What is a TB Free Community?

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Transcript What is a TB Free Community?

‫بسم هللا الرحمن الرحیم‬
ACSM
Advocacy , Communication and Social Mobilization
In Tuberculosis Control
‫حمایت – ارتباطات و بسیج اجتماعی‬
‫درکنترل بیماری سل‬
‫گرد آورندگان ‪:‬‬
‫دکتر بهنام هنرور – متخصص پزشکی اجتماعی و‬
‫هماهنگ کننده سل استان فارس‬
‫مریم فراهانی – کارشناس اداره سل و جذام‬
‫خالصه ای ازوضعیت بیماری سل‬
‫درجهان ‪ -‬منطقه مدیترانه شرقی و ایران‬
Treatment Success Rate %
Situation of TB control in EMR
100
AFG
80
IRQ
SOM SYR
EMR
PAK
LEB
Ideal
Area
TUN
UAE SUD EGY IRN
60
MOR
DJB
YEM
SSA
140
JOR
QTR
OMN
150
KUW
40
20
BAH
0
0
10
20
30
40
50
60
70
Case Detection Rate %
80
90
100
Global TB Control Targets
(2005)
- To detect at least 70% of infectious TB cases
- To treat successfully at least 85% of detected cases
‫میزان بیماریابی سل ریوی اسمیرخلط مثبت و موفقیت درمانی ‪:‬‬
‫(سال ‪)2003‬‬
‫بیماریابی‬
‫درجهان ‪:‬‬
‫درمنطقه مدیترانه شرقی‪:‬‬
‫درایران ‪:‬‬
‫‪%45‬‬
‫‪%34‬‬
‫‪%58‬‬
‫موفقیت درمانی‬
‫‪%82‬‬
‫‪%82‬‬
‫‪%84‬‬
‫‪ 22‬کشور در دنیا به اهداف اختصاص ی مبارزه با سل یعنی‬
‫دستیابی به حداقل ‪ %70‬بیماریابی و ‪ %85‬موفقیت در درمان‬
‫بیماران مبتال به سل ریوی اسمیر خلط مثبت رسیده اند ولی‬
‫از طرف دیگر‪ 22‬کشور در جهان هنوز بار زیادی از این بیماری‬
‫را متحمل میشوند ( قابل ذکر اینکه دو کشور همسایه یعنی‬
‫افغانستان و پاکستان در این گروه قرار دارند) ‪.‬‬
‫کشور جمهوری اسالمی ایران جزء کشورهای با بار متوسط‬
‫سل در منطقه مدیترانه شرقی است‪.‬‬
‫بيست و دو كشور داراي بيشترين باربيماري‬
‫بیماریاب ی س ل ریوی اسمیر خل ط مثب ت‬
‫‪100%‬‬
‫‪70%‬‬
‫‪90%‬‬
‫‪58%‬‬
‫‪80%‬‬
‫‪70%‬‬
‫‪45%‬‬
‫‪60%‬‬
‫‪34%‬‬
‫‪50%‬‬
‫‪40%‬‬
‫‪30%‬‬
‫‪20%‬‬
‫‪10%‬‬
‫‪0%‬‬
‫ایران‬
‫‪EMRO‬‬
‫جهان‬
‫ه دف‬
‫تاسا ل‬
‫‪ 2010‬برای ‪EMRO‬‬
Global TB Control Targets
MDGS (2015)
Goal 6:
Combat HIV/AIDS , Malaria and Other diseases
Target 8:
To have halted by 2015 and begun to reverse the
incidence of Malaria and Other major diseases
Global TB Control Targets
MDGS (2015)
Indicator 23 :
50% Reduction in prevalence and deaths
associated with TB by 2015
Indicator 24 :
Proportion if TB cases detected and cured under
DOTS (100%)
‫اهداف توسعه هزاره و برنامه جهانی مبارزه با سل‬
‫هدف های مبارزه با سل را چنین ترسیم کرده است‪:‬‬
‫جهان تا سال ‪ 2015‬و‬
‫منطقه مدیترانه ای شرقی تا سال ‪2010‬‬
‫به توقف رشد بروزسل و ازآن به بعد کاهش بروزآن‬
‫درسال‬
‫نصف شدن شیوع و مرگ ناش ی از سل و سپس‬
‫یک نفردرهریک‬
‫‪ 2050‬به مرحله حذف ( بروز سل کمتر از‬
‫میلیون نفر) بایستی نائل گردد‪.‬‬
‫با توجه به ارقام ذکرشده آیا تنها با تکیه برروش های فعلی میتوان به‬
‫اهداف توسعه هزاره تا سال ‪ 2015‬دست یافت؟‬
‫و‬
‫آیا بدون مداخالت جدید و اصالحی قادرخواهیم بود به رویای تا سال‬
‫حذف سل )‪ 2050(TB Elimination‬تحقق دهیم؟‬
‫امروزه بسیج اجتماعی و ارتباطاتی در سراسر دنیا و همچنین در‬
‫منطقه مدیترانه شرقی به عنوان یک ابزارپشتیبانی قوی مطرح می‬
‫باشد و شواهد زیادی دال بردردر بسیاری ازکشورهای دنیا‬
‫تاثیر و کارآیی همچون ویتنام ‪ -‬اندونزی – پرو – ‪ACSM‬‬
‫بنگالدش و ‪ ...‬وجود دارد‪ .‬لذا ما احتیاج به کمک ازجوامع خودمان‬
‫به برنامه ها و استراتژیهایی که فعالیت ‪ ACSM‬داریم و نیاز‬
‫های به عنوان هسته و جزء اصلی آنها باشند‪.‬‬
‫براین اساس سازمان جهانی بهداشت ‪ 7‬استراتژی‬
‫را درپیش روی خود قرارداده است ‪:‬‬
‫‪ -1‬توسعه ‪DOTS‬‬
‫(با تاکید برتوانمند سازی آزمایشگاه های سل – دخالت بیشتربخش های خصوص ی دربرنامه مبارزه با سل –‬
‫سل درکودکان و زدودن فقر)‬
‫‪ : DOTS - PLUS -2‬مدیریت بهتر بیماران مبتال به سل مقاوم به دارو‬
‫‪TB/HIV-3‬‬
‫‪ – 4‬کشف روشهای تشخیص ی جدید درسل‬
‫‪ -5‬کشف داروهای جدید دردرمان سل‬
‫‪ -6‬کشف واکسن های جدید برعلیه سل‬
‫‪ -7‬حمایت – ارتباطات و بسیج اجتماعی )‪(ACSM‬‬
‫که دراین زمینه کارگروههای مربوطه را تشکیل داده و برآوردهای بودجه ای را بران اساس قرارداده است‪.‬‬
will, the funds and the 
actions together
With the
we can stop TB
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
[email protected]
Advocacy
Gov’t makes TB
control high
priority
Gov’t
provides
quality DOTS
