making advocacy, communication, and social mobilization ...€¦ · pre-workshop acsm quiz 1 name:...
TRANSCRIPT
Handout 1.1 Pre-workshop ACSM Quiz
1
Name: Country
Date:
1. Advocacy, communication, and social mobilization
have the same objectives and target audiences. �True � False
2. Training medical providers to improve their counseling skills is an example of a communications activity.
�True � False
3. The goal of advocacy activities is to increase TB awareness among as many people as possible.
�True � False
4. What does “KAP” mean?
5. The Cough-to-Cure Pathway is a new diagnostic test for screening TB patients.
�True � False
6. “Stakeholders analysis” is a technique for assessing the importance and influence of various people and groups who affect a TB project or intervention.
�True � False
7. Most communication messages only need to be disseminated through the media once.
�True � False
8. It is more important to implement ACSM interventions quickly (because behavior change takes time) than it is to collect and analyze data and evidence to design the interventions.
�True � False
9. ACSM activities are essential components for reaching and sustaining national TB control targets.
�True � False
10. Identifying problems that TB patients have in adhering to treatment is an example of a “barriers analysis.”
�True � False
11. Television is always the most effective method of communication.
�True � False
12. The main goal of monitoring is to provide management and staff with information to make decisions.
�True � False
13. The main goal of social mobilization activities is increasing TB knowledge of journalists and politicians.
�True � False
14. Assessing ACSM needs may include various research methods.
�True � False
15. Tools and technical support to countries for ACSM planning and implementation can be accessed free of charge from the Stop TB Partnership.
�True � False
Handout 1.2 ACSM Challenges
2
Challenge # 1
In a country called Arana, the National AIDS Control department is in a mess. Because
of inefficiency and poor administration, its donors withdrew funding. The department is
now understaffed, demotivated, and ineffective. In contrast, the National TB Control
program is vibrant, productive, and efficient. It is well appreciated by the donors for its
professional management and has been receiving increasing levels of funding. The TB
program is not very interested in improving coordination with the AIDS control project,
which is seen as slow and burdensome.
In Arana, however, the majority of new TB cases are among HIV-positive people, and
the lack of coordination between the two programs is affecting the ability of people co-
infected with TB and HIV to access diagnosis, care, and treatment. TB case detection
rates are not increasing as had been expected because of the rising stigma associated
with the link between TB and HIV, so that people do not go to health services for fear of
being diagnosed with HIV.
What steps would you, as the ACSM officer in Arana’s NTP, take to remedy this?
1. What advocacy actions need to be taken to improve the situation?
2. What communications actions might be important?
3. What social mobilization work is most critical?
3
Challenge # 2
In the country of Siriland, a major donor is planning to fund a mass media campaign
encouraging people with TB to go immediately for voluntary HIV counseling and testing.
Their reason for funding this is a decision taken recently in the donor country’s
government to make a concerted push for simultaneous testing for TB and HIV, in the
wake of emerging XDR-TB. As an official of the National TB Program, you are
concerned that such a direct communication in the mass media will be viewed out of
context and will fuel rising levels of fear and stigma. However, you are equally
concerned that by objecting too strongly you might jeopardize future funding for your
own country program.
As the ACSM Officer for Siriland, what action and activities would you
recommend for dealing with this situation?
1. What advocacy actions could be taken to improve the situation?
2. What communications messages might be important?
3. Are there social mobilization actions that could contribute to your goal?
4
Challenge # 3
In the country of Indalia, recently, a high-profile minister has come forward to speak
about his personal experience with TB disease and treatment. However, he also
revealed that he travelled abroad to receive medical treatment because he did not
believe he could get the kind of care he needed in Indalia. While his acknowledgment
that he has TB and is being treated could have had a very positive effect on stigma
reduction, the fact that he does not have confidence in the country’s TB control program
has seriously weakened the NTP’s media campaign asking people with suspected TB to
go for early diagnosis at their local public health facility. As a branch of the government,
the NTP is hesitant to contradict a minister. However, inaction could jeopardize the
outcomes and targets of the TB control activities.
As the ACSM Officer for Indalia, how would you deal with this predicament?
1. What advocacy actions need to be taken to improve the situation?
2. Are there communications actions that might be important?
3. What social mobilization actions could support your goals?
5
Challenge # 4
In the country of Monga, the new government is offering mass amnesty to large
numbers of incarcerated people and new trials to those who were prosecuted as
political prisoners under the previous regime. As a physician who works with the prison
system and a special advisor to the National TB Program, you are aware of the high
rate of prevalence of TB among prisoners in Monga. The prisons of Monga have weak
health care systems, and people with TB are generally not treated, or they receive
medicines intermittently. You are concerned about the increase in TB transmission that
could be caused by such a large number of people with TB being released into the
general population, as well as the negative consequences for the individuals being
released, who may not know where to get continuing treatment and thus are at risk for
MDR-TB. At the same time, you understand the unfairness of their incarceration and do
not want to recommend a quarantine.
As the ACSM Officer for Monga’s National TB Program, what would be your best
course of action to address this?
1. What advocacy actions could be taken to improve the situation?
2. Are there communications actions that might be important?
3. What social mobilization actions could be useful?
6
Challenge # 5
In the country of Grewali, TB control has been effectively decentralized. TB diagnosis
and treatment services are now available right at the village health center level. TB staff
are highly motivated and very well trained. However, the disbursement of TB control
funds is still a centralized activity controlled by the Ministry of Finance. Their system
slows down the release of the money to the local bank account and follows a lengthy
procedure under which the district-level official has to seek permission from the Ministry
prior to each withdrawal. Fresh funds are not sanctioned until the previous withdrawal is
accounted for satisfactorily. Because of these delays, money sat unused for over a
year, and the National TB Program failed to meet its Global Fund objectives. As a
result, the next tranche was not released and future funding was suspended. The
program is soon to run short of critical diagnostic supplies and drugs for TB treatment.
At the same time, the Ministry of Finance is sensitive to criticism and resists any
suggestions about third-party financial management by a professional international
agency.
What steps would you, as the ACSM officer in Grewali’s NTP, take to bring about
a change in the financial management mechanism and address the immediate
crisis?
