Community-led monitoring and advocacy is improving TB response in Zimbabwe
Despite of the Patients' Charter for Tuberculosis Care being an integral part of the Global Stop TB Strategy, and major thrust on community engagement in the Global Plan to Stop TB, communities are yet not optimally engaged by the TB programmes in high burden countries. However there are promising examples where community engagement has led to improved TB programme outcomes, and health outcomes over all.
At the 40th Union World Conference on Lung Health in Cancun, Mexico, co-chairs Dorothy Namutamba, East African Regional Coordinator for International Community of Women with HIV/AIDS (ICW) and Erin Howe from Public Health Watch, moderated a very interactive session on community engagement in TB responses. Albert Makone from Community Working Group on Health (CWGH) shared an inspiring example of how communities were engaged and mobilized for the uptake of intensified TB case finding in HIV-care settings.
"Our role has been over the past years to encourage community participation and to build mechanisms so that community can engage - our motto is health is your right and also your responsibility" said Albert Makone. "We began working on HIV in 1998 and integrated TB issues too in 2007" informed Albert. "The evidence that was coming from the civil society on people getting impacted by both: HIV and TB - led us to integrate TB in our initiatives."
"We engaged parliamentarians, national TB programme (NTP) managers, and other stakeholders" said Albert. "We elected the parliamentarians and we thought that engaging them will increase accountability of them towards their own electorate" said Albert. "The Abuja Declaration that demanded 15% budget allocation for health was a great tool to push parliamentarians for upping domestic funding on health. We believe one day we will invest more than 15% of budget on health" shares Albert.
"We began working closely with regional campaign for essential medicines. Nokia, mobile phone manufacturer, distributed mobile phones to every health centre and clinics so that clinics can communicate with the health centres and inform them about depleting drug stocks. This was an intervention in response to drug stock-outs in Zimbabwe" said Albert.
"There were reports about theft in dispensaries so we mobilized funds for security guards so that drugs go to the people who need it most" said Albert.
Speaking about community monitors called "TB Monitors" at village level, Albert says: "We were able to do community monitoring by training people to be TB monitors at the village level. These monitors were trained for five days on HIV and TB issues and screened local people to boost intensified new TB case finding - and increase treatment literacy for better treatment outcomes" says Albert.
"One of the key challenge was vertical programming of TB and HIV - and we need to find solutions to up the collaborative TB/HIV activities on the ground" remarks Albert.
The lack of coordinated mechanism between the new agencies addressing TB has required Albert's organization to take on a leadership role in pushing the TB/HIV advocacy agenda in Zimbabwe.
"It was a long process to engage parliamentarians as their awareness on health was low. We finally organized two days workshop with parliamentarians to sensitize them on health and emphasize the TB/HIV epidemics in Zimbabwe. We focussed on reaching out to the portfolio committee on health and slowly the role of community was becoming evident to policy makers - that community is there not only to criticize but also to help give input and shape solutions as informed and treatment literate partner" said Albert.
"Issue of infrastructure is there as it is in a very dilapidated state in Zimbabwe. Laboratory capacity is weak and domestic funding is low" shares Albert.
"NTP managers should consider community as equal partner and listen to their voices. If they don't involve affected communities in a meaningful manner, it will be a missing link. We will have good laboratories, diagnostics, drugs but continue to have higher infection rates. We need to listen to community voices and resolve the issues they face to improve TB programme performances" said Albert.
As a result of the growing movement for TB/HIV collaborative activities, a quarter of the AIDS service organizations in two districts of Zimbabwe are offering TB screening to their clients and referring them for diagnosis and treatment of TB.
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