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ACS Outcome Mapfor TBControl

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Information about ACS Outcome Mapfor TBControl
Education

Published on January 7, 2008

Author: lusi

Source: authorstream.com

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How Can Communication And Social Mobilization Help the DOTS Strategy? :  How Can Communication And Social Mobilization Help the DOTS Strategy? An Outcome Map To Strengthen DOTS Strategy To STOP TB © Johns Hopkins University Center for Communication Programs HCP STOP TB Team Contact: Benjamin V. Lozare blozare@jhuccp.org Slide2:  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 Slide3:  Advocacy Gov’t makes TB control high priority Gov’t provides quality DOTS services Gov’t ensures adequate drug supply # Cases drop long term 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? Providers detect potential cases and diagnose correctly Providers ensure correct treatment regimen STOP TB Monitoring Slide4:  Advocacy Gov’t makes TB control high priority Gov’t provides quality DOTS services Providers detect potential cases and diagnose correctly Gov’t ensures adequate drug supply Providers ensure correct treatment regimen # Cases drop long term Key Challenges in the DOTS Strategy Weak Weak STOP TB Monitoring Slide5:  Advocacy Gov’t makes TB control high priority Gov’t provides quality DOTS services Providers detect potential cases and diagnose correctly Gov’t ensures adequate drug supply Providers ensure correct treatment regimen # Cases drop long term Key Challenges in the DOTS Strategy Weak Weak Literature suggests lots of room for improvement Weakness is strategic as it dampens overall effort STOP TB Monitoring Slide6:  Advocacy Gov’t makes TB control high priority Gov’t provides quality DOTS services Providers detect potential cases and diagnose correctly Gov’t ensures adequate drug supply Providers ensure correct treatment regimen # Cases drop long term Key Challenges in the DOTS Strategy Weak Weak Only 42% cases detected worldwide against 70% target Weakness is strategic as it dampens success in treatment! STOP TB Monitoring Slide7:  Advocacy Gov’t makes TB control high priority Gov’t provides quality DOTS services Gov’t ensures adequate drug supply # Cases drop long term More Challenges in the DOTS Strategy Weak Weak Close to target! Could improve Could improve Providers detect potential cases and diagnose correctly Providers ensure correct treatment regimen STOP TB Monitoring Slide8:  Advocacy Gov’t makes TB control high priority Gov’t provides quality DOTS services Gov’t ensures adequate drug supply # Cases drop long term More Challenges in the DOTS Strategy Weak Weak Close to target! Could improve Could improve Providers detect potential cases and diagnose correctly Providers ensure correct treatment regimen Literature suggests lots of room for improvement STOP TB Monitoring Slide9:  Advocacy Gov’t makes TB control high priority Gov’t provides quality DOTS services Gov’t ensures adequate drug supply # Cases drop long term More Challenges in the DOTS Strategy Weak Weak Close to target Could improve Could improve Providers detect potential cases and diagnose correctly Providers ensure correct treatment regimen 81% cure against 85% target! Growing concerns for MDR TB and lower quality of services as program expands STOP TB Monitoring Slide10:  Advocacy Gov’t makes TB control high priority Gov’t provides quality DOTS services Gov’t ensures adequate drug supply Providers, community and households team up to encourage correct treatment regimen # Cases drop long term 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 Slide11:  Advocacy Communication Gov’t makes TB control high priority Gov’t provides quality DOTS services Gov’t, community, households team up to eliminate TB stigma Gov’t ensures adequate drug supply Providers, community and households team up to encourage correct treatment regimen # Cases drop long term Social Mobilization The 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 ++ means plus communication and social mobilization STOP TB Monitoring Slide12:  More Effecitve Advocacy Communication Gov’t makes TB control high priority People with symptoms seek health care Gov’t provides quality DOTS services Gov’t, community, households team up to eliminate TB stigma Gov’t ensures adequate drug supply Providers, community and people team up to encourage correct treatment regimen # Cases drop long term 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 Slide13:  More Effective Advocacy More Effective Communication Gov’t makes TB control high priority Community works with Gov’t ,and households to eliminate TB in the community People with symptoms seek health care Gov’t provides quality DOTS services Gov’t, community, households team up to eliminate TB stigma Gov’t ensures adequate drug supply Providers, community and people team up to encourage correct treatment regimen # Cases drop long term Gov’t, community and households integrate into culture appropriate health values and practices Social Mobilization Households learn about TB symptoms, transmission and treatment # of TB free communities increase Possible Contributions of Social Mobilization To Desired Outcomes to Community allocates resources and nurtures appropriate environment to eliminate TB in community Providers, community and people team up to detect potential cases and diagnose correctly STOP TB STOP TB Monitoring Slide14:  More Effective Advocacy More Effective Communication Gov’t makes TB control high priority Community works with Gov’t , households to eliminate TB in the community People with symptoms seek health care Gov’t provides quality DOTS services Gov’t, community, households team up to eliminate TB stigma Gov’t ensures adequate drug