services
Gov’t
ensures
adequate
drug supply
Providers
detect
potential
cases and
diagnose
correctly
The DOTS Strategy to
STOP
TB
Monitoring
STOP
TB
Providers
ensure correct
treatment
regimen
# Cases
drop long
term
Advocacy
Gov’t makes TB
control high
priority
Gov’t
provides
quality DOTS
services
Monitoring
Gov’t
ensures
adequate
drug supply
Providers
detect
potential
cases and
diagnose
correctly
STOP
TB
Providers
ensure
correct
treatment
regimen
# Cases
drop long
term
Very well in
some countries,
mixed in others.
World wide # of
cases are
growing or
dropping?
How well is the DOTS Strategy working?
Is this due to
better
detection?
Advocacy
Gov’t makes TB
control high
priority
Gov’t
provides
quality DOTS
services
Gov’t
ensures
adequate
drug supply
STOP
TB
Monitoring
Weak
Weak
Providers
detect
potential
cases and
diagnose
correctly
Key Challenges in the DOTS Strategy
Providers
ensure
correct
treatment
regimen
# Cases
drop long
term
Advocacy
Gov’t makes TB
control high
priority
Gov’t
provides
quality DOTS
services
Gov’t
ensures
adequate
drug supply
STOP
TB
Monitoring
Weak
Literature
suggests lots of
room for
improvement
Weak
Providers
detect
potential
cases and
diagnose
correctly
Weakness is
strategic as it
dampens
overall effort
Key Challenges in the DOTS Strategy
Providers
ensure
correct
treatment
regimen
# Cases
drop long
term
Advocacy
Gov’t makes TB
control high
priority
Gov’t
provides
quality DOTS
services
Weak
Weak
Monitoring
Gov’t
ensures
adequate
drug supply
Providers
detect
potential
cases and
diagnose
correctly
Providers
ensure
correct
treatment
regimen
Only 42% cases detected
worldwide against 70%
target
Weakness is strategic as
it dampens success in
treatment!
Key Challenges in the DOTS Strategy
STOP
TB
# Cases
drop long
term
Could
improve
Advocacy
Gov’t makes TB
control high
priority
Gov’t
provides
quality DOTS
services
Weak
Weak
Could
improve
Gov’t
ensures
adequate
drug supply
STOP
TB
Monitoring
Providers
detect
potential
cases and
diagnose
correctly
Close to
target!
More Challenges in the DOTS Strategy
Providers
ensure
correct
treatment
regimen
# Cases
drop long
term
Could
improve
Advocacy
Gov’t makes TB
control high
priority
Literature suggests
lots of room for
improvement
Gov’t
provides
quality DOTS
services
Weak
Weak
Monitoring
Gov’t
ensures
adequate
drug supply
Providers
detect
potential
cases and
diagnose
correctly
Close to
target!
More Challenges in the DOTS Strategy
Could
improve
Providers
ensure
correct
treatment
regimen
STOP
TB
# Cases
drop long
term
Could
improve
Advocacy
Gov’t makes TB
control high
priority
Gov’t
provides
quality DOTS
services
Weak
Weak
81% cure against 85%
target!
Growing concerns for MDR
TB and lower quality of
services as program
expands
Could
improve
Gov’t
ensures
adequate
drug supply
STOP
TB
Monitoring
Providers
detect
potential
cases and
diagnose
correctly
Close to
target
More Challenges in the DOTS Strategy
Providers
ensure
correct
treatment
regimen
# Cases
drop long
term
Advocacy
Gov’t makes TB
control high
priority
Gov’t
ensures
adequate
drug supply
Gov’t
provides
quality DOTS
services
STOP
TB
Monitoring
Providers,
community and
households
team up to
detect potential
cases and
diagnose
correctly
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?
# Cases
drop long
term
Advocacy
Gov’t makes TB
control high
priority
Gov’t
ensures
adequate
drug supply
Gov’t
provides
quality DOTS
services
STOP
TB
Monitoring
Communication
Gov’t,
community,
households
team up to
eliminate TB
stigma
Providers,
community and
households
team up to
detect potential
cases and
diagnose
correctly
Providers,
community and
households team
up to encourage
correct
treatment
regimen
# Cases
drop long
term
Social
Mobilization
The DOTS++ Strategy
++ means plus communication and
social mobilization
Would adding communication and social
mobilization help produce better outcomes?
