Democratic Republic of Congo Dr BENGEYA : Deputy NTP Manager Community meeting in Addis - Current status of integrated community based TB service ...

 
Democratic Republic of Congo Dr BENGEYA : Deputy NTP Manager Community meeting in Addis - Current status of integrated community based TB service ...
Current status of integrated community based TB service
 delivery and the GF work plan to find missing TB cases

        Democratic Republic of Congo
     Dr BENGEYA : Deputy NTP Manager

         Community meeting in Addis
              Intercontinental Hotel, 11-13 April 2018
Democratic Republic of Congo Dr BENGEYA : Deputy NTP Manager Community meeting in Addis - Current status of integrated community based TB service ...
History of community engagement
                   in DR Congo
• DRC health strategy is founded on PHC including
  community engagement - Health Committees
  (COSA) with community workers (ReCo) responsible
  for a number of households in the village linked to
  each health centre
• TB control historically integrated in PHC
  systematically looking for opportunities to boost
  performance through effective approaches including
  ENGAGE-TB

4/20/2018            Addis Abeba meeting           2
Democratic Republic of Congo Dr BENGEYA : Deputy NTP Manager Community meeting in Addis - Current status of integrated community based TB service ...
Background : Majors indicators

                                            NUB           BUL         HUL
                                    SUB
                                          MGL                           ITR
                                   EQT                   TOP
                                            TAP
                                                                      NKV
                                 MND
                                                   SKR           SKV
                           KIN                             MNM
                  KCO             KWL KAS
                   K  KCE                          KOR   LMM
                   C             KWG         KAC                 TGK
                   O
                                                         HLM
                                                  LLB
                                                                HKT

                 517               1830                     76                   3
   26                                                                                      1
                Health           TB health                Xpert               culture
provinces                                                                               Hain lab
               Districts          centers                Machines               lab

 4/20/2018                             Addis Abeba meeting                                    3
Democratic Republic of Congo Dr BENGEYA : Deputy NTP Manager Community meeting in Addis - Current status of integrated community based TB service ...
Background : Majors indicators 2017
• TB :
    –   9th World Range ,                                                                              BUL
                                                                                         NUB                       HUL
    –   2nd Africa Range (after RSA and Ethiopia)                                 SUB
    –   Detection Rate : 48% (2017)                                                     MGL                          ITR
    –   Success rate : 89% (2017)                                                                     TOP
                                                                                 EQT
    –   Notification cases : 151.832 (2017, NTP Report)                                 TAP
                                                                                                                   NKV
• TB-VIH :                                                                      MND
    –   8ème
           en Afrique,                                                                         SKR            SKV
    – HIV testing : 63%                                                   KIN                           MNM
                                                              KCO                KWL KAS
    – HIV prevalence : 9,9%                                    K  KCE                                 LMM
                                                                                                KOR
    – Cases on ART : 82% (and 90% CTX)                         C                          KAC                 TGK
                                                                                KWG
                                                               O
• TB-PR:                                                                                              HLM
    –   14ème sur 30 pays,                                                                    LLB
    –   Taux de notification : 12,7%                                                                         HKT
    –   Succès thérapeutique : 80%
    –   TBRR/MR notifié : 878 / 6908 (2017, NTP Report)
• TB Resources :
    – LIC : 3% domestic ressources ,
    – 30% du budget non financé, médicaments gratuits
                                                                 5 hot spot provinces et 6 middle
 4/20/2018                                          Addis Abeba meeting                                                  4
Democratic Republic of Congo Dr BENGEYA : Deputy NTP Manager Community meeting in Addis - Current status of integrated community based TB service ...
Background: Detection
180000

160000                                                                                                                                                           151832

140000                                                                                                                                                   132515
                                                                                                        118636                                   120508
                                                                                               115625                                   117214
                                                                                                                 114290 112786 113881
120000                                                                                108215
                                                                             102764
                                                              99558 97081
                                                      96288
100000
                                              86715

 80000                                72065
                              68104
         58917 59531 61024
 60000

 40000

 20000
         1998   1999   2000   2001    2002    2003    2004    2005    2006    2007     2008     2009     2010     2011   2012   2013     2014     2015    2016    2017
     0
          1      2      3      4       5       6       7       8        9     10       11       12       13        14    15     16       17       18       19         20

                                                               Années          Notification de cas TB

    4/20/2018                                                      Addis Abeba meeting                                                                            5
Democratic Republic of Congo Dr BENGEYA : Deputy NTP Manager Community meeting in Addis - Current status of integrated community based TB service ...
Background: success rate
                                                 Success rate
100
                                                 88    89          91   90        88   89   89   89   89   89%
 90                               85   85   87               87              87
                             83
              80   78   80
 80     74
 70