1. What advocacy actions need to be taken to improve the situation?
2. Are there communications actions that might be important?
3. Are there social mobilization actions that could be useful?
Han
do
ut
1.3
Ad
voca
cy A
ctiv
itie
s
7
Co
un
try:
___
____
____
__ C
hal
len
ge
#: _
___
#W
hat
is t
he
pro
ble
m?
W
hat
ch
ang
e is
nee
ded
?
Wh
o h
as t
he
po
wer
to
cr
eate
th
e ch
ang
e?
Wh
o is
th
e ad
voca
te
(ch
ang
e ag
ent)
?
Wh
at a
ctiv
itie
s w
ill in
flu
ence
th
e p
eop
le in
po
wer
?
1T
B p
atie
nts
do n
ot h
ave
a sa
y in
issu
es
conc
erni
ng p
olic
y,
diag
nosi
s, o
r tr
eatm
ent
Invo
lvem
ent o
f pat
ient
s in
is
sues
con
cern
ing
polic
y,
diag
nosi
s, a
nd tr
eatm
ent
MO
H
TB
pat
ient
s
TB
pat
ient
s pa
rtic
ipat
ing
in
key
MO
H m
eetin
gs, e
.g.,
TB
IC
C a
nd m
ajor
TB
act
iviti
es -
W
orld
TB
day
s
2
3
Han
do
ut
1.4
Co
mm
un
icat
ion
Act
ivit
ies
8
Co
un
try:
___
____
____
____
Ch
alle
ng
e #:
___
____
# W
hat
is t
he
pro
ble
m?
W
hat
ch
ang
e is
n
eed
ed?
Wh
o a
re y
ou
try
ing
to
re
ach
? (
targ
et
aud
ien
ce)
Wh
at m
essa
ge(
s) n
eed
s to
be
com
mu
nic
ated
?
Wh
at c
om
mu
nic
atio
n
chan
nel
s co
uld
be
use
d?
1 T
he h
ealth
pro
vide
rs a
re
not c
omm
unic
atin
g ef
fect
ivel
y w
ith p
atie
nts
abou
t TB
trea
tmen
t.
Impr
ovin
g he
alth
car
e pr
ovid
ers’
inte
rper
sona
l co
mm
unic
atio
n an
d co
unse
ling
skill
s.
Hea
lth c
are
prov
ider
s (p
rimar
y)
Hea
lth p
rogr
am
man
ager
s (s
econ
dary
)
To
impr
ove
patie
nt’s
ad
here
nce
to
trea
tmen
t, it
is
impo
rtan
t tha
t you
r pa
tient
und
erst
ands
the
trea
tmen
t pro
cess
co
mpl
etel
y.
IPC
C tr
aini
ng
Flip
cha
rts
2
3.
Han
do
ut
1.5
So
cial
Mo
bili
zati
on
Act
ivit
ies
9
Co
un
try:
___
____
____
____
Ch
alle
ng
e #:
___
___
# W
hat
is t
he
pro
ble
m?
W
hat
ch
ang
e is
nee
ded
?
Wh
o is
in y
ou
r ta
rget
au
die
nce
?
Wh
o c
ou
ld b
e th
e so
cial
mo
bili
zer
(ch
ang
e ag
ent)
?
Wh
at a
re p
ote
nti
al s
oci
al
mo
bili
zati
on
act
ivit
ies?
1 T
here
is s
hort
age
of fa
cilit
ies
that
offe
r T
B a
nd H
IV
serv
ices
.
The
num
ber
of fa
cilit
ies
shou
ld in
crea
se.
MO
H, r
egio
nal
heal
th o
ffici
als
PLW
HA
s an
d pe
ople
w
ith T
B
Est
ablis
hing
a c
omm
unity
ac
tion
grou
p of
PLW
HA
s an
d pe
ople
with
TB
to
advo
cate
for
acce
ssib
le
serv
ices
.
2
3
Han
do
ut
2.1
Nat
ion
al T
B C
on
tro
l Ob
ject
ives
, Ch
alle
ng
es, a
nd
Gap
s
10
Co
un
try:
___
____
____
____
____
____
____
____
T
B c
on
tro
l go
al:
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
N
atio
nal
TB
Co
ntr
ol
Ob
ject
ives
T
B C
on
tro
l Ch
alle
ng
es a
nd
Gap
s P
oss
ible
Co
ntr
ibu
tin
g F
acto
rs
Ex
Rea
ch th
e ta
rget
of 7
0%
case
det
ectio
n by
201
0 C
ase
dete
ctio
n is
onl
y 55
%, b
elow
the
targ
et
of 7
0%
1.
Lack
of s
uffic
ient
hum
an r
esou
rces
to s
taff
all m
icro
scop
y ce
nter
s.
2.
Hig
h le
vel o
f stig
ma
rela
ted
to T
B a
nd H
IV p
reve
nts
peop
le fr
om
atte
ndin
g se
rvic
es.
1
2
3
Han
do
ut
2.2
Co
un
try
AC
SM
Act
ivit
y S
tatu
s
11
Co
un
try:
___
____
____
____
____
____
____
____
____
__
Co
un
try
AC
SM
go
al:_
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
_
A
ctiv
ity
Sta
tus
TB
Co
ntr
ol
Ob
ject
ives
A
CS
M O
bje
ctiv
es
AC
SM
Act
ivit
ies
Co
mp
lete
d
In
pro
gre
ss
Hal
ted
N
ot
beg
un
No
t p
lan
ned
b
ut
des
irab
le
Han
do
ut
3.1
AC
SM
Gap
s an
d O
pp
ort
un
itie
s
12
Co
un
try:
___
____
____
____
____
____
____
__
AC
SM
act
ivit
ies
no
t ye
t im
ple
men
ted
th
at w
e w
ou
ld
like
to s
tart
in t
he
nex
t 6–
12
mo
nth
s
Wh
at T
B c
on
tro
l ob
ject
ive
do
es
this
act
ivit
y su
pp
ort
?
