Community Tuberculosis  Prevention & Care Delivery

Name of Project    :               Community Tuberculosis  Prevention & Care Delivery 

  1. INRODUCTION
  2. Project Goal, purpose and outcomes

The goal of the project is to reduce new TB cases and TB-related morbidity and mortality among vulnerable and risky groups, the restoration of quality of life, reduction of transmission of TB within the communities and prevention of the development and spread of Multi-Drug-Resistant Tuberculosis. The following are the project purposes:

  • Increased % of notified TB cases
  • Increased number of cases registered for treatment
  • Increased number of TB patients receiving adherence support at community level
  • Reduced TB mortality and morbidity in communities
  • Increased number of confirmed cases of MDR-TB enrolled on treatment according to national guidelines
  • Restored quality of life for TB patient
  1. Brief description

Through the Community TB Prevention and care project, community volunteers are identified with the help of community leaders who are then built capacity in community sputum collection from TB suspects within the communities.The volunteers are stationed in Community Sputum Collection Points (CSCP) where walk in patients who voluntarily want to submit sputum go to.

The volunteers are supplied with enablers to help them work safely and effectively. The samples are then sent to community health posts where the samples are examined. The volunteers follow up on the sputum results and communicate the same to the patients in the communities.

The volunteers also provide adherence support to patients that are on ant-TB medication by providing counselling and providing DOTS support.

The volunteers work hand in hand with community TB focal persons from MoH who provide a supervisory role to them within the communities. Good coordination from the diocesan staff and MOH staff from the district offices and community health centers is key and paramount in the success of this project.

Volunteers report on monthly basis on the total number of samples they have sent for examining and also based on the results of those samples. Total number of patients receiving adherence support is also recorded.

  1. Target population

The project target groups ranges across the TB module, with some being in high risk institutions where people live under clouded conditions and communities at large. Thus the project will target Under Five’s, adolescents, couples or cohabiting, PLHIV and community at large in all the 7 districts of Lilongwe, Kasungu, Nkhotakota, Salima, Ntchisi, Dowa and Mchinji. However the direct beneficiaries are under five children and their mothers, adolescents, PLHIV and adults between the ages of 25 to 34 years of age where the incidence of TB is highest, and with low knowledge of TB issues and with limited access to other TB and HIV and AIDS services.

  1. Main project activities
  1. A. District level Quarterly supportive supervision and mentoring support to HFs

(i) Brief Description of activity

District level Quarterly supportive supervision and mentoring support to HFs are supervision and mentoring visits that will be conducted by Project Officer, DTO staff and a driver to health facility where volunteers and MoH staff at facility level are involved. Supervision & Mentoring is done using standard tools provided by NTP intended to capture right data and offer mentorship to these volunteers.

This activity will only take place in districts that are not supported by the World Bank and these include  Dowa, Mchinji, Salima,  Ntchisi, Nkhotakota.

Three (3)  people including driver will be involved once every quarter to conduct the supportive and mentoring to the health facilities. 

  1. Train 2000 new CSCPs volunteers

(i) Brief Description of activity

This activity would have involved training 10 volunteers for each of the  new CSCP that would have been opened for five days. This activity will no longer take place in all the 7 districts because of the new strategy in Active Case Finding which is attached. Funds allocated in this budget line must not be used unless advised in writing by the SR. 

  1. Facility level quarterly review meetings between HSAs, volunteers and other stakeholders

 (i) Brief Description of activity

Facility level quarterly review meetings are meetings that will be held between HSAs, volunteers and other stakeholders at a health facility on quarterly basis. At this forum, the volunteers present  summarized data from the communities and challenges encountered in the preceding quarter are discussed and way forward drawn. At the same meetings, the HSA’s will also look at the community registers and any errors or problems will discussed with the volunteers to ensure credible data.

This activity will take place in all registration sites in all the 7 districts that the eight (8) SSRs are implementing the project. 2 Representative from CSCPs  and also 2 representatives from registration centers will attend the facility level review meetings.

  1. Establish 40 new sputum collection points- Meeting at community level

(i) Brief Description of activity

This activity would have involved opening up new CSCP’s  by providing CSCP enablers to volunteers that will have been identified by the help of community leaders and TB focal persons in the community.

