1. Community Based TB
Programming: Seeking your
Input
Draft- Engaging NGOs and Civil Society
Organizations in Community Based TB
activities: A Primer and Reference Manual
Devasena Gnanashanmugam
Consultant, CORE Group

2. Why do we need yet another
document in TB?
• The past
• TB control delegated to Ministries of
Health/ NTPs
• NGOs/ Civil Societies not encouraged to
participate
• The problem
• Health facilities overburdened by TB
disease (fueled by the HIV epidemic)
• Although a “social disease”, community
involvement was lacking

3. Why another one?
• The present
• NGOs and CSOs are encouraged to get
involved
• But they aren’t quite sure how…
• The need
• More awareness about scale and impact of
TB on communities
• Practical steps on getting started to
address TB

4. Intent of the document
• Audience: NGOs and CSOs
• Those interested in TB by any/ all of the
following:
• Starting new efforts
• Expanding to or linking to existing programs
• Basic overview of TB & how to control it
• Reader is referred to more exhaustive
sources
• Written to ENCOURAGE involvement

5. A sample of included items…
• educate and mobilize communities about TB
• find men, women and children with symptoms
and get them where they need to go
• collect sputum samples to send to labs for
diagnosis
• trace contacts—men, women and children
who have been exposed to someone with TB
• provide patient-friendly treatment support over
the many months of taking medicine
• locate people who stopped their treatment,
and help get them back on track.

6. Key components for TB
programs
• Partnership
• Focus on Participation
• Invest in Social Mobilization and Behavior
Change
• Ensure a Strong Referral System
• Integrate programs into existing health
systems and services

7. Current TOC: the Basics
• Global TB Burden
• A Brief History of the Fight Against TB
• The current STOP TB Strategy

8. TOC: How to get Started
• Infection control.
• Care for your health providers.
• Assessing viability of getting involved and
possible roles
• Understanding the overall TB program
landscape
• Assess your NGOs’ Strengths: Initial
questions to ask

9. Initial Questions to Ask
• Do you have existing links in the Ministry of Health,
Education, or other relevant entities?
• What is your current area of expertise? How might you best
integrate TB with your current activities?
• Your NGO’s location
• What are the local rates and patterns of TB?
• Will this involve drug resistant- TB?
• Are you in one of the high burden countries?
• Will you need to consider HIV co-infection?
• If your expertise is advocacy
• Can you use your advocacy/ messaging for consistent
messaging or training in ACSM in TB?
• Can you leverage your capacity to reach out to inaccessible
and remote areas, including conflict zones?

10. Key Program Design Elements
• Overview of DOTS & how to expand
current direct observed therapy goals
• Potential Program Areas
• Special Populations

11. DOTS Elements
• Sustained political commitment to TB control
• Case Detection by quality assured
bacteriology
• Provide standardized treatment with
supervision, and patient support
• An effective drug supply and management
system
• Monitor and evaluate performance and impact

12. Potential Program Areas
• Active Case Finding and Contact
Investigations
• Directly Observed Therapy (DOT)—Watching
patients take their pills
• Methods to Improve Adherence
• Community Health Workers and Volunteers
• Integration of TB with other services
• Advocacy, Communication, Social
Mobilization and Behavior Change
Communication

13. Potential Program Areas
• Stigma
• Training and Supervision to Build Local
Capacity and Capacity building
• Public- private partnership mix
• Operations/Implementation Research

14. Special Populations
• Gender
• TB/ HIV
• Drug resistance (drug-resistant TB)
• Pediatric TB: TB in Children
• Access to Vulnerable or “Hard to Reach”
Populations
• Engaging TB patients
• People in Urban settings

15. Conclusion
• Pitfalls/ Lessons learned
• Key documents
• Your thoughts/ ideas/ comments?