1. Blessina Kumar TB/HIV Activist New Delhi, India Community Representative DEWG STBP Addressing poverty through quality TB control and research, Stop Tb Symposium 40 th Union Conference Cancun Mexico 3 rd Dec 2009

2. Community and patient perspectives in addressing poverty 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.

3. 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 Community and patient perspectives in addressing poverty

4.  Good guidelines  Establishes approaches to address issues affecting the poor  Let’s look at this from the perspective of the poor (patients) Community and patient perspectives in addressing poverty

5. Grocery Store keeper, Ngwenya, Malawi Community and patient perspectives in addressing poverty Malawi Example

6. 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. 2007;12:1464-1471 China example People’s perceived costs are higher than real costs. Community and patient perspectives in addressing poverty

7.  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. Community and patient perspectives in addressing poverty

8.  Where is the service placed?  Timings?  No of visits required?  Attitude of the healthcare workers?  Services Equitable? Community and patient perspectives in addressing poverty

9. 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) Community and patient perspectives in addressing poverty

10. 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

11. Community and patient perspectives in addressing poverty 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!!!\

12. Community and patient perspectives in addressing poverty 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.

13. 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!! Community and patient perspectives in addressing poverty

14. “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 Community and patient perspectives in addressing poverty

15. Thank You Community and patient perspectives in addressing poverty