supply Providers, community and people team up to encourage correct treatment regimen # Cases drop long term Gov’t, community and households integrate into culture appropriate health values and practices Social Mobilization Households learn about TB symptoms, transmission and treatment # of TB free communities increase What is a TB Free Community? Community allocates resources and nurtures appropriate environment to eliminate TB in community Providers, community and people team up to detect potential cases and diagnose correctly No active untreated cases of TB detected the last 3 years STOP TB Monitoring Slide15:  More Effective Advocacy More Effective Communication Gov’t makes TB control high priority Community works with Gov’t , households to eliminate TB in the community People with symptoms seek health care Gov’t provides quality DOTS services Gov’t, community, households team up to eliminate TB stigma Gov’t ensures adequate drug supply Providers, community and people team up to encourage correct treatment regimen # Cases drop long term Gov’t, community and households integrate into culture appropriate health values and practices Social Mobilization Households learn about TB symptoms, transmission and treatment # of TB free communities increase Other Types of Communities To Compare With TB Free Communities Community allocates resources and nurtures appropriate environment to eliminate TB in community Providers, community and people team up to detect potential cases and diagnose correctly Communities with DOTS coverage No DOTS Coverage but with low prevalence of TB No DOTS Coverage but with high prevalence of TB Status unknown Vs TB Free communities 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 Slide16:  An example of data presented in a color coded map Slide17:  More Effective Advocacy More Effective Communication Gov’t makes TB control high priority Community works with Gov’t , households to eliminate TB in the community People with symptoms seek health care Gov’t provides quality DOTS services Gov’t, community, households team up to eliminate TB stigma Gov’t ensures adequate drug supply Providers, community and people team up to encourage correct treatment regimen # Cases drop long term Gov’t, community and households integrate into culture appropriate health values and practices Social Mobilization Households learn about TB symptoms, transmission and treatment # of TB free communities increase Why use the concept of TB Free Community? Community allocates resources and nurtures appropriate environment to eliminate TB in community Providers, community and people team up to detect potential cases and diagnose correctly 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. STOP TB Slide18:  More Effective Advocacy More Effective Communication Gov’t makes TB control high priority Community works with Gov’t , households to eliminate TB in the community People with symptoms seek health care Gov’t provides quality DOTS services Gov’t, community, households team up to eliminate TB stigma Gov’t ensures adequate drug supply Providers, community and people team up to encourage correct treatment regimen # Cases drop long term Gov’t, community and households integrate into culture appropriate health values and practices Social Mobilization Households learn about TB symptoms, transmission and treatment # of TB free communities increase Some additional indicators to consider Note: There should be no conflict with continued use of current indicators like # cases per 100,000 to provide other views of overall macro picture Community allocates resources and nurtures appropriate environment to eliminate TB in community Providers, community and people team up to detect potential cases and diagnose correctly STOP TB # of communities with DOTS coverage increase # of communities of unknown status decrease Slide19:  Advocacy Communication Gov’t makes TB control high priority Community works with Gov’t , households to eliminate TB in the community People with symptoms seek health care Gov’t provides quality DOTS services Gov’t, community, households team up to eliminate TB stigma Gov’t ensures adequate drug supply Providers, community and people team up to encourage correct treatment regimen # Cases drop long term Gov’t, community and households integrate into culture appropriate health values and practices Social Mobilization Households learn about TB symptoms, transmission and treatment # of TB free communities increase An Outcome Map for DOTS++ Strategy to Community allocates resources and nurtures appropriate environment to eliminate TB in community Providers, community and people team up to detect potential cases and diagnose correctly STOP TB STOP TB Monitoring Slide20:  More Effective Advocacy More Effective Communication Gov’t makes TB control high priority Community works with Gov’t , households to eliminate TB in the community People with symptoms seek health care Gov’t provides quality DOTS services Gov’t, community, households team up to eliminate TB stigma Gov’t enlsures adequate drug supply Providers, community and people team up to encourage correct treatment regimen # Cases drop long term Gov’t, community and households integrate into culture appropriate health values and practices Social Mobilization Households learn about TB symptoms, transmission and treatment # of TB free communities increase The Vietnam Case Study Community allocates resources and nurtures appropriate environment to eliminate TB in community Providers, community and people team up to detect potential cases and diagnose correctly STOP TB Monitoring 80% know symptoms 65% know transmission 80 % 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 Slide21:  Advocacy Communication Gov’t makes TB control high priority Community works with Gov’t , households to eliminate