 60

 50

 40

 30

 20

 10

  0
       1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

      4/20/2018                                  Addis Abeba meeting                                        6
Democratic Republic of Congo Dr BENGEYA : Deputy NTP Manager Community meeting in Addis - Current status of integrated community based TB service ...
Background: HIV Cascade
                           Cascade Co-infection porte TB en 2017

                151832
 140000

 120000
                            63%
 100000

   80000                           96900

   60000                                     9,9%
                                                          82%
   40000
                                                                                    90%
   20000                                           9688          7982        8796

        0
            Cas notifiés    TB testés          TB VIH+          TB VIH+ S/   TB VIH +
                                                                  TARV        S/CTX

4/20/2018                               Addis Abeba meeting                               7
Democratic Republic of Congo Dr BENGEYA : Deputy NTP Manager Community meeting in Addis - Current status of integrated community based TB service ...
Background: Community roles
•     Advocacy
•     Sensitization
•     Building capacities (management, training, planification, monitoring)
•     Money raising (Funds de counterparties)
                                    Managerial activities (national level)
• Community sensitization                                  • Psychosocial support for TB, HIV-TB
• Household contact tracing                                • DOT support
• Referral of symptomatic                                  • Identification of lost to follow up for
• Referral of persons with TB for HIV                        continuation of treatment
  testing                                                  • Follow-up laboratory exams
• Referral of PLHIV for TB testing                         • ARV and condom distribution to
• Transport of specimens for                                 stable PLHIV
  diagnosis                                                • Sputum transport
• M&E                                                      • M&E
                Detection activities (field)                         Accompaniment activities (field)
    4/20/2018                                  Addis Abeba meeting                                      8
Democratic Republic of Congo Dr BENGEYA : Deputy NTP Manager Community meeting in Addis - Current status of integrated community based TB service ...
Key community stakeholders with coverage

 • Government :
       – Through health committee (comité de santé)
 • Stop TB platform:
       – LNAC
       – CAD
       – Femmeplus
       – 12 new NGO involved in 2017 (after training)
 • Global Fund PR ( Caritas, Cordaid) :
       – Using Local NGO (HIV NGO and TB NGO)

 4/20/2018                  Addis Abeba meeting         9
Democratic Republic of Congo Dr BENGEYA : Deputy NTP Manager Community meeting in Addis - Current status of integrated community based TB service ...
Implementation mechanism
• Stages:
      – National consultation (NTP, affected communities and
        NGOs/CSOs) on community-based TB activities
      – Production of national guide for community engagement
        strengthening in TB and HIV responses
      – Definition of roles and activities in implementation (NTP and
        community)
      – Defining a single monitoring and evaluation system,
        integrated in the national NTP M&E system including
        indicators and data collection tools
      – Elaboration of training modules for community-based
        activities

4/20/2018                     Addis Abeba meeting                   10
Implementation mechanism
      – Mapping of NGOs/other CSOs
      – Capacity building of NGOs and other CSOs in
        community-based delivery of TB services
        including support for resource mobilization of
        NGOs
      – Signature of MOU between the NTP and
        selected NGO; negotiated cost of consultation
      – Implementation in provinces
      – Monitoring and evaluation

4/20/2018                Addis Abeba meeting             11
Support of implementation
• DRC national: policies is based on PHC (SSP)
• TB Guideline: includes community aspects (PATI 5,éd 2016)
• ENGAGE Guideline : since 2014
• Training/capacity building strategy for CHWs/CVs
   – In 2016: 1146 (445 women and 701 men) vs 1133 planed
• Supervision mechanism
   – NGO :Twice (national to local level) but very insufficient in
      field
• Monitoring and evaluation of CHW/CV performance
   – NGO: each quarter
   – NTP: coordination meeting

4/20/2018                   Addis Abeba meeting                      12
Implementation tools (actualized)
• National guidelines for community based TB activities
      – PATI 5 and ENGAGE TB,
• Referral mechanisms and tools (for presumptive TB)
      – BILO AND FIDESCO,
• Job aids for referral, diagnosis and treatment of TB
      – In training document,
• Recording and reporting tools
      – TB register, Tb lab, TB quarterly report in Health centre
• Tools to ensure treatment completion and patient support
      – TB register, TB lab, TB quarterly report in Health centre

