TB REACH is a results-driven funding mechanism, which has proven itself to be a cost effective mechanism for investment through its mid-term evaluation launched in November 2012. TB REACH’s goal is to find and treat the 3 million TB cases that aren’t reached by the Global Fund and national governments every year. In areas with limited or non-existent TB care, TB REACH supports innovative and effective techniques to find people with TB quickly, avert deaths, stop TB from spreading and halt the development of drug-resistant strains.
The delegation visited an outreach programmed to increase TB detection and coverage in the rural area of Awasa. The project is integrated within the Ethiopian Ministry of Health’s existing Health Extension Programmed which has been successful in delivering primary healthcare to communities by training 36,000 Health Extension Workers. The current TB REACH programmed has already doubled TB detection rates compared to its control area during the two year pilot period.
Welcome to Ethiopia and Hawassa beautiful city in southern Ethiopia. We are very delighted to host you for the field visit to the rural community to understand how the innovative community based approach works and share our experience, performance, challenges and future direction.
Short description of the field visit
i. Nure Dulecha Health Post Brief community based activities
Performance of TB control program before and after the project period Integration of the activities in the community Benefits to the patients, the community and the health system What is interesting in the intervention in relation to HEP and the community?
Discuss with Health Extension Worker, Health Development Army and beneficiaries
ii. Dulacha Teberako health centre Performance of TB control program before and after the project Integration of the activities in the community Benefits to the patients, the community and the health system Discuss with health centre head, laboratory professional and TB focal person
iii.District health office Performance of TB control program before and after the project Contribution of the project to health system strengthening Discuss with District Health Office head, TB focal person and their team
Tuberculosis is one of the major causes of morbidity and mortality in Ethiopia. Despite the expansion of the DOTS programme in the country, the number of cases notified remained low. The National TB programme follows a passive case finding approach and TB cases are identified among patients visiting health facilities. However, TB diagnostic centres are located in urban and semi-urban areas and patients often need to make several visits before initiating treatment. These visits are onerous for rural population, women, children, elderly and patients with disabilities. Geographic accessibility, socioeconomic and cultural barriers affect health seeking behaviour of the communities. Stigma associated with TB and lack of awareness about the disease and availability of the services further compromise service utilization. In October 2010 LSTM and the Southern Region Health Bureau of Ethiopia initiated a project in Sidama zone with financing of the TB REACH initiative. The main objectives are to improve TB case detection, treatment uptake and adherence among populations with limited access to diagnosis and treatment and to improve the routine TB recording and reporting system.
A package of interventions include conducting extensive advocacy, communication and social mobilization (ACSM) activities, engaging all stakeholders, councils, communities and Health Extension Workers (HEWs) in TB control activities, training of HEWs, staff working in TB clinics and TB coordinators. HEWs conduct house-to-house visits as part of the routine community-based activities and identify TB suspects, collect sputum samples, prepare and fix smears. Then, HEWs contact supervisors by telephone to collect and transport smeared slides to laboratories for smear-microscopy. Supervisors initiate treatment for smear-positive TB cases within their community and examine contacts of index cases and initiate Isoniazid preventive therapy (IPT) for asymptomatic young children. HEWs support and supervise treatment and report drug adverse effects and treatment outcome. The field team and the supervisors conduct regular supportive supervision and review meetings with HEWs and staff, discuss progress and challenges encountered and agree on action points
During the project period (Oct 2010 to Dec 2011), the HEWs identified 49,857 TB suspects,; of these, 2,262 (4.5%) were diagnosed as smear-positive TB cases and initiated treatment. 60% of TB suspects screened by HEWs and 53% of smear-positive TB cases diagnosed at community level were women. During the same period (including the estimated number for January 2012), a total of 5,429 cases with smear-positive TB and 7,553 with all forms of TB were diagnosed and initiated treatment in the zone. This corresponds to an increase in case notification of 100% and 78% respectively in comparison to the period preceding the implementation of the project. The additionality achieved exceeded the targets in the first year of implementation. In addition, 8,005 contacts of smear-positive TB cases were visited, 1,949 (13%) were symptomatic, 1290 (66%) were screened by smear-microscopy and 62 (6.9%) were diagnosed as smear-positive TB cases and 7 children were diagnosed as smear-negative and/or EPTB cases. All TB cases started treatment. A total of 2,477 young children in contact with smear-positive TB cases were identified and 1,080 (44%) asymptomatic children were offered IPT.
The project was conceived and designed to address the key problems and gaps of the TB control programmed, which in turn was based on evidences and experiences in the area. It engaged the existing community-based health systems and actors with a component of innovation and strong monitoring and evaluation.
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