community mobilization: indonesia mitra tb project

© 2005, CARE USA. All rights reserved.

Community Mobilization:Community Mobilization:Indonesia MITRA TB ProjectIndonesia MITRA TB Project

CORE Spring Meeting 2010CORE Spring Meeting 2010


MITRA

Pandeglang Lebak

Serang

Tangerang District

Tangerang City

Cilegon


National Context National Integrated Movement to Control TB,

by MOH in 1999: GERDUNAS In 2005, International TB monitoring mission

noted little contribution from local Gerdunas chapters


WHO ACSM

TB control at the country level:

Improving CDR and treatment adherence Combating stigma and discrimination Empowering people affected by TB Mobilizing political commitment and resources for TB


Paguyuban Paguyuban translation: “A group of people with the

same interests or goals” Members include:

Current TB patients Ex-TB Patients Family members DOTS TB officers Religious leaders Trained volunteers CBTO Supervisors


Paguyuban: Role

Linking puskesmas to community Advocating for TB and TB-HIV

prevention and treatment Counseling Coordinating TB activities at

puskesmas and community Coordination of activities among

different religious leaders, MOH, CBTO Supervisors, and volunteers

Primary Source of TB information in the community


Paguyuban: Results 79 Paguyubans formed 60 training sessions

completed 888 Paguyuban members

trained 50% MITRA initiated, 50%

MITRA encouraged Membership ranged in

size from 15-20 (100) members 80% women


CBTO Supervisors CARE created

additional level of treatment observer, the CBTO Supervisor

CBTO Supervisor manual accepted by MOH for national replication Sustainability of CBTO

system/MITRA


CBTO Supervisors: Role Ensure TB patients receive

DOTS treatment on time Follow up with patients for

sputum testing Refer TB suspects to puskesmas Members of Paguyubans Meet with puskesmas TB officer

regularly Provide supportive supervision

to CBTOs Prevent defaults


CBTO Supervisors: Results CBTOs and CBTO Supervisors

provide 30% of all TB information in their communities

222 CBTO supervisors trained 2,233 CBTOs managed by CBTO

Supervisors Expanding diagnoses

405 CBTO referrals 160 diagnosed with TB (40%)

TB community awareness 1,252 outreach activities

CBTO Supervisor manual accepted by MOH for national replication Sustainability of CBTO system/MITRA


Religious Leaders Religious leaders significant in stigma reduction 139 religious leaders trained 33 religious leaders became members of

paguyubans 155 religious leaders regularly disseminate TB

messages to community, particularly during Friday prayer


Surpassed the national Case Detection Rate (CDR) target of 70%, achieving a CDR of 76.5% in project areas

High levels of the Treatment Success Rate were maintained at 94%, exceeding the national target of 85%

MITRA

Cilegon

Serang Tangerang District

Tangerang City

LebakPandeglang

319,555

1,776,995

1,488,666

3,317,331

1,125,474

1,062,813


Goal: Decrease morbidity and mortality caused by tuberculosis (to support National TB Program) in the Child Survival program area

Strategic Objectives: Create sustainable community-based TB

control structures Strengthen the delivery capacity of the

district and provincial TB Program Increase private sector participation in the

TB Program.

Successfully integrated community support in 3 key areas:

Paguyubans CBTO Supervisors Religious Leaders


Sustainable structure Self-sustaining Minimal MITRA staff support Self-generating finances through voluntary funds

and solicitations of factories and supermarkets Expected to continue 5-10 years post MITRA

10 Golden Paguyubans


CBTO Supervisors TB treatment last 6-8 months with

side effects and high risk of MDR TB for defaulting patients

WHO recommends each TB patient have a treatment observer who is not a family member

Treatment observers were primarily family members, causing inefficient retention of CBTO (Community Based Treatment Observers)

CARE and KNCV created additional level of treatment observer, the CBTO Supervisor

CBTO supervisors are established members of community and highly respected Sustainability of CBTO system


Religious Leaders

Inaccessibility in Pandeglang District lead to barriers in staffing and resources

Community surveys found stigma associated with TB

Religious Leaders identified as key players to address issues related to TB


Religious Leaders: Role Religious leaders helped to

reduce stigma Participation and facilitation of

community health education TB is an infectious disease and not

a curse or punishment from God Testing & treatment for TB are free

at the puskesmas Those experiencing cough for 2 or

more weeks should get tested for TB at puskesmas

community mobilization: indonesia mitra tb project

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