Rea
son
s fo
r im
ple
men
tati
on
d
elay
s (b
arri
ers)
F
acto
rs/r
eso
urc
es t
hat
can
su
pp
ort
imp
lem
enta
tio
n
1
2
3
4
5
Handout 3.2 Research Case Studies
13
CASE STUDY A Country A has on of the top ten highest TB burdens globally. Due to social, religious, and cultural traditions, men and women access health services differently. For example, women in rural areas are not allowed to visit health facilities unaccompanied. The National TB Program would like to study gender differences in knowledge and attitudes towards TB in urban and rural communities, and to compare male and female TB health-seeking behavior. Previous research suggests that knowledge of TB is poor; however it is not known what the differentials are between women and men, or rural and urban residents. Social isolation and rejection of people with TB disease is high, as well as misconceptions about TB transmission. TB is a disease to be feared, particularly by married women who are worried about consequences if they tell their husbands they are infected. Questions: 1. What research methods would you recommend be used to find out more? 2. What are key areas of inquiry/questions that you would suggest exploring? 3. Does the existing data provide you with any initial insight into what types of ACSM
interventions could be most effective?
CASE STUDY B Country B ranks third among the top ten high-burden countries for TB. Next year, the National TB Program is planning to lead a TB prevalence survey that will be administered to 10,000 people in all provinces of the country. According to existing data, awareness of TB as a curable illness is high; however, accurate knowledge of transmission and symptoms is low. Very few people voluntarily present for TB screening, and TB is generally detected when the patient’s infection is advanced. Local TB doctors have indicated that patients are often surprised to learn that TB screening and treatment are free. Questions: 1. What research methods would you recommend be used to find out more? 2. What are key areas of inquiry/questions that you would suggest exploring? 3. Does the existing data provide you with any initial insight into what types of ACSM
interventions could be most effective?
14
CASE STUDY C In Country C, initial research and experience suggest that TB patients are not treated very well by medical staff. Medical staff look down on the patients, and some of them fear being infected by the patients. Initial visits to clinics reveal that visual and oral privacy and confidentiality of medical records are not observed. Nurses come and go from the exam rooms abruptly, interrupt the doctors, and leave doors open. There is a significant problem with patients who don’t return after their initial visits, and with incomplete treatment. The NTP and nongovernmental partners know that they want to conduct training of medical providers as part of their communications strategy. Questions: 1. What research methods would you use to find out more about the providers’ situation
and reason for their poor performance? 2. What research methods would you use to find out more about the patients’
experience? 3. What are key areas of inquiry/questions that you would suggest exploring? 4. How would you measure impact of the planned training of providers? 5. What kinds of elements should be included in the training of providers? In the
education of patients or the public?
Handout 3.3: Assessing Needs through Research
15
Country: ___________________________
Instructions:
• Work in your country groups. Read, discuss, and respond to the following questions.
• Designate a representative to report back to the large group.
1. Describe the research or needs-assessment methods that have been used in your country to
assess needs for advocacy, communication, or social mobilization. � Were the methods qualitative or quantitative? � How many people were surveyed, interviewed, or observed? � In your experience, what were the most useful methods for your programming?
2. How did you use the results of the research or needs-assessment activity? � What dissemination activities were conducted to ensure sharing of the research
results?
16
3. Give an example of a situation when you would choose to use qualitative research methods,
and explain why.
4. Give an example of a situation when you would choose to use quantitative research methods,
and explain why.
17
Handout 3.4 Ten Steps to Developing a Strategic Advocacy Plan
Ten steps to developing a strategic advocacy agenda
Advocacy is often a helpful tool in achieving public health goals through policy change. Given the many different methods to influence policies and the limited resources usually available to do so, it is important to assess your options and tactics strategically. Below are ten steps that you may find helpful as you determine your program’s advocacy objectives and activities.
Step 1: Establish a process for assessing and understanding the challenges and needs of the target population.
• Conduct a needs assessment of the affected population or use data already collected. • Develop a process for ongoing feedback and input from the target population.
Step 2: Identify policy changes that would address the needs of the target population.
Examples:
• Increased resources
• Enforced, changed, or new policies or regulations
Step 3: Identify decision-maker(s) who have the power and influence to change policy to address the needs.
Examples:
• Politicians (elected & appointed officials)
• Social leaders.
• Government agencies
• International bodies
Step 4: Determine why decision-makers have not implemented the desired change.
Examples: • Too expensive • Not a priority • Lack of understanding • Lack of community demand
Step 5: Identify opposition to the policy change and the reasons for their opposition.
• Who are opposing the policy? • What are their key arguments? • With whom do they have influence?
Step 6: Assess your institution’s strengths and weaknesses in advocating for the policy change.
Examples: • Expertise • Spokespeople • Relationships/influence • Unique niche
Conduct a policy scan: • Track government funding histories. • Identify supportive policies/regulations that
exist but are not being enforced. • Identify policies/regulations that exist but
should be changed. • Seek gaps that need to be filled with new
policies/regulations.
18
Step 7: Identify others who have a similar interest in addressing the problem. Assess risks/benefits of your organization’s partnership with each one.
Examples: • Patient coalition • Professional organization • Faith-based organization • Activist/advocacy organization
Step 8: Identify advocacy activities and messengers that could influence those in power.
Examples of activities: • Meeting with decision-makers • Public event • Petition
Examples of messengers: • Media • Celebrities • Patients • Experts • Peers • Donors
Step 9: Assess current and future resources that could be accessed to pursue the change.
Examples: • Financial • Human • Intellectual • Networking
Step 10: Determine how to evaluate progress and success. Outputs measure whether the advocacy activities have been carried out successfully. Outcomes measure the effectiveness of the advocacy activities in achieving identified goals.
Examples:
Outputs • Public statement of support from decision-maker • Number of signatures on petition • Number of attendees at a rally
Outcomes • New resources allocated • Law passed/changed • Regulation implemented/changed
Be strategic! Identify a set of criteria to assess and select among each of your options. Consider using the following criteria: • Level of influence the activity would have on
decision-makers. • Level of risk to your program/institution in
pursuing the activity. • Resources that would be needed. • Access to effective messengers.
Hint! Include those who could be partners, but currently are not.For example, you may want to reach out to businesses or others with political influence that could be affected—directly or indirectly—by the policy change, but have not yet been actively engaged in the issue.
