the health promotion handbook

i

The Health PromotionH a n d b o o k

A Guide to Doing Advocacy,

Communication, and

Social Mobilization for the

TB Control Program

in the Community

This publication was produced for review by the United States Agency

for International Development. It was prepared by the National Center for

Health Promotion of the Department of Health, Philippines, through the TB LINC

(Linking Initiatives and Networking to Control Tuberculosis) Project under the

terms of Cooperative Agreement Number 492-A-00-06-00032-00.

The opinions expressed herein are those of the authors and do not

necessarily reflect the views of USAID or the United States Government.

ii

ISSN 978-971-9064-08-4

Printed in Manila, Philippines

2008

iii

Table of Contents

FFFFForewordorewordorewordorewordoreword-------------------------------------------------------vvvvv

AcknowledgmentAcknowledgmentAcknowledgmentAcknowledgmentAcknowledgment ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- v i iv i iv i iv i iv i i

List of Abbreviations and AcronymsList of Abbreviations and AcronymsList of Abbreviations and AcronymsList of Abbreviations and AcronymsList of Abbreviations and Acronyms -------------------------------------------------------------------------------- x ix ix ix ix i

GlossarGlossarGlossarGlossarGlossaryyyyy-- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -x i i i- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -x i i i- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -x i i i- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -x i i i- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -x i i i

How to Use the HandbookHow to Use the HandbookHow to Use the HandbookHow to Use the HandbookHow to Use the Handbook ---------------------------------------------------------------------------------------------------------------------------------------------------------------- 11111

Introduction ----------------------------------------------------- 1

Features of the Handbook ---------------------------------- 2

Overview of Chapters in the Health

Promotion Handbook ---------------------------------- 3

Chapter 1Chapter 1Chapter 1Chapter 1Chapter 1 The Essentials of TB and DOTS The Essentials of TB and DOTS The Essentials of TB and DOTS The Essentials of TB and DOTS The Essentials of TB and DOTS ---------------------------------------------7

Introduction ----------------------------------------------------- 7

Facts on Tuberculosis ------------------------------------------ 7

Magnitude of TB Problem Globally

and Nationally ------------------------------------------ 10

The National Tuberculosis Control

Program (NTP) ------------------------------------------ 12

DOTS Strategy ------------------------------------------------ 13

TB DOTS Certification and Accreditation ----------- 15

Hospital-based DOTS -------------------------------------- 17

TB in Children ------------------------------------------------ 17

Comprehensive and Unified Policy to Control

Tuberculosis in the Philippines ---------------------- 19

Public-Private Mix DOTS ---------------------------------- 20

Frequently Asked Questions ----------------------------- 21

About TB ------------------------------------------------- 21

About Treatment --------------------------------------- 22

Summary -------------------------------------------------------- 25

iv

Chapter 2 Introduction to Health PromotionChapter 2 Introduction to Health PromotionChapter 2 Introduction to Health PromotionChapter 2 Introduction to Health PromotionChapter 2 Introduction to Health Promotion 2 92 92 92 92 9

Introduction --------------------------------------------------- 29

Health Promotion Defined ------------------------------- 29

Principles of Health Promotion ------------------------- 31

Five Action Areas of Health Promotion-------------- 32

Health Promotion in the Context of NTP ---------- 36

Health Promotion for Behavior Change

in TB Control -------------------------------------------- 39

Summary -------------------------------------------------------- 40

Chapter 3 AChapter 3 AChapter 3 AChapter 3 AChapter 3 Advocacydvocacydvocacydvocacydvocacy, Communication,, Communication,, Communication,, Communication,, Communication,

and Social Mobilization (ACSM)and Social Mobilization (ACSM)and Social Mobilization (ACSM)and Social Mobilization (ACSM)and Social Mobilization (ACSM) ------------------------------------------------------------------------------------- 4 14 14 14 14 1

Introduction --------------------------------------------------- 41

ACSM for TB Initiatives ------------------------------------ 41

Advocacy for TB Control --------------------------------- 43

Communication for TB Control ------------------------ 48

Social Mobilization for TB Control -------------------- 53

Summary -------------------------------------------------------- 59

Chapter 4 How to Apply ACSM in theChapter 4 How to Apply ACSM in theChapter 4 How to Apply ACSM in theChapter 4 How to Apply ACSM in theChapter 4 How to Apply ACSM in the

FFFFFive Aive Aive Aive Aive Action Areas of Health Pction Areas of Health Pction Areas of Health Pction Areas of Health Pction Areas of Health Prrrrromotionomotionomotionomotionomotion ------------------------- 6 16 16 16 16 1

Introduction --------------------------------------------------- 61

Building Healthy Public Policy -------------------------- 62

Creating Supportive Environment --------------------- 67

Strengthening Community Action --------------------- 69

Developing Personal Skills -------------------------------- 73

Reorienting Health Services ------------------------------ 85

Summary -------------------------------------------------------- 92

Chapter 5 How to Develop an ACSM PlanChapter 5 How to Develop an ACSM PlanChapter 5 How to Develop an ACSM PlanChapter 5 How to Develop an ACSM PlanChapter 5 How to Develop an ACSM Plan ------------------------- 9 59 59 59 59 5

How to Develop an ACSM Plan ------------------------ 95

Practical Steps for Designing an ACSM Plan -------- 95

Sample ACSM Plan ------------------------------------------ 98

Answer KeysAnswer KeysAnswer KeysAnswer KeysAnswer Keys --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 1 05105105105105

ReferencesReferencesReferencesReferencesReferences ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 1 101 10110110110

v

F o r e wo r d

Health Promotion is a process of

enabling people to take action to improve

health. Within the context of primary health care,

health promotion is critical to improving

outcomes in the prevention and control of both

chronic and communicable diseases, particularly

tuberculosis. Health promotion has a crucial role

to play in fostering healthy public policies and

health supportive environments, enhancing

positive social conditions and personal skills, and

promoting healthy lifestyles.

Local Government Units (LGUs), communities,

non-government organizations and the private

sector often lead in initiating, shaping, and

undertaking health promotion. They need to

have the right resources and opportunities to

enable their contributions to be amplified and

sustained. In less active communities, support for

capacity building is particularly important.

In order to address the capability building

concern, a draft Health Promotion Handbook

was developed in 2005 by the National Center

for Health Promotion (NCHP) and the National

Tuberculosis Control Program (NTP) of the

National Center for Disease Prevention and

Control (NCDPC). The Philippine Tuberculosis

Initiatives for the Private Sector (PhilTIPS)

provided technical and financial assistance.

vi

The draft handbook then served as the basis for the

development in 2007 of the The Health Promotion

Handbook: A Guide to Doing Advocacy,

Communication and Social Mobilization for the TB

Control Program in the Community. This was

supported by the USAID-funded TB LINC (Linking

Initiatives and Networking to Control Tuberculosis)

Project.

Congratulations to all who shared their time and

expertise for this accomplishment. This is a

milestone document for the National TB Control

Program that will help boost our control efforts

against TB in our communities.

FRANCISCO T. DUQUE III, MD, MSc

Secretary of Health

vii

A c k n o w l e d g m e n t

DOH Central Office

The Health Promotion Handbook is the product of

wide consultation between and among health

professionals from different parts of the country.

These dedicated health workers consist of officials

from the Department of Health’s Central Office and

Centers for Health Development, local government

units, TB LINC (Linking Initiatives and Networking

to Control Tuberculosis), and the Philippine Business

for Social Progress.

Dir. Yolanda Oliveros

Dir. Angelina Sebial

Dir. Jaime Lagahid

Dr. Rosalind Vianzon

Dr. Ernesto Bontuyan, Jr.

