
Kannada, Malyalam, Marathi, Oriya,
Punjabi, Tamil, Telugu
Objective To spread awareness about TB and its
cure through DOTS

Annexure 3 | 155
Annexure 4
Index of Health Communication Materials
Used in Orissa

Annexure 2 provides further details about each IEC material developed for
RNTCP Orissa. It is hoped that this would facilitate the replication of materials
elsewhere. Please note that Annexure 1 refers to the numbered items of Annexure
2, so that it can easily be inferred which IEC activities need which IEC materials.

No. 1
Type of Material Pictorial folder
Title in Oriya Chabitia Katha Tia
Title in English One Picture —One Message
Content Cause, mode of spread, signs
and symptoms of TB
Language Oriya
Target Audience Specially developed for
illiterate audiences
Remarks Developed by a tribal group
and based on the perception
of tribals

No. 2
Type of Material Folder
Title in Oriya Jakhma Rogamukta Samaj
Gathana Pain Eka Nibadana
Title in English Appeal for control of TB to
people’s representatives
Content Role of people’s representatives
in the promotion of RNTCP
Language Oriya
Target Audience People’s representatives

156 | A Health Communication Strategy for RNTCP


No. 3
Type of Material Booklet
Title in Oriya Saria Deichi Chithi
Title in English Saria writes a letter
Content RNTCP and TB messages in story form
Language Oriya
Target Audience Neoliterate groups

No. 4
Type of Material Booklet
Title in Oriya Jakhma Roga Bhala Hoi Paruchi Ma
Title in English TB is now curable
Content All facts on TB including symptoms,
diagnosis and treatment procedure
Language Oriya
Target Audience Patients and general community
Remarks Mainly for patient education

No. 5
Type of Material Leaflet
Title in Oriya Jakhma Roga Samparkare Keteka Janib a
Katha
Title in English Some important information about TB
Content Facts on TB, availability of diagnosis and
treatment under RNTCP
Language Oriya
Target Audience General community

No. 6
Type of Material Pictorial pamphlet
Title in Oriya Jakhma roga arogya sadhya
Title in English TB is curable
Content Symptoms of TB and availability of diagnosis
and treatment
Language Oriya and Alchick
Target Audience General and tribal communities
Remarks Specially developed for IPC

Annexure 4 | 157
No. 7
Type of Material Poster
Title in Oriya Jhara, funka, guni, tuni se yugara katha
Title in Alchick Ran murgan omkhari agli halflam ktha
Title in English DOTS cures TB
Content To undertake DOTS for TB
Language Oriya and Alchick
Target Audience Patients and general/tribal community

No. 8
Type of Material Poster
Title in Oriya Heu pachhe ma tara jakhma rogitia sisu pain
ma khira amruta parai
Title in English Encouraging breast-feeding even if mother
is under DOTS
Content Value of breast-feeding during DOTS
Language Oriya
Target Audience Patients and general community

No. 9
Type of Material Poster
Title in Oriya Tinee hapta dahari jadi lagirahe kasa kapha
parakhiba jai dakatar pase
Title in English Get your sputum examined if you are
coughing for three weeks
Content Symptoms of TB
Language Oriya
Target Audience General community

No. 10
Type of Material Poster
Title in Oriya Tinee hapta hela na chhade kasa ebe jiba
dakatar pase
Title in English Go to the doctor if cough persists for three
weeks
Content Encouraging early diagnosis of TB
Language Oriya
Target Audience General community

158 | A Health Communication Strategy for RNTCP


No. 11
Type of Material Poster
Title in Oriya Enetene chepa pakantu nahin
Title in English Do not spit any- and everywhere
Content Precaution for sputum disposal
Language Oriya
Target Audience Patients and family members

No. 12
Type of material Poster
Title in Oriya Amara lakhya ati kaamre 85 vage jakhma
roginku rogamukta ariba
Title in English Our objective is to cure at least 85% TB
cases
Content Objective of RNTCP
Language Oriya
Target Audience Health personnel

No. 13
Type of Material Poster
Title in English Tre a t m e n t re g i m e n , s p u t u m
examination
Content Treatment category and sputum
follow-up
Language English
Target Audience Medical officers and laboratory
technicians
Remarks Reproduced from key concept, to
display in OPDs and laboratories

No. 14
Type of Material Poster
Title in English Treatment
Content Types of patients under different
treatment categories
Language English
Target Audience Medical officers and laboratory
technicians
Remarks Reproduced from key concept, to
display in OPDs and laboratories

