Democratic Republic of Congo Dr BENGEYA : Deputy NTP Manager Community meeting in Addis - Current status of integrated community based TB service ...
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Current status of integrated community based TB service
delivery and the GF work plan to find missing TB cases
Democratic Republic of Congo
Dr BENGEYA : Deputy NTP Manager
Community meeting in Addis
Intercontinental Hotel, 11-13 April 2018
History of community engagement
in DR Congo
• DRC health strategy is founded on PHC including
community engagement - Health Committees
(COSA) with community workers (ReCo) responsible
for a number of households in the village linked to
each health centre
• TB control historically integrated in PHC
systematically looking for opportunities to boost
performance through effective approaches including
ENGAGE-TB
4/20/2018 Addis Abeba meeting 2
Background : Majors indicators
NUB BUL HUL
SUB
MGL ITR
EQT TOP
TAP
NKV
MND
SKR SKV
KIN MNM
KCO KWL KAS
K KCE KOR LMM
C KWG KAC TGK
O
HLM
LLB
HKT
517 1830 76 3
26 1
Health TB health Xpert culture
provinces Hain lab
Districts centers Machines lab
4/20/2018 Addis Abeba meeting 3
Background : Majors indicators 2017
• TB :
– 9th World Range , BUL
NUB HUL
– 2nd Africa Range (after RSA and Ethiopia) SUB
– Detection Rate : 48% (2017) MGL ITR
– Success rate : 89% (2017) TOP
EQT
– Notification cases : 151.832 (2017, NTP Report) TAP
NKV
• TB-VIH : MND
– 8ème
en Afrique, SKR SKV
– HIV testing : 63% KIN MNM
KCO KWL KAS
– HIV prevalence : 9,9% K KCE LMM
KOR
– Cases on ART : 82% (and 90% CTX) C KAC TGK
KWG
O
• TB-PR: HLM
– 14ème sur 30 pays, LLB
– Taux de notification : 12,7% HKT
– Succès thérapeutique : 80%
– TBRR/MR notifié : 878 / 6908 (2017, NTP Report)
• TB Resources :
– LIC : 3% domestic ressources ,
– 30% du budget non financé, médicaments gratuits
5 hot spot provinces et 6 middle
4/20/2018 Addis Abeba meeting 4
Background: Detection
180000
160000 151832
140000 132515
118636 120508
115625 117214
114290 112786 113881
120000 108215
102764
99558 97081
96288
100000
86715
80000 72065
68104
58917 59531 61024
60000
40000
20000
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Années Notification de cas TB
4/20/2018 Addis Abeba meeting 5
Background: success rate
Success rate
100
88 89 91 90 88 89 89 89 89 89%
90 85 85 87 87 87
83
80 78 80
80 74
70
60
50
40
30
20
10
0
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
4/20/2018 Addis Abeba meeting 6
Background: HIV Cascade
Cascade Co-infection porte TB en 2017
151832
140000
120000
63%
100000
80000 96900
60000 9,9%
82%
40000
90%
20000 9688 7982 8796
0
Cas notifiés TB testés TB VIH+ TB VIH+ S/ TB VIH +
TARV S/CTX
4/20/2018 Addis Abeba meeting 7
Background: Community roles
• Advocacy
• Sensitization
• Building capacities (management, training, planification, monitoring)
• Money raising (Funds de counterparties)
Managerial activities (national level)
• Community sensitization • Psychosocial support for TB, HIV-TB
• Household contact tracing • DOT support
• Referral of symptomatic • Identification of lost to follow up for
• Referral of persons with TB for HIV continuation of treatment
testing • Follow-up laboratory exams
• Referral of PLHIV for TB testing • ARV and condom distribution to
• Transport of specimens for stable PLHIV
diagnosis • Sputum transport
• M&E • M&E
Detection activities (field) Accompaniment activities (field)
4/20/2018 Addis Abeba meeting 8
Key community stakeholders with coverage
• Government :
– Through health committee (comité de santé)
• Stop TB platform:
– LNAC
– CAD
– Femmeplus
– 12 new NGO involved in 2017 (after training)
• Global Fund PR ( Caritas, Cordaid) :
– Using Local NGO (HIV NGO and TB NGO)
4/20/2018 Addis Abeba meeting 9
Implementation mechanism
• Stages:
– National consultation (NTP, affected communities and
NGOs/CSOs) on community-based TB activities