More Effecitve
Advocacy
Gov’t makes TB
control high
priority
Gov’t
ensures
adequate
drug supply
Gov’t
provides
quality DOTS
services
STOP
TB
Monitoring
Communication
Households
learn about
TB
symptoms,
transmission
and treatment
Gov’t,
community,
households
team up to
eliminate TB
stigma
People with
symptoms
seek health
care
Providers,
community
and people
team up to
detect
potential
cases and
diagnose
correctly
More
Effective
Social
Mobilization
Possible Communication Contributions To
Desired Outcomes to STOP
TB
Providers,
community and
people team up
to encourage
correct
treatment
regimen
# Cases
drop long
term
More Effective
Advocacy
Gov’t makes TB
control high
priority
Gov’t
ensures
adequate
drug supply
Gov’t
provides
quality DOTS
services
STOP
TB
Monitoring
More Effective
Communication
Households
learn about
TB
symptoms,
transmission
and treatment
Gov’t,
community,
households
team up to
eliminate TB
stigma
People with
symptoms
seek health
care
Social
Mobilization
Community works with
Gov’t ,and households to
eliminate TB in the
community
Providers,
community
and people
team up to
detect
potential
cases and
diagnose
correctly
Community allocates
resources and nurtures
appropriate environment
to eliminate TB in
community
Providers,
community and
people team up
to encourage
correct
treatment
regimen
Gov’t,
community and
households
integrate into
culture
appropriate
health values
and practices
Possible Contributions of Social Mobilization
To Desired Outcomes to STOP
TB
# Cases
drop long
term
# of TB free
communities
increase
More Effective
Advocacy
More Effective
Communication
Gov’t makes TB
control high
priority
Households
learn about
TB
symptoms,
transmission
and treatment
Gov’t
provides
quality DOTS
services
Gov’t,
community,
households
team up to
eliminate TB
stigma
People with
symptoms
seek health
care
Monitoring
Gov’t
ensures
adequate
drug supply
Providers,
community
and people
team up to
detect
potential
cases and
diagnose
correctly
Providers,
community and
people team up
to encourage
correct
treatment
regimen
No active untreated
cases of TB detected the
Gov’t,
last 3 years
community and
Social
Mobilization
Community works with
Gov’t , households to
eliminate TB in the
community
Community allocates
resources and nurtures
appropriate environment
to eliminate TB in
community
What is a TB Free Community?
households
integrate into
culture
appropriate
health values
and practices
STOP
TB
# Cases
drop long
term
# of TB free
communities
increase
More Effective
Advocacy
Gov’t makes TB
control high
priority
Gov’t
provides
quality DOTS
services
Communities with DOTS coverage
Gov’t
ensures
adequate
drug supply
No DOTS Coverage but with low prevalence of TB
Providers,
STOP
TB
Gov’t, with high community
No DOTS Coverage but
prevalence
of TB
Providers,
More Effective
Communication
Households
learn about
TB
symptoms,
transmission
and treatment
Status unknown
Vs
community,
households
team up to
eliminate TB
stigma
People with
TB Free communities
symptoms
seek health
care
Social
Mobilization
and people
team up to
detect
potential
cases and
diagnose
correctly
community and
people team up
to encourage
correct
treatment
regimen
Gov’t,
community and
households
integrate into
culture
appropriate
health values
and practices
Every country can present this geographic based
Community works with
allocates
approach through a Community
color coded
TB Status Map.
Gov’t , households to
resources and nurtures
eliminate
in the representation
appropriatecould
environment
This TB
visual
be of great value
community
to eliminate TB in
in planning and monitoring
community interventions.
Other Types of Communities To Compare
With TB Free Communities
# Cases
drop long
term
# of TB free
communities
increase
An example of data presented in a color coded map
Because TB transmission is by proximity, it is
logical to use a geographic based strategy.
More Effective
Advocacy
makes TB
Gov’t
Gov’t
TBGov’t
is
not
evenly
distributed.
We
need
to
allocate
control high
provides
ensures
priority resources more
quality
DOTS
scarce
effectively
and adequate
efficiently.
services
drug supply
We need to motivate communities with a
Providers,
Gov’t,
community goal.
community
More Effective
Communication
Households
learn about
TB
symptoms,
transmission
and treatment
community,
households
team up to
eliminate TB
stigma
and people
team up to
detect
potential
cases and
diagnose
correctly
Providers,
community and
people team up
to encourage
correct
treatment
regimen
Designation of a TB free community gives a clear
sense of victory. Highly motivational.
Easier to understand than number of cases per
People with
100,000 which is notsymptoms
meaningful at community
seek health
level.
Gov’t,
care
Social
Mobilization
community and
households
integrate into
culture
appropriate
health values
and practices
We can use the number and % of TB free
Community works with
Community allocates
communities and other
types of communities for
Gov’t , households to
resources and nurtures
eliminate
TB in the
appropriate environment
tracking
and benchmarking
purposes.
community
to eliminate TB in
community
TB-free communities can serve as model for high
TB prevalence communities.
Why use the concept of TB Free Community?
STOP
TB
# Cases
drop long
term
# of TB free
communities
increase
Because TB transmission is by proximity, it is
logical to use a geographic based strategy.
More Effective
Advocacy
makes TB
Gov’t
Gov’t
TBGov’t
is
not
evenly
distributed.