Dr. Anna Marie Celina Garfin

Ms. Luz Tagunicar

Ms. Rosemarie Aguirre

Mr. Anthony Roda

Ms. Edna Nito

Dr. Jessica De Leon

Ms. Alegria Gablan

Ms. Evelyn Perez

Ms. Ellen Gisala

Ms. Ma. Victoria Madura

Mr. Manuel Jacob

Mr. Ferdinand La Puebla

Ms. Ma. Arlene Rivera

Centers for HealthDeve l opmen tDr. Ma. Leticia J. Macaranas

Mr. Floro Orata

Mr. Renato Franco

Mr. Romulo Buenaventura

Ms. Therese Malubag

Ms. Noemi Bron

Ms. Helen Rivera

Ms. Consuelo Briones

Mr. Augusto Tapia

Mr. Noland Sabling

Mr. Gerald Basaca

Ms. Marites Garcia

Ms. Regina Siojo

Ms. Mary Divine Hilario

Ms. Jenelyn Ventura

Ms. Soralde Amilat

viii

Aklan

Ms. Adelfa Cordova

Dr. Levens Maravilla

Ms. Araceli Regalado

Ms. Yolanda Crispino

Dr. Marilyn Tabang

Ms. Lourdes Cielo Tabang

Ms. Salvacion Garino

Negros Occidental

Ms. Lorna Garde

Dr. Nelly Añonuevo

Ms. Virginia Dawa

Ms. Babette Mahilum

Ms. Marilou Caballero

Ms. Liezl Gumban

Mr. Jacinto Talebrico

Cagayan de Oro City

Dir. Julito Sabornido, Jr.

Ms. Regina Patricia Bernad Siojo

Bukidnon

Dr. Inocentes Dagohoy

Ms. Emmanuelita Barrera

Ms. Gloria Sitoy

Ms. Teresita Ilustrisimo

Compostela Valley

Dr. Jeorgie Arvin Legaspi

Ms. Pilar Marin

Ms. Nobleza Ang

Ms. Loida Cruz

Mr. Daniello Rublibos

Ms. Lourdes Andan

Ms. Velita Alemania

Quezon City

Ms. Felisa Tang

Bulacan

Dr. Emma Agustin-Bartolome

Ms. Rosemay Fernandez

Ms. Darlene Ivy Losa-Zafra

Ma. Lourdes Alborida

Ms. Lolita D. Ramos

Ms. Evelyn Aduna

Pangasinan

Ms. Prescilla Bersamin

Dr. Paz Mejia

Ms. Norma Soriano

Ms. Celsa Alaras

Albay

Ms. Gay Gloria Berango

Ms. Mari-Ann Esquivel

Dr. Marie Jane Revereza

Ms. Vivian Revilla

Ms. Helen Ricafort

Dr. Joana Limos

Ms. Marilyn Secillano

Ms. Maria Tablato

Bohol

Ms. Polizena Rances

Ms. Leoncia Lao

Ms. Pacita Castrodes

Local Government Units

ix

Maguindanao

Dr. Elvis Crispino

Ms. Jean Gisela Señase

Ms. Clara Fe Chiong

Ms. Lutgarda Beltran

Cotabato City

Dr. Manuel Dulay, Jr.

Ms. Julie Villadolid

Lanao Del Sur

Ms. Edna Rosas

Ms. Amina Macud

Ms. Emelyn Alvarez

Ms. Gloria Limitares

Basilan

Dr. Vicente Yu III

Ms. Lilia Paterno

Ms. Edith Casinillo

Sarangani

Dr. Israel Peralta

Publications StaffDr. Ma. Theresa Velasco,

Technical Editor

Mr. Bernabe Remoquillo,Layout Artist

PhilTIPSDr. Juan Antonio Perez, III

Mr. Jose Ibarra Angeles

Ms. Elaine Umali

Dr. Paz Diaz,

Consultant

TB LINCDr. Dolores Castillo

Dr. Mariquita Mantala

Dr. Arthur Lagos

Ms. Nenita Ortega

Ms. Rosario Nolasco

Dr. Rogelio Ilagan

Dr. Pilar Mabasa

Dr. Lydia Rogando

Ms. Lea Jordan

Ms. Lorna Flores

PBSPMr. Eric Camacho

Mr. Rino Naida

Ms. Rowena Cañete

PhilCATMs. Amelia Sarmiento

Mr. Angelo Concepcion

World VisionMr. Tito Rodrigo

Ms. Grace Gayoso

WHODr. Michael Voniatis

Hea l thProDr. Napoleon Juanillo

Dr. Jeanne Valderrama

Mr. Ronald Jabal

xi

List of Abbreviationsand Acronyms

ACSM Advocacy, Communication, and Social

Mobilization

BCG Bacillus Calmette Guerin

BHW Barangay Health Worker

CBMIS Community-Based Management Information

System

CDR Case Detection Rate

CHD Center for Health Development

CHO City Health Office/Officer

CUP Comprehensive and Unified Policy to Control

Tuberculosis in the Philippines

DOH Department of Health

DOT Directly Observed Treatment

DOTS Directly Observed Treatment, Short Course

DSSM Direct Sputum Smear Microscopy

FAQs Frequently Asked Questions

FDC Fixed Dose Combination

GO Government Organization

HEPO Health Education and Promotion Officer

HMO Health Management Organization

IEC Information, Education, and Communication

ILHZ Inter-Local Health Zone

IO Information Officer

IPC Interpersonal Communication

IRR Implementing Rules and Regulations

LCE Local Chief Executive

LGU Local Government Unit

LOR Locus of Responsibility

MDR-TB Multi-Drug Resistant Tuberculosis

MHO Municipal Health Office/Officer

MOA Memorandum of Agreement

MOP Manual of Procedures for the National

Tuberculosis Control Program

xii

NCDPC National Center for Disease Prevention

and Control

NCHP National Center for Health Promotion

NGO Non-Government Organization

NTP National Tuberculosis Control Program

PhilCAT Philippine Coalition Against Tuberculosis

PhilHealth Philippine Health Insurance Corporation

PHN Public Health Nurse

PHO Provincial Health Office/Officer

PLWD Person Living With Disability

PPMD Public-Private Mix DOTS

RHM Rural Health Midwife

RHU Rural Health Unit

RMT Registered Medical Technologist

SB Sangguniang Bayan

TB Tuberculosis

TBDC TB Diagnostic Committee

TB LINC Linking Initiatives and Networking to

Control Tuberculosis

TNA Training Needs Assessment

TWG Technical Working Group

WHO World Health Organization

xiii

G l o s s a r yAccreditation A process done by PhilHealth to enable a

facility to avail itself of the PhilHealth

Outpatient Anti-Tuberculosis/DOTS

Benefit Package

Advocacy Activities designed to place TB control

high on the political and development

agenda, foster political will, increase

financial and other resources on a

sustainable basis, and hold authorities

accountable to ensure that pledges are

fulfilled and results achieved; the act of

persuading people – using either verbal

or non-verbal, oral or visual

communication – to bring about a

voluntary change in judgment so that

they will support a cause and adhere to a

belief they may not have held before

Alliance-building Coalition building with community

organizations in support of advocacy for

health

Certification The process that assures the public and

payers of health care that TB DOTS

centers are capable of providing safe and

effective services

Communication An overarching term which refers to the

process people use to exchange

information about TB; the process of

establishing common understanding

between and among the parties involved

CUP Policy (embodied in Executive Order no.

187 s. 2003) to harmonize and unify TB

control efforts in the Philippines

xiv

DOT A trained DOTS facility worker (or

treatment partner) personally observes

TB patient take anti-TB medicines

everyday during the whole course of

treatment

DOTS A comprehensive strategy recommended

by WHO to detect and cure TB patients;

DOTS services include sputum

microscopy for TB symptomatics, free

drugs for TB patients, sputum follow-up

to monitor the status of patients, and

ensuring daily drug intake through a

treatment partner.

