Events 10 community_presentation-delyuzar-indonesia


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Events 10 community_presentation-delyuzar-indonesia

  1. 1. Community Involvement in Indonesia 27 November 2006 Dr Delyuzar, Medan
  2. 2. The STOP TB Strategy Component 5: Empower people with TB and communities
  3. 3. 5yr Strategic Plan to Control TB in Indonesia 2006-2010EXPANSION of TB CONTROL1. Pursue quality DOTS expansion and enhancement2. Address TB/HIV, MDR-TB and other challenges3. Involve all care providers4. Engage TB patients and affected communitiesSupported by Health System Strengthening:5. Strengthened policy and ownership6. Strengthened health system and TB control management7. Research
  4. 4. What is Community TB Care (CTBC)Operational partnership between the health services and civil society (motivated individuals, existing community volunteers, etc.) aimed at contributing to TB care. Support to patients (DOT) throughout treatment Bringing services closer to patients (sputum collection) Patient, family and community education Case detection (referral of pts with chronic cough) Advocacy for political commitment to TB control Health promotion (creating demand for services in society)
  5. 5. Community Challenges in Indonesia• Access to healthcare (private, remote)• Cost-barriers (transport, userfees)• Low local political commitment to health• Lack of partnerships at local level• Low level of involvement of (ex) TB patients• Health care seeking patters differ across country
  6. 6. Treatment seeking practices in patients with hx of TB (Prevalence survey 2004) Initiation of treatment60%50% Initiation of treatment40% Hospital & BP4 Initiation of treatment30% Primary Health Care20% Initiation of treatment Private Practicioners10%0% Ending of treatment SUMATRA KT I JAVA 70% 60% 50% Ending of treatment Hospital & BP4 40% Ending of treatment Primary 30% Health Care Ending of treatment Private 20% Practicioners 10% 0% SUMATRA KTI JAVA
  7. 7. TB Community models1. Sub healthcentre/ TB posts (mobile) linked to health centre with TB program2. Community members linked to health centre TB program3. Urban health centre managed by NGOs/ faith- based networks
  8. 8. Family/ Clan leaders (‘Ninik Mamak’) Indonesia, West-Sumatra• Clan-leaders identify, support, accompany and refer suspects to health centre (referral form), and become support to daily treatment supporter (PMO) who is family member• Standardized referral sheets are used by Health centre for the suspect identification. This adds to: 1. Professionalize referral from community groups 2. Account and validate community contribution 3. Encourage positive contributions
  9. 9. Effectiveness of Ninik Mamak involvement at Kampung Dalam Health Center, Padang Pariaman – West Sumatra 300 266 250 Suspect (refered by Ninik 200 179 Mamak) 144 Suspect Total 150 Sm (+) 100 36 42 50 18 16 0 10 0 2004 2005 2006 (Q1) Suspect (refered by 0 144 16 Ninik Mamak) Suspect Total 179 266 42 Sm (+) 18 36 10Support from Ninik Mamak:• Increase of TB suspect thanks to Ninik Mamak (54%: 2005 and 38%: Q1 2006)• Proportion of Sm+ among suspect examined > 10% identify TB patient• TB knowledge increased people come themselves
  10. 10. Indonesia: Active community participation180 Family members as DOTS160 treatment observers140120 Central Sulawesi 1996-1998100 • TB case notification increases in a community based tuberculosis80 program (CBTP) • Results before and after60 introduction of the program40 • Comparison with area where the CNR - CTB CNR - non CTB program was and was not20 SR - CTB introduced. 0 SR - non CTB • Maintain high treatment success 1996 1997 1998 rates and sputum conversion rates M. Becx-Bleumink, H. Wibowo, W. Apriani, H. Vrakking, INT J TUBERC LUNG DIS 5(10):920–925 © 2001 IUATLD
  11. 11. TB PROGRAMJARINGAN KESEJAHTERAAN/ KESEHATAN MASYARAKAT JL. WILLIEM ISKANDAR NO. 107 B Phone: (061) 77817575 – 4576350, Fax. (061) 4576350 Email:
  12. 12. Tackling TB in 7 districts in North Sumatra Province, Indonesia
  13. 13. Phase I performance (First Year):• 2 interventions – five new microscopy centers and 21 satellite clinics, – training community volunteers to enhance suspect identification and case holding.• Facilitate inaccessible populations in remote areas
  14. 14. Socialization & set-up• 5 districts mobilize the Provincial Health Authorities and Municipal Health Authorities• Selection and recruit of staffs and Health Cadres (HCs)• Preparation of project (laboratory and health service)• Method of training, orienting the staffs in technical work, and operational standard procedure
  15. 15. Community volunteers• From permanent resident in target areas• Motivated to care for TB control, and cure patient and their family.• An initial 500 community volunteers were trained to increase community awareness, and assist with case holding.• Of 500 community volunteers initially trained, 360 remained active during the project.
  16. 16. Training Curriculum• Communication skills• TB Basic Science- epidemiology• Health Promotion• Collecting sputum & Case Holding
  17. 17. Phase II activities (Second year):• 3 Interventions:1. Community empowerment through existence of health cadres/ volunteers;2. develop two mobile clinics unit;3. setting up two new microscopy centers in one new district.
  18. 18. Health promotion• Health promotion Materials• Radio broadcast (52 times in a year)• Newspapers advertisement (everyday during the project life)• Leaflets
  19. 19. Mobile clinics• Two mobile clinics unit to cover more remote areas.• Mobile clinic visit suspect’s house and patient’s house, with smear preparer and TB medicine. (collect sputum, sputum fixation of slide, case holding activities).• Achieved 60% increase of category of limited access from those specific areas in phase II
  20. 20. Results• 7 additional diagnostic centres,• New staff working: – 7 doctors – 14 nurses – 7 lab technicians – 29 smear preparers – 440 volunteers• Quaterly meetings• 5322 cases detected (between July 2004 and June 2005)• 54% increase of the previous year
  21. 21. Thank you