Community Mobilization: Indonesia MITRA TB Project

Community Mobilization:
Indonesia MITRA TB Project
CORE Spring Meeting 2010

MITRA Pandeglang Lebak Serang Tangerang District Tangerang City Cilegon

National Context
National Integrated Movement to Control TB, by MOH in 1999: GERDUNAS
In 2005, International TB monitoring mission noted little contribution from local Gerdunas chapters

WHO ACSM
TB control at the country level:
Improving CDR and treatment adherence
Combating stigma and discrimination
Empowering people affected by TB
Mobilizing political commitment and resources for TB

Paguyuban
Paguyuban translation: “A group of people with the same interests or goals”
Members include:
Current TB patients
Ex-TB Patients
Family members
DOTS TB officers
Religious leaders
Trained volunteers
CBTO Supervisors

Paguyuban : Role
Linking puskesmas to community
Advocating for TB and TB-HIV prevention and treatment
Counseling
Coordinating TB activities at puskesmas and community
Coordination of activities among different religious leaders, MOH, CBTO Supervisors, and volunteers
Primary Source of TB information in the community

Paguyuban: Results
79 Paguyubans formed
60 training sessions completed
888 Paguyuban members trained
50% MITRA initiated, 50% MITRA encouraged
Membership ranged in size from 15-20 (100) members
80% women

CBTO Supervisors
CARE created additional level of treatment observer, the CBTO Supervisor
CBTO Supervisor manual accepted by MOH for national replication
Sustainability of CBTO system/MITRA

CBTO Supervisors : Role
Ensure TB patients receive DOTS treatment on time
Follow up with patients for sputum testing
Refer TB suspects to puskesmas
Members of Paguyubans
Meet with puskesmas TB officer regularly
Provide supportive supervision to CBTOs
Prevent defaults

CBTO Supervisors : Results
CBTOs and CBTO Supervisors provide 30% of all TB information in their communities
222 CBTO supervisors trained
2,233 CBTOs managed by CBTO Supervisors
Expanding diagnoses
405 CBTO referrals
160 diagnosed with TB (40%)
TB community awareness
1,252 outreach activities
CBTO Supervisor manual accepted by MOH for national replication
Sustainability of CBTO
system/MITRA

Religious Leaders
Religious leaders significant in stigma reduction
139 religious leaders trained
33 religious leaders became members of paguyubans
155 religious leaders regularly disseminate TB messages to community, particularly during Friday prayer

Surpassed the national Case Detection Rate (CDR) target of 70%, achieving a CDR of 76.5% in project areas
High levels of the Treatment Success Rate were maintained at 94%, exceeding the national target of 85%
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

Goal : Decrease morbidity and mortality caused by tuberculosis (to support National TB Program) in the Child Survival program area
Strategic Objectives :
Create sustainable community-based TB control structures
Strengthen the delivery capacity of the district and provincial TB Program
Increase private sector participation in the TB Program.
Successfully integrated community support in 3 key areas:
Paguyubans
CBTO Supervisors
Religious Leaders

Sustainable structure
Self-sustaining
Minimal MITRA staff support
Self-generating finances through voluntary funds and solicitations of factories and supermarkets
Expected to continue 5-10 years post MITRA
10 Golden Paguyubans

CBTO Supervisors
TB treatment last 6-8 months with side effects and high risk of MDR TB for defaulting patients
WHO recommends each TB patient have a treatment observer who is not a family member
Treatment observers were primarily family members, causing inefficient retention of CBTO (Community Based Treatment Observers)
CARE and KNCV created additional level of treatment observer, the CBTO Supervisor
CBTO supervisors are established members of community and highly respected
Sustainability of CBTO system

Religious Leaders
Inaccessibility in Pandeglang District lead to barriers in staffing and resources
Community surveys found stigma associated with TB
Religious Leaders identified as key players to address issues related to TB

Religious Leaders: Role
Religious leaders helped to reduce stigma
Participation and facilitation of community health education
TB is an infectious disease and not a curse or punishment from God
Testing & treatment for TB are free at the puskesmas
Those experiencing cough for 2 or more weeks should get tested for TB at puskesmas

Community Mobilization: Indonesia MITRA TB Project

by jehill3 on May 04, 2010

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Community Mobilization: Indonesia MITRA TB Project — Presentation Transcript