Reaching the unreached migrants in unorganised workforce with health services
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Shobha Shukla (CNS)
Contd from previous issue
Community-based services are critical to reach the unreached
Afsar shares that “Community-based HIV testing was an important part of migrant workers testing project - they got rapid test kits from Gujarat State AIDS Control Society of the government.
“These kits were given to community volunteers after proper training, so that they could take those test kits and offer a test in communities.”
Jogendra reflects: “Our next step is testing family members (spouse, children, or others) for HIV and TB – and linking them to care as needed. But our project is a humble initiative whereas India is a large and diverse nation. There is an urgent need to scale up interventions to reach the unreached workers of informal or unorganised sector in every other state and ensure continuum of care.”
GAP partners with local district TB office of the government’s National TB Elimination Programme, which trains them in doing community-based TB screening (looking for classical TB symptoms), collecting sputum samples and handing them to laboratory of primary health centre or sub-centre for TB testing. If active TB disease is detected, then GAP supports the person through the TB treatment and ensures completion.
GAP also ensures that the person is availing government-support schemes such as those that provide INR 500 per month of financial support (directly in the bank account of the patient) during treatment. GAP also provides supplementary nutritional support like protein powder, vitamin syrup, or other local nutritious food.
Over 96% of people screened for HIV were also screened for TB voluntarily, says Jogendra. Many were also screened (and referred as indicated) for hepatitis and a range of STIs.
One recent example of a person-in-need supported by GAP is of a female labour worker of a cold storage warehouse. She was diagnosed with HIV, multidrug-resistant TB, and cervical cancer. She received her treatment through local government-run antiretroviral clinic, treatment for drug-resistant TB through local government-run TB clinic, and referred to a gynaecologist for cervical cancer management, informed Jogendra. “Her son was linked to government-run scholarship programme for education in Gujarat state.”
Comprehensive care is vital, feel Jogendra and Pankaj. For instance, they also screen people for diabetes and blood pressure. Diabetes can heighten risk for TB as well as complicate outcomes of HIV care.
Every six months a person with HIV is offered a TB test.
No wonder that ILO has recognised GAP’s work several times as a best practice example, share Jogendra and Pankaj – for helping make a difference and doing justice to the legacy of Dr Radium Bhattacharya and GAP.
Do we know how to reach those who are currently unreached?
We are aiming to reach 95% of people living with HIV by 2025 so that they can know their status, and 95% of those who know their status should receive the treatment, and 95% of those on treatment should be virally suppressed. But do we have the right programmatic mix to reach those we are leaving behind- the unreached?
GAP’s intervention, supported by ILO and many other partners, provides some insights.
“We must reach the places where we have not reached earlier - such as places where migrant workers sit, work or live. They often do not have time to go to a health facility and get tested - if they go there then there is an opportunity cost - they do not get the daily wage for that day - therefore we have to take the services where they are,” reemphasises Afsar.
"A large number of people have been tested (for HIV), and those who are found positive are put on treatment. These are the people who were asymptomatic and a lot of them were young people, who are now on treatment and virally suppressed so that they can lead happy and productive lives," rightly says Afsar.
Awareness or health literacy is key
We have to enhance risk perception for both TB and HIV so that people consider taking a TB test or HIV test and linkage to public services. “That is why in our workplace programmes we take help of peer educators, who go and create awareness, and enhance risk perception - this cannot be done in a lecture-driven or PPT driven approach,” said Afsar.
“We never impose HIV (or TB) testing. Testing is not the first step. First step is awareness generation - and do it in an environment where people’s rights are protected. That is why we engage and sensitise the employers and government agencies too along with other stakeholders to give confidence to workers that if they are found positive (for HIV or TB) they will not risk losing their job. Instead, they will get support, care and treatment to live healthy and well,” said Afsar.
Health justice in a socially unjust world
We all have to strive for health justice, and eventually social justice, which is ecologically sustainable. HIV, TB, hepatitis or STIs responses are part of this overarching approach. Let us hope GAP continues to bridge the gap in access to healthcare and social protection for those in informal or unorganised sector – and such people-centred approaches get scaled up everywhere.