Annexure 4 | 159
No. 15
Type of Material Poster
Title in English Diagnosis
Content Diagnostic procedure
Language English
Target Audience Medical officers and laboratory
technicians
Remarks Reproduced from key concept, to display
in OPDs and laboratories

No. 16
Type of Material Game
Title in Oriya Sapa and Sidi
Title in English Snakes and Ladders
Content Right answers go up the ladder, wrong
answers fall into the mouth of the snake
Target Audience For SHGs, youth groups and mahila
mandals

No. 17
Type of Material Flipbook (two types)
Title in Oriya TB/jakhma roga bisayare kichi
jani ba katha
Title in English Facts about TB
Content Different aspects of TB with
related pictures
Language Oriya
Target Audience Health workers and trainees

No. 18
Type of Material Flash card
Title in Oriya Training Guide
Content Different aspects of TB
with related pictures
Language Oriya
Target Audience Health workers and
trainees

160 | A Health Communication Strategy for RNTCP


No. 19
Type of Material Cloth banner (10’ x 3’)
Title in Oriya Apana Janichhanti ke? Jakhma roga arogya sadhya
Title in English Do you know? TB is curable
Content Curability of TB
Language Oriya
Target Audience Patients and general community
Remarks One set containing 10 pieces used during group discussions
and other small training programmes.

No. 20
Type of Material Cloth banner (10’ x 3’)
Title in Oriya Mane rakhantu - Chikicha majhir jadi Apana ousda sabana
banda karanti, tebe rogo sangatik akara dharana karipara
Title in English Please remember - if you stop treatment the consequences
can be dangerous
Content Danger of irregular treatment
Language Oriya
Target Audience Patients and general community

Annexure 4 | 161
No. 21
Type of Material Cloth banner (10’ x 3’)
Title in Oriya Nija ghara rahi adhunika ousad bebahara kari Jakhma rogaru
mukta huantu
Title in English Take drugs at home and be cured
Content TB patients can be treated at home
Language Oriya
Target Audience Patients and general community

No. 22
Type of Material Cloth banner (10’ x 3’)
Title in Oriya Jdi apanku kramagata bhabe tinee hapta kasa lagi rahithya
ba jyar hoithya, sanga sanga dakatarnka sa paramrsa karntu
o kapha ra tinoti namuna parikhya karai niontu
Title in English If you are coughing for three weeks, get three specimens of
sputum examined
Content Symptoms of TB and examination of three samples of
sputum
Language Oriya
Target Audience Patients and general community

162 | A Health Communication Strategy for RNTCP


No. 23
Type of Material Cloth banner (10’ x 3’)
Title in Oriya Jani rakhantu - Jakma rogara niyamita chikicha samatha
sarakari swasthya kendrare bina mulyare karajeithya
Title in English Free diagnosis and treatment of TB is provided at all PHIs
Content Diagnosis and treatment of TB available free of cost in health
institutions
Language Oriya
Target Audience Patients and general community

No. 24
Type of Material Cardboard poster
Title in Oriya Eha gurutua purna
Title in English This is really important
Content Regularity of treatment
Language Oriya
Target Audience Patients and general community

No. 25
Type of Material Cardboard poster
Title in Oriya Bastabata
Title in English True facts
Content Measures to prevent spread of TB
Language Oriya
Target Audience Patients and general community

No. 26
Type of Material Cardboard poster
Title in Oriya Jani rakhantu
Title in English Remember some inportant facts
Content Preventive measures for TB
Language Oriya
Target Audience Patients and general community

Annexure 4 | 163
No. 27
Type of Material Cardboard poster
Title in Oriya Jani rakhantu
Title in English Remember some important facts
Content Diagnosis of TB
Language Oriya
Target Audience Patients and general community

No. 28
Type of Material Cardboard poster
Title in Oriya Apna kana jananti?
Title in English What do you know?
Content Problem of TB
Language Oriya
Target Audience Patients and general community

No. 29
Type of Material Cinema slide
Title in Oriya Apananku tini saptaha kasa
heuchiki?
Title in English Are you coughing for three
weeks?
Content How to suspect TB and what to
do
Language Oriya
Target Audience Patients and general community

164 | A Health Communication Strategy for RNTCP


No. 30
Type of Material Video cassette
Title in Oriya Sabitri
Title in English Sabitri
Content A film about a TB patient who died due to negligence
Language Oriya
Target Audience Patients and general community

No. 31
Type of Material Audiocassette (rural)
Title in Oriya No title
Title in English No title
Content Songs about TB symptoms, diagnostic procedure, importance
of regular treatment etc.
Language Oriya
Target Audience Patients and general community

