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

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

Situation of TB in Zanzibar

Rationale of the Action Plan TB estimation for Tanzania - 300/100,000 Tanzania detecting 51% % -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 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

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 their HIV 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 the in the community increased Many people died from TB Undermine the efficiency of 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 and HIV decreased Modern treatment accepted TB suspects are examined and diagnosed on time Information of programme problems in the community collected No communication strategy 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 cconfidence on 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 Date Zanzibar Islands Zanzibar Rural Community March 06 Narrative SummaryObjectively Verifiable Indicator Means of VerificationImportant Assumption Overall Goal TB 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 purpose Zanzibar 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 Outputs 1.Outreach information of TB disease in the community increased 2.TB suspects are on time examined and diagnosed By the year 2011, more than 80% of the community informed about TB disease 70% 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 (2 nd KAP study at the end of the project) -Monitoring, annual evaluation and revision of methods

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

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