We
need
to
allocate
control high
provides
ensures
priority resources more
quality
DOTS
scarce
effectively
and adequate
efficiently.
services
drug supply
We need to motivate communities with a
Providers,
Gov’t,
community goal.
community
More Effective
Communication
Households
learn about
TB
symptoms,
transmission
and treatment
community,
households
team up to
eliminate TB
stigma
and people
team up to
detect
potential
cases and
diagnose
correctly
Providers,
community and
people team up
to encourage
correct
treatment
regimen
Designation of a TB free community gives a clear
sense of victory. Highly motivational.
Easier to understand than number of cases per
People with
100,000 which is notsymptoms
meaningful at community
seek health
level.
Gov’t,
care
Social
Mobilization
community and
households
integrate into
culture
appropriate
health values
and practices
We can use the number and % of TB free
Community works with
Community allocates
communities and other
types of communities for
Gov’t , households to
resources and nurtures
eliminate
TB in the
appropriate environment
tracking
and benchmarking
purposes.
community
to eliminate TB in
community
TB-free communities can serve as model for high
TB prevalence communities.
Why use the concept of TB Free Community?
STOP
TB
# Cases
drop long
term
# of TB free
communities
increase
More Effective
Advocacy
More Effective
Communication
Gov’t makes TB
control high
priority
Households
learn about
TB
symptoms,
transmission
and treatment
Gov’t
provides
quality DOTS
services
Gov’t,
community,
households
team up to
eliminate TB
stigma
People with
symptoms
seek health
care
Social
Mobilization
Community works with
Gov’t , households to
eliminate TB in the
community
Gov’t
ensures
adequate
drug supply
Providers,
community
and people
team up to
detect
potential
cases and
diagnose
correctly
Community allocates
resources and nurtures
appropriate environment
to eliminate TB in
community
Providers,
community and
people team up
to encourage
correct
treatment
regimen
Gov’t,
community and
households
integrate into
culture
appropriate
health values
and practices
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
STOP
TB
# Cases
drop long
term
# of TB free
communities
increase
# of
communities
with DOTS
coverage
increase
# of
communities
of unknown
status
decrease
Advocacy
Gov’t makes TB
control high
priority
Gov’t
ensures
adequate
drug supply
Gov’t
provides
quality DOTS
services
STOP
TB
Monitoring
Communication
Households
learn about
TB
symptoms,
transmission
and treatment
Gov’t,
community,
households
team up to
eliminate TB
stigma
People with
symptoms
seek health
care
Social
Mobilization
Community works with
Gov’t , households to
eliminate TB in the
community
Providers,
community
and people
team up to
detect
potential
cases and
diagnose
correctly
Gov’t,
community and
households
integrate into
culture
appropriate
health values
and practices
Community allocates
resources and nurtures
appropriate environment
to eliminate TB in
community
An Outcome Map for DOTS++ Strategy to
Providers,
community and
people team up
to encourage
correct
treatment
regimen
STOP
TB
# Cases
drop long
term
# of TB free
communities
increase
Wide
More range
Effective
Advocacy
of
advocacy
activities
conducted
Gov’t
Four program
Gov’t
Gov’t
achieves
levels of TB control
provides
enlsures
almost
100
quality
DOTS
adequate
activity
services
drug
supply
coverage in Quality
STOP
ensured
Monitoring
TB
1998
through effective
Gov’t declated
Gov’t makes TB
TB high
controlpriority
high
priority
in 1995
forms
More All
Effective
Communication
of
media used
to educate
people
Gov’t,
community,
households
symptomsteam up to
eliminate TB
transmission
stigma
Households
learn about
TB80% know
symptoms,
65% know
transmission
80treatment
% know
and
TB is
curable
Providers,
monitoring
community
people
80%and
team up to
cases
detect
potential
detected
cases and
diagnose
People
withknow that
100%
correctly
symptoms
detected
case of TB
seek
health
care
should seek medical
care
Social
High level
Mobilization
of
community
mobilization
Community
works with
Partnerships
Gov’t , households to
created
at all
eliminate
TB in the
community
levels
Community allocates
resources and nurtures
Peer education
appropriate environment
toused
eliminate
TB in
fully
community
recovered
patients
The Vietnam Case Study
Providers,
93% completed
community
and
people
team up
# Cases
treatment
to encourage
drop long
correct
89% cured term
treatment
regimen
Gov’t,
community and
households
integrate into
culture
appropriate
health values
and practices
# of TB free
communities
increase
Advocacy
Gov’t makes TB
control high
priority
Gov’t
ensures
adequate
drug supply
Gov’t
provides
quality DOTS
services
STOP
TB
Monitoring
Communication
Households
learn about
TB
symptoms,
transmission
and treatment
Gov’t,
community,
households
team up to
eliminate TB
stigma
People with
symptoms
seek health
care
Social
Mobilization
Community works with
Gov’t , households to
eliminate TB in the
community
Providers,
community
and people
team up to
detect
potential
cases and
diagnose
correctly
Community allocates
resources and nurtures
appropriate environment
to eliminate TB in
community
Illustrative Indicators of Outcomes
Providers,
community and
people team up
to encourage
correct
treatment
regimen
Gov’t,
community and
households
integrate into
culture
appropriate
health values
and practices
STOP
TB
Note: Click on colored text to see illustrative indicators. When
finished, click on button on the right to see illustrative activities.
