What do people-centred interventions to end TB look like?
Simply put, it means that we design an activity to reach a group of people based on what we know about them. That knowledge is provided by the community groups themselves, and the community health workers who live and work with them.
This is especially important when it comes to efforts to end contagious diseases like tuberculosis (TB). TB is a disease that not only affects someone’s health; it also impacts their family and social lives, and their livelihoods.
To end TB, we need to reach everyone with TB education, treatment and support services, particularly groups that are harder to reach because they are marginalised. These groups—those with hearing or sight impairments, drug users, sex workers—are among the most at-risk of contracting TB.
This is because they have jobs that expose them to more people, or because they cannot get access to the usual health information and services that others can access. We need to adapt the programme to effectively reach them.
Reaching schoolchildren with hearing impairments
Radio and public loudspeaker are the two most common health education channels in Zanzibar. Both require you to be able to hear the messages broadcast. So, what if you cannot hear? How do you get the TB education that everyone needs?
Amref trained the existing sign language teachers in secondary schools on TB-specific health education sign language. They were then engaged to translate a TB education session delivered to hearing and deaf children in school.
Substance users
People who are addicted to alcohol or drugs are best reached by substance users, or recovering substance addicts. There is a trust there which is not replicable with a CHW from outside that group, as they understand the unique context and issues this group faces, and they can talk to them in a relatable way about both TB and rehabilitation.
In this way, we reach this group with TB information and services that will help their own recovery journeys. The Amref model and programme learning on this has informed the government programme on harm reduction for substance users.
Apprentice CHWs
Every district in Zanzibar has a secondary school with several hundred students. Amref set up school health clubs and trained students on TB education and prevention messaging. Equipped with the TB information posters CHWs use, and record books, students were tasked to reach their households and 2-3 more neighbouring households with these messages. They record names and numbers of people reached and notes on any referrals to local facilities (they do not do screening or diagnosis). This helps to build a volunteering spirit and sense of civic responsibility at a young age, creating the community workforce of the future!
Young people
Approximately two in every five people in Zanzibar are under the age of 35. This is the economic powerhouse generation, so keeping them healthy is critical to the health of the nation.
Amref works with young community members to develop TB education tools such as this video which will effectively reach young people in a language they relate to, on a channel where they consume information. In this case, Instagram or TikTok. In this way, we are working to tackle TB myths and misinformation, and provide accurate, reliable information.
People-centred interventions are also vital once a person is diagnosed with and treated for TB. Myths about TB drive stigma which can affect a TB patient’s whole life even after recovery. Stigma can cause them to self-isolate or be forced to isolate by others. It can also stop them from working, or even having children. Read more about the common myths driving TB stigma.
That’s why interventions like entrepreneurship training are necessary, to fight these myths and misinformation and to help recovered TB patients rebuild their lives and livelihoods.
The training includes building knowledge and understanding about TB, and helping recovered patients to develop financial and marketing skills that will help them build livelihoods to support themselves and their families. This is particularly crucial when the main breadwinners in families have self-isolated or stopped working because of TB myths.
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