Transcript ACS Outcome Map for TB Control

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]
Main Point
• We would benefit significantly from a multidisciplinary 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
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
Monitoring
Weak
Weak
Gov’t
ensures
adequate
drug supply
Providers
detect
potential
cases and
diagnose
correctly
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!
Key Challenges in the DOTS Strategy
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
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
Could
improve
Gov’t
ensures
adequate
drug supply
Providers
detect
potential
cases and
diagnose
correctly
81% cure against 85%
target!
Outcome dampened by low
detection rates.
STOP
TB
Monitoring
Close to
target
Growing concerns for MDR
TB and lower quality of
services as program
expands
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
Providers,
community and
households
team up to
detect potential
cases and
diagnose
correctly
Communication
Providers,
community and
households team
up to encourage
correct
treatment
regimen
# Cases
drop long
term
Social
Mobilization
The Comm- DOTS Strategy
Comm 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 Social Mobilization Contributions 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
Or
Community allocates
resources and nurtures
appropriate environment
to eliminate TB in
community
households
integrate into
culture
appropriate
health values
and practices
No deaths from TB in
community the last 3
years.
What is a TB Free Community?
STOP
TB
# Cases
drop long
term
# of TB free
communities
increase
More Effective
Advocacy
Gov’t makes TB
control high
priority
TB Free communities
versus
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
detect
potential
cases and
diagnose
correctly
Providers,
community and
people team up
to encourage
correct
treatment
regimen
Communities with DOTS coverage
More Effective
Communication
Households
learn about
TB
symptoms,
transmission
and treatment
No DOTS Coverage but with high prevalence of TB
STOP
TB
# Cases
drop long
term
No DOTS Coverage but with low prevalence of TB
Status unknown
Social
Mobilization
People with
symptoms
seek health
care
Gov’t,
community and
households
integrate into
culture
appropriate
health values
and practices
Community allocates
Every country can present
this geographic based
resources and nurtures
approach through a appropriate
color coded
TB Status Map.
environment
to eliminate TB in
This visual representation
community could be of great value
in planning and monitoring interventions.
Community works with
Gov’t , households to
eliminate TB in the
community
Other Types of Communities To Compare
With TB Free Communities
# 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
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
Community allocates
resources and nurtures
appropriate environment
to eliminate TB in
community
An Outcome Map for Comm- DOTS Strategy to
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
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
Households
learn about
TB80% know
symptoms,
65% know
transmission
80treatment
% know
and
Gov’t,
community,
households
symptomsteam up to
eliminate TB
transmission
stigma
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
Narrow
More Effective
Advocacy
range
of
advocacy
activities
conducted
National Gov’t
Gov’t makes TB
seescontrol
TB Gov’t
high
priority but
as priority
local govts not
on same level
Gov’t
Gov’t
provides
enlsures
quality DOTS
adequate
Quality ensured
Gov’t,
services
drug supply
Monitoring
through effective
Stigma is
low 13%
monitoring
STOP
TB
Providers,
Providers,
community
85% cured
Households
community
and
76% knows about
and
people
learn about
people team up
52%
# Cases
all forms TB77% claim know
More Not
Effective
team up to
to encourage
drop long
Communication
cases
detect
symptoms,
of media
correct
symptoms
term
potential
transmission
treatment
detected
used to
65%
know transmission
cases and
and
treatment
regimen
diagnose
educate
85 % know TB is
40-56%
go for
treament
People
with
# of TB free
correctly
symptoms
people
communities
curable
to private clinics
seek health
increase
Gov’t,
19% know treatment care
is
30% go to Puskesmas community and
free
households
integrate into
Social
Community
works with
Community allocates
Low
level
of
Partnerships
culture
Mobilization
Gov’t , households to
resources and nurtures
Fully
recovered
appropriate
community eliminate
being
TB informed
the
appropriate environment
health values
topatients
eliminate TBnot
in
mobilization community
and practices
community
community,
TBhouseholds
team up to
eliminate TB
stigma
used
The Indonesian Case Study
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
Advocacy
Communication
Gov’t makes TB
control high
priority
Households
learn about
TB
symptoms,
transmission
and treatment
% or # of communities with vision of
a TB freeGov’t
community shared Gov’t
by
government,
households andensures
all
provides
adequate
quality DOTS
stakeholders.
drug supply
services
Monitoring
% or # of communities
who have a
workingGov’t,
partnership to make their
Providers,
Providers,
community
TB free which
includes
community,
community and
community
households
people team up
privateteam
sector,
businesses,
NGOs,
and people
up to
to encourage
team up to
CBOs, eliminate
Faith-based
organizations,
TB
correct
detect
stigma
treatment
PLWTB
potential
People with
symptoms
seek health
care
Social
Mobilization
Community works with
Gov’t , households to
eliminate TB in the
community
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
STOP
TB
# Cases
drop long
term
regimen
Gov’t,
community and
households
integrate into
culture
appropriate
health values
and practices
STOP
TB
# 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
Community allocates
resources and nurtures
appropriate environment
to eliminate TB in
community
An Outcome Map for Comm -DOTS Strategy to
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
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 multisectoral approach to DOTS.
???
Our choice
• Comm-DOTS
• DOTS-Comm
• DOTS ++ Comm
OR
………………………………….DOTS Alone