Enter-educate Entertainment-education; the deliberate

inclusion of socially desirable messages in

popular entertainment vehicles (e.g.,

television soap operas, songs, concerts)

to achieve some social and behavioral

change objectives

FAQs Frequently Asked Questions about TB

and DOTS, most of which spring from

misconceptions

Health A process of enabling people to take

action to improve health. It is anchored

on five pillars: building healthy public

policy; creating a supportive

environment; strengthening community

action; developing personal skills; and

reorienting health services.

Information, Encompasses information delivery,

training/human resource development,

and awareness/motivational campaigns

in support of the NTP

Education,

and

Communication

Promotion

xv

Mobilization

Lobbying A focused form of advocacy that shares

public policy in arenas of influence at the

barangay, municipal/city, provincial,

national, and even at international

levels; persuading individuals or groups

with decision-making powers to support

a certain position/issue

Networking The process of linking up diverse

individuals or groups, bringing about

their mutual agreement to share one

another’s resources and competencies as

a way of serving mutual interests

PPMD A strategy adopted by DOH that

integrates private practitioners into the

NTP through referral of TB patients to

PPMD units or through provision of

services

Social Marketing A process that adopts marketing

principles in developing, implementing,

managing, and evaluating behavior

change programs to improve health or

benefit society

Social The process of bringing together all

feasible and practical intersectoral allies

to raise awareness of and demand for a

particular program, to assist in the

delivery of resources and services, and to

strengthen community participation for

sustainability and self-reliance; the

process of engaging people in action,

redirecting existing or creating new

resources to achieve society’s or the

community’s social goals

TB (Tuberculosis) An infectious disease, caused by

Mycobacterium tuberculosis or tubercle

bacilli, that primarily affects the lungs

1How to Use This Handbook

he handbook is for frontline health

workers in health facilities at local levels

directly providing Directly Observed Treatment,

Short Course (DOTS). Health workers include

doctors, nurses, midwives, and microscopists.

Health facilities include rural health units

(RHUs), Public/Private Mix DOTS (PPMDs),

hospitals, health centers, and clinics of non-

government organizations (NGOs) and other

government organizations (GOs).

The handbook is an easy-to-read standardized

guide written to equip users with knowledge to

plan, implement, and monitor Advocacy,

Communication, and Social Mobilization

(ACSM) activities for the TB Control Program.

How to Use The Handbook

This introductory part of the Health Promotion

Handbook should enable readers to:

l Identify the intended users of the handbook;

l Explain the purpose of the handbook;

l Identify its features; and

l Describe briefly the contents of each chapter.

ntroductionI

T

2 The Health Promotion Handbook

Through ACSM activities applied in the five

areas of health promotion, health workers in

turn hope to contribute to the overall goal of

the National Tuberculosis Control Program of

increasing case detection rate (CDR) to 70 per

cent or more and cure rate to 85 per cent or

more.

The five areas of health promotion are:

l building healthy public policy;

l creating supportive environment;

l strengthening community action

l developing personal skills; and

l reorienting health services.

This handbook should enable users to:

1. cite key points on TB and DOTS;

2. correctly answer FAQs on TB;

3. discuss how health promotion, through its

five pillars, could help increase case

detection rate and cure rate;

4. design ACSM activities that could help

promote behavior change among major

stakeholders;

l For TB symptomatics to consult at RHUs

l For TB patients to complete treatment

and the required sputum examination;

and

l For local chief executives to allocate

resources for TB control.

Features of the Handbook

For easy reading, the Health Promotion

Handbook carries a standard format featuring

three sections in each chapter: introduction,

body, and summary.


l The introduction contains the explanatory

part at the start, as well as the objectives of

each chapter. The objectives spell out the

learning competencies that readers will

acquire upon completion of the chapter.

They give the readers an overview of the

topics covered in the chapter.

l The body gives in detail the contents of the

chapter. Wherever appropriate, step-by-step

procedures, as well as examples, are given.

These are written in simple, easy-to-

understand, and generally user-friendly style.

l The summary highlights key points taken up

in the chapter. It allows readers to review

what they have learned in a fun,

non-threatening way. All answer

keys may be found on pages 105-

109.

Other helpful sections are :

1) Glossary, a listing of special

terms with their corresponding

meanings;

2) List of Abbreviations; and

3) References, which lists the authors’

sources. The References section may also

lead the readers to sources of additional

information which may not be found in

the handbook.

Overview of Chapters in the

Health Promotion Handbook

The handbook contains five chapters:

Introduction How to Use the Handbook

Chapter 1 The Essentials of TB and DOTS

Chapter 2 Introduction to Health Promotion

Chapter 3 Advocacy, Communication, and

Social Mobilization


Chapter 4 How to Apply ACSM in the Five

Action Areas of Health Promotion

Chapter 5 How to Develop an ACSM Plan

How to Use The Handbook guides readers on how

to find information in the handbook. It explains the

purpose of the handbook, identifies its intended

readers, enumerates the features of each chapter, and

walks the readers through the contents of each

chapter.

Chapter 1 gives readers the basic facts about

tuberculosis – the nature of the disease, its signs and

symptoms, modes of transmission, prevention, and

cure. It explains fully the DOTS strategy, which is the

global strategy for TB cure recommended by the

World Health Organization (WHO). Chapter 1 also

emphasizes the magnitude of the TB problem both

from the global and national perspectives. Readers

are introduced to the key points about the National

Tuberculosis Control Program (NTP) in this chapter.

Chapter 1 also lists not only the Frequently Asked

Questions (FAQs) on TB and DOTS but also the

scientifically-based answers to these questions. Most

of the FAQs undoubtedly spring from

misconceptions.

Chapter 2 defines the broad concept of

health promotion and situates it in the

context of the NTP. The chapter also

discusses in detail the principles and five

action areas of health promotion. The

last part explains the desired behavior

change from each target group of the

TB Control Program.


Chapter 3 discusses how advocacy,

communication, and social mobilization

activities can be carried out for the NTP. Various

activities under each of the ACSM are also given.

Chapters 4 and 5 are essentially the “how-to”

portions of the handbook. Chapter 4 tackles the

application of ACSM in the five action areas of

health promotion on the NTP. More

importantly, this chapter guides readers on how

to use the various techniques of ACSM to

increase success rate in carrying out activities

under the five action areas.

Chapter 5, on the other hand, gives a concrete

example of an ACSM plan under each of the

five action areas. The sample plans are

community-based plans relevant to the intended

readers’ situation.


1. The Health Promotion Handbook is meant for:

a. Doctors

b. Nurses

c. Midwives

d. ______________

2. The NTP’s goal is ___% CDR and ___% cure rate.

3. The _____________is the part of the Health

Promotion Handbook that lists special terms and

their meanings.

4. The ______________ section is also important

because this may be able to supply sources of

additional information for readers.

5. ______ is the strategy currently implemented

worldwide to address the TB problem.

Supply the missing words in the review questions. The

words, in jumbled letters, are in the blue box. Answers

may be found on page 105.

85%

DSTO

miorcisssptoc

resefcrnee

gsaolyrs

ummaryS

70%

7Chapter 1 The Essentials of TB and DOTS

Chapter 1The Essentials of TB and DOTS

Facts on Tuberculosis

hat is tuberculosis? hat is tuberculosis? hat is tuberculosis? hat is tuberculosis? hat is tuberculosis? Tuberculosis is an

infectious disease caused by

Mycobacterium tuberculosis or tubercle bacilli.

The disease primarily affects the lungs and this

condition is known as pulmonary tuberculosis.

Other parts of the body may also be affected by

tuberculosis; this is known as extra-pulmonary

n t roduc t ion

A whole chapter is devoted to the facts about

tuberculosis (TB) – cause, mode of transmission,

prevention, and control, among others. Chapter 1 is

deemed an important part of the handbook because

this is where the health worker will get the answers to

most questions about the disease and its cure.

The contents of this chapter will enable readers to:

l Discuss the facts on TB;

l Describe the TB situation globally and nationally;

l Identify the NTP strategies;

l Explain the elements of DOTS; and

l Enumerate frequently asked questions (FAQs) from

patients/the community and answer these correctly.

