Sheela Singh, a young mother in Bhavprasad, a village in Sitamarhi district in Bihar, India, is tuberculosis-free and hopeful because of the determined efforts of nurse and community health officer (CHO) Pranav Kumar and his team. Sheela contracted TB from her mother-in-law, who was successfully treated at the district hospital. However, when Sheela began to display symptoms, neither she nor her family connected them to TB. Her household responsibilities, coupled with the family’s limited resources, prevented her from seeking treatment. Her condition worsened.
Pranav learned about Sheela during an outreach visit. He and his team counseled her at her home and, suspecting TB, took a sputum sample and sent it to a higher-level facility for confirmation. When the result came back positive, Pranav’s team took immediate action to ensure that Sheela received treatment and nutritional support. They also counseled the family on how to care for her and prevent further infection.
As a CHO at the Lagma Health and Wellness Center in Sitamarhi district, Pranav provides comprehensive primary health care services while overseeing a team of 17 community health workers and an auxiliary nurse-midwife. In the afternoons, Pranav and his team visit surrounding villages, going door to door to detect active or presumed cases of TB and provide information about the disease.
“As a health professional, I visualize TB-free villages to contribute towards a TB-free India,” says Pranav.
Achieving a TB-free India is no small task. According to the World Health Organization, in India, two people die from TB every three minutes, and the country accounts for around 27 percent of total TB cases worldwide. Yet this ancient disease is both preventable and treatable.
“Every life saved from TB positively impacts the entire family.”
In addition to household visits, Pranav and his team lead community dialogues to educate villagers about TB. They also address stigma and discrimination around the disease, which can prevent people from seeking care. Their goal is to foster a more compassionate community in the fight against TB.
“It is not enough to just create awareness,” says Pranav. “It includes one-to-one dialogue with the families of patients on their nutritional and hygienic care and consistency in medicines that creates a supportive home environment for patients to fully recover.”
Pranav received his CHO training from Jhpiego, a Johns Hopkins University affiliate, as part of the state government’s Strengthening Roll-out of Health and Wellness Centers in Bihar initiative. With support from the Bill & Melinda Gates Foundation, Jhpiego is providing technical assistance across all of Bihar’s 38 districts and has trained more than 3,180 CHOs to support integration of TB services at health and wellness centers.
The CHO training covers clinical aspects of TB, such as types of the disease, preventive treatment, and medicine regimes. It also covers public health aspects, including sample collection, transportation to higher-level facilities, and use of digital platforms for documentation. To strengthen their managerial skills, CHOs also learn how to conduct community screenings, lead teams to follow up cases, and coordinate with medical suppliers and government counterparts.
The efforts of Pranav and dedicated health care professionals like him are making inroads. The number of TB cases detected has increased substantially across the country—from 131.5 per 100,000 people in 2020 to 172 per 100,000 in 2022. Increased detection means more and better opportunities for treatment.
Pranav knows the importance of his role in connecting communities with essential health care services: “Every life saved from TB positively impacts the entire family.”
Sheela’s husband would agree: “I would have lost my wife, and my family would have crumbled down, had the health and wellness center team not helped us,” he said. ◼
Hena Naqvi is a senior documentation officer in Jhpiego’s Bihar, India office. Raja Ram Pandey, senior program officer in Jhpiego’s Bihar office, also contributed to this article.
Hena Naqvi / Jhpiego
Jhpiego, affiliated with Johns Hopkins Medical Institutions, is a nonprofit organization with partnerships in 40 countries, working to ensure moms and babies receive quality health care to survive and thrive. Hena Naqvi is a senior documentation officer in Jhpiego’s Bihar, India office. Raja Ram Pandey, senior program officer in that office, also contributed to this article.