by Samar Ibrahim

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Advocacy Communication Social Mobilization for
TB control in EMR

• by Samar Ibrahim
• Advocacy and Communication Assistant
• Communicable Disease Control
• WHO EMRO

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Our Regional situation from the Global Targets

• Regional figures so far show that we are still
  far from achieving the global targets. (82-38
  vs. 85-70).
• Although big progress has been made towards
  achieving these targets in the Region, the
  challenges are still tremendous.
• Case detection remains very low, quality of DOTS
  is not as high as expected and the Regional share
  of financial support is not sufficient to keep TB
  control sustainable.

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A Regional Strategy to Stop TB

• In order for us to address these challenges and
  define our strategic directions to achieve the
  MDGs, the Regional Office has initiated the
  development of a regional strategic plan for
  2006-2015.
• This regional guiding document will be a part
  of the recently launched Second Global Plan to
  Stop TB and the Global Strategy to Stop TB.

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ACS in the Global and Regional Strategies

• ACS as supportive tools for TB control
  globally and in the Region have become
  increasingly valued and its implementation
  strategy has become more mature because of the
  major role it can play.
• In the past, ACS has been taking place in
  different shapes and forms in the various
  countries of the Region. Activities have been
  concentrated mainly around World TB Day and they
  usually included Seminars, rallies, media
  interviews, print material and promotional items

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ADVOCACY

• Activities designed to place TB high on the
  political and development agenda, foster
  political will, increase financial and other
  resources on a sustainable basis.
• Outcome
• Highly committed politicians
• Enough resources to ensure sustainability of ACS
  activities

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Situation at present Stop TB budget EMRO vs.
WRPO
WPRO (4.6M)
EMRO (1.5M)
Japan
Staff support from HQ
AGFUND
USAID
Activity support from HQ
AusAID
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COMMUNICATION

• Increase knowledge among general public about TB
  and TB control services, improve interpersonal
  communication between patients and program
  providers contributing to behavioral change.
• Outcome
• Improved public knowledge about TB and overcoming
  problems such as patients delay in seeking
  treatment, stigma and discrimination
• Increase number TB suspects

Example The SGSs Patient Delay study
recommendations about the need to provide basic
knowledge about TB and to reduce stigma.
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SOCIAL MOBILIZATION

• The mobilization of communities for action to
  fight stigma and eliminate TB as a public health
  threat.
• Outcome
• Elimination of stigma and discrimination
• Improve patient-provider relationship
• Improved TB suspect tracing, case detection and
  treatment adherence

• Examples
• SGS study Pakistan about community involvement
  in enhancing case detection and treatment success
  rates in TB patients under DOTS
• Patients Charter fro TB Care to empower people
  with TB and communities and make the
  patient-provider relationship mutually beneficial.

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Increased case detection in BDN area
Evidence derived from SGS-supported study
(November 2003-March 2005)
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Regional Priorities

• Establish and launch the Regional Stop TB
  partnership to scale up our strategic support to
  countries
• 1st inter-country training workshop on ACS for TB
  control in the countries of the EMR which was was
  held in Islamabad, Pakistan, 21-24 February 2006
  to train medical, social and communication
  specialists from 7 countries of the Region on the
  effective use of health communication tools to
  develop successful national ACS strategies.
• Increasing the financial resources (GFATM and
  others) to ensure sustainability of TB control
  activities including ACS (In Round 6 of GF, 9
  countries from the Region applied for funding,
  all of which have incorporated an ACS component
  in their proposals )

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A 10-step guide to ACS planning and implementation

• Step 1) Secure qualified communication focal
  point(s) in the NTP
• Step 2) Create a specific ACS committee/task-force
  /partnership
• Step 3) Conduct a systematic needs assessment
• Step 4) Develop an ACS national strategy
• Step 5) Develop a workplan and budget for ACS
  activities
• Step 6) Identify ACS focal points at all levels
• Step 7) Develop, pre-test and produce ACS
  materials.
• Step 8) Improve human resource skills and
  institutional capacity
• Step 9) Implementation
• Step 10) Monitoring and Evaluation

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i.e. What to do? PREP

• Step 1) Doctors treat patients, communication
  experts bring them to the door. Recruit a
  professional to design, implement and evaluate
  ACS interventions
• Step 2) You need to know who is in charge of
  planning, implementing and evaluating all ACS
  activities at national and sub-national levels
  (ACS taskforce)
• Step 3) You need to determine what are your
  behavioral goals, who is your target audiences,
  what are the social behavioral barriers to
  treatment seeking or compliance and by which
  media (needs assessment)
• Step 4) Based on the results of the needs
  assessment and in line with the national TB
  control strategy, you need to develop an ACS
  strategy
• Step 5) Develop your detailed workplan and draft
  your budget for ACS interventions.

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i.e. What to do? DEVELOP

• Step 6) Identify ACS focal points at all levels,
  they will be your hands and ears in the field.
• Step 7) In developing your ACS material posters,
  flyers, TV commercials etc, dont assume, if you
  want to know, pre-test
• Step 8) Conduct specialized training workshops to
  make sure everybody is doing it right

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i.e. What to do? IMPLEMENT, ME

• Step 9) According to your workplan, begin
  implementation
• Step 10) Establish ACS impact indicators in
  district/provincial/national TB reporting formats
  to be able to review progress. Monitor and
  evaluate your interventions on ongoing basis and
  make sure to include pre and post-campaign
  evaluation

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ACS suggested workplanBeginning 2007- End 2008
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• Thank you and Good luck