Transcript 怎样将ACSM整合进入DOTS策略

How To Integrate Advocacy,
Communication And Social
Mobilization In The DOTS
Strategy
怎样将ACSM整合进入DOTS策略
一个加强DOTS策略的产出地图
Benjamin V. Lozare, Ph.D
© Johns Hopkins University
Center for Communication Programs
STOP
TB
Life From Many Angles
不同角度的生活
– Is there only one way to see things?
– Is there only one TRUTH?
– How can we develop multiple perspectives?
– 看事物仅有一种方式吗？
– 仅有一个事实吗
– 我们怎样去建立多样的观点
• From Zoom, an illustrated book (1995) by Istvan Banyai, Hungarian
artist
• 摘自《Zoom》， Istvan Banyai （匈牙利画家）的图解书
Where do leaders operate?
领导在那里发挥作用？
Beyond Imagination 超越想象
That’s Impossible 那是不可能的
Looks Difficult
Easy to do
看起来很难
做起来容易
Systems Thinking and The Role of Leadership
系统思考和领导角色
• Leaders operate in “what is beyond imagination, impossible, and
difficult.”
• 领导在“超越现象，不可能和困难”的时候起作
用
• We need to appreciate leadership at all levels of the health system,
not just at the top.
• 我们需要领导在卫生系统的各个层面起作用，而
不仅仅是高层。
• Leaders go where there are “no maps”, they go to uncharted
territories, e.g. beyond “evidenced-based” thinking.
• 领导去那些“没有地图”的地方，去在地图上没
有标明的地方，比如，超越“询证”的思维
Public health is like a three-legged stool.
Each leg is important.
公共卫生是三条腿的凳子，每条腿
都不可或缺
Disease- oriented
疾病导向
Services-oriented
服务导向
Community-oriented
社区导向
Public health is like a three-legged stool.
Each leg is important.
公共卫生是三条腿的凳子，每条腿
都不可或缺
Disease- oriented
疾病导向
Services-oriented
服务导向
Communication
and leadership
沟通和领导力
Community-oriented
社区导向
Main Point
重点
• We would benefit significantly from a
systems (multi-disciplinary and multisectoral) approach to DOTS.
• 我们将从多学科和多部门的DOTS系统中受
益
Six Blind Men And
The Elephant
盲人摸象
We may have failed
to see that the
forest is part of the
elephant!
我们可能忽略了树
林和大象是一体的！
Advocacy
倡导
Gov’t makes TB
control high
priority
政府将结核病控制
做为优先领域
Gov’t
provides
quality DOTS
services
Monitoring
政府提供高质 监控
量的DOTS
Gov’t
ensures
adequate
drug supply
政府确保充
足的药品供
应
Providers
detect
potential
cases and
diagnose
correctly
服务提供
者诊断潜
在病例并
正确诊断
The DOTS Strategy to
STOP
TB
STOP
TB
Providers
ensure correct
treatment
regimen
# Cases
drop long
term
服务提供者确保
正确的治疗方案
病例数下
降
Advocacy
倡导
Gov’t makes TB
control high
priority
政府将结核病控制
做为优先领域
Gov’t
provides
quality DOTS
services
Monitoring
政府提供高质 监控
量的DOTS
Gov’t
ensures
adequate
drug supply
政府确保充
足的药品供
应
Providers
detect
potential
cases and
diagnose
correctly
服务提供
者诊断潜
在病例并
正确诊断
STOP
TB
Providers
ensure correct
treatment
regimen
# Cases
drop long
term
服务提供者确保
正确的治疗方案
病例数下
降
Very well in some
countries, mixed in
others.
在一些国家非常好，在另
外一些比较多样的
World wide # of cases
are growing or dropping?
世界范围内病例数上升还
是下降？
The DOTS Strategy to
STOP
TB
Is this due to better
detection?
