Sustaining Active Case Finding Through the Star Network of SMC: Innovative approaches to combat TB in Bangladesh
Social Marketing Company (SMC) has been a trusted public health partner in Bangladesh for decades, applying innovative social marketing and community-based service delivery approaches to advance national health priorities. Established in 1974 as a USAID-supported initiative and later transformed into a not-for-profit company in 1990 governed by a voluntary Board of Directors, SMC has built a strong legacy of working with government, development partners, and the private sector to improve health outcomes nationwide. Tuberculosis (TB) remains one of Bangladesh's most persistent public health challenges, disproportionately affecting underserved and hard-to-reach communities. Tuberculosis (TB) has remained a critical focus area within SMC's broader health portfolio. Over time, SMC has demonstrated the ability to design, operationalize, and scale TB interventions—especially in hard-to-reach and underserved settings—while aligning closely with the National TB Control Program (NTP).
2009–2010: Integrated Services and Mass Awareness in Hard-to-Reach Areas: SMC's TB engagement accelerated in 2009 through the Modhumita Program, implemented in partnership with FHI 360 to address TB-HIV co-infection. Through 10 strategically located clinic operations, trained sputum collectors conducted community awareness sessions, screened presumptive TB cases, collected sputum samples, and linked clients to nearby microscopy centers for diagnosis. Diagnosed patients were subsequently followed up by clinic teams to support treatment continuation and adherence—an early example of SMC's capacity to deliver integrated TB services with continuity of care. In 2010, SMC expanded community outreach and stigma reduction efforts by developing a TB-themed drama, Rongila Bao, and airing it through mobile audio-visual platforms. To reach populations in remote riverine regions, SMC used an innovative floating motor launch to bring TB messages directly to communities—demonstrating operational creativity and strong community engagement capability. During the same period, SMC began systematically strengthening its informal provider platform, building capacity among Blue Star Providers (BSPs) to improve referral of presumptive TB cases to nearby service delivery points—laying an early foundation for the scalable private and community provider engagement model that would later become central to SMC's Active Case Finding approach.
2020–January 2025: Scaling Active Case Finding (ACF) Through the Star Network Under USAID's ACTB: Building on earlier community-based approaches, SMC played an expanded role as part of USAID's Alliance for Combating TB in Bangladesh (ACTB) by mobilizing its nationwide informal provider network—Blue Star Providers (BSPs), Green Star Providers (GSPs), and Gold Star Members (GSMs)—to strengthen TB Active Case Finding (ACF) and referral systems. From February 2021 to January 2025, ACTB implementation by SMC supported TB control in 32 districts through structured training, supervision, and referral linkages with NTP systems. SMC trained 6,415 Star Providers on symptom screening, identification of presumptive TB, and referral to NTP-designated diagnostic facilities—operationalizing a “Search, Treat, and Prevent” approach to accelerate detection and linkage to care. Key results achieved during ACTB (February 2021–January 2025) include:
Community Mobilization and Advocacy: Sustained Demand Creation for TB Services: Alongside provider-led screening and referral, SMC drove robust community awareness and advocacy activities critical for reducing stigma, increasing TB literacy, and improving care-seeking behavior. During ACTB, SMC conducted extensive outreach, including:
System Linkages and Quality Assurance: Alignment with NTP Referral and DOT Systems: A consistent strength of SMC's TB programming has been its emphasis on formal linkages with NTP-endorsed DOT centers and referral laboratories to enable timely referrals, documentation, and coordinated action. SMC periodically organized advocacy and coordination meetings with NTP, referral laboratory staff, and stakeholders to maximize service delivery effectiveness in a harmonized manner—reinforcing SMC's ability to work within national systems and uphold program accountability.
Digital Innovations: Improving Monitoring, Counseling, and Referral Tracking: SMC also introduced digital solutions to strengthen case management, oversight, and patient support. During ACTB, SMC piloted and used innovations such as the ACTB Solution App and Tele-Jiggasha to enable real-time reporting, remote counseling, and improved referral tracking and adherence support. The Tele-Jiggasha platform, in particular, supported counseling and follow-up for presumptive and confirmed TB cases and facilitated referrals related to adverse drug reactions (ADRs)—demonstrating SMC's capability to incorporate technology into TB programming for improved quality and continuity of care.
January 2025–Present: Sustaining ACF After ACTB Closure—SMC's Commitment in Action: Following the premature closure of USAID-funded ACTB in January 2025, SMC made a strategic decision to continue ACF activities through its non-graduate informal Star Network Providers. This reflects SMC's institutional commitment to sustaining essential TB screening and referral services even during funding transitions—ensuring that community-level TB service momentum is not lost. SMC's Star Network Providers remain trained to apply standardized symptom screening during routine interactions, use screening tools consistently, and issue referral slips to guide presumptive cases to the nearest NTP-designated diagnostic centers for confirmatory testing, especially sputum testing. This approach reduces diagnostic delays, supports early detection, and brings TB services closer to vulnerable communities. Importantly, in the past six months, Star Providers have already referred more than 150,000 presumptive TB patients to NTP-designated diagnostic facilities—an encouraging signal of both continued community demand and the scale and reach of SMC's provider platform.
Why SMC Is Well-Positioned to Implement TB Programs Under NTP: SMC's TB program experience demonstrates strong operational readiness and implementation capacity, including:
Looking Ahead: Scaling Impact with Renewed Support: SMC's continued ACF efforts after ACTB closure underscore a resilient and sustainable model for accelerating TB detection and linkage to care. At the same time, the high volume of presumptive case referrals reinforces the ongoing need for strengthened investments to expand provider coverage, reinforce digital reporting and tracking systems, enhance laboratory linkages and follow-up, and scale community mobilization to reduce delays in diagnosis and treatment initiation. With its proven operational systems, trusted community networks, and experience delivering results in partnership with NTP, SMC remains ready to support Bangladesh's TB control agenda through high-impact, scalable interventions—bringing the country closer to national and global End TB goals.
SMC ACTB Program: Click here
