Community Mobilization: Indonesia MITRA TB Project


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Community Mobilization: Indonesia MITRA TB Project

TB Working Group Showcase

CORE Group Spring Meeting, April 29, 2010

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Community Mobilization: Indonesia MITRA TB Project

  1. 1. <ul><li>Community Mobilization: </li></ul><ul><li>Indonesia MITRA TB Project </li></ul><ul><li>CORE Spring Meeting 2010 </li></ul>
  2. 2. MITRA Pandeglang Lebak Serang Tangerang District Tangerang City Cilegon
  3. 3. National Context <ul><li>National Integrated Movement to Control TB, by MOH in 1999: GERDUNAS </li></ul><ul><li>In 2005, International TB monitoring mission noted little contribution from local Gerdunas chapters </li></ul>
  4. 4. WHO ACSM <ul><li>TB control at the country level: </li></ul><ul><li>Improving CDR and treatment adherence </li></ul><ul><li>Combating stigma and discrimination </li></ul><ul><li>Empowering people affected by TB </li></ul><ul><li>Mobilizing political commitment and resources for TB </li></ul>
  5. 5. Paguyuban <ul><li>Paguyuban translation: “A group of people with the same interests or goals” </li></ul><ul><li>Members include: </li></ul><ul><ul><li>Current TB patients </li></ul></ul><ul><ul><li>Ex-TB Patients </li></ul></ul><ul><ul><li>Family members </li></ul></ul><ul><ul><li>DOTS TB officers </li></ul></ul><ul><ul><li>Religious leaders </li></ul></ul><ul><ul><li>Trained volunteers </li></ul></ul><ul><ul><li>CBTO Supervisors </li></ul></ul>
  6. 6. Paguyuban : Role <ul><li>Linking puskesmas to community </li></ul><ul><li>Advocating for TB and TB-HIV prevention and treatment </li></ul><ul><li>Counseling </li></ul><ul><li>Coordinating TB activities at puskesmas and community </li></ul><ul><li>Coordination of activities among different religious leaders, MOH, CBTO Supervisors, and volunteers </li></ul><ul><li>Primary Source of TB information in the community </li></ul>
  7. 7. Paguyuban: Results <ul><li>79 Paguyubans formed </li></ul><ul><li>60 training sessions completed </li></ul><ul><li>888 Paguyuban members trained </li></ul><ul><li>50% MITRA initiated, 50% MITRA encouraged </li></ul><ul><li>Membership ranged in size from 15-20 (100) members </li></ul><ul><ul><li>80% women </li></ul></ul>
  8. 8. CBTO Supervisors <ul><li>CARE created additional level of treatment observer, the CBTO Supervisor </li></ul><ul><li>CBTO Supervisor manual accepted by MOH for national replication </li></ul><ul><ul><li>Sustainability of CBTO system/MITRA </li></ul></ul>
  9. 9. CBTO Supervisors : Role <ul><ul><li>Ensure TB patients receive DOTS treatment on time </li></ul></ul><ul><ul><li>Follow up with patients for sputum testing </li></ul></ul><ul><ul><li>Refer TB suspects to puskesmas </li></ul></ul><ul><ul><li>Members of Paguyubans </li></ul></ul><ul><ul><li>Meet with puskesmas TB officer regularly </li></ul></ul><ul><ul><li>Provide supportive supervision to CBTOs </li></ul></ul><ul><ul><li>Prevent defaults </li></ul></ul>
  10. 10. CBTO Supervisors : Results <ul><li>CBTOs and CBTO Supervisors provide 30% of all TB information in their communities </li></ul><ul><li>222 CBTO supervisors trained </li></ul><ul><ul><li>2,233 CBTOs managed by CBTO Supervisors </li></ul></ul><ul><li>Expanding diagnoses </li></ul><ul><ul><li>405 CBTO referrals </li></ul></ul><ul><ul><ul><li>160 diagnosed with TB (40%) </li></ul></ul></ul><ul><li>TB community awareness </li></ul><ul><ul><li>1,252 outreach activities </li></ul></ul><ul><li>CBTO Supervisor manual accepted by MOH for national replication </li></ul><ul><ul><li>Sustainability of CBTO </li></ul></ul><ul><ul><li>system/MITRA </li></ul></ul>
  11. 11. Religious Leaders <ul><li>Religious leaders significant in stigma reduction </li></ul><ul><li>139 religious leaders trained </li></ul><ul><li>33 religious leaders became members of paguyubans </li></ul><ul><li>155 religious leaders regularly disseminate TB messages to community, particularly during Friday prayer </li></ul>
  12. 12. <ul><li>Surpassed the national Case Detection Rate (CDR) target of 70%, achieving a CDR of 76.5% in project areas </li></ul><ul><li>High levels of the Treatment Success Rate were maintained at 94%, exceeding the national target of 85% </li></ul>MITRA Cilegon Serang Tangerang District Tangerang City Lebak Pandeglang 319,555 1,776,995 1,488,666 3,317,331 1,125,474 1,062,813
  13. 13. <ul><li>Goal : Decrease morbidity and mortality caused by tuberculosis (to support National TB Program) in the Child Survival program area </li></ul><ul><li>Strategic Objectives : </li></ul><ul><li>Create sustainable community-based TB control structures </li></ul><ul><li>Strengthen the delivery capacity of the district and provincial TB Program </li></ul><ul><li>Increase private sector participation in the TB Program. </li></ul><ul><li>Successfully integrated community support in 3 key areas: </li></ul><ul><li>Paguyubans </li></ul><ul><li>CBTO Supervisors </li></ul><ul><li>Religious Leaders </li></ul>
  14. 14. <ul><li>Sustainable structure </li></ul><ul><ul><li>Self-sustaining </li></ul></ul><ul><ul><li>Minimal MITRA staff support </li></ul></ul><ul><ul><li>Self-generating finances through voluntary funds and solicitations of factories and supermarkets </li></ul></ul><ul><ul><li>Expected to continue 5-10 years post MITRA </li></ul></ul>10 Golden Paguyubans
  15. 15. CBTO Supervisors <ul><li>TB treatment last 6-8 months with side effects and high risk of MDR TB for defaulting patients </li></ul><ul><li>WHO recommends each TB patient have a treatment observer who is not a family member </li></ul><ul><li>Treatment observers were primarily family members, causing inefficient retention of CBTO (Community Based Treatment Observers) </li></ul><ul><li>CARE and KNCV created additional level of treatment observer, the CBTO Supervisor </li></ul><ul><li>CBTO supervisors are established members of community and highly respected </li></ul><ul><ul><li>Sustainability of CBTO system </li></ul></ul>
  16. 16. Religious Leaders <ul><li>Inaccessibility in Pandeglang District lead to barriers in staffing and resources </li></ul><ul><li>Community surveys found stigma associated with TB </li></ul><ul><li>Religious Leaders identified as key players to address issues related to TB </li></ul>
  17. 17. Religious Leaders: Role <ul><li>Religious leaders helped to reduce stigma </li></ul><ul><li>Participation and facilitation of community health education </li></ul><ul><ul><ul><li>TB is an infectious disease and not a curse or punishment from God </li></ul></ul></ul><ul><ul><ul><li>Testing & treatment for TB are free at the puskesmas </li></ul></ul></ul><ul><ul><ul><li>Those experiencing cough for 2 or more weeks should get tested for TB at puskesmas </li></ul></ul></ul>