I

W


tuberculosis. It may affect the bones, meninges,

joints, genito-urinary tract, intestines, liver,

kidneys, and the heart.

How does one get tuberculosis? How does one get tuberculosis? How does one get tuberculosis? How does one get tuberculosis? How does one get tuberculosis? A person gets

infected with TB if he or she inhales the bacteria

released from air droplets when a person with

TB coughs or sneezes. Generally, the bacteria

will be killed in five minutes after direct

exposure to sunlight. But these bacteria can

survive for up to one year in a dark, moist, and

poorly ventilated area.

A Pulmonary TB patient whose sputum is

positive for TB bacilli may spread the disease to

about 10-20 persons in a year for two years.

Once the patient starts on taking anti-TB drugs,

sputum will become negative within two weeks

in most patients. But he or she needs to take the

drugs completely for six months to eliminate all

the TB bacilli in the lungs and be cured.

What are the signs and symptoms of TB?What are the signs and symptoms of TB?What are the signs and symptoms of TB?What are the signs and symptoms of TB?What are the signs and symptoms of TB?

l Cough for two weeks or more is the most

common symptom of tuberculosis.

l Other signs and symptoms are fever, chest or

back pain not referable to other diseases, loss

of weight, and blood-streaked sputum or

hemoptysis.

How does one know if he or sheHow does one know if he or sheHow does one know if he or sheHow does one know if he or sheHow does one know if he or she

has TB? has TB? has TB? has TB? has TB? Direct sputum smear

examination should be done for persons

with cough of two weeks or more.

Direct Sputum Smear Microscopy (DSSM)

is the primary diagnostic tool because:

1) DSSM is specific; 2) the procedure is

simple and economical; and 3) it can be

done even in remote areas. Chest x-ray


may be used to establish the diagnosis of TB if

the sputum is negative. Chest x-ray is secondary

to DSSM because: 1) there are no shadows in the

x-ray that are specific for TB; 2) it is more

expensive; and 3) about 40 per cent of patients

diagnosed by chest x-ray alone do not have

active TB.

Can TB be cured? Can TB be cured? Can TB be cured? Can TB be cured? Can TB be cured? Yes, TB can

be cured if:

1) anti-TB drugs are taken

regularly;

2) in the correct dosage; and

3) for the right duration.

Treatment will last for a minimum

of six months. The complete anti-

TB drugs for six months cost from

P1,000 to P4,000. Since treatment

for TB is expensive, the

government provides free drugs so that patients

will comply with the minimum six-month

treatment, or eight-month treatment if they are

re-treatment cases.

If patients do not take the drugs regularly or if

they will not complete their treatment, they will

develop Multi-Drug Resistant TB (MDR-TB).

This means that they will not be cured with the

use of first-line drugs and they will continue to

spread TB in the community. They will be using

second-line anti-TB drugs, which:

l are more expensive;

l may not all be available in the Philippines;

l have more side effects; and

l require treatment duration of 18 months to

2 years.


The best prevention for MDR-TB is DOTS. If DOTS strategy

is well implemented, every patient started on treatment will

be cured and he or she will no longer spread the disease.

How can the spread of TB be prevented?How can the spread of TB be prevented?How can the spread of TB be prevented?How can the spread of TB be prevented?How can the spread of TB be prevented?

The best way to prevent the spread of TB is to find the TB

patient early and provide treatment through DOT to cure

the patient. It is best for individuals to adopt a healthy

lifestyle to boost the immune system. Remember to: engage

in physical activity or exercise regularly; get enough rest; eat

a balanced diet; keep the living area well ventilated; and

maintain personal hygiene. It is also best to cover the nose

and mouth when coughing and sneezing.

Magnitude of TB Problem Globally andNa t iona l l y

Global Situation

Tuberculosis continues to be a major cause of death

worldwide although the global epidemic is on the threshold

of decline. In 2005, there were an estimated 8.8 million

new TB cases, about 7.4 million of which were in Asia and

sub-Saharan Africa. Also, 1.6 million people have died of

TB, including 195,000 infected with HIV.

Source: http://www.worldlungfoundation.org/pics/map.jpg


Source: Philippine Health Statistics (1970 - 2000)

The Philippines is one of the 22 high-burdened

countries under the World Health Organization

(WHO) watch list. Ranking has improved from 7th

to 9th. In the Western Pacific region, the Philippines

ranks third in case notification rate.

National Situation

Tuberculosis continues to be a major public health

problem in the Philippines. TB is the sixth leading

cause of deaths and illnesses and TB accounts for 7

per cent of the total deaths. About 75 people die

of TB everyday. The trends for morbidity and

mortality rates are decreasing but these are still high

compared to the target of decreasing them by half

by 2015. Figures are still very far from the

elimination level of one case per million

population.

What is the economic impact of TB?What is the economic impact of TB?What is the economic impact of TB?What is the economic impact of TB?What is the economic impact of TB? TB robs

an average male worker of compensation worth

P451 per day and the female worker P216 per day

(Measuring the Burden of Disease and EconomicConsequences of TB in the Philippines, 2003). The

most affected group is the 15-54-year-old age

group, the economically productive age group

(1997 National Prevalence Survey). As such, the

impact of the disease will be felt by their families,

including children.

Trend of TBMorbidity and

Mortality Rates per100,000 population,Philippines,1970 to 2000


The National Tuberculosis ControlProgram (NTP)

Vision, Mission, and Goals

Vision: To make the Philippines a country where

TB is no longer a public health problem

and that is when the incidence of smear-

positive cases is less than 1 per million

population

Mission: To ensure that TB DOTS services are

available, accessible, and affordable to

the communities, in collaboration with

the Local Government Units and other

partners

Goals: To reduce mortality due to TB and

prevalence by half by the year 2015 in

line with the Millennium Development

Goals

Targets: To cure at least 85 per cent or more of the

new smear-positive TB cases detected and

to detect at least 70 per cent or more of

the estimated new smear-positive TB cases

Guided by these goals and targets, the NTP

has embarked on several initiatives, in

partnership with local and international

partners. The overarching framework for TB

control is the DOTS strategy. Other

initiatives are:

l Comprehensive and Unified Policy to

Control Tuberculosis in the Philippines

(CUP);

l Public-Private Mix DOTS (PPMD);

l TB DOTS Certification and

Accreditation;

l Hospital-based DOTS; and

l TB in Children.


DOTS Strategy

DOTS is a comprehensive strategy recommended

by WHO to detect and cure TB patients. All rural

health units (RHUs), selected private clinics, city

health centers, and selected government and

private hospitals and health centers are offering

DOTS services. DOTS services include sputum

microscopy for TB symptomatics, free drugs for

TB patients, sputum follow-up to monitor the

status of patients, and ensuring daily drug intake

through a treatment partner.

DOTS strategy was implemented in 1996 in

selected areas and in all public health centers by

2003. By 2005, the Philippines has reached the

targets of 70 per cent case detection rate and 85

per cent success rate.

What are the five elements of DOTS?

1. P1. P1. P1. P1. Political commitment at all levels –olitical commitment at all levels –olitical commitment at all levels –olitical commitment at all levels –olitical commitment at all levels –

This is the support given by the government to

implement TB control activities nationwide.

Political commitment is needed to foster

partnership to address the TB problem in the

community. Health staff should provide data to

show the burden of TB and explain to the local

government officials the needs of the community

with regard to TB control.

2. Quality Sputum Microscopy – 2. Quality Sputum Microscopy – 2. Quality Sputum Microscopy – 2. Quality Sputum Microscopy – 2. Quality Sputum Microscopy – This is the

diagnostic tool used to detect sources of infection

among patients with TB symptoms. Sputum

examination should be validated so that smear-

positive cases could be identified correctly.

