Community Based TB Programming: Seeking

your Input

Draft- Engaging NGOs and Civil Society Organizations in Community Based TB

activities: A Primer and Reference ManualDevasena Gnanashanmugam

Consultant, CORE Group

Why do we need yet another document in TB?

• The past• TB control delegated to Ministries of

Health/ NTPs• NGOs/ Civil Societies not encouraged

to participate• The problem

• Health facilities overburdened by TB disease (fueled by the HIV epidemic)

• Although a “social disease”, community involvement was lacking

Why another one?• The present

• NGOs and CSOs are encouraged to get involved

• But they aren’t quite sure how…• The need

• More awareness about scale and impact of TB on communities

• Practical steps on getting started to address TB

Intent of the document• Audience: NGOs and CSOs

• Those interested in TB by any/ all of the following:• Starting new efforts• Expanding to or linking to existing

programs• Basic overview of TB & how to control

it• Reader is referred to more exhaustive

sources• Written to ENCOURAGE involvement

A sample of included items…

• educate and mobilize communities about TB• find men, women and children with symptoms

and get them where they need to go• collect sputum samples to send to labs for

diagnosis• trace contacts—men, women and children

who have been exposed to someone with TB• provide patient-friendly treatment support

over the many months of taking medicine• locate people who stopped their treatment,

and help get them back on track.

Key components for TB programs

• Partnership• Focus on Participation• Invest in Social Mobilization and

Behavior Change• Ensure a Strong Referral System• Integrate programs into existing

health systems and services

Current TOC: the Basics

• Global TB Burden• A Brief History of the Fight Against

TB• The current STOP TB Strategy

TOC: How to get Started

• Infection control.• Care for your health providers.• Assessing viability of getting

involved and possible roles• Understanding the overall TB program

landscape• Assess your NGOs’ Strengths: Initial

questions to ask

Initial Questions to Ask• Do you have existing links in the Ministry of Health,

Education, or other relevant entities?  • What is your current area of expertise? How might you

best integrate TB with your current activities?• Your NGO’s location

• What are the local rates and patterns of TB? • Will this involve drug resistant- TB? • Are you in one of the high burden countries? • Will you need to consider HIV co-infection?

• If your expertise is advocacy• Can you use your advocacy/ messaging for consistent

messaging or training in ACSM in TB?• Can you leverage your capacity to reach out to

inaccessible and remote areas, including conflict zones?

Key Program Design Elements

• Overview of DOTS & how to expand current direct observed therapy goals

• Potential Program Areas• Special Populations

DOTS Elements• Sustained political commitment to TB

control• Case Detection by quality assured

bacteriology • Provide standardized treatment with

supervision, and patient support• An effective drug supply and

management system• Monitor and evaluate performance and

impact

Potential Program Areas

• Active Case Finding and Contact Investigations

• Directly Observed Therapy (DOT)—Watching patients take their pills

• Methods to Improve Adherence• Community Health Workers and Volunteers• Integration of TB with other services• Advocacy, Communication, Social

Mobilization and Behavior Change Communication

Potential Program Areas

• Stigma• Training and Supervision to Build

Local Capacity and Capacity building• Public- private partnership mix• Operations/Implementation Research

Special Populations• Gender• TB/ HIV• Drug resistance (drug-resistant TB)• Pediatric TB: TB in Children• Access to Vulnerable or “Hard to

Reach” Populations• Engaging TB patients• People in Urban settings

Conclusion• Pitfalls/ Lessons learned• Key documents

• Your thoughts/ ideas/ comments?