NIKSHAY is the web-enabled patient management system for TB control as part of the National Tuberculosis Elimination Program (NTEP). It is developed and maintained by the Central TB Division (CTD) of the Department of Health and Family Welfare of the Government of India in collaboration with the National Tuberculosis Elimination Program (NTEP), Informatics Center (NIC) and the World Health Organization Country Office for India.
NIKSHAY is used by health officials at various levels across the country, both in the public and private sectors, to register cases in their care, order various types of tests in laboratories across the country, record treatment details, monitor treatment compliance and refer cases between healthcare providers. It also acts as a national TB surveillance system and allows for the transmission of various surveillance data to the Indian government.
Tribal population
Tribal people (10.4 Cr, 8.6% of the total population) have a higher prevalence (703 per 100,000) of TB compared to the national average (256 per 100,000).3 Indigenous people account for 10.4% of all reported TB patients Communities.4 The national TB program has prioritized this population subgroup since 2005 through tribal action plans.
However, access, availability and use of TB care services in these communities are hampered by geographical barriers, poor status of social determinants, high impact of malnutrition, insufficient community involvement, health system limitations including lack of trained staff, cultural and communication gaps between the care provider and the community, etc. The COVID19 pandemic has likely made the situation worse.
Role of stakeholders
CTD, MoHFW
The national TB division would develop the overall plan with MoTA and USAID and coordinate with state/county TB officials to create the state/county specific implementation plan. The MoHFW would provide full oversight and oversight of the tribal TB initiative and its implementation at the field level
MoTA
MoTA through its Special Central Assistance for Tribal Sub-Schemes (SCA to TSS) and GrantinAid programs makes grants to states that have notified ST. Funds under the Development of Tribal Groups at Vulnerability (PVTG) program would be made available to States/UTs that have reported PVTGs.
These grants are in addition to funds allocated by the NHM and are provided for state government tribal development initiatives and efforts to fill critical gaps in various areas of tribal development, including health and nutrition.
The MoTA also provides funds to the state government based on your request to complete review gaps in strengthening health services for TS, including but not limited to building health infrastructure in remote locations, TB diagnosis and treatment with a particular focus on nutritional issues in children at the EMRS school/ashram.
Engaging Tribal Research Institutes (TRI) and MoTA Centers of Excellence (CoE) to identify gaps and conduct research in the TB care cascade that could then contribute to better implementation. Development of state/district specific implementation plans in coordination with MoHFW and USAID Technical Assistance
USAID
Establishment of a National Program Management Unit (NPMU) to provide technical support to monitor and implement the Tribal TB Initiative. Conduct awareness and capacity building workshops for volunteers on the use of vulnerability mapping tools. Improving operational excellence to increase the efficiency of existing demand-side interventions such as Village Health Sanitation and Nutrition Days (and Committees), Jan Arogya Samiti Platforms, Jan Andolan Initiatives, TBChampions Engagement and Healer Education and other community influencers.
AT for periodic Active Case Search (ACF) campaigns in the identified States. Facilitate the implementation of isoniazid preventive therapy (IPT) for identified at-risk populations. TA for the national strategy of long-term measures to reduce susceptibility to TB. Coordination between NTEP, NHM, Northeast Region Development Department, Department of Tribal Affairs at national, state and district level. Levels by the technical support unit at a national level.
Development of a district-level implementation plan based on the Joint Action Plan Guide developed by MoTA and MoHFW. Work with private sector actors to leverage resources to eradicate TB in tribal communities.