Stop TB Strategy - Component 5:
Empower people
with TB
and communities
Giuliano GARGIONI
TB/HIV and Multidrug resistance Unit,
Stop TB Department, WHO
Issues

Terminology
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Effectiveness and cost-effectiveness
have been studied

How to proceed in promoting
empowerment of people with TB and
communities
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Explore motivation and sustainability
Where can we
learn lessons from?
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WHO and partners' research and publications
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Literature review: current debate on
community empowerment
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Global review in 7 countries, indicated by
Regional Advisers

Describe the interaction of health system and civil
society

Explore motivation using qualitative methods

Country narratives and discussion
Consensus Meeting of the
Task Force - Objectives

Present results

Agree on some fundamental
terminology

Take stock of lessons learnt

Agree on draft guidelines on
Promotion of CTBC initiatives
Process
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Propose membership
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Web-based forum on a concept paper
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Inclusion of comments
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Presentations and discussions at TF meeting
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Preparation of draft recommendations
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Briefing to the ACSM Subgroup at country
level
Further work with TF members to finalize
Recommendations/Guidelines
Publication and wide dissemination
Draft Recommendations
Proposed structure

Target audience: NTPs and partners
(people affected by TB, CSOs,
communities)

Structure:
 Overarching principles
 Identification of key elements
 Principles
 Actions, with clear recommendations
to the relevant stakeholder(s)
Overarching principles

Social justice

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Subsidiarity

Individual
Responsibility

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Solidarity


Sustainability


Partnerships and
involvement of
patients, local
community, and civil
society
Empowerment
stigma and
discrimination
self-esteem
specific
recommendations for
each key partner

local ownership

no one-size-fits-all

in line with MDGs
1 - Policy Guidance: principles
Develop or revise NTP policy to include Component Five of
Stop TB strategy.

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Guiding principles create an enabling institutional and policy
framework. Empowerment cannot remain a vague commitment.
Adapting general policy recommendation for implementation into
the local context, building on local experience and expertise.
No “one size fits all” approach; approaches for urban vs rural
areas, vulnerable groups
If the community is seen as a partner, this must influence the
way interventions are planned, designed and implemented
(importance of stating principles of a right-based approach).
National policy should define HOW communities can be
empowered.
and HOW empowered communities can contribute to promote
health, improve case detection and treatment adherence, combat
stigma and discrimination, mobilize political commitment and
resources for TB.
1 – Policy Guidance: actions

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Establish a national-level multi-sectoral core
working group, or "Vision team", to work on
policy guidance.
Conduct situation analysis to identify gaps, needs
and opportunities.
Define roles and responsibilities for each of the
stakeholders.
Develop model adapted to specific (local) context.
Implement in demonstration areas and learn
lessons followed by (rapid) phased
implementation (ensuring in field supervision)
2 - ACSM: principles
Prepare strategy and operational plan for component 5
with specific behavioural objectives and targets.

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Advocacy to build and maintain political commitment,
including commitment to mobilize resources, and obtain
support at community level as well as at the
political/administrative level.
Address in particular the challenge of securing funds for
PHC activities at community level, to facilitate the work of
public health staff and/or CHWs.
Building on existing development and social initiatives.
Community partnership: to participate in design, planning
and implementation from the earliest stages.
2 - ACSM: actions


Presentation to national/local political and administrative
authorities: TB burden, analysis of local situation,
opportunities posed by community empowerment. Discuss
funding.
Communication: preparation of simple and clear messages
to inform and create awareness among the general public
about TB and available services and how people can be
empowered to take action.

Proposal of community partnership.
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Dialogue about challenges, roles and responsibilities.
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Decision about priorities.
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Preparation of "model".

….
3 - Capacity building
Build capacity for Component Five: ACSM and all other
areas relevant for model at country-level
Principles: "ACSM to fight TB, 10-year framework for action",
Patient's Charter, Int'l Standards of Care and the
overarching principles mentioned above provide guidance
to countries on this essential element.
Actions:

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Training for all stakeholders, guided by task analysis.
Develop flowcharts and checklists of activities with
sequence of events.
HR crisis: partnership (and partial devolution of responsibility for supervision) with NGOs already operating in hardto-reach areas, or urban settings or other specific
situations. Option for formal national partnership.
4 - Development of tools

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Develop IEC and BCC strategy (including materials and
methodologies) for different levels and stakeholders.
……
5 - Specific challenges
Approaches to component 5 need to take into account
special challenges (e.g. TB/HIV, MDRTB, indigenous
populations, prisoners, etc.)
Principles:

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Greater community involvement in TB programmes,
building on the experience and collaborating with HIV/AIDS
civil society initiatives, can provide a strong basis for
advocacy for improved TB/HIV services.
NGOs working in the field of HIV/AIDS should as well
coordinate their activities with community-based TB
initiatives.
Actions:

Ensure coordination between TB and HIV programmes as
well as with and between CSO's and other relevant
stakeholders with respect to component 5.
6 - Ensuring quality
Ensuring quality of broad range of services provided at
community level.
Principles:


Ensure services are patient-oriented and tailored to local
culture.
Ensure adequate link between the level of health services
interfacing with community directly, and ensure resources
to enable them to do their job.
Actions:

Ensure community is TB literate, e.g. knowledge of nature
of TB (curable, infectious, etc.), symptoms, availability of
free treatment, etc
7 - Establishing M & E and
supervision plan
Principles:
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Clearly define activities.
Ensure all relevant stakeholders are involved in identifying
indicators of community empowerment and baselines for
targets, in line with overarching objectives.
Collect essential disaggregated data by variables such as
age, gender etc.
Ensure community capacity to assess their own
contribution.
Actions:
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Revise R&R system to reflect M&E of E5
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……
8 - Budgeting and Financing
Principles:

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Clearly define activities.
Identify comprehensive list of expenditures relevant to
involvement of different stakeholders (e.g. training,
transportation, barriers for patients such as hunger, etc)
including hidden costs.
Carefully address issues around remuneration or enablers
or incentives of (voluntary) work of involved stakeholders
considering functions and time spent.
Discuss what relevant stakeholders/partners can provide
and raise development issue (communities have resources
not directed at health, often seen as exclusive MoH
responsibility)
9 - Operational Research
Additional operations research is needed to answer
general or context-specific questions.
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Emphasize (ex-)patient contribution, issues around gender.
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Document good practices.
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Link operational research with M&E.
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Identify innovative schemes