Engaging Key Vulnerable Populations in Designing, Planning and Implementing TB

Community Activities

development of NSP FOR tuberculosis control the core components

Divonne, France, 17 – 26 February 2014‏

Blessina Kumar Chair, GCTA

the

achieve

ments

people treated for TB since 1995 56 million

Reduction in TB mortality Since 1990 45%

Lives saved Since 1995 22 million

target global 10 / 100k 125/ 100k

1990 2000 2010 2020 2030 2040 2050 2060 2070 2080 2090 2100 2110 2120 2130 2140 2150 2160 2170 2180 2190 2200 2210 2230 2250 2270 2290 year

TB incidence

the

burden

2180 2035

the road to 10 / 100,000 TB incidence

• Scale-up to 100% coverage of

proven interventions

• Prioritized focus on vulnerable

groups- including women and

children

• Integration within country-region

context and system

• New tools

today 125

10

Key affected population groups in relation to TB

Key affected population (KAP) in TB

• People at increased risk of TB

– because of other diseases

• People who are vulnerable

– because of their social conditions, behaviors or unsafe workplaces

• People who are underserved

– because of stigma, discrimination and access barriers

How to identify KAPs

• Opportunities – Programme review

– NSP development

– Country dialogue

• Who identifies them – NTP and partners

– NGO/CSOs working among these groups

– Community members from these groups

– Ministries that are responsible for these groups (e.g. Ministry of justice/home affairs, Ministry for mines

• Action: Important to involve them in the opportunities

How to assess the size and burden of TB in identified KAP groups

• Include this in the TORs of the epidemiological assessment that happens along with the programme review

• Review literature related to the KAPs

• Expert opinion

– From members of the community and those who work in the community

How to plan for addressing TB in KAPs

• Participatory planning

– Involve members of the community and those who work in the community

• Consider

– Additional services – outreach, screening, etc.

– Innovative models of care delivery that are sensitive to the socio-cultural needs of KAP groups

– Involve peer community members in care delivery

Role of civil society in planning for KAPs

• Advocate for addressing KAPs

• Highlight issues and share best practices

• Participate in epidemiological assessments to identify KAPs, estimate size and burden

• Actively participate in NSP development and country dialogue to ensure KAPs are addressed

• Contribute to GF Concept Note development

People at increased risk of TB - because of other diseases

Examples:

•PLHIV

•Diabetes

•Silicosis and other dust related lung disorders

•Other health conditions with decreased immunity (e.g. people on long term therapeutic steroids, people on immune suppressant treatment, malnourishment, etc.)

People who are vulnerable - because of their social conditions,

behaviors or unsafe workplaces

Examples:

• Prisoners and incarcerated people

• Migrants, refugees and internally displaced people

• Indigenous peoples and ethnic minorities

• Miners, peri-mining or mining-affected population

• Slum dwellers in urban settings

• Health care workers

• People who use tobacco

• Sex workers and victims of sex trafficking

People who are underserved - because of stigma, discrimination and

access barriers

Examples:

•People who use drugs

•Homeless

•Elderly, women and children in certain settings

•Remote populations

•People living with disabilities

Human Rights and TB

• All people have the right to reach and attain basic health standards

• In many settings key populations are criminalized and barriers created that prevent access to health services

• Interventions are most effective when designed with a human rights based approach to remove barriers to TB services

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• Human rights based approach is centered on the three principles of human dignity, non discrimination, transparency and accountability

• In designing national strategic plans an in-depth discussion about human rights violations that could affect access to services is key. (e.g prisoners, migrants, workers in mines, urban slums)

• Starting point is understanding who the key populations are

• What health inequities they face?

• What the level of uptake of services is?

• What barriers (legal or human rights) may affect their access to TB prevention and treatment services?

Gender and TB • Analysing gender dimensions of TB is key to

overcome barriers to effective prevention, coverage and treatment of TB.

• Young women are at a greater risk of HIV infection than men in the same age group, in sub-saharan Africa.

• Gender considerations on health seeking behaviour, should inform designing and implementation of TB programs

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Communities if engaged effectively can become part of the solution!!!!

Thank you.