4/20/2018                           Addis Abeba meeting             13
Implementation tools (actualized)
PROGRAMME NATIONAL DE LUTTE CONTRE LA TUBERCULOSE                                                                                                                                                    MINISTERE DE LA SANTE PUBLIQUE
                                                                                                                                                                                                     PROGRAMME NATIONAL DE LUTTE CONTRE LA TUBERCULOSE
                                                                                                                                                                                                                                       BILLET DE SUIVI DU CAS ORIENTE N°…………

                      BILLET D'ORIENTATION DU PRESUME TUBERCULEUX N°………………                                                                                                                           Année………………………………………………………….
                                                                                                                                                                                                                          Trimestre………..
                                                                                                                                                                                                     Province………………………………………………..
                                                                                                                                                                                                                          DPS/CPLT………..           Zone de Santé………..         CSDT………………………………
                                                                                                                                                                                                     Aire de Santé…………………………………………………………
                                                                                                                                                                                                                          Organisation/personne qui oriente………………………………………………………………..
Année…………………………………………….
                     Trimestre :……………………..
                                                                                                                                                                                                     Nom et post nom du présumé tuberculeux…………………………………………………………………………………..
Province……………..          DPS/CPLT………………..                 Zone de Santé:…………..
Aire de Santé…………………………………………………………
                     CSDT…….                              Organisation/personne qui oriente……………………………………
                                                                                                                                            BILO                                                     Age……….ans               Sexe M                   F
                                                                                                                                                                                                     Adresse et N° Tél……………………………………………………………………………………………………

Nom et post nom du présumé tuberculeux……………………………………………………………………………
                                                                                                                                                                                                     Motif d'orientation               Toux
Age……….ans               Sexe M                   F
Adresse et N° Tél………………………………………………………………………………………………
                                                                                                                                                                                                     Orienté (e) le………………………………………….. Arrivé (e) au CSDT/CST le……………………………
                                                                                                                                                                                                     Confirmé (e) TB Oui/Non         N° Registre TB……………………………………………...

                                                                                                                                                                                                                                                                            Folow up
Motif d'orientation           Toux

                                                                  Referral
                                                                                                                                                                                                         DOTS communautaire Conseillé :             Oui/ Non    Visite à domicile : ……. …TDO Oui/Non
                                                                                                                                                                                                                             Rappel : F2/3 Oui/Non         F5 Oui/Non           F6/8 Oui/Non
Date……………………………………………
                 Noms et signature…………………………………………………………………………..                                                                                                                                                             Récupéré     Oui/Non           Appui nutitionnel        Oui/Non

                                                                                                                                                                                                     Issues thérapeutiques            Guéri / Traitement terminé / Echecs / DCD / PDV.

                                                                                                                                                                                                     Noms et signature …………………………………………………………………………………………………

                                                                                                              PROGRAMME NATIONAL DE LUTTE CONTRE LA TUBERCULOSE
                                                                                                                         LNAC -CAD - FemmePlus - RECO

                                                                                                            FICHE D'INVESTIGATION SYSTEMATIQUE DES SUJETS CONTACTS
                                                                                                                                        (FIDESCO)
                                                    DPS/CPLT: ………………………………………………..
                                                                               Zone Santé: …………………………………………….
                                                                                                         CSDT: ……………………………………………………….
                                                    IDENTIFICATION
                                                    Nom et post-nom du cas index : ………………………………………………………………………………….
                                                                                                          Age (en année) : ………….
                                                                                                                              Sexe: M / F                                                                 Forme de la TB: TB+ , RR/MDR, XDR
                                                                                                                                                                                     Taille:                Taille:
                                                    Adresse complète: ……………………………………………………………………………………………………………
                                                                                                   Lieux d'investigation: Menage                                                               Travail                N° TB de la Formation : ……..
                                                    INVESTIGATION                                                                                                     Autres:………………………….

          FIDESCO                                    N°     Nom du sujet contact         Age     Sexe
                                                                                                                 Signes de présomption de la tuberculose

                                                                                                        Toux Atcd TB
                                                                                                                       Sueurs
                                                                                                                      nocturne
                                                                                                                                Perte de
                                                                                                                                 poids
                                                                                                                                          Fièvre PVVIH Diabète
                                                                                                                                                               Orientation du
                                                                                                                                                                présumé au
                                                                                                                                                                CST / CDST
                                                                                                                                                                                   Date
                                                                                                                                                                                                      Résultats

                                                                                                                                                                              d'orientation TP+ TP/C TEP
                                                                                                                                                                                                          RR/
                                                                                                                                                                                                          MDR
                                                                                                                                                                                                                XDR                           VIH
                                                                                                                                                                                                                                                     Observations