No. 32
Type of Material Exhibition set (wooden)
Title in Oriya Raimani takes DOTS and is cured
Title in English A Success Story
Content Songs about TB symptoms, diagnostic
procedure, importance of regular treatment,
etc.
Language Oriya, English
Target Audience Patients and general community
Remarks One set containing 15 storyboards

No. 33
Type of Material Mela kit
Title in English Mobile exhibition unit
Content Various information materials on
different aspects of TB
Language Oriya
Target Audience Patients and general
community
Remarks Folding stall with information on TB

Annexure 4 | 165
No. 34
Type of Material Bounded cloth board
Title in English World – India Statistics of TB
Content Statistical information on TB in
India
Language English/Oriya
Target Audience Health personnel/trainers/NGOs
No. 35

Type of Material Folding cloth banner


Title in Oriya Adharu ausadha band karaktu nahin
Title in English Do not stop treatment in the middle
of a course
Content Symptoms, diagnostic procedure,
importance of regular treatment etc.
Language Oriya
Target Audience Patients
Remarks One set five

No. 36
Type of Material Video cassette
Title in English Shanta – Model Community
Mobiliser
Content IEC activities in RNTCP
Language English
Target Audience Community health providers, IEC
staff

166 | A Health Communication Strategy for RNTCP


No. 37
Type of Material Video cassette
Title in Oriya Jakhma - prana binasakari hele madhya arogyo sadhya
Title in English Tuberculosis—A curable killer
Content Introduction of RNTCP and DOTS strategy in Orissa
Language English
Target Audience Health administrators/donor agencies/trainers

No. 38
Type of Material Pocket folder
Title in Oriya Paribartita jatiya jakhma niantran karyakram
(sankhipta suchana)
Title in English Revised National TB Control Programme
Content Basic information on TB
Language Oriya
Target Audience Political representatives PRI members NGOs
teachers

No. 39
Type of Material Audiocassette for the Santhal tribe
Content Songs about TB symptoms, diagnosis procedure, importance
of regular treatment etc.
Language Alchick
Target Audience Patients and general community

Annexure 4 | 167
No. 40
Type of Material Folder with success stories
Title in Oriya Sabo muhon re hasso
Jhauli lata re phoolo
Moo Ethiru kano pauchi tume kano
bujhibo
Ghanti phuni bajilani
Ae kano sathore kimia na kano
Tanka gudiko panire pakai dele sinna…
Koti kare gotia
Nijo jibho nijo hato re kati deli
Sato kahibaku kiyan daribi
Mu para eveready battery
Title in English To be happy and make others happy
Happiness regained
Noble investment
Preaching DOTS
DOTS - the saviour
Paid a price to learn a lesson
One in a million
Duped by a quack
Want to hear my story?
Yours always
Content Small case narratives of patients who
suffered from TB
Language Oriya and English
Target Audience Providers and patients

No. 41
Type of Material Paper belts
Title in Oriya Baidya/DP
Title in English Traditional Healer/DOT Provider
Language Oriya
Target Audience General community (this belt is used
by participants in a mock kabaddi
game, one side representing traditional
healers and the other side representing
DOT provider)

168 | A Health Communication Strategy for RNTCP


No. 42
Type of Material Apron
Title in Oriya Pratyakha tattwabadhanare ausadha khai
mun Jakhama rogoru arogya hoichi
Title in English I was cured of TB by taking the medicines
under direct observation
Content Used by participants in rallies
Language Oriya
Target Audience General community

No. 43
Type of Material Cap
Title in Oriya TB safala chikitsha ra sathika jawab
DOTS
Title in English DOTS—sure cure for TB
Language Oriya
Target Audience General Community

No. 44
Type of Material Pocket Folder
Title in Oriya DOTS subidha apanantu, Jakhma rogoru
mukti huantu
Title in English Adopt DOTS and get rid of TB
Content A brief outline of DOTS and precautions
to be taken during treatment
Language Oriya
Target Audience Patient

No. 45
Type of Material Poster
Title in Oriya Laboratory technician kaan pain keteka
manerakhiba katha
Title in English Few things for the Laboratory Technicians
to remember
Content Information on sputum microscopy
Language Oriya
Target Audience Laboratory technicians

Annexure 4 | 169
No. 46
Type of Material Certificate of recognition
Title in Oriya Priya DOT Provider
Title in English Dear DOT Provider
Content This is given to DOT providers in
recognition of their work
Language Oriya
Target Audience DOT providers

