Strengthening Pediatric and Extrapulmonary Tuberculosis (EPTB) Care for Women and Children in Urban Slums of India
Situation:
India carries the world’s highest tuberculosis (TB) burden, and the disease remains deeply entrenched in the urban slums of Mumbai and Howrah. Overcrowding, poor nutrition, delayed diagnosis and limited access to quality care fuel the spread of TB—especially multidrug-resistant TB (MDR-TB), extrapulmonary TB (EPTB) and pediatric TB. Women and children are particularly affected, facing stigma, late treatment, and long-term health and social consequences.
Health facilities in disadvantaged areas often lack the resources to diagnose and manage complex TB cases, including EPTB, which requires specialised procedures. Childhood TB also remains underdiagnosed due to non-specific symptoms and limited testing options. Malnutrition and poverty further worsen treatment outcomes.
To address these gaps, the project strengthens TB care for women and children through community-based action in partnership with long-standing local organisations in Mumbai and Howrah. Key components include active case finding in schools and households, improved diagnosis and referral for EPTB, and integrated treatment for co-infections such as HIV and diabetes. The project also builds a network of qualified and informal providers to ensure consistent, evidence-based TB care.
Nutritional support, psychosocial counselling, and school and vocational assistance help families manage the socioeconomic impacts of TB. Over 300 frontline health workers will be trained in pediatric and EPTB care, supported by 200 community volunteers and TB champions. Additional measures include stigma reduction, peer support, and training young women to become nurses specialising in TB.
By strengthening coordination with the National Tuberculosis Elimination Program and community-based organisations, the project improves access, quality and continuity of care for vulnerable groups. It offers a scalable model for reducing TB in India’s urban slums—advancing health, dignity and social justice for women and children most affected by the disease.
Objectives:
Project Objective:
The project aims to reduce TB-related illness and death in the slums of Mumbai and Howrah by significantly improving care for women and children affected by pediatric and extrapulmonary TB. Earlier diagnosis, better treatment, and stronger community support are intended to reduce treatment interruptions and decrease stigma.
Sub-Objective 1:
Access to early TB detection will be expanded through community outreach, school-based screenings, and contact tracing. In Howrah, the network of local healthcare providers will be strengthened to ensure rapid and qualified referrals.
Sub-Objective 2:
Women with EPTB and children with TB will receive comprehensive medical care, nutritional assistance, and psychosocial support. Severe cases will receive surgical treatment, and vocational training will enhance the economic resilience of affected women and girls.
Sub-Objective 3:
By training healthcare workers, mobilizing community volunteers, and conducting broad awareness campaigns, community structures will be strengthened and TB-related stigma reduced. Schools will play a central role in prevention and knowledge dissemination.
1. By end of the project, the treatment coverage for EPTB and pediatric TB in the catchment areas of Howrah and Mumbai has increased by 30% from its baseline (EPTB 30-33 cases/year; pediatrc: 30cases /year).
1.1 3.600 women screened for EPTB.
1.2 600 children tested for TB via school-based screening.
1.3 5.400 family members of TB patients screened through contact tracing over 3 years
2. By end of the project, 70% of the patients involved in the project report satisfaction with provided TB services.
2.1 300 women with EPTB receive quality care, including 120 inpatient cases.
2.2 120 children complete TB treatment.
2.3 240 TB patients receive nutrition support.
2.4 60 women and girls affected by TB complete vocational training (sewing, baking, handicrafts)
Active Case Finding in Schools, Households and Communities
Active case finding is central to the project’s strategy to stop TB transmission early, especially among women and children in urban slums. The project will conduct school-based TB screenings in 60 partner schools and carry out systematic household contact tracing for all newly diagnosed cases—reaching around 5,400 family members. Community health workers will take sputum samples during home visits, while awareness campaigns in slum communities promote TB knowledge, reduce stigma, and encourage early health-seeking.
Care and Support for Patients with EPTB
For patients with extrapulmonary TB (EPTB), the project strengthens referral pathways to partner hospitals for specialized diagnostics and treatment, including surgeries when needed. Support includes pre- and post-operative care, physiotherapy, adherence and psychosocial counseling, as well as nutritional supplements for women and children. To reduce economic vulnerability, the project also offers vocational skills training for women and girls from TB-affected families.
Capacity Building
The project will train 300 frontline health workers in updated pediatric and EPTB management, diagnostic procedures, and patient-centered care. Additionally, 200 community volunteers and TB champions will be trained to support outreach, adherence monitoring, and stigma reduction, strengthening the link between communities and health services.
Project Accompanying Activities
A kick-off workshop will bring together national and international partners to align expectations, define roles, and establish the MEAL framework. Regular supervision visits will ensure quality and progress. A stigma survey at baseline and endline will measure change, and findings will be shared at national and international platforms to promote best practices and project visibility.
Sustainability is a core element of the project design, ensuring that benefits continue beyond the EKFS funding period. The project includes a structured handover, strong capacity building, and integration into existing government and NGO systems.
Handover to Local Partners and Government
The project is implemented with experienced local NGOs and district health authorities, fully aligned with NTEP protocols. Continuous training ensures that screening, referral, data management, and patient support can be absorbed into routine services. In the final year, a formal handover plan—including assets, documentation, and SOPs—will be developed.
Follow-up by GLRA India
After project completion, GLRA India will provide technical support, monitoring, refresher trainings, and participation in district TB coordination meetings. Lessons learned will be shared with partners and authorities to sustain improvements.
Sustained Impact in the Region
By combining early detection, comprehensive care, capacity building, and community engagement, the project strengthens local systems and reduces stigma. School health clubs, TB champions, and community committees will continue supporting TB-affected families. Vocational training enhances economic resilience among women and girls.
Funding Beyond EKFS Support
Activities are designed to be integrated into national health and social support schemes such as NTEP and the Nikshay Poshan Yojana. GLRA India and partners will also pursue additional funding from donors and CSR initiatives to ensure continuity.
Together, these measures secure lasting improvements in TB care, community health, and social resilience in the project areas.
- Holistic TB approach: Combines early case detection, medical care, psychosocial support, and economic empowerment.
- Focus on vulnerable groups: Reaches women, children, and families in urban slums who are often missed by the health system.
- School and community outreach: TB screening in 60 schools and extensive household contact tracing strengthen early detection.
- Enhanced EPTB care: Provides access to specialized diagnostics, treatment, and surgeries not readily available in public facilities.
- Strong capacity building: Trains frontline health workers and community volunteers to improve local TB services long term.
- Built-in sustainability: Aligns with NTEP protocols, integrates into government systems, and supports long-term continuation through local partners.