                                                     1

                                                     2

                                                     3

                                                     4

                                                     5

                                                     6

                                                     7

                                                     8

                                                     10

                                                     11
                 4/20/2018                                                                                                    Addis Abeba meeting
                                                    N.B: Pour tout enfant de moins de 5 ans ou PVVIH, orientation obligatoire vers le CSDT pour une éventuelle prévention à l'INH.       Une investigation des contacts est obligatoire autour d'un enfant
Monitoring and evaluation
• Data collection and data flow structure
      –     BILO ( referral presumptive document and follow up document for TDO)
      –     TB laboratory register (collect)
      –     TB register (collect)
      –     Quarterly report (for diagnose health centre and Health District) : transmission
• Data systems (status of DHIS2 adoption) : 39% of district use it for TB
• Data elements collected : address, sex, age, TB specificities, HIV status, output
• Indicators used to track contributions of community health workers/volunteers to:
      -     Proportion of referral TB presumptive cases
      -     Proportion of new TB case notification through community
      -     Proportion of TB accompanied
      -     Treatment success rate
• Geographic coverage of monitoring and evaluation and related tools
      - All 517 Health District are covered quarterly
      - All 1830 Diagnosis health centre are covered quarterly
4/20/2018                                Addis Abeba meeting                                   15
support   of TB
                 Integrated implementation
                               service delivery

  • Integration (how, what and who) of TB activities at community
    level:
        – National level : advocacy, money raising, pacification, guidelines
        – Provincial level : advocacy, money raising, pacification
        – Local level : detection et follow up activities
  • Mechanisms to support integration:
        – All TB community workers are linked with the TB program according
          level
        – There is meeting but not formal board and not regularly (we must
          improve)
        – NTP supervisions and review include community aspects but there is
          community supervision held buy NGO Leaders. Grant are very
          insufficient to cover all community supervisions planed by NTP or NGO
        – Joint data validation exercises are very low because of lack of grant

4/20/2018                          Addis Abeba meeting                         16
Mechanisms for coordination of community
           based TB activities
• There is not a formal NTP-NGO body , but
      – There is an NGO platform called: Stop TB RDC
• What are key functions of this group :
      – Regulation of community interventions, capacity building,
        mentoring, advocacies,
      – Concertation of TB-NGO, sharing experiences with others NGO
      – TB Observatory .
• How frequent are their meetings : Quarterly
• Any funding support ? :
      – NMF2 by GF 18-2020 ????
      – OMS ????
      – Stop TB partnership ????
4/20/2018                     Addis Abeba meeting                     17
Challenges, Bottlenecks and Solutions
• Challenges:
      – To have communities interventions in all DRC health Districts
      – To show clearly the community contribution on TB ( detection, success and many raising)
      – Raising money for community activities
• Bottlenecks:
      – Coordination:
            • Deficiency of provincial teams ( weak NGO involvement) difficulties to regulate and control
              community interventions in the provinces not covered by the members of the Platform,
            • Hence, we must increase CSOs/NGO in TB work ( in field and provincial level)
      – Service delivery:
            • Poor documentation of community activities done in the field,
            • Partial reporting of community activities and contributions.
            • Capacity building of CSOs/NGO, increase funding and make tools available.
      – Monitoring and evaluation:
            • Very low supervision in the field for community actors,
            • Not holding community data validation meetings.
            • Need of support for community M & E.

4/20/2018                                    Addis Abeba meeting                                            18
Success story (1)
• Community TB day celebration (24 June, 2017) with TB key populations and
  leaders with a TB specific message

      A policeman                                          A catholic preacher

                                   A PLWHIV

4/20/2018                       Addis Abeba meeting                          19
Success story (2)

  A autochthone people                               A road children (abandoned)

                                                    Parliamentary TB coccus created
       Sensitization
4/20/2018                     Addis Abeba meeting                                     20
Results 1 (for ENGAGE Project 2015)
• Demonstration phase                              • At national level
• 2831 cases (41% of all cases       • National ENGAGE-TB policy for
  in 33 health centres) during         integration of TB into other sectors
  implementation period                and engagement of NGOs and
                                       development of guide and tools
  detected thanks to ENGAGE-
  TB project                         • Development of indicators and tools
                                       integrated in the national NTP
• Treatment success of 93% vs          system
  national average of 88%            • Establishment of a national platform
• Increase in utilization of TB        for coordination of NGOs and other
  health services thanks to            CSOs (Stop TB DR Congo)
  referral of persons with           • Establishment of simple
  presumptive TB                       standardized tools for household
                                       contract tracing

 4/20/2018                   Addis Abeba meeting                         21
Results 2 : through NTP 2016-2017