This activity will no longer be implemented due to the new Active Case Finding strategy which  has been attached. Funds for this activity should not be used unless advised in writing by the SR.

  1. Active cases finding through House to house TB screening in hot spot area using volunteers

(i) Brief Description of activity

Two(2) volunteers are expected to work twice a week in the hotspot areas within the high TB burdened districts as stipulated by the new Active Case Finding  Strategy. The volunteers will be conducting door to door TB screening in the high TB burdened hotspots. The volunteers will be provided with lunch allowance for conducting this activity twice a week 

  1. Support drama groups in communities on TB issues

(i) Brief Description of activity

In the first grant, Story Workshop trained Ten (10) drama team members for each district on how to sensitize the communities on TB issues. In this grant, the drama team members will be  provided with lunch allowance for their services 2 times per month. The drama groups will work in collaboration with volunteers in the community sputum collection points to provide TB messages in the communities.

  1. District Level Quarterly Program Performance review

(i) Brief Description of activity

These meetings will involve District TB Officers, Assistant TB Officer, District HMIS Officers, Laboratory Technicians, all other TB focal persons working in the districts and the SSR staff as indicated by the budget assumptions. The district review meetings will be two (2) day quarterly meetings conducted at district level and will be a forum where challenges & successes from the preceding quarter within TB arena are discussed and lessons  drawn from the same to improve future performance.

The district level quarterly program performance review meetings will be conducted in all the districts that are not supported by the World Bank.

  1. Supervisory visits by SR/SSRs

(i) Brief Description of activity

These supervisions will be done by SR/SSR staff once in a quarter for five days and the supervisions will involve visiting health facilities and CSCP using the supervision tool provided by the NTP.  2 SR staff and 1 driver per SR will be provided with DSA and fuel cost at 200km per day. This will complement the mentorship visits by district staff to health facilities and communities. The activity will also include MoH, PR and 2 SR staff. 

  1. Refresher training for Active case finding volunteers and community health workers

(i) Brief Description of activity

Instead of the two (2) day refresher training for Active Case Finding, the Active Case Finding training will be a full five (5) day training for the two (2) new volunteers, one (1) microscopist, one (1) TB focal person and one (1) facility in-charge in the hotspot health facility in the eight (8) high TB burdened districts.

DTO’s, EHO’s. AEHO’s and Laboratory Technicians will be engaged to facilitate these trainings and a maximum of three (3) facilitators will facilitate these trainings.

  1. Active cases finding through House to house TB screening in hot spot area using volunteers

(i) Brief Description of activity

This activity will involve one volunteer and one HSA from the hotspot health facility conducting house to house visits for TB screening in hotspot areas twice a week and lunch allowance provided by the SSR.

  1. Support sputum sample transportation in hard to reach areas within the districts

(i)   Brief Description of activity

In this activity, one rider from MoH (DHO) will be engaged one day per week to collect samples in hard to reach areas within the districts. A radius of 200 kilometers is estimated per day within the district. Fuel and lunch allowance for the MoH rider will be provided by the SSR.

 

  1. M. Bicycle maintenance

(i) Brief Description of activity

This activity involves the procurement of a tube and a tire twice a year to maintain the provided bicycles. This is meant to avoid procurement of new bicycles. Two thousand eight hundred (2800)  bicycles were already distributed in 2016 and 200 more are expected to be distributed in 2018 making a total of three thousand (3000).

 

 

  1. Time frame

Actual implementation of the project commenced in May 2018 and the project is expected to end in December, 2018.

  1. Project Performance Indicators

The following indicators are reported to Global Fund on a quarterly basis. Please note that indicator number 5 will only be reported by Blantyre, Lilongwe, Mangochi and Chikhwawa arch/dioceses as Active Case Finding will only be conducted in the 8 burden districts which are impact districts for these dioceses;

  1. Number of notified TB cases, all forms, contributed by non-NTP providers – community referrals
  2. Number of notified cases of all forms of TB – bacteriologically confirmed plus clinically diagnosed, new and relapses
  3. Number of Community Sputum Collection Points established
  4. Number of functional Community Sputum Collection Points
  5. Number of House to House visits conducted