这是得益于更好的发现吗
Advocacy
倡导
Gov’t makes TB
control high
priority
政府将结核病控制
做为优先领域
Gov’t
provides
quality DOTS
services
Monitoring
政府提供高质 监控
量的DOTS
Gov’t
ensures
adequate
drug supply
政府确保充
足的药品供
应
Providers
detect
potential
cases and
diagnose
correctly
Weak 薄弱
Weak 薄弱
The DOTS Strategy to
STOP
TB
服务提供
者诊断潜
在病例并
正确诊断
STOP
TB
Providers
ensure correct
treatment
regimen
# Cases
drop long
term
服务提供者确保
正确的治疗方案
病例数下
降
Advocacy
倡导
Gov’t makes TB
control high
priority
政府将结核病控制
做为优先领域
Gov’t
provides
quality DOTS
services
Monitoring
政府提供高质 监控
量的DOTS
Weak 薄弱
Literature suggests
lots of room for
improvement
文献提示有很多可以改
善的地方
Gov’t
ensures
adequate
drug supply
政府确保充
足的药品供
应
Providers
detect
potential
cases and
diagnose
correctly
Weak 薄弱
Weakness is
strategic as it
dampens overall
effort
影响到整体进程的薄弱
环节是战略性的
The DOTS Strategy to
STOP
TB
服务提供
者诊断潜
在病例并
正确诊断
STOP
TB
Providers
ensure correct
treatment
regimen
# Cases
drop long
term
服务提供者确保
正确的治疗方案
病例数下
降
Advocacy
倡导
Gov’t makes TB
control high
priority
Gov’t
provides
quality DOTS
services
Monitoring
政府提供高质 监控
量的DOTS
政府将结核病控制
做为优先领域
Weak 薄弱
Weak 薄弱
Only 61% cases detected worldwide against 70% target.
Large disparities exist- Africa 46%, Europe-52%,
Mediteranean-52%.
全世界范围内仅有61％的病例被诊断，而目
标是70％，较大差距存在于：非洲46％，欧
洲52％，中东52％
Gov’t
ensures
adequate
drug supply
政府确保充
足的药品供
应
Providers
detect
potential
cases and
diagnose
correctly
服务提供
者诊断潜
在病例并
正确诊断
STOP
TB
Providers
ensure correct
treatment
regimen
# Cases
drop long
term
服务提供者确保
正确的治疗方案
病例数下
降
DOTS expansion accounts for most of growth in detection.
多数情况下病例发现的增加得益于DOTS的
扩展
Weakness is strategic as it dampens success in treatment!
影响到治疗结果的薄弱环节是战略性的
The DOTS Strategy to
STOP
TB
Could improve
Could improve
可以改善
Advocacy
倡导
Gov’t makes TB
control high
priority
政府将结核病控制
做为优先领域
可以改善
Gov’t
provides
quality DOTS
services
Monitoring
政府提供高质 监控
量的DOTS
Gov’t
ensures
adequate
drug supply
政府确保充
足的药品供
应
Providers
detect
potential
cases and
diagnose
correctly
Weak 薄弱
Weak 薄弱
服务提供
者诊断潜
在病例并
正确诊断
Providers
ensure correct
treatment
regimen
# Cases
drop long
term
服务提供者确保
正确的治疗方案
病例数下
降
Close to target!
接近目标
The DOTS Strategy to
STOP
TB
STOP
TB
Literature suggests lots of room
for improvement
文献提示有很多可以改
善的地方
Weak 薄弱
Weak 薄弱
Close to target!
The DOTS Strategy to
STOP
TB
接近目标
Could improve
Could improve
可以改善
Advocacy
倡导
Gov’t makes TB
control high
priority
政府将结核病控制
做为优先领域
可以改善
Gov’t
provides
quality DOTS
services
Monitoring
政府提供高质 监控
量的DOTS
Providers
detect
potential
cases and
diagnose
correctly
Weak 薄弱
84.7% cure against 85% target!
Outcome dampened by low
detection rates.
治愈率84.7％，目标是85％
Gov’t
ensures
adequate
drug supply
政府确保充
足的药品供
应
Weak 薄弱
服务提供
者诊断潜
在病例并
正确诊断
STOP
TB
Providers
ensure correct
treatment
regimen
# Cases
drop long
term
服务提供者确保
正确的治疗方案
病例数下
降
结果被低的发现率所拖累
Growing concerns for MDR TB and
lower quality of services as
program expands
随着规划的扩展，MDR-TB和服务
的质量越发受到关注
Close to target!
接近目标
The DOTS Strategy to
STOP
TB
Advocacy
倡导
Gov’t makes TB
control high
priority
政府将结核病控制
做为优先领域
Gov’t
provides
quality DOTS
services
Monitoring
政府提供高质 监控
量的DOTS
Gov’t
ensures
adequate
drug supply
政府确保充
足的药品供
应
Providers,
community and
households
team up to
detect potential
cases and
diagnose
correctly
Are revisions in wording of the DOTS
Strategy above better? If so, how do we
make these outcomes happen?
