Background and Rationale by wuyunyi

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									                                                Stop TB Depart ment, World Health Organization, March 2007


           Stop TB Planning Frame work for Global Fund TB Proposals - Round 7
           Advocacy, Communication and Social Moblisation (ACSM) for TB Control

OBJECTIVES: Stop TB Strategy component 5: Empowe r people with TB, and
communities

SDA 5.1: To develop context-specific advocacy, communication and social mobilization; and
supporting development of a patent's charter for the TB community.

ACSM also covers Stop TB Strategy component 1: purs ue high quality DOTS expansion,
SDA 1.1 :political commitment with increased and sustained financing

                                PBF
   Stop TB Strategy         framework
                                            Examples of indicators for Global        Acti vities/ Budget by
(Components and Sub           (Service
                                                   Fund reporting                    Service Delivery Area
     components)              Delivery
                               Areas)
       Advocacy,                          Number of people trained on
                                                                                     All ACSM excluding
       communication                      communication skills, Number of
 5.1                      ACSM                                                       Advocacy (already
       and social                         radio/ TV spots produced and
                                                                                     included under 1.1)
       mobilization                       broadcasted

The Stop TB Strategy, launched in 2006, underscores that ACSM at Country Level must be
enhanced to improve case detection and treatment adherence, to combat stigma and
discrimination, to empower people affected by TB and to mobilize political commitment and
resources for TB. To date, many of the global ACSM approaches have focused, quite
successfully, on mobilizing resources and strengthening political and governmental commitment.
However, there is now an urgent need to intensify communication efforts and to engender greater
civil society engagement in TB control and elimination.

A growing body of evidence demonstrates that an integrated and sustained ACSM strategy can
positively impact a country’s ability to achieve case-detection targets. A strategic ACSM effort
allowed the countries to surpass the TB control targets (70% case detection/ 85% cure rate).
Please visit the ACSM at Country Level website for example of best practices:
http://www.stoptb.org/wg/advocacy%5Fcommunication/acsmcl/

The lines between advocacy, communication and social mobilization, especially in national/sub-
national contexts, often overlap. The key point to remember is that ACSM is an important ally in
TB control efforts and should be an integral, funded element in any TB control program.

SDAs and activities should be mutually exclusive. To avoid duplicate activities careful attention should
be given to check if ACSM activities are included in SDA 1.1 on political commitment, SDA 5.2 on
community participation, SDA 5.3 on patients charter and to less extent in SDA 1.5.2 on management
and supervision activities in SDA 1.5.3 on human resources, in SDA 2.1 on TB/HIV; SDA 2.2 on
MDRTB management, SDA 2.3 on special groups




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                                                Stop TB Depart ment, World Health Organization, March 2007


Table 1: Planning Framework for ACSM Components: ADVOCACY

SERVICE DELIV ERY AREA (SDA): ADVOCACY, COMMUNICATION AND SOCIAL MOBILI ZATION


A. ADV OCACY                DEFINITION:                          POSSIBLE COV ERAGE INDI CATORS :

                            Acti vities de signed to place TB    1) Percentage increase of national
                            high on the political and            budget spent on TB control activitie s
                            development agenda, foster           over time.
                            political will, increase and
                            sustain financial and other          2) Percentage of national budget spent
                            resource s                           on advocacy, communication, and social
                                                                 mobilization.


ACTIVITIES UNDER            POSSIBLE BUDGET ITEMS                POSSIBLE I NDICATORS
ADV OCACY

A.1 Activity:               Radio, TV, print medi a (ad buys,    # of TV, radio and print programs produced
Mass Media                  etc)                                 # of radio/TV spots aired
                                                                 # of news paper ads purc hased
                            Designing an ad (cost of graphic
                            designer, media consultant)

A.2 Activity:               Media consultant                     # of press conferences organized
Press Conferences           Venue cost, other logistics          # of articles generat ed


A.3 Activity:               Developing training mat erials       # of journalists trained in TB issues
Journalism Trainings and    (content, design, printing)          # of articles generat ed
Workshops                   Facilitators
                            Participants travel expense
                            Venue cost, other logistics

A.4 Activity:               Developing promotional mat erials,   # of promotional materials distributed
Information Education and   such as for World TB Day
Communication               (content, design, printing)

                            TB advocacy kits (content,           # of kits distributed
                            design, printing)

A.5 Activity:               Support or ex pand national and      # of organizations reached
Civil Society Engagement    local networks of advocates and      # of organizations active
and Outreach                champions                            # of new part ners




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                                                    Stop TB Depart ment, World Health Organization, March 2007


Table 2: Planning Framework for ACSM Components: COMMUNICATION


B. COMMUNICATION              DEFINITION:                            POSSIBLE COV ERAGE INDI CATORS :

                              Acti vities de signed to create        1) % of population who are aware that a
                              and improve knowledge among            chronic cough could be a sign of TB.
                              the general public about TB            2) % of population who know TB testing
                              (e.g. its symptom s and                and treatment is free.
                              curability), TB control service s      3) % of the population who know TB is
                              (e.g. diagnosi s and treatment)        curable.
                              and to improve interpersonal           4) % increase in client satisfaction with
                              communication                          TB program service s over time.