No. 47
Type of Material Booklet
Title in Oriya Chaalo aabe aame gaaonku jiba,
Jakhma rogo katha bujhai deba
Title in English Come lets go to our village and give the
message about TB to everybody
Content Description of signs and symptoms
of TB the importance of DOTS and
RNTCP in a nutshell.
Language Oriya
Target Audience General community

No. 48
Type of Material Flipbook
Title in Oriya DOT Provider kaan pain sankhipta
talim pathyakrama
Title in English A brief curriculum for the DOT
Providers
Content Detailed description of the symptoms
of TB, the role of DOT providers and
the importance of adopting DOTS.
Language Oriya
Target Audience General community

170 | A Health Communication Strategy for RNTCP


No. 49
Type of Material Banner
Title in Oriya Aangyan tike sunantu
Title in English Kindly listen
Content This pictorial banner aptly describes how a person is cured
of TB, in the words of the cured patient
Language Oriya
Target Audience General community

No. 50
Type of Material Poster
Title in Oriya DOTS pradanakari kaan pain ketoti
suchana
Title in English Some information for the DOT Provider
Content Brief information about the role of DOT
providers.
Language Oriya
Target Audience General community

No. 51
Type of Material Poster
Title in Oriya DOTS pradatire hin Jakhma arogya
sadhya
Title in English The only cure for TB is DOTS
Content Adopt DOTS under the supervision of one
person
Language Oriya
Target Audience General community

Annexure 4 | 171
No. 52
Type of Material Poster
Title in Oriya TB parikhya abang chikitsha saamasta
sarakari swastya kendra re maaganare
mile
Title in English Free treatment for TB is available in all
government medical centres
Content Signs and symptoms of TB and the importance of DOTS
Language Oriya
Target Audience General community

No. 53
Type of Material TV spots (two)
Title in English DANTB DOTS
Content Messages on DOTS and TB
Language Oriya
Target Audience General community

No. 54
Type of Material Badge
Title in English DOTS—sure cure for TB
Language English
Target Audience General community

172 | A Health Communication Strategy for RNTCP


Annexure 5
User Guidelines for the Health
Communication Video Modules CD
Learning from past experience, the RNTCP is currently engaged in strengthening
IEC activities and institutionalising successful models through further training
and dissemination of the communication strategy, and developing mass media
campaigns for the entire country. This series of IEC video modules has been
developed with this requirement in focus.

The modules are in VCD and VCR format. So, they are appropriate for viewing
by small audiences consisting of about 20 members. They can be viewed on a
television or on a computer screen.

The modules capture the essential elements of implementing a particular


communication activity in RNTCP.

The modules are organised as follows:

Module 1 – Introduction

1. RNTCP-DOTS
2. TB situation in Orissa
3. IEC strategy—goals, target, audiences, components, responsibilities
4. The trialogue approach

Module 2 – Orientation

1. Orientation of SHGs
2. Orientation of traditional healers
3. Orientation of students and teachers
4. Orientation of PRIs
5. Orientation of cured patients
6. Orientation of NGOs
7. Orientation of industrial workers
8. Orientation of jail inmates

Annexure 5 | 173
Module 3 – Advocacy and Social Mobilisation

1. Exhibitions
2. Mass rallies
3. Interactive stalls
4. Puppet show
5. Training on street theatre technique
6. Performances of street theatre groups
7. Group discussions

Module 4 – Types of Health Communication Material and


Their Use

1. IEC material development workshop


2. Pre-testing of IEC material
3. Media workshop
4. Use of IEC material

 Posters
 Storyboards
 Pamphlets, booklets, folders
 Banners
 Audio/video cassettes
 Games, quizzes
 Flipbooks, flash cards
 Mela kits
 Exhibition sets

174 | A Health Communication Strategy for RNTCP


Annexure 6
Suggested Format for Planning IEC
Activities at State and District

Permissible Budget as per Norms


Target Activities Planned at District-/State-level Responsible Estimated Cost Total
Group/ Officer per Activity Cost
Activity (all activities to No. of No. of Activities Proposed in
Objective for These Unit
be planned as per local Activities the Next Financial Year,
Activities
needs, catering to the Held in Quarter-wise
target groups specified) Last Four
Apr- July- Oct- Jan-
Quarters
Jun Sep Dec Mar
Patients and Outdoors
General Public/ • Wall paintings
For awareness • Hoardings
generation • Tin plates
and social • Banners
mobilisation • Others
Outreach activities
• Patient-provider
interaction meetings
• Community meetings
• Mike publicity
• Others
Puppet shows/street
plays etc.
School activities
Print publicity
• Posters
• Pamphlets
• Others
Media activities on cable/
local channels/radio
Any other activity
Opinion Sensitisation meetings
leaders/NGOs
for advocacy
Media activities
PowerPoint presentations/
one-to-one interaction
Information booklets/
brochures
World TB Day activities
Any other public event
Healthcare • CME programmes
providers • Interaction meetings
• Public and • One-to-one interaction
private meetings
• Information booklets
• Any other
Any other
activities
proposed
Total Budget