上述DOTS策略中的修改有改善吗？如果有，我
们怎么才能得到这个结果？
The DOTS Strategy to
服务提供者、
社区以及家庭
联合起来发现
潜在的患者并
正确诊断
STOP
TB
Providers,
community
and
households
team up to
encourage
correct
treatment
regimen
服务提供者、
社区以及家庭
联合起来促进
正确的治疗方
案
STOP
TB
# Cases
drop long
term
病例数下
降
Advocacy
倡导
Gov’t makes TB
control high
priority
政府将结核病控制
做为优先领域
Gov’t
provides
quality DOTS
services
Monitoring
政府提供高质 监控
量的DOTS
Gov’t
ensures
adequate
drug supply
政府确保充
足的药品供
应
Providers
detect
potential
cases and
diagnose
correctly
Communication
传播
服务提供
者诊断潜
在病例并
正确诊断
Social Mobilization
The Comm- DOTS Strategy
社会动员
Comm- DOTS策略
STOP
TB
Providers
ensure correct
treatment
regimen
# Cases
drop long
term
服务提供者确保
正确的治疗方案
病例数下
降
Comm means plus communication
and social mobilization
Comm 意思是增加传播和社会动员
Would adding communication and social
mobilization help produce better outcomes?
增加传播和社会动员会使结果更好吗？
More Effecitve
Advocacy
更有效的倡导
Gov’t makes TB
control high
priority
Gov’t
ensures
adequate
drug supply
Gov’t
provides
quality DOTS
services
STOP
TB
Monitoring
Communication
传播
Households
learn about
TB symptoms,
transmission
and treatment
Gov’t,
community,
households
team up to
eliminate TB
stigma
家庭了解结核
病症状、传播
和治疗
政府社区和家庭
联合一起来消除
结核病歧视
More Effective
Social Mobilization
更有效的社会动员
People with
symptoms
seek health
care
Providers,
community
and people
team up to
detect
potential
cases and
diagnose
correctly
服务提供者、
社区以及家庭
联合起来发现
潜在的患者并
正确诊断
Providers,
community and
people team up
to encourage
correct
treatment
regimen
服务提供者、社
区以及家庭联合
起来促进正确的
治疗方案
有症状的人
寻求诊治服
务
Possible Communication Contributions To Desired Outcomes to
适当的传播活动帮助达成预期的结果
STOP
TB
# Cases
drop long
term
More Effective
Advocacy
更有效的倡导
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
更有效的传播
Households
learn about
TB symptoms,
transmission
and treatment
家庭了解结核
病症状、传播
和治疗
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
Gov’t,
community and
households
integrate into
culture
appropriate
health values
and practices
有症状的人寻
求治疗
Social
Mobilization
社会动员
Community works with
Gov’t ,and households to
eliminate TB in the
community
社区与政府和家庭一起在
社区消除结核病
Community allocates
resources and nurtures
appropriate environment
to eliminate TB in
community
社区分配资源并培养适当
的环境消除社区的结核病
Possible Social Mobilization Contributions To Desired Outcomes to
适当的社会动员活动帮助达成预期的结果
Providers,
community and
people team up
to encourage
correct
treatment
regimen
STOP
TB
政府、社区和家
庭在文化、适当
的健康信念和实
际操作方面整合
起来
# Cases
drop long
term
# of TB free
communities
increase
无结核病的社
区数量不断增
加
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
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
last 3 years
People with
symptoms
seek health
care
在过去三年没有未治疗的活
动性病例
Gov’t,
Or 或者
Social
Mobilization
Community works with
Gov’t , households to
eliminate TB in the
community
What is a TB Free Community?
无结核病的社区什么样？
Community allocates
resources and nurtures
appropriate environment
to eliminate TB in
community
community and
households
integrate into
culture
appropriate
health values
and practices
No deaths from TB in
community the last 3
years.
在过去三年社区中没有发现
因结核死亡的病例
STOP
TB
# Cases
drop long
term
# of TB free
communities
increase
无结核病的社
区数量不断增
加
TB Free communities
More Effective
Advocacy
无结核的社区
Gov’t makes TB
control high与
versus
priority
Gov’t
provides
quality DOTS
DOTSservices
coverage
Gov’t
ensures
adequate
drug supply
Communities with
No DOTS Coverage but with high prevalence of TB
Providers, of TB
No DOTS Coverage butGov’t,
with low prevalence
community
Providers,
Status
unknown
community,
and people
Households
community and
More Effective
Communication
households
learn about
team up to
DOTS覆盖的社区
TB symptoms,
eliminate TB
transmission
stigma
and treatment
DOTS未覆盖但是结核病患病率较高
People with
DOTS未覆盖但是结核病患病率较低
情况未知
Social
Mobilization
team up to
detect
potential
cases and
diagnose
correctly
STOP
TB
people team up
to encourage
correct
treatment
regimen
symptoms
seek health
care
Gov’t,
community and
Every country can present this geographic based
households
integrate
into
Community
worksthrough
with
approach
a color
coded
TB Status Map.