Identified smear-positive cases should be started

on treatment right away to stop the spread of

infection. One smear-positive case can infect


10-20 persons in a year. Smear-negative cases are

less infectious. They can infect 1-2 persons in a

year. Sputum microscopy is more specific because

TB bacilli can be seen in the sputum smear. There is

no specific shadow for TB seen in the chest x-ray.

Sputum microscopy is also more economical

compared to chest x-ray.

3. Directly Obser3. Directly Obser3. Directly Obser3. Directly Obser3. Directly Observed Tved Tved Tved Tved Treatment (DOT) –reatment (DOT) –reatment (DOT) –reatment (DOT) –reatment (DOT) –

Treatment for TB is standardized and drug

preparation has been changed to Fixed-Dose

Combination (FDC) to facilitate adherence.

Supervised treatment is done to ensure that

patients are taking their drugs daily to achieve cure

and to prevent the development of MDR-TB.

Supervision of treatment should be based on the

situation in the locality, as well as the patient’s

status.

4. Recording and Reporting – 4. Recording and Reporting – 4. Recording and Reporting – 4. Recording and Reporting – 4. Recording and Reporting – Standardized

records and reports should be in place to monitor

the status of the patient. These documents can

provide information that will be needed to

monitor the treatment outcomes of the patients

and to determine the problems identified in the

areas. These will help the program manager

determine the needs of the program.

5. Quality Drugs – 5. Quality Drugs – 5. Quality Drugs – 5. Quality Drugs – 5. Quality Drugs – Regular and adequate

supply of quality drugs through procurement and

delivery of drugs based on the number of cases

registered must be ensured. There should be

adequate supply of quality drugs to ensure that

identified TB patients are started on treatment

right away to prevent the spread of the disease.

The DOTS strategy has been proven to:

l Cure TB patients and produce cure rates as

high as 95 per cent even in poor countries;

l Prevent new infections among children and

adults; and

l Be cost-effective.


TB DOTS Certification and Accreditation

CertificationCertificationCertificationCertificationCertification is the process that assures the general

public and payers of health care that the government

can deliver safe and effective services to patients.

With the PPMD strategy, there is a need for

certification to ensure quality DOTS

implementation.

Certification aims to:

1. oversee quality DOTS implementation both in

the public and private sectors;

2. provide a response to the capacity of the private

sector to implement DOTS services; and

3. serve as a means for patients to avail themselves

of the PhilHealth Outpatient Anti-Tuberculosis/

Directly Observed Treatment, Short Course

(DOTS) Benefit (OPB) Package.

What facilities may be certified? Health facilities, like

RHUs, health centers, hospital-based clinics, Health

Management Organizations (HMOs), factory clinics,

church-based clinics, school-based clinics, and private

facilities can be certified. The Department of Health

(DOH) is the main agency responsible for

certification. Certifiers are the staff at the

Centers for Health Development. CHD staff

may be joined by PhilCAT representatives if

private facilities need to be certified.

Before a health facility can be certified, it

has to fill out the self assessment tool

provided by the Provincial NTP

Coordinators. The coordinators can also

help or provide technical assistance in filling

out the form. Once the facility is ready, it will be

assessed by the CHD staff and will be certified

once it has complied with the 10 standards.


Ten Standards for Certification

1. The TB DOTS Center is easily located and

patients have convenient and safe access to

the Center.

2. The TB DOTS Center provides facilities for

the comfort and privacy of its patients and

staff.

3. The TB DOTS Center provides for the safety

of its patients and staff.

4. All patients undergo a comprehensive

assessment to facilitate the planning and

delivery of treatment.

5. All patients have continuous access to

accurate and reliable TB diagnostic tests.

6. A care plan is developed and followed for

all patients.

7. Patients have continuous access to safe and

effective anti-TB drugs throughout the

duration of their treatment.

8. Policies and procedures for providing care to

patients are developed, disseminated,

implemented, and monitored for

effectiveness.

9. Policies and procedures for managing

patient information are developed,

disseminated, implemented, and monitored

for effectiveness.

10. The TB DOTS Center has an adequate

number of qualified personnel skilled in

providing DOTS services.

AccreditationAccreditationAccreditationAccreditationAccreditation is done by PhilHealth. Once

accredited, the facility can avail itself of the

PhilHealth OPB Package. This is given to the


facility for every new TB case it identifies and

starts on treatment.

1. A flat rate of P4,000 per case, given in two

separate payments, is paid to an accredited

DOTS facility. This fee covers diagnostic

work-up, consultation services, and anti-TB

drugs.

2. The first payment of P2,500 is paid after the

patient has completed the intensive phase of

treatment. The final payment of P1,500 is

paid to the DOTS facility after the end of

the continuation phase.

Hospital-based DOTS

This strategy is undertaken to increase case

detection and to enhance the delivery of DOTS

services in the hospitals. It will ensure that TB

patients are not lost from the NTP system even

if they are initially managed at the hospitals,

both for in- and out-patients. This will improve

the referral system from the hospitals to the

health centers.

TB in Children

The target group for childhood tuberculosis

consists of children below 14 years old.

A child shall be suspected of having TB and will

be considered a TB symptomatic if he or she has

any threeany threeany threeany threeany three of the following signs and

symptoms:

1. Cough/wheezing of two weeks or more;

2. Unexplained fever of two weeks or more;


3. Loss of appetite/loss of weight/failure to gain

weight/weight faltering;

4. Failure to respond to two weeks of appropriate

antibiotic therapy for lower respiratory tract

infection; or

5. Failure to regain previous state of health two

weeks after a viral infection or exanthem (an

eruptive disease, such as measles, or its

symptomatic eruption).

A child shall be clinically diagnosed or confirmed of

having TB if he/she has any threeany threeany threeany threeany three of the following:

1. Exposure to an adult/adolescent with active TB

disease;

2. Positive tuberculin test of 10 mm;

3. Any three of the signs and symptoms suggestive

of TB;

4. Abnormal chest radiograph suggestive of TB; or

5. Laboratory findings suggestive or indicative of

TB (histological, cytological, biochemical,

immunological, and/or molecular).

TB in children is usually non-infectious and the

source of infection is the adult within the household

or neighborhood.

DOH shall provide anti-TB drugs,

tuberculin reagents (2TU RT23

Tween 80), information/

education/communication (IEC)

materials, and recording and

reporting forms.


Comprehensive and Unified Policy toControl Tuberculosis in the Philippines(CUP)

In 2003, Executive Order no. 187 s. 2003 was

signed by the President of the Philippines to

harmonize and unify TB control efforts in the

Philippines. Government agencies and private

organizations have been mandated to work

together on the dissemination and training

aspects of the Comprehensive and Unified

Policy for TB Control in the Philippines.

Public Agencies

l Department of Health

l Department of Education

l Department of Interior and Local

Government

l Department of National Defense

l Department of Justice – Bureau of

Corrections

l Department of Social Welfare and

Development

l Department of Agriculture

l Department of Agrarian Reform

l Department of Science and Technology

l Department of Labor and Employment

l Philippine Health Insurance Corporation

l Overseas Workers and Welfare

Administration

l National Economic and Development

Authority

l National Commission on Indigenous

Peoples

l Government Service Insurance System

l Social Security System

l Employees Compensation Commission


Private Organizations

l Philippine Coalition Against Tuberculosis

l Philippine Medical Association

l Trade Union Congress of the Philippines

l Employers Confederation of the

Philippines

l Association of Health Maintenance

Organizations of the Philippines

Public-Private Mix DOTS (PPMD)

PPMD is a strategy adopted by the Department

of Health, in partnership with the PhilCAT, to

address the problems attendant to the disease.

This strategy integrated private practitioners

into the National TB Control Program through

referral of TB patients to PPMD units or through

provision of services.

The primary objectives of PPMD are:

1) to increase case detection; and

2) to synchronize the diagnosis and treatment

of TB.