19
Handout 3.5 Strategic Advocacy Planning Country: ______________________ Advocacy objective:______________________________________________________________________
Step Your Own Example of Each Step
1. Assess the situation and define the challenge(s).
Example: Insufficient resources, not enough TB clinics, lack of training
2. Identify policy changes that would address the needs of the target population.
Example: Changes in budget allocation processes, lifting of hiring freeze
3. Identify decision-maker(s) who have the power and influence to change policy to address the needs.
Example: Minister of Health and/or Finance
4. Determine why decision-makers have not implemented the desired change.
Example: Too expensive, not a priority, lack of understanding
5. Identify opposition to the policy change and the reasons for their opposition.
Questions to answer: • Who is the opposition? • What are their key arguments? • With whom do they have
influence?
6. Assess your institution’s strengths and weaknesses in advocating for the policy change.
Examples: • Expertise • Spokespeople • Relationships/influence • Unique niche
20
Step Your Own Example of Each Step
7. Identify others who have a similar interest in addressing the problem. Assess risks/benefits of your organization’s partnership with each one.
Examples: • Patient coalition • Professional organization • Faith-based organization • Activist/advocacy organization
8. Identify advocacy activities and messengers that could influence those in power.
Examples of activities: • Meeting with decision-makers • Public event • Petition
Examples of messengers: • Media • Celebrities • Patients • Experts • Peers • Donors
9. Assess current and future resources that could be accessed to pursue the change.
Examples: • Financial • Human • Intellectual • Networking
10. Determine how to evaluate progress and success. Outputs measure whether the advocacy activities have been carried out successfully. Outcomes measure the effectiveness of the advocacy activities in achieving identified goals.
Examples:
Outputs • Public statement of support from
decision-maker • Number of signatures on petition • Number of attendees at a rally
Outcomes • New resources allocated • Law passed/changed • Regulation implemented/changed
Handout 3.6 Steps in Developing a Strategic Communication Plan
21
# Step Examples of tools & activities What resources outside the NTP
could help?
1 Define the TB control problem and the behavioral change you want to see.
Examples: • Low case detection—we want
people to report to a health facility as soon as they experience TB symptoms.
• Mistrust of health services—we want to improve providers’ communication and counseling skills.
• Stigmatization and fear of TB—we want to decrease stigma.
• KAP survey • Focus group discussions (FGD) • Exit interviews • DHS questions • Community stakeholder
consultation to identify individual, family, and societal barriers to health-seeking behavior
Research agency
NGO
2 Identify the audiences affected by the problem. Examples:
• People in rural areas.
• Migrant workers.
• Medical providers.
• FGD analysis
• Stakeholder analysis
3 Identify the appropriate channel for reaching the audiences effectively. Examples:
• Radio.
• Community theater.
• Leaflets, posters, billboards.
• Training.
• KAP survey • FDGs
4 Plan the content and style of communication. Examples: • Messages. • Dialogue and discussions. • Interactive communication. • Endorsements.
• KAP survey • Focus group discussions
Advertising or design agency
NGO
22
# Step Examples of tools & activities What resources outside the NTP
could help?
5 Determine how you will evaluate your progress and success. Examples:
• Identify measurable indicators.
• Establish an evaluation plan before implementing.
ACSM focal point, working group, consultant
6 Make a draft strategic communication plan.
Outline: • Key findings • Strategic directions • Objectives • Audiences • Interventions • Content • Media • M&E • Work plan
ACSM focal point, working group, consultant
7 Stakeholder review of draft strategic communication plan.
• Conduct stakeholder workshops to review the plan.
ACSM focal point, working group, consultant
8 Identify advocacy resources to strengthen your communication campaign. Examples:
• Community leaders.
• Football stars or other celebrities.
ACSM focal point, working group, consultant
9 Finalize strategic communication plan.
• Launch it publicly with media, field staff and NGOs.
NTP with ACSM focal point, working group, consultant
Handout 3.7 Strategic Communication Planning
23
# Step
What information already exists? What data need to be gathered? How to collect it?
What activities would you plan?
1 Define the problem and behavioral change(s) you want to see.
2 Identify the audiences affected by the problem.
3 Identify the appropriate channel for reaching the audiences effectively.
4 Plan the content and style of communication.
5 Determine how you will evaluate your progress and success.
6 Make a draft strategic communication plan.
7 Stakeholder review of draft strategic communication plan
8 Identify advocacy resources to strengthen your communication campaign.
9 Develop final version of Strategic Communication Plan.
Han
do
ut
4.1
Dev
elo
pin
g a
So
cial
Mo
bili
zati
on
Pla
n
24
Co
un
try:
___
____
____
____
____
____
____
__
S
M O
bje
ctiv
e S
M A
ud
ien
ce
Ad
voca
cy a
nd
/or
Co
mm
un
icat
ion
O
bje
ctiv
e S
up
po
rted
T
arg
et A
ud
ien
ce
SM
Act
ivit
y
Ex
Incr
ease
pub
lic s
uppo
rt fo
r ad
equa
te D
OT
S fa
cilit
ies.
C
omm
uniti
es
PLW
A
TB
gro
ups
(Med
ia)
Ad
voca
cy o
bje
ctiv
e
Incr
ease
num
ber
of h
ealth
faci
litie
s th
at
offe
r D
OT
S s
ervi
ces.
MoH
MoF
Eve
nt a
t a h
ealth
faci
lity
that
la
cks
serv
ices
in w
hich
co
mm
unity
lead
ers,
PLW
A, a
nd
TB
gro
ups
high
light
thei
r ne
ed
for
mor
e D
OT
S c
ente
rs a
nd
serv
ices
.
Med
ia to
be
mob
ilize
d to
cov
er
the
even
t and
rep
ort o
n th
e sh
orta
ge.
Ex
Dev
elop
com
mun
ity
supp
ort t
o en
cour
age
peop
le w
ith c
ough
to g
o fo
r ev
alua
tion.
