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

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.

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

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  1. 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

  2. UNITED REPUBLIC OF TANZANIA ZANZIBAR ISLANDS

  3. 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

  4. TB NOTIFICATION PER 100,000 POPULATION BY REGION, 2004

  5. Situation of TB in Tanzania- 1979-2004

  6. Situation of TB in Zanzibar 1988 - 2004

  7. 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

  8. 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

  9. 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

  10. Stakeholder Analysis Beneficiaries Zanzibar rural Community Implementing Agencies NTLP 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 Agencies Zanzibar Government, GLRA, GF Decision makers Zanzibar Government & MOH&SW-NTLP Potential Opponents Culture and belief of the Zanzibar rural community Supporting Group Local leaders (Shehas), Religious leaders, Health workers, TBAs, HBCs

  11. Problem tree Undermine the efficiency of TB programme Morbidity due to TB in the in the community increased Many people died from TB Community continue to be infected with TB baccilli 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 Limited outreach information in the community Low priority of TB in the health facility TB patients are not ready to know their HIV status Trust and confidence on traditional healers Lack of knowledge on TB disease Lack of supportive supervision by programme staff Lack of ACS of TB disease in the community Limited information of programme problems exist in the community Discrimination of PLWHA No treatment for HIV provided to AIDS patients Death Incompetent health worker No advocacy, communication & social mobilization strategy in NTLP No operational researches done to identify problems Un-motivated health workers toward TB disease Operational research is given low priority among the programme activities

  12. Objective tree Good indicator for TB programme efficiency Community free from TB Fewer people died from TB TB became no longer a public health problem Increasing detection rate in Zanzibar rural community Information of TB disease provided Stigma of TB and HIV decreased Modern treatment accepted Information of TB disease in the community increased TB suspects are examined and diagnosed on time Test for HIV agreed Trust and cconfidence on modern treatment developed Knowledge of TB disease increased Supportive supervision by TB programme staff to the health Modern Rx Approach TB campaign in the community increased Information of programme problems in the community collected Patients with HIV/AIDS ARVs are provided Patient with TB and HIV survived PLWHA are not discriminated Health worker became competent & TB cases suspected Advocacy, communication & Social mobilization strategy developed Operation research is among the programme activities highly prioritized Stigma reduction Approach Health worker participate in TB activities motivated ACS Approach No communication strategy

  13. The Project Design Matrix (PDM) Project Name -Improving Zanzibar case detection through Advocacy, communication & Social mobilization Duration - March2006-February 2012 Target Area Target Group Date Zanzibar Islands Zanzibar Rural CommunityMarch 06

  14. 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)

  15. 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

  16. 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

  17. Inputs Project finance - Zanzibar Government, GLRA,GF Country -Tanzania, Zanzibar Personnel-ACS coordinator, Public Health Officers, DTLCs, Drivers, Secretaries Facility - ACS, Supervision, Operational researches, Project implementation and management cost

  18. 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

  19. Pre-conditions Donors does not change their will to support NTLP

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