Community Based DOTS - Mozambique_Dr. Paul Robinson
1. Findings from mid-term evaluation of
CSGHP – TB Project in Mozambique
Dr. Paul Robinson, MBBS, MTS, MPH
Director, Health and Social Development Team
World Relief
CORE Group Spring Meeting/TB Working Group
Baltimore, MD
April 24, 2013
Community Based DOTS
…accomplishments and challenges
2. Project background
Key mid-term results
Major constraints
Questions and Answers
Overview
5. Intermediate results
IR1: Empower people with TB to seek & complete
treatment with support from their communities
IR2: Strengthen provincial TB control program to
improve TB service delivery and treatment outcomes
IR3: Decrease burden of HIV in patients with TB and
decrease burden of TB in PLWHA
15. Village Health Committees with local data on
TB cases increased from 0% to 100%
Quarterly assessment of all health centers by
Dist. TB Supervisor using M-DRAT is 100%
Quarterly supervision of health posts by
District TB Supervisor fell from 83.3% to 50%
Major errors in lab diagnosis is <1%
Health facilities with sputum bottle stock-out
declined from 25% to 0%
Health centers with TB drug stock-out reduced
from 87.5% to 62.5%
Other mid-term findings
16. Case notification has declined from 128.3
to103.7 per 100,000 population
Default (treatment interruption) rate decreased
from 3.6% to 3.2%
All TB patients screened for HIV (100%)
TB/HIV+ patients on cotrimoxazole preventive
therapy is maintained at 98.8%
Other mid-term findings
17. Modified District Rapid Assessment Tool (MDRAT)
uses data from (1) dist. TB register and (2) lab
registers.
VHC maintains community level data using village
TB registers, which informs Proj. M&E.
Some health centers did not record if patients are on
CB-DOTS, thereby compromising the accuracy of TB
case registration.
The MOH plans to introduce a revised TB register
for HCs nationally, which will have a column for
reporting on patients who are on CB-DOTS.
Constraints and challenges
18. Unknown but a significant proportion of men
migrate to S. Africa for working at mines. They
return home sometimes with TB and
HIV/AIDS. These semi-nomadic sub
population may not have consistent access to
TB and HIV/AIDS services
Use of volunteers empowers communities with
low access to services
Challenge is to keep the volunteers motivated
with satisfying tasks, perhaps through
increasing scope of voluntary work without
over burdening them
Constraints and challenges
20. • Henk Eggens, MD, MPH
Mid-Term Team Leader/External Consultant
• Adolfo E. Cambule, MD,
CB-DOTS Manager, World Relief, Mozambique
• Pieter Ernst, MD
Director of Program Integration, World Relief, Mozambique
• Debbie Dortzbach
Sr. Health Advisor, World Relief, Baltimore, MD
• Melanie Morrow
Director of MCH programs
• Meredith Crews, MPH
Health Advisor, CSHGP, USAID
• Nazo Kureshy
Team Leader/AOR, CSHGP, USAID
Acknowledgement
In 2011 WHO reported among 22 TB high burden countries Mozambique has:3rd highest incidence rate of all forms of TB (544/100,000)6th highest prevalence rate of all forms of TB (491/100,000)4th highest TB mortality rate (49/100,000)Lowest case detection rate (34%)Gaza province notified 1,874 TB BK+ (Bacteriologically Confirmed) cases in 2011 with a SS+ CNR of 135/100,000. This rate is considerably higher than the national SS+ CNR of 87/100,000.
WR introduced the Vurhonga TB CB-DOTS project in late 2009Covering a population of 581,212 in six rural dists. and three urban areas.Overall goal: reduction of TB burden, in line with WHO Stop TB Strategy and the Moz National Strategic PlanPrimary Objective – twofold: increase the case notification rate by 50% and achieve 85% treatment success rate in project areas
Three Intermediate Results.
Project trains community volunteers – structured CARE GROUPS which has been in existence since 1995 in connection with previous CSPs in the project areas. Project re-established Village Health Committees including a TB focal point volunteers for each VHC appointed by MISAU (MOH)Also, project mobilizes Pastors’ Networks, OVC volunteers and Home Based Care Activists in urban areasProject trained a total of 48,352 community volunteers since onset of project (in 2 years)These trained volunteers--- --Educate communities about TB--Detect TB cases--Refer them to health facilities for testing and --Monitor treatment compliance
--Project sponsors training of peripheral nurses and lab technicians in TB diagnostics--Joint supervision of health centers and communities undertaken by WR Care Group supervisors and MOH district TB supervisorsCollaboration with MOH fostered at several levels from the village to the health facility.