Community Based TB Programming: Seeking your Input Draft- Engaging NGOs and Civil Society Organizations in Community Based TBactivities: A Primer and Reference Manual Devasena Gnanashanmugam Consultant, CORE Group
Why do we need yet another document in TB?• The past • TB control delegated to Ministries of Health/ NTPs • NGOs/ Civil Societies not encouraged to participate• The problem • Health facilities overburdened by TB disease (fueled by the HIV epidemic) • Although a “social disease”, community involvement was lacking
Why another one?• The present • NGOs and CSOs are encouraged to get involved • But they aren’t quite sure how…• The need • More awareness about scale and impact of TB on communities • Practical steps on getting started to address TB
Intent of the document• Audience: NGOs and CSOs • Those interested in TB by any/ all of the following: • Starting new efforts • Expanding to or linking to existing programs • Basic overview of TB & how to control it • Reader is referred to more exhaustive sources • Written to ENCOURAGE involvement
A sample of included items…• educate and mobilize communities about TB• find men, women and children with symptoms and get them where they need to go• collect sputum samples to send to labs for diagnosis• trace contacts—men, women and children who have been exposed to someone with TB• provide patient-friendly treatment support over the many months of taking medicine• locate people who stopped their treatment, and help get them back on track.
Key components for TB programs• Partnership• Focus on Participation• Invest in Social Mobilization and Behavior Change• Ensure a Strong Referral System• Integrate programs into existing health systems and services
Current TOC: the Basics• Global TB Burden• A Brief History of the Fight Against TB• The current STOP TB Strategy
TOC: How to get Started• Infection control.• Care for your health providers.• Assessing viability of getting involved and possible roles • Understanding the overall TB program landscape • Assess your NGOs’ Strengths: Initial questions to ask
Initial Questions to Ask• Do you have existing links in the Ministry of Health, Education, or other relevant entities?• What is your current area of expertise? How might you best integrate TB with your current activities?• Your NGO’s location • What are the local rates and patterns of TB? • Will this involve drug resistant- TB? • Are you in one of the high burden countries? • Will you need to consider HIV co-infection?• If your expertise is advocacy • Can you use your advocacy/ messaging for consistent messaging or training in ACSM in TB? • Can you leverage your capacity to reach out to inaccessible and remote areas, including conflict zones?
Key Program Design Elements • Overview of DOTS & how to expand current direct observed therapy goals • Potential Program Areas • Special Populations
DOTS Elements• Sustained political commitment to TB control• Case Detection by quality assured bacteriology• Provide standardized treatment with supervision, and patient support• An effective drug supply and management system• Monitor and evaluate performance and impact
Potential Program Areas• Active Case Finding and Contact Investigations• Directly Observed Therapy (DOT)—Watching patients take their pills• Methods to Improve Adherence• Community Health Workers and Volunteers• Integration of TB with other services• Advocacy, Communication, Social Mobilization and Behavior Change Communication
Potential Program Areas• Stigma• Training and Supervision to Build Local Capacity and Capacity building• Public- private partnership mix• Operations/Implementation Research
Special Populations• Gender• TB/ HIV• Drug resistance (drug-resistant TB)• Pediatric TB: TB in Children• Access to Vulnerable or “Hard to Reach” Populations• Engaging TB patients• People in Urban settings