TB in the community People with symptoms seek health care Gov’t provides quality DOTS services Gov’t, community, households team up to eliminate TB stigma Gov’t ensures adequate drug supply Providers, community and people team up to encourage correct treatment regimen # Cases drop long term Gov’t, community and households integrate into culture appropriate health values and practices Social Mobilization Households learn about TB symptoms, transmission and treatment # of TB free communities increase 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. Community allocates resources and nurtures appropriate environment to eliminate TB in community Providers, community and people team up to detect potential cases and diagnose correctly STOP TB STOP TB Monitoring Click here to see illustrative activities Slide22:  Advocacy Communication Gov’t makes TB control high priority Community works with Gov’t , households to eliminate TB in the community People with symptoms seek health care Gov’t provides quality DOTS services Gov’t, community, households team up to eliminate TB stigma Gov’t ensures adequate drug supply Providers, community and people team up to encourage correct treatment regimen # Cases drop long term Gov’t, community and households integrate into culture appropriate health values and practices Social Mobilization Households learn about TB symptoms, transmission and treatment # of TB free communities increase Illustrative indicators for people’s knowledge Community allocates resources and nurtures appropriate environment to eliminate TB in community Providers, community and people team up to detect potential cases and diagnose correctly STOP TB 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 Slide23:  Advocacy Communication Gov’t makes TB control high priority Community works with Gov’t , households to eliminate TB in the community People with symptoms seek health care Gov’t provides quality DOTS services Gov’t, community, households team up to eliminate TB stigma Gov’t ensures adequate drug supply Providers, community and people team up to encourage correct treatment regimen # Cases drop long term Gov’t, community and households integrate into culture appropriate health values and practices Social Mobilization Households learn about TB symptoms, transmission and treatment # of TB free communities increase Illustrative indicators for people’s knowledge Community allocates resources and nurtures appropriate environment to eliminate TB in community Providers, community and people team up to detect potential cases and diagnose correctly 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 Note: Click on text again to go return to framework Slide24:  Advocacy Communication Gov’t makes TB control high priority Community works with Gov’t , households to eliminate TB in the community People with symptoms seek health care Gov’t provides quality DOTS services Gov’t, community, households team up to eliminate TB stigma Gov’t ensures adequate drug supply Providers, community and people team up to encourage correct treatment regimen # Cases drop long term Gov’t, community and households integrate into culture appropriate health values and practices Social Mobilization Households learn about TB symptoms, transmission and treatment # of TB free communities increase Illustrative activities to achieve an outcome Community allocates resources and nurtures appropriate environment to eliminate TB in community Providers, community and people team up to detect potential cases and diagnose correctly 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. Note: Click on text again to go return to framework Slide25:  Advocacy Communication Gov’t makes TB control high priority Community works with Gov’t , households to eliminate TB in the community People with symptoms seek health care Gov’t provides quality DOTS services Gov’t, community, households team up to eliminate TB stigma Gov’t ensures adequate drug supply Providers, community and people team up to encourage correct treatment regimen # Cases drop long term Gov’t, community and households integrate into culture appropriate health values and practices Social Mobilization Households learn about TB symptoms, transmission and treatment # of TB free communities increase Illustrative indicators of TB stigma reduction Community allocates resources and nurtures appropriate environment to eliminate TB in community Providers, community and people team up to detect potential cases and diagnose correctly 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 Note: Click on text again to go return to framework Slide26:  Advocacy Communication Gov’t makes TB control high priority Community works with Gov’t , households to eliminate TB in the community People with symptoms seek health care Gov’t provides quality DOTS services Gov’t, community, households team up to eliminate TB stigma Gov’t ensures adequate drug supply Providers, community and people team up to encourage correct treatment regimen # Cases drop long term Gov’t, community and households integrate into culture appropriate health values and practices Social Mobilization Households learn about TB symptoms, transmission and treatment # of TB free communities increase Illustrative indicators of TB stigma reduction Community allocates resources and nurtures appropriate environment to eliminate TB in community Providers, community and people team up to detect potential cases and diagnose correctly 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 Note: Click on text again to go return to framework Slide27:  Advocacy Communication Gov’t makes TB control high priority Community works with Gov’t , households to eliminate TB in the community People with symptoms seek health care Gov’t provides quality DOTS services Gov’t, community, households team