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Improving case detection of rural area in Zanzibar through Advocacy, Communication & Social mobilization Dr Sira Ubwa Mamboya MD, Ms Trop Med. Programme Manager Tuberculosis and Leprosy Programme Zanzibar, Tanzania

Dr Sira Ubwa Mamboya MD, Ms Trop Med. Programme Manager Tuberculosis and Leprosy Programme

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Improving case detection of rural area in Zanzibar through Advocacy, Communication & Social mobilization. Dr Sira Ubwa Mamboya MD, Ms Trop Med. Programme Manager Tuberculosis and Leprosy Programme Zanzibar, Tanzania. UNITED REPUBLIC OF TANZANIA. ZANZIBAR ISLANDS. - PowerPoint PPT Presentation

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Improving case detection of rural area in Zanzibar through Advocacy,

Communication & Social mobilization

Dr Sira Ubwa Mamboya MD, Ms Trop Med.Programme Manager

Tuberculosis and Leprosy Programme Zanzibar, Tanzania

UNITED REPUBLIC OF TANZANIA

ZANZIBARISLANDS

Zanzibar Background Information

• Zanzibar - Unguja & Pemba islands• Land area - 2,332 sq/km• Population - Almost 1 million• Annual population growth rate - 2.8% • Fertility rate of 5.6• Literacy rate - 60% with a gross enrolment

rate of 85%. • 33% of the population live in urban and 67%

in rural areas

TB NOTIFICATION PER 100,000 POPULATION BY REGION, 2004

Situation of TB in Tanzania- 1979-2004

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

1979

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

Smear + Return Fail Other Relapse Smear - Extra-P

Situation of TB in Zanzibar 1988 - 2004

0100200300400500600700800900

1,000

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Smear + #REF! #REF! #REF! Smear - Extra-P Realpse

Rationale of the Action Plan

• TB estimation for Tanzania - 300/100,000

• Tanzania detecting 51% - 66000

• 70% -756,000

• Zanzibar average detection -384 patient/Y

• 50% - town 33% population

• 50% - rural area 68% population

Reasons for selection of the project•Since NTLP launched HE strategy not introduced•During supervision – patient delay to seek treatment•The review team findings

-IEC materials depends on prints, no electronics and understandable to technical member of the community

-IEC limited number and types

-Material limited to health facility excluding general pop.

-Given HE not cover the existing relationship between TB and TB/HIV

Reasons Cont…..•KAPB study results in Iringa, Temeke and Ifakara– Low knowledge on newly diagnosed, sign and transmission, treatment is free of charge, misconception and stigma of TB contributing factor for delay

•KAPB study results in Zanzibar rural community -Low knowledge of TB disease & prevention, misconception of mode of transmission, negative attitude towards TB patients

Conc. NTLP should develop a communication strategy and use appropriate methods for public education

Stakeholder AnalysisBeneficiariesZanzibar rural Community

Implementing AgenciesNTLP staff, HEU, Regional Medical & Health Officers, District Medical & Health Officers, Regional & District commissioners, RTLCS & DTLCs, Media, Teachers, Ex TB patients, NGOs, CBOs, FBOs, Traditional healers, VCTs staff, Chest clinics staff & community

Funding AgenciesZanzibar Government, GLRA, GF

Decision makersZanzibar Government & MOH&SW-NTLP

Potential OpponentsCulture and belief of the Zanzibar rural community

Supporting GroupLocal leaders (Shehas), Religious leaders, Health workers, TBAs, HBCs

Low detection rate in Zanzibar rural community

Lack of information of the TB disease

Stigma of TB disease in connection with HIV

Belief of traditional medicine

Low priority of TB in the health facility

Limited information of programme problems exist in the community

No operational researches done to identify problems

No advocacy, communication & social mobilization strategy in NTLP

Lack of supportive supervision by programme staff

Un-motivated health workers toward TB disease

Incompetent health worker

TB patients are not ready to know theirHIV status

Discrimination of PLWHA

Death

Trust and confidence on traditional healers

Lack of knowledge on TB disease

Limited outreach information in the community

Lack of ACS of TB disease in the community

Community continue to be infected with TB baccilli

Morbidity due to TB in thein the community increased

Many people died from TB

Undermine the efficiencyof TB programme

No treatment for HIV provided to AIDS patients

Problem tree

Operational research is given low priority among the programme activities

Increasing detection rate in Zanzibar rural community

Information of TB disease provided

Stigma of TB andHIV decreased

Modern treatment accepted

TB suspects are examined and diagnosed on time

Information of programme problems in the community collected

Operation research is among the programme activities highly prioritized

Advocacy, communication &Social mobilization strategy developed

Supportive supervision by TB programme staff to the health

Health worker participate in TB activities motivated

Health worker became competent & TB cases suspected

Test for HIV agreed

PLWHA are not discriminated

Patient with TB and HIV survived

Trust and cconfidenceon modern treatment developed

Knowledge of TB disease increased

Information of TB disease in the community increased

TB campaign in the community increased

TB became no longer a public health problem

Community free from TB

Fewer people died from TB

Good indicator for TB programme efficiency

Patients with HIV/AIDS ARVs are provided

Objective tree

ACS Approach

Stigma reduction Approach

Modern Rx Approach

The Project Design Matrix (PDM)Project Name -Improving Zanzibar case detection through Advocacy, communication & Social mobilization

Duration - March 2006-February 2012 Target Area Target Group DateZanzibar Islands Zanzibar Rural Community March 06

Narrative Summary Objectively Verifiable Indicator

Means of Verification Important Assumption

Overall GoalTB no longer a public health problem

No of patient detected decline

Mortality rate due to TB decrease from10 % - > 5%

Quarterly and annual reports

Ministry of health to make TB programme not a priority programme

Project purposeZanzibar detected > 70%of TB patients by the year 2011

Zanzibar detecting >70% of estimated TB patient

Annual notification reports of TB patients

Number of estimated TB suspect by WHO not the real number are in Zanzibar community

Outputs1.Outreach information of TB disease in the community increased2.TB suspects are on time examined and diagnosed

By the year 2011, more than 80% of the community informed about TB disease70% or more TB patients diagnosed to have TB disease by the year 2011

Repeated KAP survey report on TB Programme reports on the increasing trend of TB patients to reach 70% or more of all infected population

Suspect of TB disease did not attend to the health facilities

Activities

-Initiate ACS of TB disease in NTLP-Develop ACS tools for all levels-Establish TB committees at district and shehia levels-Conduct ACS awareness meetings for leaders-Conduct training on the remaining stakeholders-Mobilize communities through different methods (group discussions, dramas, film shows, radio and local dances etc)

Activities

Supportive supervision by TB programme staff to the health worker reinforced-Conduct monthly supportive supervision-Conduct on job training-Involve health workers in community mobilization at their respective areas

Activities

- Conduct operational research to asses the effectiveness of ACS (2nd KAP study at the end of the project)-Monitoring, annual evaluation and revision of methods

Inputs

Project finance - Zanzibar Government, GLRA,GF Country -Tanzania, ZanzibarPersonnel-ACS coordinator, Public Health Officers, DTLCs, Drivers, SecretariesFacility - ACS, Supervision, Operational researches, Project implementation and management cost

Assumptions

-Developed advocacy, communication and social mobilization strategy used

-Money for conducting operational research are going to be disbursed as planed

-Motivated health worker are not going to be often changed

Pre-conditions

Donors does not change their will to support NTLP