Contd from previous issue
Community-based services are critical to reach the unreached
Afsar shares that “Community-based HIV testing was an important part of migrant workers testing project - they got rapid test kits from Gujarat State AIDS Control Society of the government.
“These kits were given to community volunteers after proper training, so that they could take those test kits and offer a test in communities.”
Jogendra reflects: “Our next step is testing family members (spouse, children, or others) for HIV and TB – and linking them to care as needed. But our project is a humble initiative whereas India is a large and diverse nation. There is an urgent need to scale up interventions to reach the unreached workers of informal or unorganised sector in every other state and ensure continuum of care.”
GAP partners with local district TB office of the government’s National TB Elimination Programme, which trains them in doing community-based TB screening (looking for classical TB symptoms), collecting sputum samples and handing them to laboratory of primary health centre or sub-centre for TB testing. If active TB disease is detected, then GAP supports the person through the TB treatment and ensures completion.
GAP also ensures that the person is availing government-support schemes such as those that provide INR 500 per month of financial support (directly in the bank account of the patient) during treatment. GAP also provides supplementary nutritional support like protein powder, vitamin syrup, or other local nutritious food.
Over 96% of people screened for HIV were also screened for TB voluntarily, says Jogendra. Many were also screened (and referred as indicated) for hepatitis and a range of STIs.
One recent example of a person-in-need supported by GAP is of a female labour worker of a cold storage warehouse. She was diagnosed with HIV, multidrug-resistant TB, and cervical cancer. She received her treatment through local government-run antiretroviral clinic, treatment for drug-resistant TB through local government-run TB clinic, and referred to a gynaecologist for cervical cancer management, informed Jogendra. “Her son was linked to government-run scholarship programme for education in Gujarat state.”
Comprehensive care is vital, feel Jogendra and Pankaj. For instance, they also screen people for diabetes and blood pressure. Diabetes can heighten risk for TB as well as complicate outcomes of HIV care.
Every six months a person with HIV is offered a TB test.
No wonder that ILO has recognised GAP’s work several times as a best practice example, share Jogendra and Pankaj – for helping make a difference and doing justice to the legacy of Dr Radium Bhattacharya and GAP.
Do we know how to reach those who are currently unreached?
We are aiming to reach 95% of people living with HIV by 2025 so that they can know their status, and 95% of those who know their status should receive the treatment, and 95% of those on treatment should be virally suppressed. But do we have the right programmatic mix to reach those we are leaving behind- the unreached?
GAP’s intervention, supported by ILO and many other partners, provides some insights.
“We must reach the places where we have not reached earlier - such as places where migrant workers sit, work or live. They often do not have time to go to a health facility and get tested - if they go there then there is an opportunity cost - they do not get the daily wage for that day - therefore we have to take the services where they are,” reemphasises Afsar.
"A large number of people have been tested (for HIV), and those who are found positive are put on treatment. These are the people who were asymptomatic and a lot of them were young people, who are now on treatment and virally suppressed so that they can lead happy and productive lives," rightly says Afsar.
Awareness or health literacy is key
We have to enhance risk perception for both TB and HIV so that people consider taking a TB test or HIV test and linkage to public services. “That is why in our workplace programmes we take help of peer educators, who go and create awareness, and enhance risk perception - this cannot be done in a lecture-driven or PPT driven approach,” said Afsar.
“We never impose HIV (or TB) testing. Testing is not the first step. First step is awareness generation - and do it in an environment where people’s rights are protected. That is why we engage and sensitise the employers and government agencies too along with other stakeholders to give confidence to workers that if they are found positive (for HIV or TB) they will not risk losing their job. Instead, they will get support, care and treatment to live healthy and well,” said Afsar.
Health justice in a socially unjust world
We all have to strive for health justice, and eventually social justice, which is ecologically sustainable. HIV, TB, hepatitis or STIs responses are part of this overarching approach. Let us hope GAP continues to bridge the gap in access to healthcare and social protection for those in informal or unorganised sector – and such people-centred approaches get scaled up everywhere.