Vill
age
elde
rs
Com
mun
ity
lead
ers
Dis
tric
t Hea
lth
Offi
cers
Co
mm
un
icat
ion
ob
ject
ive
Incr
ease
num
ber
of p
eopl
e w
ith c
ough
w
ho g
o to
a D
OT
S c
ente
r fo
r ev
alua
tion
Indi
vidu
als
with
cou
gh
Com
mun
ity le
ader
s us
e th
eir
com
mun
ity m
eetin
gs a
nd fo
rum
s to
del
iver
thre
e m
essa
ges:
1)
E
arly
dia
gnos
is fo
r co
ugh
is
impo
rtan
t to
keep
the
com
mun
ity h
ealth
y.
2)
TB
is a
cur
able
dis
ease
and
tr
eatm
ent i
s fr
ee.
3)
Any
one
can
get T
B, a
nd
mem
bers
of t
he c
omm
unity
w
ith T
B s
houl
d no
t be
disc
rimin
ated
aga
inst
.
1
2
3
25
S
M O
bje
ctiv
e S
M A
ud
ien
ce
Ad
voca
cy a
nd
/or
Co
mm
un
icat
ion
O
bje
ctiv
e S
up
po
rted
T
arg
et A
ud
ien
ce
SM
Act
ivit
y
4
5
Handout 4.2 Cough-to-Cure Pathway Analysis
26
The Cough-to-Cure Pathway was developed as an analytical and planning tool for the Stop TB Partnership by the Academy for Educational Development. The model maps out the ideal pathway of behavior for an individual with TB, as well as possible barriers that may work against successful diagnosis and cure. Barriers may be related to patient factors (lack of money for transport to health facility), provider factors (poor relationships with patients), community behavior (pervasive stigma related to TB) or flaws in the systems in which they operate (poor accessibility of TB services). Country: ____________________________
Reasons why ideal behavior is not occurring
ACSM interventions to promote ideal behavior
����������� ��� ������������������������
Individual level�
Group level�
System level�
����������� ����� ������ ��������
Individual level�
Group level�
System level�
����������� ����� ��������������������� �������
Individual level�
Group level�
System level�
Han
do
ut
4.3:
S
amp
le C
ou
ntr
y A
CS
M A
ctio
n P
lan
27
Co
un
try:
CA
MB
OD
IA
Cu
rren
t st
atu
s o
f A
CS
M:
•
No
AC
SM
str
ateg
y bu
t AC
SM
com
pone
nts
are
incl
uded
in th
e 20
06–2
010
natio
nal T
B p
lan.
•
Impl
emen
ting
IEC
act
iviti
es, b
ut n
ot A
CS
M.
•
No
AC
SM
gui
delin
es.
•
No
AC
SM
tech
nica
l gro
up, f
ocal
poi
nts,
cha
mpi
ons.
•
Littl
e kn
owle
dge
amon
g st
akeh
olde
rs a
nd k
ey p
laye
rs o
f AC
SM
or
how
A
CS
M c
an c
ontr
ibut
e to
the
natio
nal g
oals
.
Wh
at w
e w
ou
ld li
ke t
o a
cco
mp
lish
in t
he
nex
t te
n
mo
nth
s:
1.
Adv
ocac
y to
sta
keho
lder
s (M
OH
, NT
P, N
GO
s, d
onor
s, jo
urna
lists
) to
in
crea
se s
uppo
rt fo
r A
CS
M.
2.
For
m a
foca
l poi
nt te
am a
t nat
iona
l lev
el w
ithin
NT
P.
3.
Com
plet
e a
draf
t AC
SM
str
ateg
y w
ith M
OH
end
orse
men
t. 4.
R
evie
w c
urre
nt IE
C p
lan
and
deve
lop
it fu
rthe
r to
incl
ude
A, C
, and
SM
co
mpo
nent
s w
here
nee
ded.
5.
B
uild
ont
o th
e In
tera
genc
y C
ount
ry C
oord
inat
ing
Com
mitt
ee g
roup
to fo
rm
an A
CS
M T
echn
ical
Wor
king
Gro
up.
Wh
o m
ust
ap
pro
ve o
r su
pp
ort
th
is p
lan
: N
TP
mus
t app
rove
and
then
will
sub
mit
to M
OH
for
appr
oval
.
T
imel
ine
(mo
nth
s)
Oct
ob
er 2
007
to J
uly
200
8 O
bje
ctiv
es
Act
ivit
ies
Wh
o Is
R
esp
on
sib
le f
or
Imp
lem
enti
ng
Op
po
rtu
nit
ies
& R
eso
urc
es
Ava
ilab
le
Ch
alle
ng
es &
R
eso
urc
es
Nee
ded
1
2 3
4 5
6 7
8 9
10
11
12
Adv
ocac
y to
st
akeh
olde
rs
(incl
udin
g m
inis
try
of
info
rmat
ion,
jo
urna
lists
as
soci
atio
n) to
in
crea
se
know
ledg
e an
d de
epen
un
ders
tand
ing
Nat
iona
l re
pres
enta
tives
w
ith s
uppo
rt o
f N
GO
will
app
roac
h N
TP
Dire
ctor
for
debr
iefin
g fr
om th
is
wor
ksho
p an
d sh
arin
g dr
aft p
lan
of a
ctio
n.
Tea
m a
t wor
ksho
p w
ith s
uppo
rt fr
om
NG
O (
PA
TH
).
Sup
port
from
M
OH
for
atte
ndan
ce a
t A
CS
M
wor
ksho
p—th
ey
expe
ct
som
ethi
ng b
ack.
No
addi
tiona
l re
sour
ces
need
ed.
X
28
Tim
elin
e (m
on
ths)
O
cto
ber
200
7 to
Ju
ly 2
008
Ob
ject
ives
A
ctiv
itie
s W
ho
Is
Res
po
nsi
ble
fo
r Im
ple
men
tin
g
Op
po
rtu
nit
ies
& R
eso
urc
es
Ava
ilab
le
Ch
alle
ng
es &
R
eso
urc
es
Nee
ded
1
2 3
4 5
6 7
8 9
10
11
12
on T
B a
nd
AC
SM
with
the
goal
of
appr
ovin
g an
d su
ppor
ting
the
AC
SM
st
rate
gy.
