How Can Communication And Social Mobilization Help the DOTS Strategy? An Outcome Map To Strengthen...

How Can Communication And Social Mobilization Help the

DOTS Strategy?

An Outcome Map To Strengthen DOTS Strategy To STOP

TB

© Johns Hopkins UniversityCenter for Communication ProgramsHCP STOP TB Team

Contact: Benjamin V. [email protected]

Main Point

• We would benefit significantly from a multi-disciplinary and multi-sectoral approach to DOTS.

Advocacy Gov’t makes TB control high priority

Gov’t provides quality DOTS services

Gov’t ensures adequate drug supply

# Cases drop long term

The DOTS Strategy to

Providers detect potential cases and diagnose correctly

Providers ensure correct treatment regimen

STOP TB

STOP TB

Monitoring





How well is the DOTS Strategy working?

Very well in some countries, mixed in others.

World wide # of cases are growing or dropping?

Is this due to better detection?



STOP TB

Monitoring







Key Challenges in the DOTS Strategy

Weak

Weak

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Monitoring








Weak

WeakLiterature suggests lots of room for improvement

Weakness is strategic as it dampens overall effort

STOP TB

Monitoring








Weak

Weak

Only 42% cases detected worldwide against 70% target.

DOTS expansion accounts for most of growth in detection. WHO estimates that without improvements, 100% coverage may not surpass 50% detection.

Weakness is strategic as it dampens success in treatment!

STOP TB

Monitoring





More Challenges in the DOTS Strategy

Weak

Weak

Close to target!

Could improve

Could improve



STOP TB

Monitoring






Weak

Weak

Close to target!

Could improve

Could improve



Literature suggests lots of room for improvement

STOP TB

Monitoring






Weak

Weak

Close to target

Could improve

Could improve



81% cure against 85% target!

Outcome dampened by low detection rates.

Growing concerns for MDR TB and lower quality of services as program expands

STOP TB

Monitoring




Providers, community and households team up to encourage correct treatment regimen


Are revisions in wording of the DOTS Strategy above better? If so, how do we make these outcomes happen?

Providers, community and households team up to detect potential cases and diagnose correctly

STOP TB

Monitoring

Advocacy

Communication

Gov’t makes TB control high priority



Providers, community and households team up to encourage correct treatment regimen


Social Mobilization

The Comm- DOTS Strategy

Would adding communication and social mobilization help produce better outcomes?

Providers, community and households team up to detect potential cases and diagnose correctly

Comm means plus communication and social mobilization

STOP TB

Monitoring

More Effecitve Advocacy

Communication


People with symptoms seek health care


Gov’t, community, households team up to eliminate TB stigma


Providers, community and people team up to encourage correct treatment regimen


More Effective Social Mobilization

Households learn about TB symptoms, transmission and treatment

Possible Communication Contributions To Desired Outcomes to

Providers, community and people team up to detect potential cases and diagnose correctly

STOP TB

STOP TB

Monitoring

More Effective Advocacy

More Effective Communication


Community works with Gov’t ,and households to eliminate TB in the community







Gov’t, community and households integrate into culture appropriate health values and practices

Social Mobilization


# of TB free communities increase

Possible Social Mobilization Contributions To Desired Outcomes to

Community allocates resources and nurtures appropriate environment to eliminate TB in community


STOP TB

STOP TB

Monitoring




Community works with Gov’t , households to eliminate TB in the community








Social Mobilization



What is a TB Free Community?


Providers, community and people team up to detect potential cases and diagnose correctlyNo active untreated

cases of TB detected the last 3 years

Or

No deaths from TB in community the last 3 years.

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Monitoring












Social Mobilization



Other Types of Communities To Compare With TB Free Communities



TB Free communities

versus

Communities with DOTS coverage

No DOTS Coverage but with high prevalence of TB

No DOTS Coverage but with low prevalence of TB

Status unknown

Every country can present this geographic based approach through a color coded TB Status Map. This visual representation could be of great value in planning and monitoring interventions.

STOP TB

An example of data presented in a color coded map












Social Mobilization



Why use the concept of TB Free Community?



Because TB transmission is by proximity, it is logical to use a geographic based strategy.

TB is not evenly distributed. We need to allocate scarce resources more effectively and efficiently.

We need to motivate communities with a community goal.

Designation of a TB free community gives a clear sense of victory. Highly motivational.

Easier to understand than number of cases per 100,000 which is not meaningful at community level.

We can use the number and % of TB free communities and other types of communities for tracking and benchmarking purposes.

TB-free communities can serve as model for high TB prevalence communities.

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Social Mobilization



Some additional indicators to considerNote: There should be no conflict with continued use of current indicators like # cases per 100,000 to provide other views of overall macro picture



STOP TB

# of communities with DOTS coverage increase

# of communities of unknown status decrease

Advocacy

Communication










Social Mobilization



An Outcome Map for Comm- DOTS Strategy to



STOP TB

STOP TB

Monitoring








Gov’t enlsures adequate drug supply




Social Mobilization



The Vietnam Case Study



STOP TB

Monitoring

80% know symptoms65% know transmission80 % know TB is curable 100% know that

detected case of TB should seek medical care

80% cases detected

93% completed treatment

89% cured

Gov’t declated TB high priority in 1995

All forms of media used to educate people

High level of community mobilization

Partnerships created at all levels

Gov’t achieves almost 100 coverage in 1998

Peer education used fully recovered patients

Quality ensured through effective monitoring

Four program levels of TB control activity

Wide range of advocacy activities conducted






Gov’t provides quality DOTS servicesGov’t,

Stigma is low 13% community, households team up to eliminate TB stigma

Gov’t enlsures adequate drug supply




Social Mobilization



The Indonesian Case Study



STOP TB

Monitoring

76% knows about TB77% claim know symptoms65% know transmission85 % know TB is curable19% know treatment is free

40-56% go for treament to private clinics

30% go to Puskesmas

52% cases detected

85% cured

National Gov’t sees TB Gov’t as priority but local govts not on same level

Not all forms of media used to educate people

Low level of community mobilization

Partnerships being formed Fully recovered

patients not used

Quality ensured through effective monitoring

Narrow range of advocacy activities conducted

Advocacy

Communication










Social Mobilization



Illustrative Indicators of Outcomes

Note: Click on colored text to see illustrative indicators. When finished, click on button on the right to see illustrative activities.