Question

Is TB hereditary?

Can TB be cured?

Can a person die of TB?

Does TB afflict only the

thin, the elderly, or the

poor people?

Can one contract TB from

doing heavy work?

Can one contract TB from

too much drinking or

smoking?

Why is there a need to

undergo sputum

examination and not chest

x-ray right away?

Answer

TB is not hereditary. Bacteria causing TB come

from air droplets from a person with TB when

he/she coughs or sneezes.

However, it is infectious such that household

members of TB patients are at risk of acquiring

the disease.

Yes, TB is curable with the correct treatment

regimen, plus nourishing food and adequate

rest. Compliance with treatment duration is a

must.

Yes, if treatment is not started early enough

and if a patient does not finish the treatment

regimen.

No. Everybody is at risk of getting TB. Those

with higher risk are the malnourished,

immunocompromised (HIV-infected, diabetic,

cancer patients), and those in contact with

patients who are sputum smear-positive.

No. However, if heavy work leads to a

lowering of body resistance, a person

becomes susceptible to the disease.

No, but excessive drinking or smoking may

weaken a person’s body resistance, making

him/her susceptible to the disease when he/

she inhales the bacteria.

Sputum examination is more specific to TB

diagnosis than chest x-ray. Chest X-ray may

indicate lung conditions other than TB. A

sputum exam determines whether the activity

is contagious or inactive.

Frequently Asked Questions

About TB


About Treatment

Question Answer

This is important to ensure accurate diagnosis.

Three sputum specimens are collected to

increase the yield of positivity for microscopic

TB bacilli.

Both results are considered. These are referred

to the TBDC (TB Diagnostic Committee),

which recommends the correct case

management.

Even if a person is x-ray positive, he/she still

has to undergo sputum examinations. If

sputum examinations yield positive results,

he/she will be given anti-TB drugs. If sputum

results are negative, these and the x-ray plate

will be sent to the TBDC for accurate

diagnosis. The TBDC will evaluate the case

and reach a consensus as to whether or notthe patient needs treatment.

Yes, but anti-TB drugs are available for free at

the health center for the entire duration of

treatment.

No. Effectiveness does not depend on who

prescribes the anti-TB drugs. Truth is, some of

the anti-TB drugs prescribed by private

physicians are the very same ones given at the

health centers.

A patient who is moving to another place may

be given only two weeks’ supply of anti-TB

drugs. He/she will be given an NTP Referral

Form so that treatment regimen will be

continued and completed in the new place of

residence.

Why is there a need to

give three sputum

specimens?

If x-ray results are

positive but sputum

examination results are

negative, which result is

adopted?

Can an x-ray positive

person avail himself/

herself of anti-TB drugs

at the health center?

Are anti-TB drugs

expensive?

Are the anti-TB drugs

prescribed by private

physicians more effective

than the ones from the

health center?

Can a patient who is

moving to another place

be given complete anti-

TB drugs so he/she can

complete the treatment

regimen?


Question Answer

In the DOTS strategy, it is very important to

ensure that the patient takes drugs daily under

a treatment partner’s supervision. The role of

the treatment partner, who personally

witnesses patient’s intake of TB medicines, is

critical in this respect.

Yes, but it would be better not to drink while

undergoing treatment because alcohol may

adversely affect the liver. It would also be

good to refrain from smoking at this time.

Hepatotoxic reactions to anti-TB drugs may

be more common among patients with a

history of excessive alcohol consumption.

Once the patient starts taking anti-TB drugs

daily, the number of bacilli-- hence the degree

of infectiousness-- decreases greatly within

two weeks. But he/she needs to complete the

six months of recommended treatment.

There is no need to do so, because TB is

transmitted through inhalation (not ingestion) of

aerosol.

A woman taking anti-TB drugs can continue

to breastfeed. All anti-TB drugs are

compatible with breastfeeding. Mother and

baby should stay together and the baby may

be breastfed in the normal way.

A breastfeeding woman with TB should receive

a full course of anti-TB treatment. Timely and

correct treatment is the best way to prevent

transmission to the baby.

BCG vaccination should be given to the infant

immediately at birth.

Why can’t the patient be

given at the start all the

anti-TB drugs he/she will

need for the entire

duration of the treatment?

Can a person drink

alcoholic beverages

while undergoing

treatment?

Is a patient still infectious

after taking anti-TBdrugs?

Is there a need to

separate the personal

belongings, especially

utensils, of the TB

patient?

Can a patient breastfeed

while on treatment?


Question Answer

What is the benefit of

giving BCG vaccination?

Can pregnant women

take anti-TB drugs?

Is it alright for a patient

on pills to take anti-TB

drugs?

Can a cured TB patient

contract TB again?

Can a patient engage

in sex?

BCG (Bacillus Calmette Guerin) should be

given to all infants because studies have

shown that BCG can give 80 per cent

protection against TB for as long as 15 years

if given before the first infection (Crofton, et al.

1999).

Most anti-TB drugs are safe for pregnant

women, except Streptomycin, which can

cause ototoxicity (deafness) to the fetus. A

pregnant woman should be advised that

successful treatment of TB with the

recommended standardized treatment

regimen is important for a successful outcome

of pregnancy.

A woman taking anti-TB drugs while on pills/

oral contraceptives has two options: 1) take

an oral contraceptive pill containing a higher

dose of estrogen (50), following consultation

with a clinician; or 2) use another form of

contraception.

Rifampicin may decrease oral

contraceptives’ protective efficacy against

pregnancy.

Yes, if he/she inhales TB bacilli when the

body resistance is low.

Yes. In most cases, a patient is no longer

infectious after two weeks of proper

medication.


S

A. Indicate whether the following statements are true

or false.

1. _____ TB, caused by tubercle bacilli, is a

disease of the lungs only.

2. _____ It is alright to stop taking TB

medication when the patient feels

great after two months of the TB

regimen.

3. _____ Chest x-ray is a conclusive indicator

of pulmonary TB.

4. _____ BCG vaccination is a must for all

infants to prevent serious forms of TB

later in life.

5. _____ In cases when diagnostic test results

are not conclusive, the TB Diagnostic

Committee decides whether or not a

TB symptomatic should undergo

treatment.

umma r y

This is a multiple-method review of the chapter on

facts about TB and the DOTS strategy. Have fun in

following the specific instructions! Answers are on

page 106.


B. Choose which letter represents the correct answer.

1. The NTP’s target case detection rate is _____ % or

more of the estimated new smear-positive TB cases.

a. 70 c. 80

b. 75 d. 85

2. The NTP’s target cure rate is _____ % or more of the

estimated new smear-positive TB cases.

a. 70 b. 75

c. 80 d. 85

3. DOTS means:

a. Directly Observable Treatment, Short Course

b. Directly Observed Treatment, Short Course

c. Directly Observable Training, Short Course

d. Directly Observed Treatment, Short

Chemotherapy

4. Which of the following is not an element of the DOTS

strategy?

a. Political commitment

b. Quality Sputum Microscopy

c. Quality X-Ray Examination

d. DOT

e. Recording and Reporting

f. Quality Drugs

5. Certifiers of health facilities are staff from one of the

agencies below:

a. PhilHealth

b. Centers for Health Development

c. Bureau of Local Health Development

d. World Health Organization


Label the following statements M if you

believe these are myths or T if these are the

truths about TB.

1. The spoons, forks, plates, and glasses

used by the TB patients, who are on

regular medication, should be set apart

from those used by other members of the

family.

2. Rifampicin may reduce the drugs’

efficacy in protecting the woman from

getting pregnant.

3. It is 100-per-cent safe to take alcohol

while on TB medication.

4. A patient who enrolls in DOTS should be

given two months’ supply of TB

medication before he/she moves to

another place of residence.

