1. Involvement of community-based organizations in the fight against Tuberculosis and TB/VIH co-infection in Burkina Faso Dr Fodé SIMAGA fode.simaga@undp.org Cancun 2009

2. Contents Introduction I. History of the project implementation II. The community response strategy III. Program Structure IV. Challenges and Perspective Conclusion

3. INTRODUCTION  Burkina Faso Round 4 Global Fund grant implementation: NTP and PAMAC partnership  In terms of community/CBO mobilization, the national context made it possible to implement a country-wide CBO involvement strategy

4. What is PAMAC?  Support Program to Community- based Organizations: National Programme funded by different Partners to support community-based organizations involved in the fight against HIV, Malaria and Tuberculosis.

5. What is PAMAC?  PAMAC's role : - Build community-based organizations' technical and financial capacity. - Empower them to deliver quality services complementing the health system - Empower them to become recognised actors.

6. I. History of the project implementation (1)  Since 2005, PAMAC is chosen as SR for the community response for GF round 4 TB It is about: - implementing the community response of the National TB Programme;

7. I. History of project implementation (2) - elaborating a community/CBO response implementation strategy respecting the demands of all actors, - organizing and coordinating community actions, - Build their capacity in a sustainable way

8. II. Key point of the community response strategy (1)  A response-design with a participative approach Taking into account health professionnals, community actors

9. Strategy baseline  National intervention taking into account urban and rural specificities;  Emphasis on vulnerable populations through patient-based and community activities;  Functional country-wide M&E and supervision system for CBO involvement

10. Key principles  Model of CBO involvement designed around following key interventions: - sensitization - community support services - a referral of TB symtomatics to the health center Complementarity and synergy between community and health institutions with actions at national and regional levels

11. Sensitization: 11 regional networks Treatment support: 1 regional network CBOs (sensitization, referrals) Traditional healers (referrals) District Health Center PLWHA org's (sensitization, referrals) TB pts orgs (support, referrals) Urban treatment support Org's (home visits, defaulter retreival, referrals) NTP

12. III- Programme structure The actors  11 Regional coordinating networks: «structures pivot» - Role: - coordination, - technical support, - financial support

13. III- Program structure  CBOs involved in sensitization - Theatre - Cinema and debates - Community sensitization dialogues ! During these activities TB symptomatics will be referred to the health centers (referral sheets developed).  Quarterly supervision by Regional Network

14. Community sensitization activity using flip chart

15. III- Program structure  CBOs involved in community support - permanent presence in the TB Tx/Dx centers - Support to patients with adherence- to-treatment-related challenges - home visits (with contact investigation and referral of symptomatics)

16. Psychological support to a patient

17. III- Program structure  Traditional healers' Associations Suspected case referral to the health centers.  Patients Associations advocacy activities in the community.  PLWHA Associations In charge of controling the HIV-Tb co- infection.

18. Results 1  From October 2005 to march 2009:  3 597 community actors trained in Tuberculosis prevention and care  28 322 prevention activities conducted in which (50% of activities supervised by health staff)

19. Results 2  More of 1 777 572 persons sensitized  7534 Tb patients benefited from one form of treatment support activity  10433 home visits realized  12162 suspected cases referred from which 873 tested positive

20. Challenges and perspectives 1  The sustainability of community mobilization with adequate financial resources;  Satisfying structure of CBO involvement, but varying level of expertise in CBOs;

21. Challenges and perspectives 2  A real integrated approach of HIV and Tb control TB/VIH coinfection  Further increase in contribution to sm+ case detection neededPrincipal challenge of the national strategy (n.b. Challenges with estimated CDR [less than 20%] – most probably a gross- understimate – prevalence survey planned in 2010)

22. Challenges and perspectives 3 Global Fund Round 8 TB: - Starting probably in January 2010 - PAMAC is becoming PR new challenges.

23. CONCLUSION  An organized and structured CBO netowork is able to respond to the challenges of fighting against Tb  The round 8 will ensure continuity of activities. It will build on the success and experiences of 5-year implementation and address observed weaknesses (primarily to respond to the principal NTP challenge: increasing case detection).