– Production of national guide for community engagement
strengthening in TB and HIV responses
– Definition of roles and activities in implementation (NTP and
community)
– Defining a single monitoring and evaluation system,
integrated in the national NTP M&E system including
indicators and data collection tools
– Elaboration of training modules for community-based
activities
4/20/2018 Addis Abeba meeting 10Implementation mechanism
– Mapping of NGOs/other CSOs
– Capacity building of NGOs and other CSOs in
community-based delivery of TB services
including support for resource mobilization of
NGOs
– Signature of MOU between the NTP and
selected NGO; negotiated cost of consultation
– Implementation in provinces
– Monitoring and evaluation
4/20/2018 Addis Abeba meeting 11Support of implementation
• DRC national: policies is based on PHC (SSP)
• TB Guideline: includes community aspects (PATI 5,éd 2016)
• ENGAGE Guideline : since 2014
• Training/capacity building strategy for CHWs/CVs
– In 2016: 1146 (445 women and 701 men) vs 1133 planed
• Supervision mechanism
– NGO :Twice (national to local level) but very insufficient in
field
• Monitoring and evaluation of CHW/CV performance
– NGO: each quarter
– NTP: coordination meeting
4/20/2018 Addis Abeba meeting 12Implementation tools (actualized)
• National guidelines for community based TB activities
– PATI 5 and ENGAGE TB,
• Referral mechanisms and tools (for presumptive TB)
– BILO AND FIDESCO,
• Job aids for referral, diagnosis and treatment of TB
– In training document,
• Recording and reporting tools
– TB register, Tb lab, TB quarterly report in Health centre
• Tools to ensure treatment completion and patient support
– TB register, TB lab, TB quarterly report in Health centre
4/20/2018 Addis Abeba meeting 13Implementation tools (actualized)
PROGRAMME NATIONAL DE LUTTE CONTRE LA TUBERCULOSE MINISTERE DE LA SANTE PUBLIQUE
PROGRAMME NATIONAL DE LUTTE CONTRE LA TUBERCULOSE
BILLET DE SUIVI DU CAS ORIENTE N°…………
BILLET D'ORIENTATION DU PRESUME TUBERCULEUX N°……………… Année………………………………………………………….
Trimestre………..
Province………………………………………………..
DPS/CPLT……….. Zone de Santé……….. CSDT………………………………
Aire de Santé…………………………………………………………
Organisation/personne qui oriente………………………………………………………………..
Année…………………………………………….
Trimestre :……………………..
Nom et post nom du présumé tuberculeux…………………………………………………………………………………..
Province…………….. DPS/CPLT……………….. Zone de Santé:…………..
Aire de Santé…………………………………………………………
CSDT……. Organisation/personne qui oriente……………………………………
BILO Age……….ans Sexe M F
Adresse et N° Tél……………………………………………………………………………………………………
Nom et post nom du présumé tuberculeux……………………………………………………………………………
Motif d'orientation Toux
Age……….ans Sexe M F
Adresse et N° Tél………………………………………………………………………………………………
Orienté (e) le………………………………………….. Arrivé (e) au CSDT/CST le……………………………
Confirmé (e) TB Oui/Non N° Registre TB……………………………………………...
Folow up
Motif d'orientation Toux
Referral
DOTS communautaire Conseillé : Oui/ Non Visite à domicile : ……. …TDO Oui/Non
Rappel : F2/3 Oui/Non F5 Oui/Non F6/8 Oui/Non
Date……………………………………………
Noms et signature………………………………………………………………………….. Récupéré Oui/Non Appui nutitionnel Oui/Non
Issues thérapeutiques Guéri / Traitement terminé / Echecs / DCD / PDV.
Noms et signature …………………………………………………………………………………………………
PROGRAMME NATIONAL DE LUTTE CONTRE LA TUBERCULOSE
LNAC -CAD - FemmePlus - RECO
FICHE D'INVESTIGATION SYSTEMATIQUE DES SUJETS CONTACTS
(FIDESCO)
DPS/CPLT: ………………………………………………..
Zone Santé: …………………………………………….
CSDT: ……………………………………………………….
IDENTIFICATION
Nom et post-nom du cas index : ………………………………………………………………………………….
Age (en année) : ………….
Sexe: M / F Forme de la TB: TB+ , RR/MDR, XDR
Taille: Taille:
Adresse complète: ……………………………………………………………………………………………………………
Lieux d'investigation: Menage Travail N° TB de la Formation : ……..