5. TB is hereditary.


Su m m a r y

Health promotion means encouraging people to take

________ in order to improve their physical, mental,

and ________ well-being. It is a proactive undertaking

that enhances public ________ of health and its

attendant dimensions. In health promotion, it is

important to fire up the following sectors: communities;

________ ; professionals; and the general ________.

The five action areas of health promotion are:

1. Building healthy public ________

2. Creating a ________ environment

3. Strengthening ________ action

4. Developing ________ skills

5. Reorienting health ________

An important principle of health promotion calls for

promoting ________ between and among various

sectors, including those beyond health care. Among

the approaches employed in health promotion is

________, along with education, legislation, fiscal

measures, organizational change, community

development, and spontaneous local activities against

health hazards.

By way of summarizing the contents of Chapter 2, do try out a

more creative approach. Have fun in accomplishing the following

Self-Assessment Exercise. Pick out the appropriate word/words

from the “list” found in the blue box. Take note that the letters are

jumbled. Answers are on page 107.

tcinoa

alocsi naseporlninutomcoimac

ripocoetona

ceiverss sneserawacilbup akoyplmesric

policy

rptusprivoe

nuytmocmi

55Chapter 3 Advocacy, Communication, and Social Mobilization

Intended Stakeholders/Target Audience

Policymakers, government

agencies or corporations,

business sector, media

organizations, other NGOs

Local chief executives,

Provincial Health Board,

Sangguniang Bayan, civic

organizations, academe,

business sector, cooperatives,

medical/professional societies,

media organizations, other

NGOs

Local chief executives of

member municipalities, chiefs of

referred hospital

Chief executives, Sangguniang

Bayan, Local Health Board, civic

organizations, academe,

business sector, cooperatives,

other NGOs, leaders of faith-

based religious organizations

Local formal and informal

leaders, people’s organizations,

religious groups or faith-based

organizations, community

groups, small entrepreneurs,

cooperatives, PLWD, cured TB

patients and their families, TB

support groups

Levels

National

Regional

Provincial/City

Inter-Local

Health Zone

Municipality

Community

Locus ofResponsibility

DOH – NCDPC, NTP,

NCHP, NGO

CHD-NTP, HEPO/IO,

PHO/CHO, NTP,

HEPO/IO

Chair of ILHZ Board

MHO – NTP Core

Team, PHN, HEPO/

IO

RHM, BHW, NGOs

81Chapter 4 How to Apply ACSM in the Five Action Areas of Health Promotion

encountered by the patients and their

partners. Hold some role playing

sessions, switching the roles of the

patient and the treatment partner for

both to better understand each

others’ situation.

l Individual counseling by the doctor may

be scheduled if patient fails to attend

education classes or if a problem already

arises.

l Regular follow-up by midwife could

ensure that patients and their partners

are doing the right thing. If they are not,

then the visit becomes an opportunity to

correct some mistakes.

g. Patients’ Testimonials

l Identify patients with success stories or

those who get cured of the disease

despite the odds.

l Develop talking points or ideas the

patients can discuss. These may include

their struggles in complying with the

treatment regimen, such as side effects,

lack of money to regularly visit the

health center, the pressure of going back

to work to earn a living, and many

more. Patients may also share the

driving force or their motivation to be

cured of TB and who helped them

achieve their goal.

l Invite said patients to special events or

media exposure opportunity to talk

about their stories.

95Chapter 5 How To Develop an ACSM Plan

Practical Steps in Designing an

ACSM Plan

1. Defining the problem. This involves the

identification of factors which cause a gap

between the existing and desired behaviors

of the target group. It can be a problem in

knowledge/ information, skill, attitude, or

resource. Problem identification methods

include observation, KAP

(knowledge, attitude, practice)

surveys, group discussions, analysis

of records, results of tests, and

special studies.

2. Formulate communicationobjectives. Objectives are goals to

aim for or desire to achieve within a

time limit through the use of

strategies and resources. It is

n t roduc t ion

How to Develop an ACSM Plan

Chapter 5 provides a guide for developing and carrying

out an ACSM plan in each of the five action areas of health

promotion. The reader may refer to this chapter for

specific ACSM activities on TB that can be done at the

community level.

I

Chapter 5


important to have a clear idea of the health

program to be communicated and the

action the identified target audiences have

to take.

3. Identify/analyze the audience. The extent to

which a message is attended to,

comprehended, and used by an audience is

largely determined by the extent to which

the source of the message understands the

audience. It is also important to break down

the audiences into sub-groups or what is

called audience segmentation. Different sub-

groups have different needs, interests, and

attitudes. Thus, different messages – or at

least different message executions – should

be tailored for different groups.

4. Design effective messages. A message should

appeal to the target audiences and hold

their interest. People pay more attention to

messages that are in consonance with their

needs and values. The message carries both

the content and image of an ACSM

campaign – not only what is said, but also

how it affects emotions, perceptions, and

attitudes. It is very important that the

message and its approaches be pretested and

revised before these are finalized and

disseminated.

5. Use multiple channels. Multiple

communication channels, both mass and

interpersonal media, tend to have a

complementary effect, and can carry

different types of information. Consider the

different types of ACSM activities discussed

in this chapter. Moreover, determine if a

mass medium is indeed justifiable in terms

97Chapter 5 How To Develop an ACSM Plan

of costs and benefits compared with other

types of channels.

6. Determine needed resources. Like other

project activities, ACSM requires allocation

of resources. An inventory of available

resources in the organization should be

done to determine what are available for

ACSM. However, if the organization’s

resources are limited, other agencies may be

tapped for resource-sharing.

7. Document, monitor, measure and evaluate.

Proper documentation is essential in any

ACSM activity. If it is not documented, it did

not happen. It is also important to carry out

both outcome evaluation and process

evaluation. It is best to remember that any

kind of evaluation should be guided by the

plan’s objectives.

A sample ACSM plan showing the activities in

each of the action areas is given in matrix

format. The sample also shows the different

features of an ACSM plan, aside from activities

-- tools, time frame, budget, locus of

responsibility, and performance indicators.

98T

he H

ealth

Pro

motio

n H

andbook

Present in the regular LHB meeting the policy gaps

of the TB Control Program

Lobby with SBs to pass resolutions/ordinances

to support the policy gaps which could be any

of the following:

* provision of funds, logistics and human resource

to health programs specifically NTP

* Philhealth Indigency program

* Philhealth accreditation

* Procurement of drugs for Category III and other

logistics

* Hiring of health professionals particularly RHMs

and RMTs/Microscopists

* Incentives for BHWs and TB Partners

Arrange for interviews of the SB for Health or the

MHO to discuss the merits of the proposed

ordiance or resolution over the local radio or TV

programs or to be featured in the local newspaper.

Conduct public discussion of the proposed

resolution/ordinance through community

assemblies.

Organize groups to attend public hearing to

express their interest and support for the proposed

resolution/ordinance.

Policy Gaps/Areas

Draft Resolution/ Ordinance

Position paper for the resolution/

ordinance highlighting its

benefits and the draft of the

resolution or ordinance

Briefer on the TB Control

Program proposed resolution/

ordinance and position papers of

various stakeholders

FAQs on the proposed

resolution/ordinance

January 2008

February 2008

February 2008

February 2008

February 2008

LHB Chair / Vice

Chair (MHO)

MHO

MHO

MHO

MHO/SB for

Health

LHB members convinced on the

need to issue new policies on TB

Local Resolution/ Ordinance

Passed

Merits of proposed resolution/

ordinance discussed over the

media

Public opinion on the proposed

resolution/ordinance created

Organized groups attended and

participated during public hearings

SAMPLE ADVOCACY, COMMUNICATION, AND SOCIAL MOBILIZATION PLAN

ACSM Activities Tools Time Frame Budget LOR Success Indicators

Building Healthy Public Policy

99C

ha

pte

r 5 H

ow

To D

evelo

p a

n A

CS

M P

lan

Orientation materials

NTP Briefer

List of Functions and

Responsibilities of each

TWG member

Manual of Operations

TB logistics, reagents,

supplies, and drugs

PHILHEALTH

accreditation procedures

and requirements

Documentation of best

practices on TB in other

areas

Project Document,

Documentation Report

Forms

March 2008

Throughout the

year

March 2008

May 2008

Throughout

project cycle

MHO, PHN, RHM

MHO, PHN, RHM

MHO, PHN, RHM

MHO

MHO, PHN, RHM

Functional TWG

Continuous provision of

diagnostic and treatment

services

PHILHEALTH accreditation of

the health facility

Project design developed and

implemented

Documentation report prepared

and shared with other areas


ACSM Activities Tools Time Frame Budget LOR Performance Indicators

Creating Supportive Environment

Organize Technical Working Groups.

