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Fight against Tuberculosis by School Students

Improvement Report
Dr. Irfan Rafiq Malik / Dr. Asim Mehmood/ Dr. Usman Hadi

Topics: Public-private mix, Social mobilization, TB case finding and diagnosis, Tuberculosis

Region and Country: Pakistan

Organization: Integrated Health Services (IHS) Pakistan
The Report


  "Burden of Tuberculosis in Pakistan" 

The “Little doctors club / Schools TB Clubs Program”, funded by GFATM, is an innovative pilot intervention being carried out for the first time as part of Round six of The Global Fund. This program envisions involving school children as ambassadors / messengers of TB, in spreading awareness about the disease among their class mates, school, home and the community as a whole. The awareness thus created aims to enhance the case detection & treatment success rates in the targeted communities / areas.

The School TB Clubs project activities being carried out in 10 selected districts of Pakistan. 





An ACSM intervention funded by GFATM-R6 & implemented by Integrated Health Services (IHS Pakistan) 


The “Little doctors club / Schools TB Clubs Program”, funded by GFATM, is an innovative pilot intervention being carried out for the first time as part of Round six of The Global Fund. This program envisions involving school children as ambassadors / messengers of TB, in spreading awareness about the disease among their class mates, school, home and the community as a whole. The awareness thus created aims to enhance the case detection & treatment success rates in the targeted communities / areas.

Agencies Involved:

Funding Agency:  

The Global Fund for Aids, TB & Malaria (GFATM), an international organization created to finance a dramatic turn-around in the fight against AIDS, tuberculosis and malaria is providing complete funding for this program.

Principal Recipient: 

Mercy Corps, an international humanitarian organization is the principal recipient (PR) of GFATM and is the supervising agency for this program.

Implementing Agency (SR):

Integrated Health Services (IHS Pakistan) is a national healthcare organization working in the curative, preventive, research and consultancy sector since 1996 in Pakistan. IHS is operating the largest school health network in Pakistan. IHS is implementing this project as Sub Recipient (SR).

Service Delivery Area:

Social Mobilization

The aim is to educate & aware the peoples & communities about TB. Goal is to reduce the burden of TB in Pakistan by 2015 in line with the Millennium Development Goals and the Stop TB Partnership targets.

Brief Project Description:

The aim of this project is to establish “The Little doctors clubs / School TB Clubs” in 50 schools in 10 selected districts (05 schools per district) in one year. Minimum 500 students in each of these schools will be given awareness about TB through lecture sessions, info literatures, poster / calendars, banners and a painting competition on a TB related theme (TB is curable).

The Little doctors club”/”School TB Clubs” are established in each of the selected schools under supervision of a school teacher. These clubs will act as small advocacy units for these schools and surrounding area / community. Up to 30 students (6% of the students attending the lecture) of each school become ‘founder members’ of the “The Little doctors clubs / School TB Clubs”.  The members act as “Ambassadors of TB / TB Advocates” and are assigned the task of creating awareness about TB in their school and the community.

Some of the figures of the program are mentioned below:

Number of districts: 10 (These districts were selected by Mercy Corps & National TB Control Program of Pakistan)

Number of schools per district: 05 each year

Number of children per district: 2500 each year

Total number of children sensitized about TB in one year: 25000

Total number of School TB Clubs established in one year: 50

Total number of students trained as TB Club members in one year: 1500


Objectives of the Program:

To sensitize 25000 school children in 10 selected districts of Pakistan every year.

To deliver TB awareness lectures in 50 schools, addressing 25000 children.

To distribute 25000 poster/calendars with TB awareness messages among school children, conveying the message to 25000 households. These calendars will be on displayed in schools and homes for about one year.

To distribute 25000 leaflets with TB awareness messages (and TB clubs membership consent form) among school children, conveying the message to 25000 households.

To hold poster competition every year in 50 schools in 10 districts with the theme “TB is curable”. Top three contestants from each school are given shields and certificates. These posters will also be included in a national competition on federal level to provide a platform and opportunity to carry the messages of ‘Stop TB’ to a vast audience across the country.

To establish 50 “The Little doctors clubs” / “School TB clubs” with 1500 members (@ 30 students per school) which is 6% of the total number of children reached. However the number can increase as the ‘founder members’ will be encouraged to enroll more members.

Training of 1500 selected school children as ambassadors / advocates for TB awareness among their communities.

Training of 50 to 100 selected teachers to supervise these TB clubs and implementing and operating a long term school TB club health initiative. 



The districts selected are those where already ACSM component for TB is being implemented by partner agencies. These districts are all across Pakistan and include the following:

Quetta (Balochistan)

Tando Allah Yar (Sindh)

Tando Mohd. Khan (Sindh)

Mandi Bahaudin (Punjab)

Khushab (Punjab)

Gujrat (Punjab)

Sialkot (Punjab)

Narowal (Punjab)

Bagh (AJK)

Muzzafabad (AJK)


Program Material:

The material used during the program is developed during the first quarter of each year in consultation with the PR and NTP.

It includes the following:

Banners for schools with TB punch lines:04 Pena-flex banners are displayed in each school. These banners are affixed permanently at the school. Each banner carries a different standardized message about TB.

TB awareness leaflet/consent forms (for school children):Quantity printed is 25000 every year.  A quantity of 500 is distributed in each school after the interactive session on TB. This leaflet also includes a consent form for becoming a member of TB club. Children are encouraged to get it signed from parents. Aim is to ensure the delivery of TB messages to 25000 house hold.

Calendar with TB related messages:

Quantity printed is 25000 every year. Each of 500 students attending the school session receives a Poster / calendar with standardized TB messages.

