Transcript Powerpoint Presentation: Innovative community-based TB program implemented by Catholic Relief Services in the Philippines. Presenters: Ms. Mila Lasquety, Health Program Manager, and Ms. Melindi Malang, CRS Behavior Change Specialist. - April 10, 2008

IPHO-Maguindanao
October 2005 – September 2009
GOAL
STRATEGIC
OBJECTIVES
Reduce TB Morbidity and Mortality in
Maguindanao
Increase detection rate of smear positive TB cases
from 69% to 75 % by September 2009
Increase cure rate of smear positive TB cases from
72% to 85% by September 2009
Target Population: 475,056 individuals aged
15 and above living in Maguindanao province.
Major Strategies:
•Quality Assurance
•Capacity Building
•Behavior Change Communication
•Advocacy and Social Mobilization
TB situation in Maguindanao
Five Elements of D.O.T.S
Gaps/Challenges
Political Commitment
Shortage of staff (medical
technologists) & funding for TB
program from LGUs.
Case detection through
Quality assured bacteriology
5 functioning laboratories; 7 medtechs;
19 microscopes; insufficient training;
no systematic quality control activities.
Standardized treatment, with
supervision and patient support
(DOT)
Geographic distance of patients to
health centers deterrent in supervised
treatment; many patients complete tx.
w/o lab confirmation.
An effective drug supply and
management system
Existing supplies insufficient to treat all
cases.
Monitoring & Evaluation System
Data not readily available; delays in
data entry & submission of reports; no
cohort analyses.
Department of Health
Autonomous Region in Muslim Mindanao
Motorist transport
smeared samples
and results from
RHUs t Lab.
Validation
Center
Irregular supervision
of RHUs & BHSs
Integrated Provincial Health Office:
Program Coordinators
District level: 4 Hospitals, serve as Lab Validation
Centers *quality control*
Municipal level: 28 RHUs
Human Resources: 13 MTs, Doctors, Nurses
TB Activities:
Med Tech receives smearing, reads & sends report to BHS
Nurse supervises RHUs.
Midwives smear & stain samples, send them to MTs with
Motorist
Receive results, sends them to BHS, DOTS.
Some patients
asked to come
back to BHS or
HNP for sampling
or results
1 Med tech/ 4
municipalities not
available all days/week
Barangay Health Stations: Midwives provide primary health care,
Including TB activities: receive sputum samples from patients, and give
results to patients, DOTS
Health and Nutrition Posts: Barangay Health Workers
TB Activities: receive sputum samples from patients, give results to patients,
DOTS
Midwives lack
smearing skills
BHWs lack
smearing
skills
Innovation one:
Improving access with BHWs role expansion
• Training in DOTS, and sputum collection & smearing
– DOTS: 2-day
– Sputum Collection & smearing: 5-day training (didactic 2 days;
practicum 3 days)
• 116 BHWs with 2 major roles:
1. Collecting sputum & smearing
– Transport slides (no MOW)
– Recording
2. As treatment partner
Innovation two:
Microscopists on Wheels
• Private transport group (mostly single motorcycle) plying
at remotest area volunteered to provide services for TB
control & prevention.
– Free or discounted fare for TB patients & symptomatics
– Free transport of slides or specimen
– Promote TB awareness & free services of RHU
• Membership: voluntary
• Loose support group or formally organized
• Process used:
– RHU recommended transport group from their area
– Gen. orientation & core group formation @ provincial level
– Follow-up meeting @ RHU level.
Innovation three
TB Club
• Serves as a peer-support
group to ensure patient’s
treatment compliance
& reduce stigma.
• Activities:
– sharing and encouragement among members to motivate adherence
to treatment regimen
– cured patients giving testimonies and serving as peer-educators
– contact tracing
– case referral
• Membership: voluntary
• Structure: flexible, formally organized or loose-group.
Table 1. Percentage Contribution of Support
Groups to Case Finding in 10 Municipalities,
Maguindanao,Philippines
Support
Groups
No. of
symptomatic
s referred
No. referred
who turned
positive
Total No. of
Smear
Positives
%
Contribution
MOW
65
27
96
28.125
TB
Clubs
39
6
96
6.25
Table 2. Percent Contribution of BHWS to Case Finding in __
Municipalities,Maguindanao Philippines, July-September 2007
Support
Group
BHWs
No. of
Slides
Smeared
No. turned
positive
Total no. %
of smear contribution
positive of BHWs
cases
(RHUs)
LESSONS LEARNED: INNOVATIONS
• Spirit of volunteerism abounds even in the poorest of
communities; people just need to be given the right
opportunities.
• Explore promising practices from other projects that can be
replicated, adapted or enhanced.
• Develop a common framework or mechanism to implement
MOWs or TBClubs across the municipalities but allow some
flexibility for operationalization.
• Mechanisms for sustaining the enthusiasm of volunteer health
workers should be part of the overall plan.
• Actively engage the support of the local government to provide
incentives to the volunteer health workers.
• A good documentation of the contribution of the support
groups is a must to demonstrate their effectiveness.
Operations Research on Gender
Inequalities
Objective: To determine the nature of disparities in the
no. of cases detected for men and women;
particularly , whether these disparities are related to
inequalities in access to TB care services for women
in Maguindanao.
Methodology:
Sampling: 5 randomly chosen high performing
RHUs
Data Collection: Clinical Observations, exit
interviews, FGD and records review
Operations Research on Gender Inequalities
Objective: To determine the nature of disparities in the
no. of cases detected for men and women; particularly
, whether these disparities are related to inequalities
in access to TB care services for women in
Maguindanao.
Methodology:
Sampling: 5 randomly chosen high performing
RHUs
Data Collection: Clinical Observations, exit
interviews, FGD and records
review
FINDINGS and Opportunities for increasing
the standard of quality of care
• No difference between sexes regarding
satisfaction with quality of care, but more
female clients reported to have received complete
information on TB treatment regimen
• Patient’s treatment card does not include sex disaggregated data to
trace contacts.
• More women registered as symptomatics but less were asked to
provide sputum samples.
• More female clients were asked to bring their contacts.
• Female clients were poorer than male clients.
• More female clients perceived lack of privacy during consultation.
• More female clients preferred face-to-face communication.
• More female clients came from same barangay where the RHU is
located, a concern of where women seek care if they don’t live near
the RHU.
• Few gave suggestions on how to improve the services of RHU but
women recommended giving the medicines for a week supply to save
time and fare while men recommended improving information.
Proposed Interventions
for gender-sensitive TB control
•
•
•
•
•
•
•
•
•
•
Include sex disaggregated data on the contacts in the treatment card
Increase active case finding among male patients for female contacts
The first TB screening for both sexes’ clients should be done in
private ward.
Ensure complete examination and request of sputum samples to
symptomatic male and female.
Increase awareness among general population for the gratuity of the
TB drugs and where they can seek TB services.
Ensure all female and male clients receive their first dose of
treatment.
Increase awareness among all TB clients & BHWs, esp. service be
negotiated with MOW for female clients living in underserve area.
Increase face-to-face activities for both clients to increase access.
Increase awareness among both clients about the role of the BHWs
as treatment partners.
Use the TB Clubs as a forum where female clients provide feedback
about the TB services and recommendations to improve it.