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Community patient perspectives inaddressing
poverty.
Addressing poverty through quality TB control and
research, Stop Tb Symposium 40th Union Conference
Cancun Mexico 3rd Dec 2009
Blessina Kumar TB/HIV Activist New Delhi,
India Community Representative DEWG STBP
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Introduction Looking at patient community
perspectives in addressing poverty is to look at
the perspective of the poor. It needs a different
pair of glasses and courage and commitment.
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TB and Poverty Guide

1. Identify the poor and vulnerable groups in the
   country/region served by the NTP
2. Identify the barriers to accessing TB services
   faced by the poor and vulnerable groups in the
   country/region
3. Identify potential actions to overcome the
   barriers to access
4. Review situations and population groups requiring
   special consideration
5. Harness resources for pro-poor TB services
6. Assess the pro-poor performance of the NTP and
   the impact of pro-poor measures

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Patient Perspectives

• Good guidelines
• Establishes approaches to address issues
  affecting the poor
• Lets look at this from the perspective of the
  poor (patients)

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Malawi Example
Grocery Store keeper, Ngwenya, Malawi
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China example Peoples perceived costs are
higher than real costs.
Liu X, Thomson R, Gong Y, Zhao F, Squire SB,
Tolhurst R, Zhao X, Yan F, Tang S How affordable
are TB diagnosis and treatment in rural China
Trop Med Int Health. 2007121464-1471
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India anti poverty example

• Indian history is strewn with several anti
  poverty programmes but one that caught the
  imagination of the poor was spearheaded by Jean
  Dreze an economist.
• His perception differed from most others because
  he saw the needs of the poor through their eyes,
  living in a slum. He saw that the poor needed
  employment, regularly and be paid adequately
  without having to beg for it.
• This was enacted as a law. NREGA- National
  Rural Employment Guarantee Act.

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Access Patients perspective

• Where is the service placed?
• Timings?
• No of visits required?
• Attitude of the healthcare workers?
• Services Equitable?

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• Empowerment The next big step
• Empowerment is the process of enhancing the
  capacity of individuals or groups to make choices
  and to transform those choices into desired
  actions and outcomes.
• Key elements of Empowerment include
• Access to information
• Inclusion and participation
• Accountability
• (worldbank.org)

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Access to information ? Patient Charter
Empowerment of a disadvantaged group is seen as a
threat by others. Empowering Community for TB
Advocacy TAG ICW model Activists trained and
empowered through a series of trainings
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Inclusion and participation Nothing for us
without us. Is the community involved in the
programme? At what level? Not easy but for pro
poor programs - Let us in on the whole show!!!\
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Accountability
Do the patients have a say in the way the program
is designed? in the budget? The poor need to be
empowered to learn the system ambassadors who
will speak for them and represent them.
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• In conclusion
• We cannot address poverty by adding a few extra
  access points to the existing system- it needs a
  paradigm shift
• We need to build a pro poor system- bottom up.
• The time is now!!

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Go to the people, Live among them, Learn from
them, Start with what they know, Build on what
they have But of the best leaders, When their
task is done, The people will remark We have
done it ourselves.
Chinese Proverb
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Thank You