This
Community
allocates
culture
Gov’t , households to
resources and nurtures
visual
representation
could
be
of
great
value
in
planning
appropriate
eliminate TB in the
appropriate environment
health values
community
and monitoring interventions.
to eliminate TB in
and practices
community
# Cases
drop long
term
# of TB free
communities
increase
每个国家可以通过颜色标示地域性结核病现状分布。这种方式
可以在规划和监控干预措施时发挥巨大价值
Other Types of Communities To Compare With TB Free Communities
其他类型的社区与无结核社区进行比较
An example of data presented in a color coded map
颜色标示地图举例
Because TB transmission is by proximity, it is logical to use a geographic
based strategy.
More Effective
Advocacy
Gov’t makes
TB
Gov’t
Gov’t
由于结核病的传播是密切接触造成的，使用地域性策略是合理的
control high
provides
ensures
priority TB is not evenly distributed.
quality DOTS
adequate
We need to allocate
scarce resources more
services
drug
supply
effectively and efficiently.
结核病分布不均衡。我们需要更有效的分配有限的资源
Providers,
STOP
TB
Gov’t,
We need to motivatecommunity,
communities with community
a community Providers,
goal.
and people
Households
community and
households
Designation
of
a
TB
free
community
gives
clear
ofteam
victory.
teamaup
to sense
learn about
people
up Highly
# Cases
More Effective
team up to
motivational.
detect
TB symptoms,
to encourage
drop long
Communication
eliminate TB
potential
transmission
correct
term
stigma
我们应当激发社区拥有社区目标。无结核社区具有明确的成功结果，
cases and
and treatment
treatment
diagnose
非常具有鼓励性
regimen
correctly
People with
# of TB free
Easier to understand
than number of cases per 100,000 which is not
symptoms
communities
meaningful at community
level.
seek health
increase
Gov’t,
care
Why use the
相比对于社区层面没有意义的十万分之的数字简单易懂
community and
households
concept of TB
We can use the number and % of TB free communities
andinto
other types of
integrate
Social
Community works with
Community
allocates
Free
communities for tracking and benchmarking purposes.
culture
Mobilization
Gov’t , households to
resources and nurtures
appropriate
Community? eliminate TB in the
appropriate environment
health values
community 我们可以使用无结核社区和其他类型社区的数字和百分数作为监控和
to eliminate TB in
and practices
对比标准
community
为什么使用无结
核社区这个概念？
TB-free communities can serve as model for high TB prevalence
communities.
无结核社区可以作为高结核病疫情社区的模版
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
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
一些其他指标
注：这些与继续使用十万分之病例数字等现有指标来提供说明整体情况的其他观点没
有矛盾
STOP
TB
Providers,
community and
people team up
to encourage
correct
treatment
regimen
# Cases
drop long
term
# of TB free
communities
increase
Gov’t,
community and 无结核病的社区
数量不断增加
households
integrate #into
of communities with
culture DOTS coverage increase
appropriate
DOTS覆盖的社区数量不
health values
断增加
and practices
# of communities of
unknown status decrease
未知状态的社区数量不断
减少
Advocacy
倡导
Gov’t makes TB
control high
priority
Gov’t
ensures
adequate
drug supply
Gov’t
provides
quality DOTS
services
STOP
TB
Monitoring
Communication
传播
Households
learn about
TB symptoms,
transmission
and treatment
家庭了解结核
病症状、传播
和治疗
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
Gov’t,
community and
households
integrate into
culture
appropriate
health values
and practices
有症状的人寻
求治疗
Social
Mobilization
社会动员
Community works with
Gov’t ,and households to
eliminate TB in the
community
社区与政府和家庭一起在
社区消除结核病
Community allocates
resources and nurtures
appropriate environment
to eliminate TB in
community
社区分配资源并培养适当
的环境消除社区的结核病
An Outcome Map for Comm- DOTS Strategy to
Comm- DOTS策略的结果地图
Providers,
community and
people team up
to encourage
correct
treatment
regimen
STOP
TB
政府、社区和家
庭在文化、适当
的健康信念和实
际操作方面整合
起来
# Cases
drop long
term
# of TB free
communities
increase
无结核病的社
区数量不断增
加
Wide
range
of
More
Effective
advocacy
Advocacy
