Health by the people: The control of tuberculosis using a community-based primary health care approach in Jamkhed, India

The Comprehensive Rural Health Project (CRHP) in Jamkhed, India embodies the community-based primary healthcare (CBPHC) philosophy, recognizing that health status is influenced by multiple elements. CRHP uses village health workers (VHWs) to implement programs including community-based healthcare, community empowerment, and income generation. We investigated the impact of CRHP's VHW-driven strategy on TB control as a measure of CRHP's effect on village health.

From June-August 2007, we surveyed TB patients to identify factors affecting access to care and treatment course. We surveyed VHWs to define their role in CRHP's TB program. We reviewed existing TB incidence data of CRHP villages from 1973-2007 and identified regional and national data for comparison.

Patient surveys (n=8) found that medication costs and employment affected treatment, and CRHP involvement included free medicine and socioeconomic assistance. VHW surveys (n=5) found that VHWs educate communities, provide detection/referral, and ensure treatment compliance through follow-ups. A two-sample t-test on TB incidence in 2000, 2002, 2004-2007 showed that rates in CRHP villages (mean=35/100000) were significantly lower than rates in “rural Maharashtra” (mean=89/100000, p<0.0001 except 2006 p=0.0813), “all Maharashtra” (mean=129/100000, p<0.0001 except 2006 p=0.0650), and national rates (mean=143/100000, p<0.0001, except 2000 p=0.0015 and 2006 p=0.0757).

We found that TB treatment is influenced by economic barriers and by VHWs' role in education, detection, and treatment compliance. Our findings of lower TB incidence in CRHP villages suggest that CRHP's program is an important component of TB control in Jamkhed. We believe that CRHP's model is adaptable worldwide to help communities improve their own condition.