Indigenous women in Chiapas

The official reported TB incidence in Chiapas is higher as the national average, and the mortality rate is three times as high.  TB places a disproportionate burden on indigenous communities, who suffer higher rates of TB; have less accurate information or education about TB prevention and treatment; and have less access to TB services due to fewer facilities, language barriers, and poor transportation infrastructure.

In 2006, HealthRight International began working with local indigenous communities to educate people about TB and to change behavior related to seeking diagnosis and completing treatment.  HealthRight is working in partnership with local indigenous organizations to disseminate accurate information about TB and to strengthen coordination between indigenous communities and the health system.  Lessons learned from the model will be shared with TB education and care programs in other parts of the country with similarly high rates.

TB Education, Behavior Change and Case Finding Campaign
To reach the indigenous communities, HealthRight has partnered with two indigenous organizations of  promotores – community volunteers who work to disseminate information on health issues and assist community members seeking care.  HealthRight trained over 200 promotores to understand the symptoms, diagnosis, and treatment of TB, and to refer people with TB symptoms for further care.

HealthRight has also worked with promotores to develop education materials including a TB education manual, posters and calendars for patients and community members in both Spanish and the Mayan language, Tzetal which is the predominate language spoken in the indigenous communities. These are the first TB education materials available in Tzetal.

Community TB Care Pilot
In 2008, HealthRight worked closely with the Chiapas State TB Program to develop the Community TB Care (CTBC) pilot program.  The pilot expands the role of the promotor to include working closely with health facilities to monitor patient treatment and collect and deliver sputum samples from patients for testing, among other duties.  The CTBC program meets all criteria for the DOTS - the primary strategy for TB control and treatment promoted by the World Health Organization. The program is the first time the complete DOTS strategy is being implemented within the indigenous communities in the project area.

In September 2008, the CTBC pilot was launched at 10 selected health facilities.  A total of 100 promotores and 17 providers were trained to participate.

The CTBC pilot is fostering unprecedented collaboration between the Government health system and the indigenous communities and seeks to address significant challenges, such as poor infrastructure, lack of transport, language and cultural barriers which have limited access to healthcare for the indigenous communities of Chiapas for so long.