Annexure 6 | 175
Annexure 7
IEC Reporting Formats
Reporting Format of DOT Patient-provider Interaction
Meeting

Name of the PHI

1. Date of Meeting 2. Place

3. Time Started 4. Time Ended

1. Attendance (please write the number of persons attending)


Type of Participant Female Male

Patients

 Category I

 Category II

 Category III

 Cured/treatment completed

 Irregulars/defaulters

 Relatives of patients
DOT providers (DPs)

 Multi-purpose Health Workers

 Laboratory technicians

 Pharmacists

 Anganwadi workers

 Balwadi workers/balwadi teachers

 Village Health Guides


 Panchayat members

 NGO workers
 Cured patients working as DPs
 Teachers
 Others (specify)

176 | A Health Communication Strategy for RNTCP


Supervisory Staff/Health Authorities Present Not present
 DTO
 MO-PHI
 STS
 STLS
 MPHS
 CDPO, Anganwadi supervisor
 Others (please specify)

2. Activities Conducted (please tick  the appropriate columns)


YES No
Activities Lecture Group Role-play Quiz Individual Counselling
Discussion
Updating knowledge regarding:
 Different categories of patients
and associated treatment
 How TB is caused and spread
 Number and timings of sputum
examinations required and
reason
 Dangers associated with
defaulting
 Diet
 Maintenance of cards
 How to handle side-effects
 Responsibilities of DPs
 Other (specify)
Raising gender issues
 Delay in diagnosis
 Stigma/fear of rejection
 Other (specify)
Cross-checking of patient cards
Review of each DP’s activities
Individual interaction between
DP and her/his patients
Sharing of DP’s experiences
 How to ensure timely sputum
examination
 How to ensure timely drug
pouch collection for new
patients
 How to promote regular drug
intake

Annexure 7 | 177
 Problems in getting support
from supervisors
 Others (specify)
Sharing of patient’s experiences
 Problems encountered in
accessing RNTCP services
 Benefits from regular treatment
 Others (specify)

3. Problems, Solutions and Responsibilities


3.1 Defaulter retrieval
(to be carried out within seven days of meeting)
Fill in these three columns during the meeting Fill these two columns after visit to patient (enter code no.)

Name and address of defaulter Who will visit? When? What action was taken? What was the Patient resumed
Patient counselling outcome? treatment
Patient refused
Family counselling
Involved village leaders
Involved cured patient

3.2 DOT providers


1. Is there a need for a special refresher course for this PHIs’ DOT providers? Yes/No

If ‘Yes’, why?

When should it be held?

Who should conduct it?

2. Is there a need to train additional DPs for this PHI? Yes/No

If ‘Yes’, how many?

Why?

178 | A Health Communication Strategy for RNTCP


4. Please comment on the following aspects of the meeting.
Good Average Poor
Attendance

Participation by patients in activities

Participation by DPs in activities

Punctuality, keeping to time schedule

Meeting hall arrangements

Drinking water arrangements

Quality of food

Transport arrangements

4.1 Did patients, DPs and supervisory staff eat together? Yes/No

5. Do you have any other comments regarding this interaction meeting? Please
mention positive and negative observations.

6. Please give suggestions for improving the


interaction meetings.

Name, designation and signature of the reporter with date:

Annexure 7 | 179
Reporting Format on Street Theatre Performance
1. Date and time of performance

2. Place of performance

Village

Sub-centre/gram panchayat

District

3. Approx. no. of audience

Male

Female

Children

4. Name and designation of local health staff present

5. Local popular persons witnessed the show (obtain their signature and comments)

6. No. of symptomatics reported at the end of show (if any). Mention their names and
addresses.

7. Technical queries compiled by

Name

Designation

Signature of reporter

(Street theatre team)

180 | A Health Communication Strategy for RNTCP


A Health Communication Strategy for RNTCP
A Health Communication Strategy
for RNTCP

Published by
Central TB Division
Directorate General of Health Services
Ministry of Health and Family Welfare
Government of India

in collaboration with
DANTB

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