Bottom-Up, Top-Down Approach to TB Outreach among Migrants in Kazakhstan

Migrants in Kazakhstan, like migrants worldwide, carry a disproportionate burden of Tuberculosis (TB) due to social and economic inequalities. The lack information about TB and the lack of access to TB diagnosis, treatment and care make them even more vulnerable. These disparities are especially evident in TB treatment outcomes. Migrants are twice as likely as the general population to drop from treatment and be impacted by this silent killer.

Project HOPE, as the principal recipient of a grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) with the assistance from local civil society organizations, has successfully implemented a month-long series of coordinated outreach campaigns to bring TB awareness, screening and support to migrants in Kazakhstan. One organization — NGO Zabota — has been focused on outreach activities within vulnerable groups since 2000, and on migrants specifically since 2015.

“Carrying outreach among migrant laborers can be difficult,” says Zabota’s founder, Ulzhan Lukpanova. Most migrants in Kazakhstan are from neighboring Tajikistan, Kyrgyzstan and Uzbekistan. Employed in construction or as household help, they are confined to their work site and overcrowded shared living quarters, and are kept hidden from view by their employers. “That is why the bottom up approach alone to reaching out to the migrant communities is not sufficient,” emphasizes Lukpanova. “A coordinated effort that also employs a top-down action is also needed through a linkage across health departments, local and municipal authorities, diasporas and businesses.”

Lukpanova and her organization were able to forge such cross-sectoral linkages with migrant diaspora leaders, including Consul General of Kyrgyzstan, municipal and community authorities (hakimats and hakimchiki), medical personnel from local clinics and the local chamber of entrepreneurs. Together, under Lukpanova’s leadership and with coordination from Project HOPE, such multisectoral alliances were able to ensure that the message about TB, the need to get tested, and the importance of treatment adherence was conveyed to migrants most effectively. The activities were not limited solely to TB information and awareness campaigns. Additionally, TB screening services were provided free of charge through mobile X-ray TB testing units, which were sent to the areas with greatest concentration of migrants like local markets or migration police offices.

Over the course of one month culminating on World TB Day on March 24, 2016, more than 500 migrants had been screened with the help of Lukpanova’s organization and with technical expertise from Project HOPE. About a dozen screened migrants had been referred for further testing at health clinics. Thanks to Project HOPE work under the GFATM grant, additional testing is also provided free of charge, while NGO Zabota provides follow up support to ensure that all diagnosed migrants enroll in and adhere to treatment.