# Cases
drop long
term
# of TB free
communities
increase
Click here to see
illustrative activities
Advocacy
Communication
Social
Mobilization
Gov’t makes TB
control high
priority
Households
learn about
TB
symptoms,
transmission
and treatment
Community works with
Gov’t , households to
eliminate TB in the
community
Clear
TB control policy Gov’t
supported by
Gov’t
provides
rhetoric
quality DOTS
services
actions
Monitoring
ensures
adequate
drug supply
STOP
TB
resources
Gov’t,
Providers,
Providers,
community,
and
communitythat community
%households
of people who knows
TB
control
is # Cases
people team up
and people
to
a team
highuppriority
of the
to encourage
drop long
teamcountry/community
up to
eliminate TB
correct
term
detect
stigma
treatment
potential
Strong collaboration
between TB and
regimen
cases and
HIV/AIDS
programs
and
those
of other
People with
diagnose
# of TB free
symptoms
correctly
communicable
diseases
communities
seek health
increase
Gov’t,
care
community and
households
integrate into
Community allocates
culture
resources and nurtures
appropriate
appropriate environment
health values
to eliminate TB in
and practices
community
Illustrative indicators for people’s knowledge
Note: Click on text again to go return to framework
STOP
TB
Advocacy
Gov’t makes TB
control high
priority
% who
know about TB symptoms
Gov’t
Gov’t
%
provides
who
qualityknow
DOTS
services
how TB
ensures
is adequate
transmitted
drug supply
% who know that
TB is curable
Monitoring
STOP
TB
%Gov’t,
who know that TB treatment is free
Communication
Households
learn about
TB
symptoms,
transmission
and treatment
community,
%households
who know
up to
if team
needed
eliminate TB
stigma
People with
symptoms
seek health
care
Social
Mobilization
Community works with
Gov’t , households to
eliminate TB in the
community
Providers,
Providers,
community and
community
where
to
secure
TB treatment# Cases
people team up
and people
to encourage
drop long
team up to
correct
term
detect
treatment
potential
regimen
cases and
diagnose
# of TB free
correctly
communities
Gov’t,
community and
households
integrate into
culture
appropriate
health values
and practices
Community allocates
resources and nurtures
appropriate environment
to eliminate TB in
community
Illustrative indicators for people’s knowledge
Note: Click on text again to go return to framework
STOP
TB
increase
Advocacy
Communication
Gov’t makes TB
control high
priority
Households
learn about
TB
symptoms,
transmission
and treatment
% who understand that people with
TB symptoms
Gov’t should seek health
ensures
care
Gov’t
provides
adequate
quality DOTS
drug supply
services
% who believe
that
Monitoring
people with TB
STOP
symptoms should seek health care
TB
Gov’t,
community,
households
team up to
eliminate TB
stigma
People with
symptoms
seek health
care
Social
Mobilization
Community works with
Gov’t , households to
eliminate TB in the
community
% who
will encourage
Providers,people they
Providers,
community and
knowcommunity
with TB symptoms
to seek
people team up
# Cases
and people
health
care.
to encourage
drop long
team
up to
correct
term
detect
treatment
% ofpotential
TB cases who come for
regimen
cases and
diagnosis
and
treatment
promptly.
diagnose
# of TB free
correctly
communities
Mean time between occurrence of
increase
symptoms andGov’t,
visit to health facility.
Community allocates
resources and nurtures
appropriate environment
to eliminate TB in
community
Illustrative activities to achieve an outcome
Note: Click on text again to go return to framework
community and
households
integrate into
culture
appropriate
health values
and practices
STOP
TB
Advocacy
Gov’t makes TB
control high
priority
% or # of communities where Gov’t,
householdsGov’t
and communities plan
Gov’t
ensures
and work together
to eliminate TB
provides
adequate
quality DOTS stigma
drug supply
services
STOP
Communication
Social
Mobilization
Households
learn about
TB
symptoms,
transmission
and treatment
Community works with
Gov’t , households to
eliminate TB in the
community
Gov’t,
community,
households
team up to
eliminate TB
stigma
%Monitoring
or # of communities with support
TB
groups for TB patients and their
Providers,
Providers,
families.
community and
community
and people
people team up
# Cases
% who
that
TB treatment
to encourage
drop long
teambelieve
up to
correctto all in need.
term
detect
should
be provided
treatment
potential
regimen
cases and
%
who
look
at
TB
patients as people
People with
diagnose
# of TB free
who correctly
need help rather than avoided
symptoms
communities
seek health
increase
Gov’t,
care
community and
households
integrate into
Community allocates
culture
resources and nurtures
appropriate
appropriate environment
health values
to eliminate TB in
and practices
community
Illustrative indicators of TB stigma reduction
Note: Click on text again to go return to framework
STOP
TB
% or # of communities where Gov’t,
Gov’t makes TB
households
and communities
jointly
Advocacy
control high
conduct activitiespriority
to ensure prompt
detection of potential cases and to
make correct diagnosis.
% of TB control Households
clinical staff who
have correct knowledge
learn about and skills to
Communication
detect potential TB
cases and to
symptoms,
diagnose correctly.
transmission
Social
Mobilization
Community works with
Gov’t , households to
eliminate TB in the
community
STOP
TB
Monitoring
Gov’t,
community,
households
team up to
eliminate TB
stigma
and treatment
% of TB control clinical staff who
have adequate tools and resources
for diagnosis and use them
Gov’t
ensures
adequate
drug supply
Gov’t
provides
quality DOTS
services
People with
symptoms
seek health
care
Providers,
community
and people
team up to
detect
potential
cases and
diagnose
correctly
Community allocates
resources and nurtures
appropriate environment
to eliminate TB in
community
Illustrative indicators of TB stigma reduction
Note: Click on text again to go return to framework
Providers,
community and
people team up
to encourage
correct
treatment
regimen
Gov’t,
community and
households
integrate into
culture
appropriate
health values
and practices
STOP
TB
# Cases
drop long
term
# of TB free
communities
increase
Advocacy
Communication
% or
# of communities where
Gov’t,
Gov’t
Gov’t makes TB
provides
control high and communities
households
quality DOTS
priority
conduct joint activities to ensure
services
correct treatment regimen both on
the part of patients and TB control
Gov’t,
providers.
community,
Households
households
learn about
up have
to
% TB
of TB control providersteam
who
eliminate
TB
symptoms,
correct
knowledge and skills
to
stigma
transmission
administer
and treatmenttreatment regimen.
