1. Community Based DOT(S) Kong Kimsan MD, PUHP JICA TB Control Project, Cambodia 11 th -July-02

2. Outline of Presentation Summary of workshop on 21st June 2002 Feed back from NGOs Experiences from community survey

3. Summary of workshop on 21st June 2002 (1) Who are eligible patients? What criteria for DOT in community? - Handicapped - Child - Very distant - AIDS Home Care client

4. Summary of workshop on 21st June 2002 (2) Who can be DOT watcher? 1. DOT watcher should be: - Members of health center committee - Community leaders - Village Health Volunteers - NGO workers/volunteers - Local health professionals - School teachers 2. What kind of training should be provided?

5. Summary of workshop on 21st June 2002 (3) Supervision: 1. Who can supervise (DOT watcher & TB patient)? - OD TB supervisor - TB Unit staff - Trained health center staff - Trained NGO health professional 2. How often? - Weekly?, Bi-weekly? ……………

6. Summary of workshop on 21st June 2002 (4) Drug management and supply: 1. Drug collection: Who? - DOT watcher - TB patient - Others 2. Who should keep TB drugs of the patient? - DOT watcher - or TB Patient

7. Summary of workshop on 21st June 2002 (5) Record? 1. TB Register: HC 2. Treatment Card: Should be kept in HC or TB Unit 3. Who record (  )? DOT watcher?, Patient? or How often? 4. Additional: Should have Special Card DOT watcher

8. Summary of workshop on 21st June 2002 (6) How often do TB patient see health worker (HC)? 1. Every week? 2. Every 2 weeks? 3. Or only 3 times in treatment? Month2, Month5 and Month8. 4. Others?

9. Summary of workshop on 21st June 2002 (7) How to follow up the patient? 1.Patient should come to see health worker? - Weekly? Every 2 weeks? Monthly? 2. Home visit by HC/OD? 3. How often?

10. Summary of workshop on 21st June 2002 (8) Detection: How to detect patient? - Symptomatic detection - Sputum collection - Sputum sending - Diagnosis or only screening: Smear+ & Smear-

11. Summary of workshop on 21st June 2002 (9) Support DOT in Community 1. Who? - HC staff - DOT watcher - Patient 2. Activities: - Training - Transportation - Incentive ….

12. Feed back from NGOs (1) RHAC: 1.Eligible patients: + Family Size, Distance 2.DOT watcher: + Job description, DOT watcher should be responsible TB drug collection. 3.Supervision: NGOs worker can be Community DOT(S) Supervisor or DOT watcher.

13. Feed back from NGOs (2) JOCS: 1. Community Participation: - TB patient detected in community is few - Needed much flexible for guideline - DOT watcher: Ex-TB patient 2. Per diem: If people understand, they will not ask money (DOT watcher)

14. Feed back from NGOs (3) MSF (Sothnikum): 1.Eligible patients: Many people in village (Very remote area) cannot come to HC every day, especially women with young children (cost & time). 2.DOT watcher: - Relative of patient, Responsible member of the community, The feedback Committee members. - A small incentive should be paid to DOT watcher by CENAT (Except relative of patient).

15. Experience from community survey (1) Prevalence survey: 1. Clusters: - Chrava Village (Kratie): - Morn Village (Kamport) - Steung Trang (Kampong Cham) 2. Who can be DOT watcher? - Family members of the TB patient - Neighbors - Village leaders/feedback committee member - Village Health Volunteers

16. Experience from community survey (2) Note Book Distribution: 1. Where? Primary School in: - Kg Tralach OD (Kg. Chhnang) - Sothnikum OD (Siem Reap) - Thmorkol OD ( Battambang) 2. Who can be DOT watcher? - Village leaders/feedback committee member - School teacher - Family members of the TB patient - Village Health Volunteers

17. Experiences from community survey (3) Review of DOTS in HC (Kampong Tralach OD): 1. Svay Chuk 2. Svay 3. Long Vek 4. Kg. Tralach Leu