1. Models of good cooperation
between Red Cross of Serbia
and Health Care system
in TB control
Marija Čukić
Project Coordinator TB Control in Serbia GFATM grant Rnd 9
Red Cross of Serbia
Sarajevo 28/29.05.2015.

2. Legal bases
• International Movement of Red Cross and Red Crescent
Resolution No 2 – Red Cross is humanitarian, voluntary
independent organisation auxilliary the Government
• Law on Red Cross of Serbia (Official Gazzette 107/05)
– article 9. bulletin 7
„in collaboration with health institutions in activities related to the
promotion of health and prevention of diseases of social and medical
importance.”
– article 13.
“The Red Cross of Serbia shall secure funds from the budget of the
Republic of Serbia and the budgets of the provincial and local
authorities for exercising its public powers referred to under articles 6
and 7 of the present Law and implementing programs referred to
under article 9, paragraph 7 of the present Law”

3. TB Control
Title of the project :
“To reduce the burden of tuberculosis in the
Republic of Serbia through scaling up MDR-TB
interventions, strengthening the DOTS
implementation, TB-HIV collaborative
activities and strengthening TB control in
vulnerable populations”
GA with TGF 1.07.2010-30.06.2015.

4. TB Control project
• Red Cross of Serbia is a second Primary Recipient
for the GF grant besides Ministry of Health RS.
There were 4 main objectives of the Project:
• Strengthening and expansion of the access to
treatment and proper management for drug
resistant TB cases – MDR and XDR TB
• Ensuring that the basic DOTS package is maintained
and further strengthened
• Addressing TB control in vulnerable populations
• Addressing the TB/HIV co-infection

5. 5 key indicators:
 Number of people trained in TB and TB/HIV issues, including the
screening of vulnerable groups for TB
 Percentage of contacts of the Roma smear-positive TB patients
referred to TB Unit and examined for TB out of all contacts of
smear positive Roma identified during the period covered.
 Number and percentage of kitchen/meal users screened for TB
 Number of female sex workers screened for TB
 Number of Injecting drug users regularly benefiting from needle
exchange programs screened for TB
First three indicators are covered by the Red Cross network
Ssecond two are covered by NGO network in 4 big cities in Serbia

6. 16 sub recipients – 9 + 7

7. At the beggining...
• Lack of trust of HS in civil society involvment
• No confidence to the system itself
• Benefiriaries with specific vulnerabilities SK,
IDU,SW
• No strong link between RC and NGO sector
• No link between the field workers- Roma health
mediators, Red Cross, NGOs
• No clue how to “glue” it

9. Good cooperation model No 1- active case finding
TB unit- visiting nurse
-info on TB patient-
Red Cross coordinator
Meeting and steps to be taken: all
stakeholders/Roma health mediators, TB unit
representatives, Red Cross coordinator/local Red
Cross, visiting nurse
Outreach work- contact tracing
( first visit- up to 17 visits!)
Medical check of contacts:
all stakeholders- Red Cross , Roma Health
Mediator
 No sense of responsibility –
numerous visits to the slam
and TB units
 Lack of trust of parents-
( PPD test-Mantou test)
 Administration silence

10. Tracing contacts and referral success
Contact tracing of TB smear positive Roma person *
Follow up of the success in tracing contacts per year
2011 2012 2013
Index persons 10 4 1
Identified and medically checked index person contacts
78%
105/135
97%
32/33
98%
42/43
Contacts- children under 18 3 15 42
TB confirmed and treated 3 15 0
No of motivation DOT parcels** 11 52 35
* Contact tracing is performed only if requested by the TB unit
**18 places in Serbia

11. Referral success of SW and IDU
Active case finding 2011. 2012. 2013. 2014.
SW
( % medically checked out of referred)
0% 8% 27% 59%
No of referred VS
No of medically checked
0/130 9/111 13/48 51/87
IDU
( % medically checked out of referred)
6% 53% 88% 84%
No of referred VS
No of medically checked
6/104 28/52 68/77 82/98
ESTABLISHING DUTIES OF TB EXPERTS IN
NGO DROP IN CENTERS