S
ensi
tizat
ion
wor
ksho
p fo
r N
TP
, M
OH
, and
oth
er
stak
ehol
ders
on
TB
an
d A
CS
M’s
co
ntrib
utio
n to
TB
co
ntro
l tar
gets
. T
ools
from
the
regi
onal
AC
SM
w
orks
hop
will
be
com
pile
d an
d pa
ckag
ed.
Sta
keho
lder
s w
ill
incl
ude:
NG
O
part
ners
wor
king
on
TB
, pro
fess
iona
l or
gani
zatio
ns (
e.g.
, jo
urna
lists
’ as
soci
atio
n an
d ph
arm
acis
ts’
asso
ciat
ion)
, M
inis
try
of
Info
rmat
ion
(MoI
).
CE
NA
T/N
TP
M
OH
/NT
P
expe
cts
this
from
th
e te
am
part
icip
atin
g in
th
e fiv
e-da
y A
CS
M
wor
ksho
p.
AC
SM
cap
acity
at
nat
iona
l and
pr
ovin
cial
leve
l. A
CS
M te
chni
cal
expe
rtis
e in
-co
untr
y
Bud
get f
or tr
avel
; ve
nue
and
mee
ting
pack
age;
pr
intin
g of
AC
SM
to
ols;
T
echn
ical
su
ppor
t fro
m
PA
TH
and
WH
O
TB
foca
l per
son.
x
29
Tim
elin
e (m
on
ths)
O
cto
ber
200
7 to
Ju
ly 2
008
Ob
ject
ives
A
ctiv
itie
s W
ho
Is
Res
po
nsi
ble
fo
r Im
ple
men
tin
g
Op
po
rtu
nit
ies
& R
eso
urc
es
Ava
ilab
le
Ch
alle
ng
es &
R
eso
urc
es
Nee
ded
1
2 3
4 5
6 7
8 9
10
11
12
Sm
all g
roup
m
eetin
gs a
mon
g N
TP
/MO
H/N
GO
to
intr
oduc
e A
CS
M.
CE
NA
T/N
TP
and
A
CS
M te
am
Sup
port
from
N
TP
for
AC
SM
; A
CS
M te
am
know
ledg
eabl
e an
d w
illin
g to
ad
voca
te fo
r A
CS
M s
trat
egy
incl
usio
n;
Too
ls fr
om
regi
onal
AC
SM
w
orks
hop
avai
labl
e to
sh
are
with
pa
rtne
rs a
nd
stak
ehol
ders
; G
FA
TM
fina
ncia
l su
ppor
t.
Bud
get f
or tr
avel
to
and
from
pr
ovin
ces
for
the
prov
inci
al A
CS
M
team
; P
ower
poi
nt
pres
enta
tion
on
AC
SM
and
how
it
can
cont
ribut
e to
nat
iona
l ta
rget
s;
No
addi
tiona
l bu
dget
is n
eede
d fo
r th
is a
ctiv
ity.
x
x x
Sen
sitiz
atio
n w
orks
hop
for
jour
nalis
ts fr
om
natio
nal a
nd
prov
inci
al le
vel;
80–1
00 jo
urna
lists
w
ill b
e in
vite
d to
pa
rtic
ipat
e.
NT
P/P
AT
H
MO
H a
nd M
oI
Doc
umen
ts o
n gl
obal
TB
si
tuat
ion;
D
ocum
ents
on
coun
try
TB
si
tuat
ion;
N
atio
nal
guid
elin
es a
nd
plan
s;
Tec
hnic
al a
nd
com
mun
icat
ions
ex
pert
ise;
N
TP
and
PA
TH
av
aila
ble
Tec
hnic
al
supp
ort f
rom
P
AT
H to
or
gani
ze
wor
ksho
p;
Tec
hnic
al
supp
ort f
rom
P
AT
H to
dev
elop
“T
B-
Mak
e It
Y
ou
r Is
sue”
ad
voca
cy
pack
age—
both
el
ectr
onic
and
ha
rd c
opie
s—
whi
ch w
ill in
clud
e fa
ct s
heet
s on
gl
obal
and
co
untr
y si
tuat
ion
on T
B; N
TP
x x
x x
30
Tim
elin
e (m
on
ths)
O
cto
ber
200
7 to
Ju
ly 2
008
Ob
ject
ives
A
ctiv
itie
s W
ho
Is
Res
po
nsi
ble
fo
r Im
ple
men
tin
g
Op
po
rtu
nit
ies
& R
eso
urc
es
Ava
ilab
le
Ch
alle
ng
es &
R
eso
urc
es
Nee
ded
1
2 3
4 5
6 7
8 9
10
11
12
guid
elin
es;
2006
–201
0 S
trat
egic
Pla
n;
stor
ies
from
the
field
; S
uppo
rt fr
om
Min
istr
y of
In
form
atio
n to
m
obili
ze th
e jo
urna
lists
; S
ome
jour
nalis
ts
may
not
be
inte
rest
ed to
pa
rtic
ipat
e if
wor
ksho
p is
co
nduc
ted
durin
g sp
ecia
l eve
nt.
Bud
get f
or ½
da
y se
nsiti
zatio
n w
orks
hop
to
cove
r tr
aini
ng
pack
age
cost
s an
d pr
intin
g co
sts.
E
quip
men
t (i.e
., la
ptop
with
LC
D
proj
ecto
r an
d sc
reen
; cam
era)
F
orm
a fo
cal
poin
t tea
m a
t na
tiona
l lev
el
with
NT
P.
Dev
elop
TO
R fo
r A
CS
M fo
cal p
oint
te
am.
NT
P a
ppoi
nts
AC
SM
foca
l tea
m;
both
nat
iona
l and
pr
ovin
cial
leve
l. N
TP
sub
mits
CE
NA
T/N
TP
A
ll to
ols
and
evid
ence
ne
eded
to
enab
le th
e fo
rmul
atio
n of
th
e A
CS
M fo
cal
poin
t tea
m.