STOP TB

STOP TB

Monitoring

Click here to see illustrative activities

Advocacy

Communication










Social Mobilization



Illustrative indicators for people’s knowledge



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STOP TB

Monitoring

Clear TB control policy supported by

rhetoric

actions

resources

% of people who knows that TB control is a high priority of the country/community

Strong collaboration between TB and HIV/AIDS programs and those of other communicable diseases

Note: Click on text again to go return to framework

Advocacy

Communication










Social Mobilization



Illustrative indicators for people’s knowledge



STOP TB

STOP TB

Monitoring

% who know about TB symptoms

% who know how TB is transmitted

% who know that TB is curable

% who know that TB treatment is free

% who know where to secure TB treatment if needed


Advocacy

Communication










Social Mobilization



Illustrative activities to achieve an outcome



STOP TB

STOP TB

Monitoring

% who understand that people with TB symptoms should seek health care

% who believe that people with TB symptoms should seek health care

% who will encourage people they know with TB symptoms to seek health care.

% of TB cases who come for diagnosis and treatment promptly.

Mean time between occurrence of symptoms and visit to health facility.


Advocacy

Communication










Social Mobilization



Illustrative indicators of TB stigma reduction



STOP TB

STOP TB

Monitoring

% or # of communities where Gov’t, households and communities plan and work together to eliminate TB stigma

% or # of communities with support groups for TB patients and their families.

% who believe that TB treatment should be provided to all in need.

% who look at TB patients as people who need help rather than avoided


Advocacy

Communication










Social Mobilization






STOP TB

STOP TB

Monitoring

% or # of communities where Gov’t, households and communities jointly conduct activities to ensure prompt detection of potential cases and to make correct diagnosis.

% of TB control clinical staff who have correct knowledge and skills to detect potential cases and to diagnose correctly.

% of TB control clinical staff who have adequate tools and resources for diagnosis and use them


Advocacy

Communication










Social Mobilization






STOP TB

STOP TB

Monitoring

% or # of communities where Gov’t, households and communities conduct joint activities to ensure correct treatment regimen both on the part of patients and TB control providers.

% of TB control providers who have correct knowledge and skills to administer treatment regimen.

% of families with TB cases who understand the consequences of not observing treatment regimen.

% of families with TB cases who encourage patients to observe correct treatment regimen.


Advocacy

Communication










Social Mobilization






STOP TB

STOP TB

Monitoring

% or # of communities with vision of a TB free community shared by government, households and all stakeholders.

% or # of communities who have a working partnership to make their community TB free which includes private sector, businesses, NGOs, CBOs, Faith-based organizations, PLWTB


Advocacy

Communication


Community works with Gov’t , households to eliminate TB in theg community








Social Mobilization






STOP TB

STOP TB

Monitoring

% or # of communities which allocate local resources to make the community TB free

% or # of communities that participate actively in the national effort to control TB.

% or # of communities that have TB free partnerships that collaborate with HIV/AIDS programs and those of other communicable diseases.


Advocacy

Communication










Social Mobilization






STOP TB

STOP TB

MonitoringThis requires development of a comprehensive instrument to measure people’s values, beliefs, practices, resource allocation related to health in general and to TB in particular.

The basic idea is that TB control programs should become obsolete as soon as possible because cultures have already integrated appropriate values and practices.


Advocacy

Communication










Social Mobilization



Illustrative activities to achieve an outcome



STOP TB

STOP TB

Monitoring

Schools integrate TB information in health education courses and text books

Enter-educate programs with TB information

Use of former TB patients as spokespersons for anti-TB campaigns

Workshops with selected media personnel

Workshops with local officials and community leaders

Use of folk media like street theater, etc.

Visits to TB Free communities by select local officials

Note: Click on text again to go return to framework or click on any

part of the screen to go to next slide.

Advocacy

Communication










Social Mobilization



An Outcome Map for Comm -DOTS Strategy to



STOP TB

STOP TB

Monitoring

Benefits of Comm-DOTS approach

• Less jargon• Uses actors, (government, providers, community,

households) and desired specific behaviors of each to describe what we want to happen, not abstract ideas.

• Lays out an overall strategic picture.• Provides practical way to plan, implement, monitor and

evaluate. .• Suggests a multi-disciplinary and multi-sectoral team

approach and helps ensure everyone is on the same page.

• Together everyone achieves more. Let’s use the Comm-DOTS approach to

STOP TB

Main Point

• We need a multi-disciplinary and multi-sectoral approach to DOTS.

???

Our choice

• Comm-DOTS

• DOTS-Comm

• DOTS ++ Comm

OR

………………………………….DOTS Alone

How Can Communication And Social Mobilization Help the DOTS Strategy? An Outcome Map To Strengthen...

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