activities
conducted
Gov’t declated TB
Gov’t makes
TB
high priority
in 1995
control high
1995年政府宣布结核
priority
病为重点
开展广泛的倡
导活动
educate people
使用各种媒体教
育人群
mobilization
社区动员程度高
80%知道症状
65%知道传播途径
80%知道结核可以治愈
Community
works with
Partnerships
Gov’tcreated
, households
at allto
eliminate TB in the
levels
community
各级都建立伙伴
关系
services
政府与1998年
达到100%覆盖
Households
learn
about
80%
know symptoms
TB symptoms,
65% know transmission
transmission
80treatment
% know TB is curable
and
forms of
More All
Effective
media used to
Communication
Social
High level of
Mobilization
community
Gov’t achieves
almostGov’t
100
coverage
in
provides
1998 quality DOTS
Gov’t,
community,
households
team up to
eliminate TB
stigma
Four program levels of
Gov’t TB control activity
enlsures
四级结核病控制
adequate
drug supply
Quality
ensured
Monitoring
through effective
monitoring
Providers,
community
通过有效监控保
证质量and people
team up to
80%detect
cases
detected
potential
cases and
80%病例发现
diagnose
People
100%with
know that detected
correctly
symptoms
case of TB should seek
seek health
medical care
care
100%知晓发现的病例应当就
诊
Community allocates
resources
and nurtures
Peer education
appropriate environment
used fully
to eliminate TB in
recovered patients
community
在完全康复的患者
中使用同伴教育
The Vietnam Case Study 越南的例子
STOP
TB
Providers,
93% completed
community and
treatment
people
team up
# Cases
to encourage
93%完成治疗 drop long
correct
term
treatment
89% cured 治愈
regimen
Gov’t,
community and
households
integrate into
culture
appropriate
health values
and practices
# of TB free
communities
increase
Narrow
range
More Effective
of advocacy
Advocacy
activities
conducted
倡导活动开展
幅度较小
National Gov’t sees
TB Gov’t as priority
Gov’t
makes
but local
govts
notTBon
control high
same priority
level
国家政府认为结核病
是重点领域，但是地
方政府认识不同
More
NotEffective
all forms of
Communication
media used to
educate people
未使用全部媒体
教育人群
Social
Low level of
Mobilization
community
mobilization
社区动员程度较
低
Gov’t
Gov’t
Stigma
is low
provides
enlsures
13% quality DOTS Quality ensured
adequate
through effective
services
drug supply
13% 歧视
monitoring
Monitoring
Gov’t,
community,
76% knows about TB
Households
households
了解结核
learn about
team up to
claim know symptoms eliminate TB
TB77%
symptoms,
transmission
表示了解症状
stigma
and
treatment
65% know transmission
通过有效监控保证质量
Providers,
community
people
52%and
cases
team up to
detected
detect病例发现
potential
cases and
diagnose to
40-56%
People
with go for treatment
correctly
private clinics 去私人诊所就诊
symptoms
了解传播途径
85 % know TB is curable
了解结核可以治愈 seek health
19% know treatment is freecare 30% go to Puskesmas
了解治疗免费
去社区卫生中心
Community
works with
Partnerships
Gov’tbeing
, households
formedto
eliminate TB in the
community
正在建立伙伴关
系
Community allocates
resources
and nurtures
Fully recovered
appropriate environment
patients not used
to eliminate TB in
community
治愈的患者没有发
挥作用
The Indonesian Case Study 印尼的例子
STOP
TB
Providers,
85% cured
community
and治愈
people team up
# Cases
to encourage
drop long
correct
term
treatment
regimen
Gov’t,
community and
households
integrate into
culture
appropriate
health values
and practices
# of TB free
communities
increase
Advocacy
Gov’t
ensures
adequate
drug supply
Gov’t
provides
quality DOTS
services
Gov’t makes TB
control high
priority
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
Providers,
community and
people team up
to encourage
correct
treatment
regimen
Gov’t,
community and
households
integrate into
culture
appropriate
health values
and practices
# Cases
drop long
term
# of TB free
communities
increase
Illustrative Indicators of Outcomes
STOP
TB
Note: Click on colored text to see illustrative indicators. When
finished, click on button on the right to see illustrative activities.