Cap
acity
on
End
orse
men
t of
AC
SM
foca
l po
int t
eam
from
M
OH
. A
dditi
onal
ca
paci
ty b
uild
ing
on A
CS
M fo
r A
CS
M fo
cal
x x
31
Tim
elin
e (m
on
ths)
O
cto
ber
200
7 to
Ju
ly 2
008
Ob
ject
ives
A
ctiv
itie
s W
ho
Is
Res
po
nsi
ble
fo
r Im
ple
men
tin
g
Op
po
rtu
nit
ies
& R
eso
urc
es
Ava
ilab
le
Ch
alle
ng
es &
R
eso
urc
es
Nee
ded
1
2 3
4 5
6 7
8 9
10
11
12
requ
est l
ette
r fo
r ap
prov
al to
MO
H.
AC
SM
C
ham
pion
s on
A
CS
M
team
. B
udge
t for
pr
ovin
cial
AC
SM
fo
cal p
oint
team
to
trav
el to
and
fr
om p
rovi
nces
.
Com
plet
e a
draf
t AC
SM
st
rate
gy w
ith
MO
H
endo
rsem
ent.
Offi
cial
req
uest
for
TA
to s
uppo
rt th
e de
velo
pmen
t of t
he
AC
SM
str
ateg
y.
Des
igna
te a
su
ppor
t tea
m fr
om
JIC
A, F
HI,
PA
TH
, N
TP
, and
AC
SM
fo
cal p
oint
team
. O
rgan
ize
and
cond
uct w
orki
ng
revi
ew m
eetin
gs.
Org
aniz
e an
d co
nduc
t a
stak
ehol
der
wor
ksho
p fo
r A
CS
M d
raft
stra
tegy
rev
iew
.
CE
NA
T/ N
TP
; te
chni
cal b
urea
u;
and
AC
SM
foca
l po
int t
eam
NT
P/T
echn
ical
bu
reau
nat
iona
l le
vel s
uppo
rts
this
act
ivity
. N
atio
nal a
nd
prov
ince
has
ca
paci
ty o
n A
CS
M
Glo
bal-R
egio
nal
AC
SM
tool
s av
aila
ble
Upd
ated
IEC
pl
ans
avai
labl
e
Tec
hnic
al
supp
ort f
rom
P
AT
H to
wor
k w
ith N
TP
and
A
CS
M te
am to
de
velo
p dr
aft
AC
SM
. F
unds
to s
uppo
rt
cons
ulta
ncy
and
the
deve
lopm
ent
of th
e A
CS
M
stra
tegy
. B
udge
t for
re
view
mee
tings
. B
udge
t for
st
akeh
olde
r re
view
w
orks
hop.
T
ime
for
NT
P
AC
SM
and
pa
rtne
rs
inpu
t/com
men
ts.
x x
x x
x x
32
Tim
elin
e (m
on
ths)
O
cto
ber
200
7 to
Ju
ly 2
008
Ob
ject
ives
A
ctiv
itie
s W
ho
Is
Res
po
nsi
ble
fo
r Im
ple
men
tin
g
Op
po
rtu
nit
ies
& R
eso
urc
es
Ava
ilab
le
Ch
alle
ng
es &
R
eso
urc
es
Nee
ded
1
2 3
4 5
6 7
8 9
10
11
12
Upd
ate
the
IEC
pl
an to
incl
ude
AC
SM
co
mpo
nent
s.
Des
igna
tive
a re
view
team
from
P
AT
H/J
ICA
/FH
I an
d ot
her
rele
vant
do
nors
. S
mal
l mee
tings
co
nduc
ted
to
revi
ew a
nd m
odify
th
e IE
C p
lan.
NT
P/T
echn
ical
bu
reau
IE
C p
lan
avai
labl
e A
CS
M
tool
s A
CS
M c
apac
ity
natio
nal a
nd
prov
inci
al le
vel
AC
SM
exp
ertis
e am
ong
revi
ew
team
Tec
hnic
al
supp
ort f
rom
P
AT
H
Don
or a
ppro
val
for
rev
isio
ns
Ava
ilabi
lity
of
revi
ew te
am to
pr
ovid
e tim
ely
com
men
ts
No
addi
tiona
l fu
ndin
g is
ne
eded
for
this
ac
tivity
x x
x x
x
Bui
ld o
n to
ICC
to
form
an
AC
SM
te
chni
cal
wor
king
gro
up.
Dev
elop
TO
R
App
oint
AC
SM
te
chni
cal w
orki
ng
grou
p
Req
uest
lette
r fo
r ap
prov
al fr
om
MO
H
Tec
hnic
al w
orki
ng
grou
p m
eets
eve
ry
thre
e-m
onth
s
CE
NA
T/N
TP
/AC
SM
fo
cal p
oint
team
T
echn
ical
di
rect
ion
from
P
AT
H a
nd o
ther
pa
rtne
rs.
IEC
team
and
A
CS
M fo
cal
pers
on.
No
addi
tiona
l bu
dget
is n
eede
d fo
r th
ese
mee
tings
.
x x
x
x
x
Han
do
ut
4.4
C
ou
ntr
y A
CS
M A
ctio
n P
lan
33
Cou
ntry
: ___
____
____
____
____
__
Cu
rren
t st
atu
s o
f A
CS
M:
W
hat
we
wo
uld
like
to
acc
om
plis
h in
th
e n
ext
____
_ m
on
ths:
Wh
o m
ust
ap
pro
ve o
r su
pp
ort
th
is p
lan
:
Tim
elin
e O
bje
ctiv
e
Act
ivit
ies � ���
W
hat
can
yo
u
do
to
mak
e th
is h
app
en?
Wh
o is
re
spo
nsi
ble
fo
r im
ple
men
tin
g?
Op
po
rtu
nit
ies
& r
eso
urc
es
avai
lab
le
Ch
alle
ng
es &
re
sou
rces
n
eed
ed
1 2
3 4
5 6
7 8
9 10
11
12
Han
do
ut
5.1
Pla
nn
ing
fo
r M
on
ito
rin
g &
Eva
luat
ion
34
Co
un
try:
___
____
____
____
____
____
___
AC
SM
Act
ivit
y P
roce
ss In
dic
ato
rs
(Are
the
expe
cted
act
iviti
es m
ovin
g fo
rwar
d?)
Res
ult
s In
dic
ato
rs
(Wha
t out
com
es a
nd im
pact
s do
you
ex
pect
? H
ave
thin
gs c
hang
ed a
s a
resu
lt of
you
r w
ork?