• 2016:
      –     24.810 TB cases was referred by community
      –     This number showed 18,7% of notification (24.810 vs 132.515)
      –     12.410 TB cases was accompanied by community
      –     This number showed 9,3% of notification (12410 vs 132.515)
• 2017:
      –     43.307 TB cases was referred by community
      –     This number showed 28,5% of notification (43.307 vs 151.832)
      –     20.273 TB cases was accompanied by community
      –     This number showed 13,3% of notification (20.273 vs 151.832)
4/20/2018                        Addis Abeba meeting                   22
Progress of results 2016-2017

                       151832
  160000
              132515
  140000

  120000

  100000

   80000

   60000
                                               43307

   40000                             24810                          20273
                                                            12410
   20000

       0
             Total TB Cases       TB cases oriented    TB cases accompagnied

                                     2016     2017

4/20/2018                       Addis Abeba meeting                            23
Country work plans for community based TB
                 activities
Country work plans for community based TB
                 activities

   Stake               District        Fonds en
            Province                                   Bailleurs
  holders              health            2017

                                                    USAID, FM , AD,
    LNAC     12 / 26   89 / 517      301.065,22$
                                                     fonds Propre

                                                   USAID, FM , fonds
     CAD     13 / 26   108 / 517 227.557,97$
                                                       Propre

4/20/2018                 Addis Abeba meeting                      25
Country work plans for community based TB
                 activities
• Stated objective :
• By the end of 2020,
      – Increase the coverage of civil society actors on TB work;
      – Strengthen coordination and visibility of “stop TB DRC” platform;
      – Strengthen the capacity of civil society organizations in the
        detection and monitoring of patients under treatment;
      – Contribute to improving access to TB care for key populations by
        CSOs actors, particularly through innovative approaches;
      – Provide work tools to civil society actors;
      – Strengthen the capacity of CSOs in resource mobilization
      – Advocate through the government to increase and disburse the
        TB specific budget line.
4/20/2018                      Addis Abeba meeting                     26
Country work plans for community based TB
                 activities
• Activities planed (1):
      – Recruit the new CSOs to join the Stop TB DRC;
      – Install gradually provincial secretariats of Stop TB DRC;
      – Update the mapping of civil society interventions through Stop TB
        DRC;
      – Organize quarterly meetings of the working group OF Stop TB
        DRC;
      – Organize the forum meeting; meeting of Stop TB DRC
        consultation framework, NTPs and partners;
      – Put in place mechanisms for the dissemination and popularization
        of platform activities (website, radio-TV programs, information
        media, ....;
4/20/2018                      Addis Abeba meeting                     27
Country work plans for community
• Activities planed (2) :
      – Organize activities related to JMT (World TB day);
      – Organize the training of trainers / civil society actors in the fight
        against TB (detection and follow-up of Treatment);
      – Reproduce and distribute work tools for data collection;
      – Monitor the activities of Stop TB CSOs;
      – Push CSO members to develop innovative approaches targeting
        special populations;
      – Organize advocacy and resource mobilization meetings with
        different partners;
      – Put in place an (observatory) mechanism for monitoring the
        efficient use of all available resources (means) for TB control in
        the country; etc ....
4/20/2018                        Addis Abeba meeting                        28
Country work plans for community based TB
                 activities

• Timelines : 36 months (2018)
• Responsibility : Stop TB RDC Board
• Percentage of the overall budget for
  community based TB activities : 5.860.650 $
  (10%)

4/20/2018         Addis Abeba meeting      29
Country specific opportunities

•   GF TB/VIH 2018 -2020 Grant.
•   Catalytic Funds (TB missing cases).
•   USAID grant (Challenge TB)
•   Domestic funds (Government)
•   Own money (volunteers) !!!!!

4/20/2018              Addis Abeba meeting   30
Anticipated implementation challenges and suggested
                     solutions
 • Money raising:
       – more advocacies and elaboration of projects
 • Demonstration of community contribution:
       – Using community documents and monthly
         monitoring of activities in field (Health districts)
       – Annual community report
 • Sustainability of activities:
       – Capacity building of NGO, professionalism and
         more advocacies for changing political and legal
         environment (law and increasing domestic fund)

 4/20/2018                   Addis Abeba meeting                31
Acknowledgement

•   DRC NTP manager
•   DRC « STOP TB » Platform
•   Community members
•   USAID (CTB-Union)
•   Damian Action
•   GF/PR
•   WHO country office

4/20/2018          Addis Abeba meeting   32
yes, we have to work for the
               people and with them

4/20/2018              Addis Abeba meeting   33
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