The mid-term evaluation of a community-based DOTS tuberculosis project in Mozambique found several accomplishments but also some challenges. Key results included an increase in the case notification rate and community knowledge about TB, along with a reduction in treatment by traditional healers and drug stock-outs. However, the case notification rate and quarterly supervision of health posts had declined. Constraints involved inaccurate recording of patients on community-based treatment and challenges retaining volunteers. The evaluation team acknowledged contributions from various partner organizations.

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

3. Vurongha CB-DOTS project
Trained volunteers educate community
members
TB patient with
medicine

4. Project profile
6 Rural
Dist
Population:
226,523
3 Urban
Dist
Population:
354,689
Project
Area
Population:
581,212
Increase CNR
by 50%
Achieve 85%
treatment
success
Community
Based
DOTS

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

6. Project inputs

7. Project inputs

8. TB testing
80.9
95.7
81.8
80
70
75
80
85
90
95
100
Baseline (2010) Q3, 2011 Q4, 2011 Target
Percent
Suspected Cases Examined by Sputum Smear

9. TB case notification
128.3
139.5
107.7
0
20
40
60
80
100
120
140
160
Baseline
(2010)
Q4, 2010 Mid-Term
(2012)
CNRper100,000population
Case Notification Rate

10. TB patients cure rate
71.4
75.5
69
70
71
72
73
74
75
76
Baseline (2010) Mid-Term (2012)
Percentage
Cure Rate

11. 0
20
40
60
80
100
TB is transmitted
through coughing
TB is curable
20.7
85.3
61.3
91.7
Percent
Baseline
Mid-Term
Community knowledge about TB

12. 0
5
10
15
20
25
Treated by traditional healers
21.1
0.7
Percent
Baseline
Mid-Term
Treatment by traditional healers

13. 0
20
40
60
80
100
Drug stock-out
87.5
62.5
Percent
Baseline
Mid-term
TB drug stock-out at health centers

14. 0
20
40
60
80
Screening for TB
44.8
71.8
60
Percent
Baseline
Mid-term
Target
TB screening for HIV+ patients

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

19. Constraints and challenges
Project office after worst flooding in a
decade, followed by looting

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

21. Questions? Comments?
Thank You!