)
Mo
nit
ori
ng
& E
valu
atio
n M
eth
od
s
Exa
mpl
e:
Lobb
y M
inis
try
of F
inan
ce a
nd
MO
H to
st
ream
line
finan
cial
m
anag
emen
t m
echa
nism
for
AC
SM
fund
s (G
FA
TM
and
ot
her
dono
rs).
Adv
ocac
y an
alys
is c
ompl
eted
and
st
rate
gy p
lann
ed.
Num
ber
of m
eetin
gs w
ith M
OH
and
M
OF
rep
rese
ntat
ives
.
Fin
anci
al m
anag
emen
t pol
icy
impr
oved
. F
inan
cial
man
agem
ent a
genc
y ap
poin
ted.
F
unds
dis
pers
ed m
ore
rapi
dly
and
in ti
me
to c
ompl
ete
plan
ned
AC
SM
act
iviti
es o
n sc
hedu
le.
Tra
ck fu
nds
thro
ugh
acco
unts
pay
able
, etc
. O
bser
vatio
n
Pro
ject
rep
orts
Exa
mpl
e:
Rad
io
cam
paig
n ta
rget
ed a
t rur
al
audi
ence
s to
ra
ise
awar
enes
s th
at
TB
trea
tmen
t th
roug
h D
OT
S
is fr
ee.
Num
ber
of r
adio
spo
ts p
rodu
ced.
N
umbe
r of
rad
io s
pots
aire
d.
Num
ber
of p
eopl
e lis
teni
ng to
rad
io
cam
paig
n.
% o
f pop
ulat
ion
who
kno
w t
hat T
B
trea
tmen
t thr
ough
DO
TS
is fr
ee.
Incr
ease
d #
of p
eopl
e pr
esen
ting
to h
ealth
fa
cilit
ies
for
eval
uatio
n.
Incr
ease
d ca
se d
etec
tion.
Mod
ule
adde
d to
TB
pre
vale
nce
surv
ey o
r D
HS
, or
KA
P s
urve
y.
Hea
lth fa
cilit
y re
cord
s.
Loca
l or
NT
P T
B d
ata.
35
AC
SM
Act
ivit
y P
roce
ss In
dic
ato
rs
(Are
the
expe
cted
act
iviti
es m
ovin
g fo
rwar
d?)
Res
ult
s In
dic
ato
rs
(Wha
t out
com
es a
nd im
pact
s do
you
ex
pect
? H
ave
thin
gs c
hang
ed a
s a
resu
lt of
you
r w
ork?
)
Mo
nit
ori
ng
& E
valu
atio
n M
eth
od
s
Exa
mpl
e:
Tra
inin
g of
co
mm
unity
le
ader
s in
so
cial
m
obili
zatio
n to
su
ppor
t TB
co
ntro
l.
Tra
inin
g m
ater
ials
pro
duce
d, p
ilote
d,
and
revi
sed.
N
umbe
r of
peo
ple
trai
ned.
N
umbe
r of
lead
ers
who
con
duct
so
cial
mob
iliza
tion
activ
ities
with
in
one
mon
th o
f tra
inin
g.
Pop
ulat
ion
cove
red
by a
ctiv
e tr
aine
d le
ader
s.
Num
ber
of c
omm
uniti
es in
whi
ch
com
mun
ity m
embe
rs v
olun
teer
to s
uppo
rt
TB
act
iviti
es a
s a
resu
lt of
soc
ial
mob
iliza
tion
activ
ities
. N
umbe
r of
TB
pat
ient
s su
ppor
ted
by th
e co
mm
unity
for
DO
T.
Pro
port
ion
of T
B p
atie
nts
com
plet
ing
trea
tmen
t.
Inte
rvie
ws
with
com
mun
ity le
ader
s an
d co
mm
unity
mem
bers
. In
terv
iew
a s
ampl
e of
Pro
vinc
ial a
nd
Dis
tric
t TB
man
ager
s.
Pro
ject
rep
orts
. Lo
cal o
r N
TP
TB
dat
a.
36
AC
SM
Act
ivit
y P
roce
ss In
dic
ato
rs
(Are
the
expe
cted
act
iviti
es m
ovin
g fo
rwar
d?)
Res
ult
s In
dic
ato
rs
(Wha
t out
com
es a
nd im
pact
s do
you
ex
pect
? H
ave
thin
gs c
hang
ed a
s a
resu
lt of
you
r w
ork?
)
Mo
nit
ori
ng
& E
valu
atio
n M
eth
od
s
Handout 5.2 Post-workshop ACSM Quiz
37
Name: Country
Date:
16. Advocacy, communication, and social mobilization
have the same objectives and target audiences. �True � False
17. Training medical providers to improve their counseling skills is an example of a communications activity.
�True � False
18. The goal of advocacy activities is to increase TB awareness among as many people as possible.
�True � False
19. What does “KAP” mean?
20. The Cough-to-Cure Pathway is a new diagnostic test for screening TB patients.
�True � False
21. “Stakeholders analysis” is a technique for assessing the importance and influence of various people and groups who affect a TB project or intervention.
�True � False
22. Most communication messages only need to be disseminated through the media once.
�True � False
23. It is more important to implement ACSM interventions quickly (because behavior change takes time) than it is to collect and analyze data and evidence to design the interventions.
�True � False
24. ACSM activities are essential components for reaching and sustaining national TB control targets.
�True � False
25. Identifying problems that TB patients have in adhering to treatment is an example of a “barriers analysis.”
�True � False
26. Television is always the most effective channel of communication.
�True � False
27. The main goal of monitoring is to provide management and staff with information to make decisions.
�True � False
28. The main goal of social mobilization activities is increasing TB knowledge of journalists and politicians.
�True � False
29. Assessing ACSM needs may include various research methods.
�True � False
30. Tools and technical support to countries for ACSM planning and implementation can be accessed free of charge from the Stop TB Partnership.
�True � False
Handout 5.3 Final evaluation form
38
1. What I liked most about the training
2. What I would suggest changing or improving about this training
3. What was your greatest area of learning from this training? 4. In what area did your skills improve the most? 5. What specific feedback do you have for the trainers/facilitators? 6. What other comments do you have?