Awareness lecture regarding TB and this project for school children:

These sessions are conducted at the school with multimedia aids by the field teams. Each session has minimum 500 students. In some schools, multiple sessions are held due to space constraints, in order to ensure that a minimum of 500 students are sensitized about TB.

Poster competition on the theme "TB is Curable" is announced during the school session:

Students are advised to prepare posters on the theme "TB is curable" with material of their choice. These posters are collected from each school 2-4 months later during the first biannual meeting of TB club. 03 winners are selected by the school management. These winners receive a shield and a certificate during the second biannual meeting, which is held at the school during last quarter every year.

Training of The Little doctors clubs” / “School TB clubs” members:

A 5-6 page document laying out the objectives, constitution, activities, etc.

Two training sessions of selected club members are held, with pre & post Tests, delivered by the field teams followed by question/answer sessionAdditionally, all club members receive: 

Membership forms for TB clubs

Activity reporting forms / register for club members

Monthly meeting report forms for TB clubs

School bags for TB club members with TB punch lines (30 per school)

TB Club badges. (30 per school)

Volunteer enrollment forms

Patients Referral forms

Activity Details:

Schools are selected based on following criteria:

5 schools are selected from each district.

High schools (Class 6 to 10) are selected.

Combined strength of students in the 5 schools should be 2500. The minimum number of students per school be 500.

50% or more schools / students are female.

All the 5 selected schools in a district are preferably within the same area / union council so that effectiveness of the intervention can be gauged. This is finalized with the help of District education dept officials.

In each school at least one (or 2) teachers are nominated as in-charge of the TB Club and the focal person for coordination with the program team besides he/she will also be responsible for the monthly reporting of the club members activities. The Field Teams visit the districts according to a pre-planned schedule keeping in view the school academic calendar of different regions. A letter with brief intro, is send to the concerned departments in respective districts. Upon reaching a particular district, the team contacts the district education office and finalizes the selection of schools and schedule for school activities. District Health authorities are also kept informed, specially the EDO Health and DTC (District TB Coordinator).

What is done at Schools?

The following is an outline of the specific activities carried out at each school by the field team.

Day 1:        

Meeting with principal

Display of banners

Day 2:

Multimedia presentation to 500 students and teachers including a TB awareness lecture and Advertisements on TB by National TB Control Program of Pakistan.

Distribution of 500 Awareness Leaflet/ consent forms for TB Club  membership

Distribution of 500 Posters / calendars with standardized TB messages.

Announcement of Poster competition

Announcement for the formation of TB clubs, inviting students to become members (6% of the total students attending the lecture)

Day 3:        

 Screening / selection / Training of TB club Members and supervisors.

Day 4:

Training of School TB Club Members and Supervisors & distribution of bags, badges and stationary among TB Club Members.

The Lecture and training of TB club members is conducted through multimedia aids and interactive sessions by the IHS TB Clubs project team. Total duration of training is 2-3 hrs on day 03 and a revision is done on last day.

Objectives / Responsibilities of the School TB Health Club

To make school children aware about the spread of TB and the ways for prevention and treatment like the NTPs designated free treatment centers. School TB Club Members reffer the suspected cases to Government Hospital and centers for diagnosis and treatment of TB free of cost.

To create awareness about TB and related issues among school children and the community at large.

Training a specific number of selected students to become messengers / advocates for TB related issues

To organize small health related activities with focus on TB

To encourage / guide students to take the message to their homes / communities and to enroll volunteers.

To utilize the UAN TB Clubs help line to answer questions related to TB and other general health issues from within the school and from community.

Celebration of important health related days (World Health Day – April 7, World TB Day 24th March)





The results of this pilot intervention are very encouraging. School kids are doing a very nice job.


IHS is receiving about 1000 to 1100 poster made by school students (50 selected school of 10 selected districts of Pakistan) on the theme "TB is Curable" every year


Many of the students have written poems on "Fight against TB". IHS has a good collection of this poetry by School Kids and we are planning to publish these poems in the form of a book.


Many Students of these selected schools have referred the suspected cases of TB to Government hospitals for diagnosis and treatment, and many patients got cured of  TB with the efforts of these school kids. These kids have shared with us their success stories. I am sharing with you some of these success stories (as attachments)



We have not any failure in these activities of School TB Clubs Projects, Although we are facing some difficulties and constraints in some areas of Pakistan while performing these activities and IHS is also not getting response from all selected schools at the same level. Some of the schools (very less in number) did not show interest & response even after establishing a School TB Club in their schools.





School kids are good assets of a nation. They give dramatic results if they are involved in any kind of healthy activities.


Schools kids can be very useful in creating awareness about any disease & any issue among the communities


27 Apr14:33

Fight against TB by School Students (Pakistan)

By drirfanmalik

Integrated Health Services (IHS) Pakistan is effectively running its School TB Clubs Project for the last 3 and a half years. Created awareness among communities through involving school kids in this fight against TB. School Children are playing their role effectively in this compaign.

27 Apr13:57

Fight against TB by School Students (Pakistan)

By drirfanmalik

Integrated Health Services (IHS) Pakistan is creating awareness about TB in the communities with the help and participation of School kids in 10 selected districts of Pakistan through its Little Doctors Clubs/School TB Clubs Project.
The Established School TB Clubs participate in awareness of the communities about TB. The club members also refer the suspected cases of TB to hospitals for diagnosis and treatment. They educate TB patients and their families throughout the whole course of TB treatment, Some of the students also worked as TB-DOTS facilitator for their families and relatives.