12. Challenges- SW and IDU
• Legal boundaries – sex work and
injecting drugs is not legal
• No personal documents
• Fear to be exposed,
• Out of personal time control,
• Seeking for help only in
emergency,
• No habit of “waiting in the
queue”
Challenges for TB
experts
• Change of the working
environment
• No white uniform- “Am I
professional enough?”
• Need additional skills
• Understanding the specifics
of the beneficiary profile
• Withholding from delivering
the “recipes” how to live a
life

13. THE STATE AND HEALTHCARE
SYSTEM HAVE RESPONSIBILITY
To enable the most efficient
access and interventions for all
patients who suffer from
serious diseases. For this
approach to be successful,
health workers within the
healthcare system must
provide services in compliance
with patients’ needs and
wishes. If a large number of
patients fail to complete the
treatment, the healthcare
system has not worked well.
In the name of public
health, PATIENTS MUST be
treated. The law regulates
this imperative. It is
believed that these patients
do not know, understand
and care of the importance
to complete the treatment.
For these reasons, the
recommendation is that
there are sanctions if the
patients do not comply
with doctor's
recommendations apart
from education, motivation
and monitoring.
Programthatisnotpatient-oriented
Patient-orientedprogram
Responsibilities?

14. Good cooperation model No 2- establishing
duties of TB experts in NGO drop in centers
• From 2012. in 3 and from 2013. in 4 NGOs –
Belgrade, Novi Sad, Nis
• First contact between SW or IDU with Health
System takes place in the familiar
environment with no fear whatsoever.
• Red Cross of Serbia established cooperation
with 3 institutions for lung diseases from
Belgrade, Vojvodina and Nis

15. • 75 places/Red Cross organizations in Serbia
• Different vulnerability than SW and IDU
• High, often non realistic expectations from the
state and community, Red Cross…
• No general determinant for poverty –
difference in SK beneficiary profile 10 years
before and today
Active case finding among SK
beneficiaries

16. Referral success of SK
Active case finding among SK
beneficiaries
2011. 2012. 2013. 2014.
SK –
( % medically checked out of referred) 20% 38% 70% 92%
No of referred VS
No of medically checked
239/1.177 287/752 265/382 315/343

17. • Beneficiary has TB symptoms
but no health card
• Beneficiary has expectations
to receive some goods in
exchange for information
• Beneficiary deliberately lies
on TB symptoms expecting
reword if respond is “yes”
• Lack of functional literacy
and administration rules ad
regulations
• “Besides feeding us
you take care of our
health”
• “You are so kind,
nobody wants to see
or hear us”
• “You helped me reach
the doctor- it is not TB
but now I am taking
my therapy”
Experience with SK beneficiaries

18. • Red Cross network used good cooperation
with local TB units
• Building trust between beneficiaries and Red
Cross staff/volunteers
• Different stakeholders involvement
• Holistic approach to the person
• Different sustainable incentive provision
Good cooperation model No 3- creation of link
between stakeholders on the local level

19. TB in vulnerable populations
Coverage
( No of confirmed TB VS
No beneficiaries)
2011. 2012. 2013. 2014.
SK
0/23.049 90*/21.313 8/19.665 5/20.278
SW 0/659 0/496 0/527 1/506
IDU 0/337 1/273 0/299 0/310
Contacts 3/135 15/33 0/43 n/a

21. Sustainability steps
• Advocating for establishing Council
for health with Red Cross members
in it and TB high on the priority list
on the local level,
• Negotiation with Republic Fund for
Health Insurance to recognize the
duties of TB experts in drop in centers
on the service list,
• Advocating for direct referral of
vulnerable population to the local TB
units for diagnostics on TB.