结果的说明性指标
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 supported
Gov’tby
Gov’t
ensures
provides
清晰的结核病控制政策获得以下支持
adequate
quality DOTS
drug supply
servicesrhetoric 文字
actionsMonitoring
行动
STOP
TB
resources 资源
Gov’t,
Providers,
Providers,
community,
% of people who knows
that TB control
is a high
community
and
community
households
people team up
# Cases
and people
priority
of the country/community
team up to
to encourage
drop long
team up to
eliminate TB
了解结核病控制是该国/社区工作重点的人员比例
correct
term
detect
stigma
treatment
potential
Strong collaboration between
TB andregimen
HIV/AIDS
cases and
programs
and those ofdiagnose
other communicable diseases
People with
# of TB free
symptoms
correctly
结核病与艾滋病规划及其它传染病规划的强力合作 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
%
Communication
Social
Mobilization
Households
learn about
TB symptoms,
transmission
and treatment
Community works with
Gov’t , households to
eliminate TB in the
community
ensures
provides
adequate
了解结核病症状的人员
quality DOTS
drug supply
services
who know how Monitoring
TB is transmitted
STOP
TB
了解结核病传播途径的人员
Gov’t,
Providers,
Providers,
community,
community and
community
%households
who know that TB is
curable
people team up
# Cases
and people
team up to
to encourage
drop long
team up to
eliminate
TB
了解结核病可以治愈的人员
correct
term
detect
stigma
treatment
potential
% who know that TB treatment
regimen
cases and is free
People with
diagnose
# of TB free
symptoms
correctly
了解结核病治疗免费的人员
communities
seek health
increase
Gov’t,
%care
who know where to secure TB treatment if needed
community and
households
了解哪里获得治疗的人员
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
% who understand that people with TB
symptoms should seek health care
Advocacy
Communication
Gov’t makes TB
control high
priority
Households
learn about
TB symptoms,
transmission
and treatment
Gov’t
Gov’t
ensures
理解具有结核病症状的人应当就诊的人员
provides
adequate
quality DOTS
drug supply
services
% who believe
that people with TB symptoms
STOP
Monitoring
should
seek health care
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
TB
相信具有结核病症状的人应当就诊的人员
Providers,
Providers,
community
community
% who
will encourage
people and
they know with
people
team
up
# Cases
and people
TB symptoms
to seek
health
care.
to encourage
drop long
team up to
correct
term
detect
将会鼓励他们认识的有结核病症状的人去就
treatment
potential
诊的人员
regimen
cases and
% of diagnose
TB cases who come for diagnosis
# of TBand
free
correctly
communities
treatment promptly.
Gov’t,
立即确诊并治疗的结核病患者
increase
community and
households
Mean time between
occurrence of symptoms
integrate into
Community allocates
and visit to health facility.
culture
resources and nurtures
appropriate
appropriate environment
出现症状到就诊的平均时间
health values
to eliminate TB in
and practices
community
Illustrative activities to achieve an outcome
Note: Click on text again to go return to framework
STOP
TB
% or # of communities where Gov’t,
households and communities plan and work
Advocacy
Gov’t makes TB
control high
priority
Gov’t
Gov’t
together to eliminate
ensures TB stigma
provides
adequate
quality DOTS 政府、家庭和社区为消除结核病歧视一起计
drug supply
services
划和工作的社区
STOP
Monitoring
TB
% or # of communities with support groups
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
for TB patients and their
families.
Providers,
Providers,
community and
community
具有患者及其家庭支持团体的社区
people team up
# Cases
and people
to encourage
dropbe
long
team
up
to
% who
believe that TB treatment should
correct
term
detect
provided
to
all
in
need.
treatment
potential
regimen
cases and
diagnose
相信应当对所有需要的人提供结核病治疗
# of TB free
correctly
communities
% who look at TB Gov’t,
patients as people
who
increase
need help rather than
avoided
community
and
households
看待结核病患者是需要帮助而非避免的人
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
Illustrative indicators of TB stigma reduction
Note: Click on text again to go return to framework
integrate into
culture
appropriate
health values
and practices
STOP
TB
% or #
of communities where Gov’t,
households
and communities
jointly
Gov’t makes
TB conduct
Advocacy
controldetection
high
activities to ensure prompt
of
potential cases and topriority
make correct diagnosis.
about potential cases
knowledge and skillslearn
to detect
TB symptoms,
and to diagnose correctly.
