A Health Literacy RCT toward Improvement of Programmatic Outcomes of Tuberculosis Control in the Tribal Areas of Pakistan Governance Support Program Post-Crisis

According to World Health Organization, 9 million people contracted tuberculosis (TB) in 2013 and in the same time period 1.5 million died from the disease (WHO, 2013). The agency estimated that in the same year 550,000 children became ill with TB and 80,000 HIV-negative children died of TB. Further that close to half a million people developed multidrug resistant TB (MDR-TB) requiring longer and costlier treatment. Pakistan is one of the 5 countries with high incidence of tuberculosis and possibly rising numbers of MDR and XDR (extensively drug resistant) varieties of the infection. In recognition of the worldwide case of resurgence of tuberculosis, Pakistan implements a National TB Control Program. One of its most important components works in the Federally Administration Tribal Areas (FATA) that are afflicted by violence and militancy for the past one decade. The traditional tribal culture and the security issues complicate access to communities. This evaluation was carried out as part of the FATA Governance Support Program’s capacity building initiatives under PCNA implementation and direct support to Directorate of M&E FATA Secretariat. TBCP was selected from a list of important projects under implementation in FATA. The program was selected due to its importance to health outcomes in the region as well as potential of policy lessons to be learnt for achieving higher results through evidence led programmatic initiatives. This evaluation was also planned to plug in gaps in information. TBCP implementation has been an ongoing program in the tribal areas since 2007. Other than the individuals coming to the diagnosis centers and patients returning for tests and additional doses of medication, little is known about the population’s knowledge of tuberculosis and attitudes toward accessing healthcare. This lack of information debilitates outreach efforts and reduces the scope of planning interventions suited to population characteristics. The evaluation seeks to provide these pieces of information for strengthening TBCP implementation in FATA and initiate evidence led interventions for improving programmatic outcomes.