People with
% of families with TB cases
who
symptoms
seek health
understand the consequences
of not
care
Gov’t
ensures
adequate
drug supply
Providers,
community
and people
team up to
detect
potential
cases and
diagnose
correctly
observing treatment regimen.
Social
Mobilization
STOP
TB
Monitoring
% of families
with TB cases
who allocates
Community
works with
Community
Gov’t
, households
to
resources and nurtures
encourage
patients
to observe
eliminate TB in the
appropriate environment
correct
community treatment regimen.
to eliminate TB in
community
Illustrative indicators of TB stigma reduction
Note: Click on text again to go return to framework
Providers,
community and
people team up
to encourage
correct
treatment
regimen
Gov’t,
community and
households
integrate into
culture
appropriate
health values
and practices
STOP
TB
# Cases
drop long
term
# of TB free
communities
increase
% or # of communities which
Gov’t makes TB
allocate local resources
to make the
Advocacy
control high
community TBpriority
free
% or # of communities that
participate actively in the national
effort to control
TB.
Households
Community works with
Gov’t , households to
eliminate TB in theg
community
STOP
TB
Monitoring
Gov’t,
community,
households
learn about
Communication
% or # of communities
that have TB team up to
TB
TB
symptoms,
free partnerships
that collaborate eliminate
stigma
transmission
with HIV/AIDSand
programs
and
those
treatment
of other communicable diseases. People with
symptoms
seek health
care
Social
Mobilization
Gov’t
ensures
adequate
drug supply
Gov’t
provides
quality DOTS
services
Providers,
community
and people
team up to
detect
potential
cases and
diagnose
correctly
Community allocates
resources and nurtures
appropriate environment
to eliminate TB in
community
Illustrative indicators of TB stigma reduction
Note: Click on text again to go return to framework
Providers,
community and
people team up
to encourage
correct
treatment
regimen
Gov’t,
community and
households
integrate into
culture
appropriate
health values
and practices
STOP
TB
# Cases
drop long
term
# of TB free
communities
increase
Advocacy
Communication
Gov’t makes TB
control high
priority
This requires development of a
comprehensive instrument to
Gov’t,
measure people’s values, beliefs,
community,
Households
practices,
resource allocation
households
learn about
to
related
andupto
TB to health in generalteam
eliminate
TB
symptoms,
TB in
particular.
stigma
transmission
and treatment
The basic idea is that TB control
People with
programs should become obsolete
symptoms
seek health
as soon as possible because
care
cultures have already integrated
appropriate values and practices.
Social
Mobilization
Community works with
Gov’t , households to
eliminate TB in the
community
Gov’t
ensures
adequate
drug supply
Gov’t
provides
quality DOTS
services
STOP
TB
Monitoring
Providers,
community
and people
team up to
detect
potential
cases and
diagnose
correctly
Community allocates
resources and nurtures
appropriate environment
to eliminate TB in
community
Illustrative indicators of TB stigma reduction
Note: Click on text again to go return to framework
Providers,
community and
people team up
to encourage
correct
treatment
regimen
Gov’t,
community and
households
integrate into
culture
appropriate
health values
and practices
STOP
TB
# Cases
drop long
term
# of TB free
communities
increase
Advocacy
Gov’t makes TB
control high
priority
Schools
integrate TB information
in health
Gov’t
Gov’t
ensures
provides courses and text
education
books
adequate
quality DOTS
services
Enter-educate
information
Communication
Social
Mobilization
Households
learn about
TB
symptoms,
transmission
and treatment
Community works with
Gov’t , households to
eliminate TB in the
community
drug supply
programs with TB
Monitoring
Gov’t,
Use
of former TB Providers,
patients asProviders,
community,
community and
spokespersons
forcommunity
anti-TB
campaigns
households
people team up
and people
STOP
TB
# Cases
to encourage
drop long
team up to
with selected
media
personnel
correct
term
detect
treatment
potential
Workshops with local
officialsregimen
and
cases and
People with
diagnose
community
leaders
# of TB free
symptoms
correctly
communities
seek health
Use
theater, etc.increase
care of folk media like streetGov’t,
community and
Visits to TB Free communities
by select
households
integrate into
Community
allocates
local
officials
culture
resources and nurtures
appropriate
appropriate environment
health values
to eliminate TB in
and practices
community
team up to
eliminate TB
Workshops
stigma
Illustrative activities to achieve an outcome
Note: Click on text again to go return to framework or click on any
part of the screen to go to next slide.
