Improving case detection of rural area in Zanzibar through Advocacy,
Communication & Social mobilization
Dr Sira Ubwa Mamboya MD, Ms Trop Med.Programme Manager
Tuberculosis and Leprosy Programme Zanzibar, Tanzania
UNITED REPUBLIC OF TANZANIA
ZANZIBARISLANDS
Zanzibar Background Information
• Zanzibar - Unguja & Pemba islands• Land area - 2,332 sq/km• Population - Almost 1 million• Annual population growth rate - 2.8% • Fertility rate of 5.6• Literacy rate - 60% with a gross enrolment
rate of 85%. • 33% of the population live in urban and 67%
in rural areas
TB NOTIFICATION PER 100,000 POPULATION BY REGION, 2004
Situation of TB in Tanzania- 1979-2004
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
Smear + Return Fail Other Relapse Smear - Extra-P
Situation of TB in Zanzibar 1988 - 2004
0100200300400500600700800900
1,000
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Smear + #REF! #REF! #REF! Smear - Extra-P Realpse
Rationale of the Action Plan
• TB estimation for Tanzania - 300/100,000
• Tanzania detecting 51% - 66000
• 70% -756,000
• Zanzibar average detection -384 patient/Y
• 50% - town 33% population
• 50% - rural area 68% population
Reasons for selection of the project•Since NTLP launched HE strategy not introduced•During supervision – patient delay to seek treatment•The review team findings
-IEC materials depends on prints, no electronics and understandable to technical member of the community
-IEC limited number and types
-Material limited to health facility excluding general pop.
-Given HE not cover the existing relationship between TB and TB/HIV
Reasons Cont…..•KAPB study results in Iringa, Temeke and Ifakara– Low knowledge on newly diagnosed, sign and transmission, treatment is free of charge, misconception and stigma of TB contributing factor for delay
•KAPB study results in Zanzibar rural community -Low knowledge of TB disease & prevention, misconception of mode of transmission, negative attitude towards TB patients
Conc. NTLP should develop a communication strategy and use appropriate methods for public education
Stakeholder AnalysisBeneficiariesZanzibar rural Community
Implementing AgenciesNTLP staff, HEU, Regional Medical & Health Officers, District Medical & Health Officers, Regional & District commissioners, RTLCS & DTLCs, Media, Teachers, Ex TB patients, NGOs, CBOs, FBOs, Traditional healers, VCTs staff, Chest clinics staff & community
Funding AgenciesZanzibar Government, GLRA, GF
Decision makersZanzibar Government & MOH&SW-NTLP
Potential OpponentsCulture and belief of the Zanzibar rural community
Supporting GroupLocal leaders (Shehas), Religious leaders, Health workers, TBAs, HBCs
Low detection rate in Zanzibar rural community
Lack of information of the TB disease
Stigma of TB disease in connection with HIV
Belief of traditional medicine
Low priority of TB in the health facility
Limited information of programme problems exist in the community
No operational researches done to identify problems
No advocacy, communication & social mobilization strategy in NTLP
Lack of supportive supervision by programme staff
Un-motivated health workers toward TB disease
Incompetent health worker
TB patients are not ready to know theirHIV status
Discrimination of PLWHA
Death
Trust and confidence on traditional healers
Lack of knowledge on TB disease
Limited outreach information in the community
Lack of ACS of TB disease in the community
Community continue to be infected with TB baccilli
Morbidity due to TB in thein the community increased
Many people died from TB
Undermine the efficiencyof TB programme
No treatment for HIV provided to AIDS patients
Problem tree
Operational research is given low priority among the programme activities
Increasing detection rate in Zanzibar rural community
Information of TB disease provided
Stigma of TB andHIV decreased
Modern treatment accepted
TB suspects are examined and diagnosed on time
Information of programme problems in the community collected
Operation research is among the programme activities highly prioritized
Advocacy, communication &Social mobilization strategy developed
Supportive supervision by TB programme staff to the health
Health worker participate in TB activities motivated
Health worker became competent & TB cases suspected
Test for HIV agreed
PLWHA are not discriminated
Patient with TB and HIV survived
Trust and cconfidenceon modern treatment developed
Knowledge of TB disease increased
Information of TB disease in the community increased
TB campaign in the community increased
TB became no longer a public health problem
Community free from TB
Fewer people died from TB
Good indicator for TB programme efficiency
Patients with HIV/AIDS ARVs are provided
Objective tree
ACS Approach
Stigma reduction Approach
Modern Rx Approach
The Project Design Matrix (PDM)Project Name -Improving Zanzibar case detection through Advocacy, communication & Social mobilization
Duration - March 2006-February 2012 Target Area Target Group DateZanzibar Islands Zanzibar Rural Community March 06
Narrative Summary Objectively Verifiable Indicator
Means of Verification Important Assumption
Overall GoalTB no longer a public health problem
No of patient detected decline
Mortality rate due to TB decrease from10 % - > 5%
Quarterly and annual reports
Ministry of health to make TB programme not a priority programme
Project purposeZanzibar detected > 70%of TB patients by the year 2011
Zanzibar detecting >70% of estimated TB patient
Annual notification reports of TB patients
Number of estimated TB suspect by WHO not the real number are in Zanzibar community
Outputs1.Outreach information of TB disease in the community increased2.TB suspects are on time examined and diagnosed
By the year 2011, more than 80% of the community informed about TB disease70% or more TB patients diagnosed to have TB disease by the year 2011
Repeated KAP survey report on TB Programme reports on the increasing trend of TB patients to reach 70% or more of all infected population
Suspect of TB disease did not attend to the health facilities
Activities
-Initiate ACS of TB disease in NTLP-Develop ACS tools for all levels-Establish TB committees at district and shehia levels-Conduct ACS awareness meetings for leaders-Conduct training on the remaining stakeholders-Mobilize communities through different methods (group discussions, dramas, film shows, radio and local dances etc)
Activities
Supportive supervision by TB programme staff to the health worker reinforced-Conduct monthly supportive supervision-Conduct on job training-Involve health workers in community mobilization at their respective areas
Activities
- Conduct operational research to asses the effectiveness of ACS (2nd KAP study at the end of the project)-Monitoring, annual evaluation and revision of methods
Inputs
Project finance - Zanzibar Government, GLRA,GF Country -Tanzania, ZanzibarPersonnel-ACS coordinator, Public Health Officers, DTLCs, Drivers, SecretariesFacility - ACS, Supervision, Operational researches, Project implementation and management cost
Assumptions
-Developed advocacy, communication and social mobilization strategy used
-Money for conducting operational research are going to be disbursed as planed
-Motivated health worker are not going to be often changed
Pre-conditions
Donors does not change their will to support NTLP