Communication
transmission
and treatment
拥有病例发现和诊断的正确知识和技能的结
Gov’t,
community,
households
team up to
eliminate TB
stigma
核病医务人员
% of TB control clinical staff who have
adequate tools and resources for diagnosis
and use them
People with
symptoms
seek health
care
Providers,
community
and people
team up to
detect
potential
cases and
diagnose
correctly
拥有充足的诊断工具和资源并使用它们的结
Social
核病医务人员
Mobilization
Community works with
Gov’t , households to
eliminate TB in the
community
STOP
TB
Monitoring
政府、家庭和社区联合开展保证及时发现潜
在患者并正确诊断活动的社区
% of TB control clinical
staff who have correct
Households
Gov’t
ensures
adequate
drug supply
Gov’t
provides
quality DOTS
services
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
% or
# of communities where Gov’t,
Gov’t
Gov’t makes TB
provides
households
and communities conduct
joint
control high
quality
DOTS
activities
priorityto ensure correct treatment regimen
services
both on the part of patients and TB control
Monitoring
providers.
政府、家庭和社区联合开展保证医患均使用
Gov’t,
正确治疗方案的活动的社区
community,
Households
Communication
households
learn about
team up
to
% TB
of TB
control providers who have
correct
symptoms,
eliminate
TB
transmission
knowledge
and skills to administer treatment
stigma
and treatment
regimen.
拥有正确的治疗管理知识和技能的结防人员
People with
symptoms
% of families with TB cases whoseek
understand
health
caretreatment
the consequences of not observing
Gov’t
ensures
adequate
drug supply
Providers,
community
and people
team up to
detect
potential
cases and
diagnose
correctly
regimen.
Social
Mobilization
Community works with
Community allocates
了解非督导治疗结果的结核病患者家庭
Gov’t
, households to
resources and nurtures
eliminate TB in the
appropriate environment
%
of families with TB cases whotoencourage
community
eliminate TB in
community
patients to observe correct treatment
regimen.
STOP
TB
Providers,
community and
people team up
to encourage
correct
treatment
regimen
Gov’t,
community and
households
integrate into
culture
appropriate
health values
and practices
鼓励患者督导服药的患者家庭
Illustrative indicators of TB stigma reduction
Note: Click on text again to go return to framework
STOP
TB
# Cases
drop long
term
# of TB free
communities
increase
% or # of communities with vision of a TB
Advocacy
Gov’t makes TB
control high
priority
free community shared by government,
Gov’t
Gov’t
householdsprovides
and all stakeholders.
ensures
adequate
quality DOTS
drug supply
与政府、家庭和其他利益相关者拥有共同
services
Monitoring
% or # of communities who have a working
Communication
Households
learn about
TB symptoms,
transmission
and treatment
partnership
to make their community TB free
Gov’t,
which includes
private sector,Providers,
businesses,Providers,
community,
community and
community
NGOs, CBOs,
Faith-based organizations,
households
people team up
and people
PLWTB team up to
to encourage
team up to
eliminate TB
correct
detect
拥有致力于消除结核病的工作伙伴（包括私
stigma
treatment
potential
营单位、企业、NGO、社区组织、宗教组织、
regimen
cases and
患者组织）的社区
People with
diagnose
symptoms
seek health
care
Social
Mobilization
Community works with
Gov’t , households to
eliminate TB in the
community
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
Gov’t,
community and
households
integrate into
culture
appropriate
health values
and practices
STOP
TB
STOP
TB
# Cases
drop long
term
# of TB free
communities
increase
% or # of communities which allocate local
resources to makeGov’t
the community
makes TB TB free
Advocacy
control high
分配地方资源支持结核病控制的社区
priority
% or # of communities that participate
actively in the national effort to control TB.
Households
积极参与国家结核病控制的社区
learn about
Communication
TB symptoms,
% or # of communities
that have TB free
transmission
partnerships that collaborate
and treatmentwith HIV/AIDS
programs and those of other communicable
diseases.