STOP
TB
Advocacy
Gov’t makes TB
control high
priority
Gov’t
ensures
adequate
drug supply
Gov’t
provides
quality DOTS
services
STOP
TB
Monitoring
Communication
Households
learn about
TB
symptoms,
transmission
and treatment
Gov’t,
community,
households
team up to
eliminate TB
stigma
People with
symptoms
seek health
care
Social
Mobilization
Community works with
Gov’t , households to
eliminate TB in the
community
Providers,
community
and people
team up to
detect
potential
cases and
diagnose
correctly
Gov’t,
community and
households
integrate into
culture
appropriate
health values
and practices
Community allocates
resources and nurtures
appropriate environment
to eliminate TB in
community
An Outcome Map for DOTS++ Strategy to
Providers,
community and
people team up
to encourage
correct
treatment
regimen
STOP
TB
# Cases
drop long
term
# of TB free
communities
increase
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
•
•
•
•
•
P - Process
‫‪Basic Processes and Principles for Population‬‬
‫‪& Family Planning Communication‬‬
‫‪P-Process‬‬
‫فرآیند ‪ P‬درحقیقت یک قالب کار )‪ (framework‬است که افراد را‬
‫قدم به قدم درجهت تدوین استراتژیهای ارتباطاتی ‪--‬بهداشتی راهنمایی می کند‪.‬‬
‫این فرآیند برای اولین باردر سال ‪ 1982‬جهت طراحی پروژه های‬
‫ارتباطاتی برای تغییر رفتاراستفاده شد و سپس دربرنامه هایی مثل‬
‫تنظیم خانواده ‪ -‬تغذیه با شیرمادر‪ -‬ایمن سازی و ‪ ...‬با اثربخش ی‬
‫قوی مورد استفاده واقع شده است‪.‬‬
Step 1 - Analysis
‫ – تجزیه و تحلیل‬1 ‫مرحله‬
Analysis is the first step to effective
communication, just as it is the first step in
any effective action . Changing health
knowledge , attitudes and behavior
starts with accurate information an indepth understanding of the problems.
‫تجزیه و تحلیل وضع موجود اولین مرحله برای یک ارتباط موثر‬
‫است و درحقیقت این مرحله اولین قدم برای هرفعالیت صحیح‬
‫ نحوه برخورد‬- ‫ تغییر دردانش بهداشتی‬. ‫و کارآمدی تلقی میشود‬
‫و رفتاربا داشتن اطالعات درست و درک عمیق از مشکالت‬
.‫موجود شروع می شود‬
Step 2 – Strategic Design
‫ – طراحی برنامه استراتژیک‬2 ‫مرحله‬
Develop SMART objectives. Position your program to
present a clear benefit. Follow a proven behavior change
model . Select media and activities. Prepare strategic
design paper . Draw up an implementation plan and
budget. Plan for evaluation.
‫ برنامه‬. ‫هرپروژه ارتباطاتی نیازمند طراحی یک برنامه استراتژیک است‬
‫استراتژیک در واقع چیزی نیست به جزنتیجه ای که ازتجزیه و‬
‫تحلیل وضع موجود بدست آمده و در کنارآن تعیین اهداف آینده و‬
.‫راه های رسیدن به آن اهداف‬
‫‪SMART‬‬
‫اهداف یک برنامه استراتژیک می باید دارای ویژگی هایی چون ‪ :‬اختصاص ی‬
‫بودن – قابلیت اندازه گیری – مناسب بودن‪ -‬واقع بین بودن و محدوده زمانی‬
‫مشخص باشند‪.‬‬
‫‪Communication Objectives that are :‬‬
‫– ‪Specific – Measurable‬‬
‫‪Appropriate‬‬
‫‪Realistic and Time bound‬‬
‫‪Step 3 – Message and Material Development , pretest‬‬
‫‪and Production‬‬
‫مرحله ‪ - 3‬تولید و بسط پیام ها و ابزارهای ارتباطی – انجام پیش آزمون و سپس تولید‬
‫نهایی‬
‫‪ 7‬جزء اصلی یک ارتباط موثر‬
‫‪ -1‬توجه و دقت داشتن )‪(Command Attention‬‬
‫‪ -2‬اثربخش ی عمیق ) ‪(Cater of Heart and Head‬‬
‫‪ -3‬روشن و واضح بودن پیام )‪(Clarify the Message‬‬
‫‪ -4‬ارتباط جهت کسب یک منفعت )‪(communicate a Benefit‬‬
‫‪-5‬ایجاد ایمان و اطمینان )‪(Create Trust‬‬
‫‪ -6‬ارسال پیام همخوان )‪(Convey a Consistent Message‬‬
‫‪ -7‬دعوت برای عمل )‪(Call for Action‬‬
Step 4 – Management , Implementation and Monitoring
‫ اجراء و پایش برنامه‬- ‫ مدیریت‬-4 ‫مرحله‬
Good management follows the strategy
and implementation plan . assigning clear
responsibilities and setting up coordinating
mechanism . Monitoring tracks outputs to
be sure that all activities take place as
planned.
‫یک مدیریت خوب میتواند برنامه استراتژیک را با روشن و‬
‫ ایجاد هماهنگی و پایش مستمربا‬- ‫تعیین نمودن وظایف‬
.‫اطمینان اجرا و ادامه دهد‬
‫‪Step 5 – Impact Evaluation‬‬
‫مرحله‪ - 5‬ارزیابی اثرات برنامه‬
‫‪Impact evaluation shows whether a‬‬
‫‪program met its objectives. changing‬‬
‫‪knowledge , attitudes or behaviour of‬‬
‫‪the intended audiences, or influencing‬‬
‫‪policy making. programs that are not‬‬
‫‪evaluated waste time and money .‬‬
‫با ارزیابی برنامه های اجرا شده می توان فهمید که آیا‬
‫به هدف اصلی که همان تغییردر میزان دانش و آگاهی –‬
‫گرایشات و رفتارهای مخاطبین است رسیده ایم ؟ آیا‬
‫توانسته ایم تاثیر و نفوذ مثبتی در سیاست ها داشته و‬
‫ازبه هدر رفتن زمان و هزینه جلوگیری نماییم؟‬
Step 6 – planning for continuity
‫ برنامه ریزی برای استمرارکار‬-6 ‫مرحله‬
Communication is an ongoing process. Not
a one-time effort or products . significant
sustained changes in attitudes , behavior
and community norms required time and
effort . Therefore the P-Process
is
continuous and cyclical.