INVESTIGATION Autres:………………………….
FIDESCO N° Nom du sujet contact Age Sexe
Signes de présomption de la tuberculose
Toux Atcd TB
Sueurs
nocturne
Perte de
poids
Fièvre PVVIH Diabète
Orientation du
présumé au
CST / CDST
Date
Résultats
d'orientation TP+ TP/C TEP
RR/
MDR
XDR VIH
Observations
1
2
3
4
5
6
7
8
10
11
4/20/2018 Addis Abeba meeting
N.B: Pour tout enfant de moins de 5 ans ou PVVIH, orientation obligatoire vers le CSDT pour une éventuelle prévention à l'INH. Une investigation des contacts est obligatoire autour d'un enfantMonitoring and evaluation
• Data collection and data flow structure
– BILO ( referral presumptive document and follow up document for TDO)
– TB laboratory register (collect)
– TB register (collect)
– Quarterly report (for diagnose health centre and Health District) : transmission
• Data systems (status of DHIS2 adoption) : 39% of district use it for TB
• Data elements collected : address, sex, age, TB specificities, HIV status, output
• Indicators used to track contributions of community health workers/volunteers to:
- Proportion of referral TB presumptive cases
- Proportion of new TB case notification through community
- Proportion of TB accompanied
- Treatment success rate
• Geographic coverage of monitoring and evaluation and related tools
- All 517 Health District are covered quarterly
- All 1830 Diagnosis health centre are covered quarterly
4/20/2018 Addis Abeba meeting 15support of TB
Integrated implementation
service delivery
• Integration (how, what and who) of TB activities at community
level:
– National level : advocacy, money raising, pacification, guidelines
– Provincial level : advocacy, money raising, pacification
– Local level : detection et follow up activities
• Mechanisms to support integration:
– All TB community workers are linked with the TB program according
level
– There is meeting but not formal board and not regularly (we must
improve)
– NTP supervisions and review include community aspects but there is
community supervision held buy NGO Leaders. Grant are very
insufficient to cover all community supervisions planed by NTP or NGO
– Joint data validation exercises are very low because of lack of grant
4/20/2018 Addis Abeba meeting 16Mechanisms for coordination of community
based TB activities
• There is not a formal NTP-NGO body , but
– There is an NGO platform called: Stop TB RDC
• What are key functions of this group :
– Regulation of community interventions, capacity building,
mentoring, advocacies,
– Concertation of TB-NGO, sharing experiences with others NGO
– TB Observatory .
• How frequent are their meetings : Quarterly
• Any funding support ? :
– NMF2 by GF 18-2020 ????
– OMS ????
– Stop TB partnership ????
4/20/2018 Addis Abeba meeting 17Challenges, Bottlenecks and Solutions
• Challenges:
– To have communities interventions in all DRC health Districts
– To show clearly the community contribution on TB ( detection, success and many raising)
– Raising money for community activities
• Bottlenecks:
– Coordination:
• Deficiency of provincial teams ( weak NGO involvement) difficulties to regulate and control
community interventions in the provinces not covered by the members of the Platform,
• Hence, we must increase CSOs/NGO in TB work ( in field and provincial level)
– Service delivery:
• Poor documentation of community activities done in the field,
• Partial reporting of community activities and contributions.
• Capacity building of CSOs/NGO, increase funding and make tools available.
– Monitoring and evaluation:
• Very low supervision in the field for community actors,
• Not holding community data validation meetings.
• Need of support for community M & E.