up to eliminate TB stigma Gov’t ensures adequate drug supply Providers, community and people team up to encourage correct treatment regimen # Cases drop long term Gov’t, community and households integrate into culture appropriate health values and practices Social Mobilization Households learn about TB symptoms, transmission and treatment # of TB free communities increase Illustrative indicators of TB stigma reduction Community allocates resources and nurtures appropriate environment to eliminate TB in community Providers, community and people team up to detect potential cases and diagnose correctly 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. Note: Click on text again to go return to framework Slide28:  Advocacy Communication Gov’t makes TB control high priority Community works with Gov’t , households to eliminate TB in the community People with symptoms seek health care Gov’t provides quality DOTS services Gov’t, community, households team up to eliminate TB stigma Gov’t ensures adequate drug supply Providers, community and people team up to encourage correct treatment regimen # Cases drop long term Gov’t, community and households integrate into culture appropriate health values and practices Social Mobilization Households learn about TB symptoms, transmission and treatment # of TB free communities increase Illustrative indicators of TB stigma reduction Community allocates resources and nurtures appropriate environment to eliminate TB in community Providers, community and people team up to detect potential cases and diagnose correctly 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 Note: Click on text again to go return to framework Slide29:  Advocacy Communication Gov’t makes TB control high priority Community works with Gov’t , households to eliminate TB in theg community People with symptoms seek health care Gov’t provides quality DOTS services Gov’t, community, households team up to eliminate TB stigma Gov’t ensures adequate drug supply Providers, community and people team up to encourage correct treatment regimen # Cases drop long term Gov’t, community and households integrate into culture appropriate health values and practices Social Mobilization Households learn about TB symptoms, transmission and treatment # of TB free communities increase Illustrative indicators of TB stigma reduction Community allocates resources and nurtures appropriate environment to eliminate TB in community Providers, community and people team up to detect potential cases and diagnose correctly 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. Note: Click on text again to go return to framework Slide30:  Advocacy Communication Gov’t makes TB control high priority Community works with Gov’t , households to eliminate TB in the community People with symptoms seek health care Gov’t provides quality DOTS services Gov’t, community, households team up to eliminate TB stigma Gov’t ensures adequate drug supply Providers, community and people team up to encourage correct treatment regimen # Cases drop long term Gov’t, community and households integrate into culture appropriate health values and practices Social Mobilization Households learn about TB symptoms, transmission and treatment # of TB free communities increase Illustrative indicators of TB stigma reduction Community allocates resources and nurtures appropriate environment to eliminate TB in community Providers, community and people team up to detect potential cases and diagnose correctly STOP TB STOP TB Monitoring This 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. Note: Click on text again to go return to framework Slide31:  Advocacy Communication Gov’t makes TB control high priority Community works with Gov’t , households to eliminate TB in the community People with symptoms seek health care Gov’t provides quality DOTS services Gov’t, community, households team up to eliminate TB stigma Gov’t ensures adequate drug supply Providers, community and people team up to encourage correct treatment regimen # Cases drop long term Gov’t, community and households integrate into culture appropriate health values and practices Social Mobilization Households learn about TB symptoms, transmission and treatment # of TB free communities increase Illustrative activities to achieve an outcome Community allocates resources and nurtures appropriate environment to eliminate TB in community Providers, community and people team up to detect potential cases and diagnose correctly 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. Slide32:  Advocacy Communication Gov’t makes TB control high priority Community works with Gov’t , households to eliminate TB in the community People with symptoms seek health care Gov’t provides quality DOTS services Gov’t, community, households team up to eliminate TB stigma Gov’t ensures adequate drug supply Providers, community and people team up to encourage correct treatment regimen # Cases drop long term Gov’t, community and households integrate into culture appropriate health values and practices Social Mobilization Households learn about TB symptoms, transmission and treatment # of TB free communities increase An Outcome Map for DOTS++ Strategy to Community allocates resources and nurtures appropriate environment to eliminate TB in community Providers, community and people team up to detect potential cases and diagnose correctly STOP TB STOP TB Monitoring Benefits of DOTS++ approach:  Benefits of 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 the overall strategic picture. Provides practical way to plan, monitor and evaluate implementation Suggests a multi-sectoral team approach and helps ensure everyone is on the same page. Together everyone achieves more. Let’s use the DOTS ++ approach to STOP TB

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