‫ارتباط درواقع یک فرایند مداوم و درحال پیشرفت‬
‫ لذا تغییردرروشها و‬. ‫است و نه یک اثرو کارموقت‬
‫رفتارها و هنجارهای جامعه باید مرتب تکرار‬
P-process ‫ به همین دلیل است که‬. ‫شوند‬
.‫یک فرآیند مداوم – متوالی و دورانی است‬
‫به طور کلی امروزه ازفرآیند ‪ P‬درموارد زیراستفاده می شود‪:‬‬
‫• طراحی برنامه ها و پروژه ها )‪(Project and Program Design‬‬
‫• کارگاه ها و کالس ها)‪(workshops and classes‬‬
‫• طراحی و آموزش نرم افزار‪SCOPE‬‬
‫)‪(SCOPE Training and Planning‬‬
‫• تهیه بروشورها – گزارشات – کتاب های راهنما و پوسترها‬
‫)‪(Brochures , Reports , Manuals and Posters‬‬
‫ارائه گزارش برنامه های مختلف )‪(Presentation‬‬
SCOPE
SCOPE
Strategic Communication Planning and Evaluation
‫ آدرس زیر ارئه می گردد‬SCOPE ‫جهت استفاده از برنامه‬
Hyyp://www.jhuccp.org/training/scope/stoptb
SCOPE is a process of discovery , assimilation of
information , creativity and learning by doing.
- ‫ کشف علل – تلفیق اطالعات‬:‫ یک فرآیند شامل‬SCOPE
.‫خالقیت و یادگیری ازطریق انجام کاراست‬
SCOPE allows users to design , implement and
evaluate effective health communication projects
directly on the computer ( that can store a great
deal of quantitative and qualitative data with
descriptive graphics, concepts and photos).
‫ به کاربرها این امکان را می دهد تا بتوانند‬SCOPE ‫نرم افزار با کمک‬
‫کامپیوترکه قادراست حجم زیادی ازداده های کمی و کیفی را به همراه‬
‫ متن ها و عکس ها درخود ذخیره کند پروژه های ارتباطاتی‬- ‫نمودارها‬
.‫سودمندی را طراحی – تکمیل و ارزیابی نمایند‬
And in fact SCOPE’s substantial and scientific
database provides the groundwork on which to
establish a communication strategy.
SCOPE ‫و درحقیقت بانک داده های حقیقی و علمی نرم افزاراساس و‬
.‫شالوده ایجاد استراتژیهای ارتباطاتی را فراهم مینمایند‬
‫‪The first version of SCOPE was developed using‬‬
‫‪data , graphs and visuals from Turkey in 1995 by‬‬
‫‪JHU/CCP and then developed in special country‬‬
‫‪versions like Bangladesh , Egypt , Ghana , Kenya‬‬
‫… ‪India , Indonesia and‬‬
‫اولین نسخه نرم افزارتصاویری ‪ SCOPE‬با استفاده ازداده ها – نمودارها و‬
‫از کشور ترکیه در سال ‪ 1995‬به وسیله بخش ارتباطاتی دانشگاه جانزهاپگینز‬
‫طراحی شد و سپس نسخه های کشوری آن برای کشورهایی مثل ‪ :‬بنگالدش –‬
‫مصر – غنا – کنیا – هند – اندونزی و ‪ ...‬تهیه گردیده است‪.‬‬
SCOPE framework based on P-Process
The P-Process is the framework for SCOPE and
SCOPE’s architecture has established into the steps
of the P-Process including:
Analysis – Design – Development – Implementation &
Evaluation and Review.
‫ طراحی گردیده و درواقع‬P-Process ‫ درقالب‬SCOPE ‫نرم افزارساختمان‬
: ‫آن برمبنای مراحل مختلف این فرآیند یعنی‬
‫تجزیه و تحلیل داده ها – طراحی – ارتقاء محتوای برنامه – اجرا و تکامل‬
.‫برنامه – ارزشیابی و بازنگری آن جهت ادامه کاربنا نهاده است‬
SUMMARY
Advocacy , Communication and Social Mobilization
Can make contribution to TB Control by:
:‫ میتواند درکنترل سل نقش داشته باشد ازطریق‬ACSM
‫افزایش بیماریابی‬

(Improving Case Detection)
‫مبارزه با ننگ و تبعیض‬

(Combating Stigma and Discrimination)
‫ایجاد قدرت و اختیاردربیماران مبتال به سل‬

(Empowering People Who Affected by TB)
‫ایجاد تعهد سیاس ی و منابع مطمئن جهت کنترل سل‬

(Political Commitment and Securing Resources for TB Control)
ACSM MUST BE INTGRAL TO NTPS
AND
ACSM REQUIRES A COUNTRY-LEAD AND
INVESTMENT IN NATIONAL CAPACITY
Actions for Life :
Toward a World Free of TB
‫تالش برای زندگی‬
‫به سوی جهانی عاری ازسل‬