Community works with
Gov’t , households to
eliminate TB in theg
community
STOP
TB
Monitoring
Gov’t,
community,
households
team up to
eliminate TB
stigma
People with
拥有遏制结核病伙伴并与艾滋病规划及其它symptoms
seek health
传染病防治规划合作的社区
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
Gov’t makes TB
control high
priority
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. Gov’t,
Communication
Gov’t
ensures
adequate
drug supply
Gov’t
provides
quality DOTS
services
community,
Households
households
这需要开发测量人们价值观、信念、行为、卫
learn about
team up to
生及结核病相关资源分配的综合工具
TB symptoms,
eliminate TB
transmission
The basic
idea is that TB control programs
stigma
and treatment
should become obsolete as soon as possible
because cultures have already integrated
People with
appropriate values and practices. symptoms
Providers,
community
and people
team up to
detect
potential
cases and
diagnose
correctly
seek health
基本思想是结核病控制规划应当尽快摒弃，因
care
为文化已经恰当的整合了价值观和行为
Social
Mobilization
Community works with
Gov’t , households to
eliminate TB in the
community
STOP
TB
Monitoring
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 education
Gov’t
Gov’t
courses and text books
ensures
provides
adequate
quality DOTS
将结核病信息整合入健康教育课程和教材的学校
drug supply
services
Enter-educate programs
with TB information
Monitoring
寓教于乐的结核病信息
STOP
TB
Gov’t,
Communication
Social
Mobilization
Households
learn about
TB symptoms,
transmission
and treatment
Community works with
Gov’t , households to
eliminate TB in the
community
Providers,for anti-TB
Providers,
Use
of former TB patients
as spokespersons
community,
community and
community
campaigns
households
people team up
# Cases
and people
team up to
to
encourage
drop long
team
up
to
利用治愈的结核病患者作为结核病宣传的代言人
eliminate TB
correct
term
detect
stigma
treatment
Workshops with selected
media personnel
potential
regimen
cases and
与选定的媒体人员研讨
People with
diagnose
# of TB free
symptoms
correctly
communities
Workshops with local officials and community leaders
seek health
increase
Gov’t,
care
与地方官员和社区领导研讨
community and
Use of folk media like street theater,households
etc.
integrate into
Community allocates
使用民间媒体，例如街头戏剧等
culture
resources and nurtures
appropriate
appropriate
environment
Visits
to TB Free
communities by select
local officials
health values
to eliminate TB in
and practices
选定的地方官员参观无结核社区
community
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
倡导
Gov’t makes TB
control high
priority
Gov’t
ensures
adequate
drug supply
Gov’t
provides
quality DOTS
services
STOP
TB
Monitoring
Communication
传播
Households
learn about
TB symptoms,
transmission
and treatment
家庭了解结核
病症状、传播
和治疗
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
Gov’t,
community and
households
integrate into
culture
appropriate
health values
and practices
有症状的人寻
求治疗
Social
Mobilization
社会动员
Community works with
Gov’t ,and households to
eliminate TB in the
community
社区与政府和家庭一起在
社区消除结核病
Community allocates
resources and nurtures
appropriate environment
to eliminate TB in
community
社区分配资源并培养适当
的环境消除社区的结核病
An Outcome Map for Comm- DOTS Strategy to
Comm- DOTS策略的结果地图
Providers,
community and
people team up
to encourage
correct
treatment
regimen
STOP
TB
政府、社区和家
庭在文化、适当
的健康信念和实
际操作方面整合
起来
# Cases
drop long
term
# of TB free
communities
increase
无结核病的社
区数量不断增
加
Public health is like a three-legged stool.
Each leg is important.
公共卫生是三条腿的凳子，每条腿
都不可或缺
Disease- oriented
疾病导向
Services-oriented
服务导向
Community-oriented
社区导向
Public health is like a three-legged stool.
Each leg is important.
公共卫生是三条腿的凳子，每条腿
都不可或缺
Disease- oriented
疾病导向
Services-oriented
服务导向
Communication
and leadership
沟通和领导力
Community-oriented
社区导向
Benefits of Comm-DOTS approach
Comm-DOTS的益处
• Less jargon 减少术语
• Uses actors, (government, providers, community, households) and
desired specific behaviors of each to describe what we want to
happen, not abstract ideas.
使用演员（政府、服务提供方、社区、家庭）及其期望的具体行
为来描述我们希望发生的，而不是抽象的想法
• Lays out an overall strategic picture.
给出总体战略
• Provides practical way to plan, implement, monitor and evaluate.
提供计划、实施、监控和评价的实用方法
• Suggests a multi-disciplinary and multi-sectoral team approach and
helps ensure everyone is on the same page.
推荐一种多学科、多部门合作的方式，帮助保证每个人进度一致
Together everyone achieves more. Let’s use the Comm-DOTS approach to
STOP
TB
Main Point 要点
• We would benefit significantly from a
systems (multi-disciplinary and multisectoral) approach to DOTS.
• 我们将会从一个系统的DOTS（多学科、多
部门）获益良多
Our choice 我们的选择
• Comm-DOTS
• DOTS-Comm
• DOTS ++ Comm
OR 或者
………………………………….DOTS Alone