Provide continuous diagnostic and treatment

services.

Work for PHILHEALTH Accreditation.

Develop new initiatives to improve program

implementation or delivery of TB services.

Document best practices and share with other

areas.

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Strengthening Community Action

Organize TB Task Forces/TB Patrol / TB Watch

sa Iskul.

Organize TB Support Groups/Clubs

- Select members to share testimonies during

TB club meetings.

- Schedule meetings of TB Clubs.

- Intensify H.E and focus on SP, follow-up

and Tutok Gamutan.

- Conduct regular meetings to get feedback

on quality of service delivery and client

satisfaction.

* Document activities and meetings.

* Provide awards and incentives.

Recruit and train TB treatment partners.

Orientation Materials, List

of Roles and

Responsibilities

Posters, leaflets, flip

chart, letter, MOA

Certificates, incentives

List of TB patients,

Briefing materials on TB

and List of Roles and

Responsibilities

March 2008

Throughout the

year

Throughout the

year

MHO/ PHN/ RHM

MHO/ PHN/ RHM

MHO/ PHN/ RHM

TB Task Forces/TB Patrol /

TB Watch sa Iskul organized

in each barangay / school

TB Clubs organized and

functional

Trained TB treatment

partners provided to each

patient

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Developing Personal Skills

Conduct IEC Development Writeshop that will

lead to the following outputs:

- Identification of target audience

- Crafting of specific messages per target

audience

- Development of prototypes of the materials

Pretest IEC materials among target audience

for clarity of messages and visuals used.

Produce IEC materials.

Distribute IEC materials.

Briefer on TB Control

Program

Documents/Reports of

Knowledge/

Attitude/Practices/

Behaviors of the people

being targeted for

communication activities

Questionnaires for

pretesting of materials

Canvass of Printers/

Suppliers

Guidelines for Distribution

and Utilization

February 2008 MHO and other

partner

agencies

Number of IEC materials

pretested and produced

Number of IEC materials

distributed to intended

audience

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Developing Personal Skills

Conduct interpersonal communication activities.

- Conduct health education classes.

- Carry out counselling during home visits.

- Conduct health education activities for patients

and treatment partners.

- Organize health events, like TB Expo, to

heighten awareness of the TB Control

Program.

IEC materials developed

or any appropriate

available IEC material

IEC materials

IEC materials

Posters, tarpaulins/

streamers, pamphlets,

and other relevant IEC

materials, List of media

people to invite, Letters of

invitation to key

stakeholders, Exhibit

materials

March-December

2008

March-December

2008

March-December

2008

August (Lung Month)

RHMs and BHWs

RHMs and BHWs

RHMs and BHWs

MHO and PHN

Number of health education

classes conducted

Number of home visits

conducted

Number of counselling

sessions conducted

Number of health education

activities conducted for

patients and treatment

partners

Number of people who

visited the TB Expo

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Reorienting Health Services

Conduct advocacy meeting with private

practitioners.

Conduct scientific forum or orientation on DOTS.

Send advocacy letters to private practitioners.

Conduct Lakbay-Aral to learn new initiatives or

best practices in other areas.

NTP Program brief, PPMD

Guidelines

NTP Protocols, Manual

and materials, PhilHealth

Guidelines, DOTS, CUP

Guidelines

NTP program brief, PPMD

Guidelines

NTP Protocols, Manual

and materials, PhilHealth

Guidelines, DOTS, CUP

Guidelines

Advocacy letter

List of areas with best

practices on TB program

and itinerary of travel

March 2008

March 2008

March 2008

April 2008

MHO

PHO/MHO

MHO

MHO

Advocacy meeting resulted in

some agreements

Memorandum of Agreement

signed

Private practitioners responded

to advocacy letters

Lakbay-Aral resulted in a new

project development

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105Answers to Summary

Answers (Introduction)

1. The Health Promotion Handbook is meant

for:

a. Doctors

b. Nurses

c. Midwives

d. Microscopists

2. The NTP’s goal is 70% CDR and 85% cure

rate.

3. The Glossary is the part of the HPH that

lists special terms and their meanings.

4. The References section is also important

because this may be able to supply

sources of additional information for

readers.

5. DOTS is the strategy currently

implemented worldwide to address the TB

problem.

Answer Keys


Answers (Chapter 1)

A. TRUE or FALSE

1. False

2. False

3. False

4. True

5. True

B. MULTIPLE CHOICE

1. a

2. d

3. b

4. c

5. b

C. MYTHS or TRUTHS

1. M

2. T

3. M

4. M

5. M


Health promotion means encouraging people to take

action in order to improve their physical, mental, and

social well-being. It is a proactive undertaking that

enhances public awareness of health and its

attendant dimensions. In health promotion, it is

important to fire up the following sectors:

communities; policymakers; professionals; and the

general public.

The five action areas of health promotion are:

1. Building healthy public policy

2. Creating a supportive environment

3. Strengthening community action

4. Developing personal skills

5. Reorienting health services

An important principle of health promotion calls for

promoting cooperation between and among various

sectors, including those beyond health care. Among

the approaches employed in health promotion is

communication, along with education, legislation,

fiscal measures, organizational change, community

development, and spontaneous local activities

against health hazards.

Answers (Chapter 2)


Answers (Chapter 3)

3

1

2

3

4A1D

4

2

5

5

L O B B Y I N G

P R O O T I O N

N E T W O R K I G

D V O C C

M O B L Z A T I N

C

M

M

U

N

I

C

A

T

I

O

N

M

A

Y

O

R

A

D

V

E

R

S

A

R

I

E

S

P

O

S

I

T

I

O

N

I

N

G

P

O

L

I

C

Y


1. Resolution

2. Ordinance

3. Advocacy Kit

4. Bingo

5. Task Force

6. ACSM

7. TBTWG

8. Press Conference

9. Texting

10. Lakbay-Aral

Answers (Chapter 4)


REFERENCES

Coleman, Patrick L. and Rita C. Meyer. 1990. The

enter-educate conference: entertainment for

social change. Baltimore: Center for

Communication Programs, Johns Hopkins

University.

Crofton, John, Norman Home, and Fred Miller,

1999. Clinical Tuberculosis 2nd Edition.

Egger, Gary, Rob Donovan, and Rob Spark. 1993.

Health and the media: principles and practicesfor health promotion. New South Wales:

McGraw-Hill Book Company Australia Pty.

Limited.

2003 Philippine Health Statistics, National

Epidemiology Center - Department of Health.

2007.

Piotrow, Phyllis T, Katherine A. Treiman, Jose G.

Rimon II, Yun Sung Hee, and Benjamin V.

Lozare. 1994. Strategies for family planning

promotion (World Bank technical paper, ISSN

0253-7494; no.223).

Regional Framework for Health Promotion

2002- 2005. WHO Regional Office for the

Western Pacific (2002).

UN Website for Millennium Development Goals,

http://www.un.org/millenniumgoals/

World Health Organization,

http://www.who.int/en/

the health promotion handbook

Documents

essentials of tb

tb dots certification

acronymslist of abbreviations

dots strategy

tb linclinking initiatives

hospitalbased dots

ilist of abbreviations

control tuberculosis