Advocacy, Communication and Social Mobilization Sub Group at Country Level: Building a Technical Ass

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Advocacy, Communication and Social Mobilization
Sub Group at Country Level Building a Technical
Assistance Network

• Presentation to the ACSM Subgroup at Country
  Level
• Session 8

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Outline

• ACSM 10-year Strategic Framework for Action
• Utilization of ACSM
• Discussion and decisions

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Utilization Rapid growth in ACSM
2002 data as gathered from ACSM Needs Assessment
Survey of HBC's 2006-2007 data gathered from HBC
DOTS Expansion survey Planned
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Funding HBCs with GFATM funding via rounds 1-5
for ACSM activities
2002 data as gathered from ACSM Needs Assessment
Survey of HBC's 2006-2007 data gathered from HBC
DOTS Expansion survey Approved grants from 5th
round GFATM
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Funds at Country Level via GFATM

• Successful 5th round for ACSM
• 35 million over two years
• 63 million over five years
• (Some TA budgeted for in some 5th grants)
• Challenge 1 How to access resources to
  maximise the impact of available GFATM funding
  and to achieve the targets as detailed in the
  GP2 and ACSM Strategic Framework for technical
  cooperation among partners and countries.

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6th round GFATM supported by partners and using
ACSM framework

• Afghanistan
• Congo Rep
• Eritrea
  
• Ethiopia
• Togo
• Zambia
• Egypt

• Iraq
• Morocco
• Pakistan
• PNG
• Vietnam
• Botswana

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Improving funding for ACSM Technical Assistance
Lagging (as of Sept 2006)
Note USAID is the largest single donor for ACSM
technical support
US9 million gap in ASCM projected TA needs at
country level
In millions
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Previous discussions on TA

• 2004CB meeting Beijing Endorsement of ISAC to
  respond to shortage funding for TA
• TB/HIV Requested funds for operational research
  and policy monitoring
• 2005CB meeting Addis Ababa Agreement to support
  countries with technical assistance to prepare
  5th GFATM Proposals
• Jan. 2006Partners TA meeting Geneva discussed
  the growing need for TA for all of technical
  issues
• Feb. 2006Coordinating Board presentation.
• TBCTA, ISAC and other channels provide needed TA
  but ACSM access to those funds is limited

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Session 8 Status Report on ACSM at Country
Level

• Presentation to the 2nd Meeting of the Sub-group
  on ACSM at Country Level
• Tanya Siraa/Stop TB

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What was the survey about?

• Annual survey sent to 22 HBC's to assess needs
  and progress of NTP's which feeds into Global TB
  Control Report.
• 2006 was the 2nd edition to include questions on
  ACSM
• Type of messages communicated
• Media types used
• Activities of patient-centred organizations
• Availability of ACSM monitoring and evaluation
  data
• Barriers to ACSM implementation

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ACSM activities are focused primarily on public
education less on advocacy.(Average, in order
of importance)
Public education

• Educating on signs and symptoms of TB
• Educating on where to go for TB testing and
  treatment
• Encouraging care seeking behaviour
• Increasing knowledge of risk factors for TB
• Combating stigma
• Calling for increased political and financial
  support
• Encouraging community action
• Providing a channel for the afflicted to voice
  their concerns

Advocacy
Source 2006 Stop TB strategy questionnaire
(Q.N3a) from Afghanistan, Bangladesh, Brazil,
China, India, Indonesia, Kenya, Myanmar, Nigeria,
Pakistan, Philippines, Russia, Tanzania, Uganda,
Vietnam, Zimbabwe. No data from Cambodia, Congo,
Ethiopia, Mozambique, South Africa or Thailand.
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Countries use a wide variety of media for their
ACSM activities(Average, in order of
importance)

• Electronic and print media
• Interpersonal communication
• Community mobilization
• Point of service promotion
• Folk media

Source 2006 Stop TB strategy questionnaire
(Q.N3a) from Afghanistan, Bangladesh, Brazil,
China, India, Indonesia, Kenya, Myanmar, Nigeria,
Pakistan, Philippines, Russia, Tanzania, Uganda,
Vietnam, Zimbabwe. No data from Cambodia, Congo,
Ethiopia, Mozambique, South Africa or Thailand.
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Activities of patient-centred organisations

• Community mobilization (100)
• Active case detection (89)
• Treatment support (78)
• Consultation with NTP regarding policy/programme
  implementation (67)
• Activism for national policy change or national
  resource mobilization (56)

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We must enable countries to gather data for
monitoring and evaluation.

