Stopping TB through social mobilization and community partnerships

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Stopping TB through social mobilization and
community partnerships
Lessons learned from FIGHT Project

• Adhi Sanjaya
• Milton Amayun
• Sri Chander

Presented in 34th Annual International
Conference on Global Health and CCIH 2007 Annual
Conference
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REPUBLIC OF INDONESIA
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MAP OF NTT PROVINCE 2004
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NTP in NTT (2000)

• Low Case Detection Rate
• Low Cure Rate
• Less coverage of DOTS service
• Poorly trained health staff in NTP
• High ratio of population per health staff
• Weak collaboration between HCs (DOTS provider)
  and hospitals or private health provider
• Low level of community involvement in health
  programs.

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FIGHT Project

• Food integrated to hinder tuberculosis.
• Funded by CIDA, March 2000 Sept 2006.
• Covers 5 districts, total population 1.1 M.
• As a partner of governments NTP.
• Goal To contribute to the decrease of TB
  mortality and morbidity among people of NTT
  province.
• Work focus district level.

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FIGHT Outcome Objectives

• Improved and sustained quality DOTS TB program
  management
• Increased participation and commitment of
  district government and TB DOTS implementers in
  TB control program
• Enhanced community participation in improving a
  sustainable community-based TB control program

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DOTS and FIGHT approaches

• Political commitment with increased and sustained
  financing
• Case detection through sputum smear microscopy
  examination
• Standardized treatment with supervision and
  patient support
• An effective drug supply and management system.
• ME system and measurement

• DOTS implementation.
• Capacity building for health staff
• Community knowledge, skill and behavior
• Monitoring, supervision and evaluation
• Networking and advocacy
• Resources mobilization
• Food aid component (discontinued since April 05)
• Micronutrient research

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Assisted areas 2000 to 2006
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Changes in district TB budget (US)
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Case Notification Rate (xx/100,000)
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Sm cases detected (total 2,859)
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A TB patients profile

• Mostly poor
• Low educated did not finish elementary school
• Low nutrition intake
• (only 922.4 Kcal / day)
• Self medicates first with traditional medicine
• Knows the disease can kill but doesnt know the
  treatment is FREE
• Slow to seek health services (12 weeks delay from
  the first symptom)

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NTT Governor Piet A. Tallo, is giving Category 1
TB drugs to a TB patient treated in Prof. Dr. W.
Z. Johannes Provincial Hospital in Kupang,
symbolizing the launching of Johannes DOTS Center
on the National Health Day 12 November 2005.
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Some lessons learned from the field

• Show them that you care! Benefits of home visits
  for treatment compliance and supervision also
  for contact tracing.
• Stress your rules! Patient signs letter of
  agreement to comply with the treatment regimen

• Give testimonies! The most effective promotion is
  the one given by ex-TB patient

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• Involve other parties
• Obtain religious institutional support in TB
  treatment and case detection.
• Invest in TB prevention in schools as public
  health investment for the future.
• Be creative and eye-catching.
• Audio visual promotion method ? more appealing to
  community.

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• Using TB patients photos (by permission) as
  advocacy tool.

• Identifying influential leaders ? to help
  mobilize community and to improve participation.

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• Dont be afraid to change!
• Open and intensive communication ? anticipate
  reaction to an unpopular decision. (eg.
  discontinuing the food aid and incentives).
• Inappropriate knowledge about the disease ?
  stigmas ? hinders case finding, treatment and
  patients monitoring activity.

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Ms. Esther Tabusan, 18 y.o.
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Terima kasih...