CLA Approaches Used to Improve TB Patient Care in India

Tuberculosis (TB) is both preventable and curable yet remains among the top ten causes of death globally. India has 27% of the total TB burden. Prime Minister Modi recognized that a top-down policy strategy has not worked: “It is difficult to get new results by following the old approach.” He called for a change and endorsed grass-roots-oriented community-based approaches. The National TB Elimination Program policy recognizes the role of the community in supporting its mission to end TB. Strategies include: “promoting community participation in decision-making processes, planning and implementation of program activities, service delivery, and monitoring & evaluation”. CLA approaches were selected to help transform processes, procedures, and relationships. First, we fostered collaboration between TB patients and healthcare providers. Second, evaluation was introduced to build a reliable and trusted data-driven decision-making system. Third, a culture of continuous learning and improvement was co-created. Implementing this collaborative approach took much longer than anticipated. We faced inadequate collaboration with local community members, a weak culture of evidence-based decision-making, and the absence of adaptive management from villages to national levels. Leaders avoided potentially confrontational community-level conversations. CLA approaches were used to improve internal and external communication, build a trusted data-driven decision-making system, apply adaptive management techniques, and produce a culture of continuous learning and improvement. CLA helped produce meaningful results. Outcomes included helping TB patients receive services and stipends, reducing stigma, and preparing TB survivors to be advocates for TB patients to improve the responsiveness of India's health care system.