• Only five out of 17 countries claim to have
  country-level data to evaluate the efficacy of
  ACSM strategic plan which will allow programme
  improvement and dissemination of information
• Brazil, China, India, Indonesia, Philippines
• The remaining 12 countries claim to have no ME
  system in place for ACSM
• Afghanistan, Bangladesh, Kenya, Myanmar, Nigeria,
  Pakistan, Russia, Tanzania, Thailand, Uganda,
  Vietnam, Zimbabwe.

Source 2006 Stop TB strategy questionnaire
(Q.N3a) from Afghanistan, Bangladesh, Brazil,
China, India, Indonesia, Kenya, Myanmar, Nigeria,
Pakistan, Philippines, Russia, Tanzania, Uganda,
Vietnam, Zimbabwe. No data from Cambodia, Congo,
Ethiopia, Mozambique, South Africa or Thailand.
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Countries face multiple barriers to implementing
ACSM programmes.

• Top six reasons across countries
• Limited staff capacity
• Limited resource availability
• Geographic/linguistic/cultural diversity
• Administrative or managerial constraints
• Identifying and reaching priority target groups
• Stigma

Source 2006 Stop TB strategy questionnaire
(Q.N3a) from Afghanistan, Bangladesh, Brazil,
China, India, Indonesia, Kenya, Myanmar, Nigeria,
Pakistan, Philippines, Russia, Tanzania, Uganda,
Vietnam, Zimbabwe. No data from Cambodia, Congo,
Ethiopia, Mozambique, South Africa or Thailand.
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Countries face multiple barriers to implementing
ACSM programmes.

• Other top reasons (average across countries)
• Lack of health sector coordination
• Poor understanding of TB risk factors
• Lack of commitment from health care providers
• Lack of commitment from civil society
• No action plan
• Lack of political commitment from central
  government

Source 2006 Stop TB strategy questionnaire
(Q.N3a) from Afghanistan, Bangladesh, Brazil,
China, India, Indonesia, Kenya, Myanmar, Nigeria,
Pakistan, Philippines, Russia, Tanzania, Uganda,
Vietnam, Zimbabwe. No data from Cambodia, Congo,
Ethiopia, Mozambique, South Africa or Thailand.
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Questions?
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Unique opportunity

• Technical assistance program

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Unique Opportunity

• USAID and Stop TB developed a TA proposal and
  secured 507K in funding from OGAC to support
  countries with rounds 1-6 ACSM implementation.
• Funding is designed to remove obstacles and
  accelerate implementation.
• Funding conditional on
• Type of TA need
• Country needs

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Examples of TA requeststhat could be funded

• Formative behavioral/demographic/market research
• Data interpretation
• Project management strengthening
• Monitoring and evaluation planning
• Micro-planning

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Program outline

• Only countries with GFATM rounds 1-6 funding are
  eligible for catalytic TA
• Component 1 Technical Assistance Mechanism
• Component 2 Country-specific Program Evaluation
• Component 3 Program Management

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Monitoring and evaluation of TA

• Two tier system
• Tier one Standardized matrix of ACSM elements
  as suggested in 10-Year Strategic Framework with
  respect to county TA needs
• Progress towards implementation as detailed in
  GFATM Grant.
• Increased NTP capacity
• Tier two Partner progress reports

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Next Steps

• Survey of country needs
• TA applications from country
• Subgroup to discuss/agree on basic standards for
  rendering TA.
• Priority countries, utilization of the Framework,
  compliance with terms of the grant.
• TA to be country/TA partner and coordinated by
  Stop TB

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Recap

• Challenge 1 How to coordinate effectively among
  partners to maximise gains, measure outcomes and
  advance the GFATM Grants in assisted countries?
• Challenge 2 What should be the guiding
  principles governing the USAID-funded Technical
  Assistance program?

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Proposed Guiding Principles

• 1) TA for ACSM will be focused on assisting
  counties in the initial phases of their GFATM
  ACSM grants.
• 2) TA for ACSM must accelerate the absorptive
  capacity and improve the performance of the ACSM
  component in those projects approved by the
  GFATM.
• 3) TA for ACSM must be catalytic in nature and
  will be targeted to remove obstacles to
  successful ACSM implementation and build local
  capacity.
• 4) TA for ACSM must be in alignment with the
  standards, methodologies, objectives as
  articulated in the component 5 of the Stop TB
  Strategy.

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Recommendations