4/20/2018 Addis Abeba meeting 18Success story (1)
• Community TB day celebration (24 June, 2017) with TB key populations and
leaders with a TB specific message
A policeman A catholic preacher
A PLWHIV
4/20/2018 Addis Abeba meeting 19Success story (2)
A autochthone people A road children (abandoned)
Parliamentary TB coccus created
Sensitization
4/20/2018 Addis Abeba meeting 20Results 1 (for ENGAGE Project 2015)
• Demonstration phase • At national level
• 2831 cases (41% of all cases • National ENGAGE-TB policy for
in 33 health centres) during integration of TB into other sectors
implementation period and engagement of NGOs and
development of guide and tools
detected thanks to ENGAGE-
TB project • Development of indicators and tools
integrated in the national NTP
• Treatment success of 93% vs system
national average of 88% • Establishment of a national platform
• Increase in utilization of TB for coordination of NGOs and other
health services thanks to CSOs (Stop TB DR Congo)
referral of persons with • Establishment of simple
presumptive TB standardized tools for household
contract tracing
4/20/2018 Addis Abeba meeting 21Results 2 : through NTP 2016-2017
• 2016:
– 24.810 TB cases was referred by community
– This number showed 18,7% of notification (24.810 vs 132.515)
– 12.410 TB cases was accompanied by community
– This number showed 9,3% of notification (12410 vs 132.515)
• 2017:
– 43.307 TB cases was referred by community
– This number showed 28,5% of notification (43.307 vs 151.832)
– 20.273 TB cases was accompanied by community
– This number showed 13,3% of notification (20.273 vs 151.832)
4/20/2018 Addis Abeba meeting 22Progress of results 2016-2017
151832
160000
132515
140000
120000
100000
80000
60000
43307
40000 24810 20273
12410
20000
0
Total TB Cases TB cases oriented TB cases accompagnied
2016 2017
4/20/2018 Addis Abeba meeting 23Country work plans for community based TB
activitiesCountry work plans for community based TB
activities
Stake District Fonds en
Province Bailleurs
holders health 2017
USAID, FM , AD,
LNAC 12 / 26 89 / 517 301.065,22$
fonds Propre
USAID, FM , fonds
CAD 13 / 26 108 / 517 227.557,97$
Propre
4/20/2018 Addis Abeba meeting 25Country work plans for community based TB
activities
• Stated objective :
• By the end of 2020,
– Increase the coverage of civil society actors on TB work;
– Strengthen coordination and visibility of “stop TB DRC” platform;
– Strengthen the capacity of civil society organizations in the
detection and monitoring of patients under treatment;
– Contribute to improving access to TB care for key populations by
CSOs actors, particularly through innovative approaches;
– Provide work tools to civil society actors;
– Strengthen the capacity of CSOs in resource mobilization
– Advocate through the government to increase and disburse the
TB specific budget line.
4/20/2018 Addis Abeba meeting 26Country work plans for community based TB
activities
• Activities planed (1):
– Recruit the new CSOs to join the Stop TB DRC;
– Install gradually provincial secretariats of Stop TB DRC;
– Update the mapping of civil society interventions through Stop TB
DRC;
– Organize quarterly meetings of the working group OF Stop TB
DRC;
– Organize the forum meeting; meeting of Stop TB DRC
consultation framework, NTPs and partners;
– Put in place mechanisms for the dissemination and popularization
of platform activities (website, radio-TV programs, information
media, ....;
4/20/2018 Addis Abeba meeting 27Country work plans for community
• Activities planed (2) :
– Organize activities related to JMT (World TB day);
– Organize the training of trainers / civil society actors in the fight
against TB (detection and follow-up of Treatment);
– Reproduce and distribute work tools for data collection;
– Monitor the activities of Stop TB CSOs;
– Push CSO members to develop innovative approaches targeting
special populations;
– Organize advocacy and resource mobilization meetings with
different partners;
– Put in place an (observatory) mechanism for monitoring the
efficient use of all available resources (means) for TB control in
the country; etc ....
4/20/2018 Addis Abeba meeting 28Country work plans for community based TB
activities
• Timelines : 36 months (2018)
• Responsibility : Stop TB RDC Board
• Percentage of the overall budget for
community based TB activities : 5.860.650 $
(10%)
4/20/2018 Addis Abeba meeting 29Country specific opportunities • GF TB/VIH 2018 -2020 Grant. • Catalytic Funds (TB missing cases). • USAID grant (Challenge TB) • Domestic funds (Government) • Own money (volunteers) !!!!! 4/20/2018 Addis Abeba meeting 30
Anticipated implementation challenges and suggested
solutions
• Money raising:
– more advocacies and elaboration of projects
• Demonstration of community contribution:
– Using community documents and monthly
monitoring of activities in field (Health districts)
– Annual community report
• Sustainability of activities:
– Capacity building of NGO, professionalism and
more advocacies for changing political and legal
environment (law and increasing domestic fund)
4/20/2018 Addis Abeba meeting 31Acknowledgement • DRC NTP manager • DRC « STOP TB » Platform • Community members • USAID (CTB-Union) • Damian Action • GF/PR • WHO country office 4/20/2018 Addis Abeba meeting 32
yes, we have to work for the
people and with them
4/20/2018 Addis Abeba meeting 33You can also read