ACTIVITIES UNDER              POSSIBLE BUDGET ITEMS                  POSSIBLE I NDICATORS
COMMUNICATION

B.1 Activity:
Mass Media                    Use of radio, TV, print media          # of PSAs produced
                              (PSAs, media buys)

B.2 Activity
Point of Service Promotion    Developing brochures (cont ent,        # of brochures listing location of DOTS
                              design, printing)                      centers distribut ed
                                                                     # of people bringing brochures to DOTS
                                                                     location

B.3 Activity:
Information, education and    Develop patient information cards      # of cards distributed
communication                 (content, design, printing)

                              Workshops to develop                   # of service providers trained in IPC
                              interpersonal communication
                              skills (venue cost, facilitator,
                              materials, other logistics)

                              Peer educator training (venue          # of service providers trained
                              cost, facilitator, materials, other
                              logistics)

B.3 Activity: Civil society   Community outreach programs to         # of community-based organizations
engagement                    distribute TB information (knowing     distributing information
                              symptoms and where to find             # of new community-based organizations
                              treatment)                             distributing information




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                                                    Stop TB Depart ment, World Health Organization, March 2007


Table 3: Planning Framework for ACSM Components: SOCIAL MOBILIZATION


C. SOCIAL                      DEFINITION:                            POSSIBLE COV ERAGE INDI CATORS :
MOBILI ZATION or (Civil
Society Mobilization)          Acti vities de signed to generate      1) % of people expressing accepting
                               public will by actively securing       attitude s towards people with TB.
                               broad consensus and social             2) % of communitie s with action plans.
                               commitment among civil                 3) % of di stricts/province s that have an
                               society to fight stigma and            active de-stigmatization program.
                               eliminate TB as a public health
                               threat


ACTIVITIES UNDER               POSSIBLE BUDGET ITEMS                  POSSIBLE I NDICATORS
SOCIAL MOBILI ZATION

C.1 Activity:
Civil society engagement       TB educational program for civil       # of community workshops/forums
                               society and community leaders          # of participants
                               (Venue cost, facilitator, materials,
                               other logistics)

C.2 Activity:
Patient engagement             Patient empowerment workshop           # of workshops for
                               (Venue cost, facilitator, materials,   public/privat e/professional and NGOs
                               other logistics)                       advocating for TB patient-centered care
                                                                      # of patients involved

C.3 Activity:
De-stigmatization activities   School, church, and/or workplace       # of schools, churches and/or work place-
                               education programs (Venue cost,        based organizations with an educational
                               facilitator, materials, other          program
                               logistics)                             # of people reached through programs




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                                                   Stop TB Depart ment, World Health Organization, March 2007


Table 4: Planning Framework for ACSM Components: CROSS-CUTTING


CROSS-CUTTI NG AREAS           DEFINITION:                          Possible Coverage indicators:
FOR ACSM
                               To provide a supportive              1) # of di stricts/province s with an
                               environment for sustainable          evidence-driven results-based work plan.
                               growth of ACSM and Health            2) # of di stricts/province s with a funde d
                               System s Strengthening (HSS)         ACSM budget.
                                                                    3) # of di stricts/province s with an
                                                                    interagency communication
                                                                    coordination/implementation
                                                                    committees/partnerships/ ta sk force s


ACTIVITIES UNDER               POSSIBLE BUDGET ITEMS                POSSIBLE I NDICATORS
CROSS-CUTTI NG AREAS

D.1 Activity:
Improved institutional         Communication staff and              % of district/provinces with designated
capacity                       management                           ACSM staff/ focal with appropriate
                                                                    experience
                               Skills development and training
                               for staff (course fee, travel)

D.2 Activity:
Needs assessment,              Behaviors studies and surveys        # knowledge, attitude and behavioral
operational research and       (staff time, consultants)            studies commissioned
planning
                               Operational researc h                # district/provinces conducting operational
                                                                    research

D.3 Activity: Monitoring and   Client satisfaction surveys (CSS)    # of studies commissioned
evaluation
                               Knowledge, attitudes, and            # district/provinces with bas eline data
                               practices studies (KAP)




Definition: What is advocacy, communication and social mobilization?
 Advocacy: Advocacy for TB is to be understood as a broad set of coordinated interventions,
   designed to place TB high on the political and development agenda, foster political will,
   increase and sustain financial and other resources.
 Communication: Within countries, and in the context of TB control, communication
   primarily seeks to create and improve knowledge among the general public about TB (e.g. its
   symptoms and curability), TB control services (e.g. diagnosis and treatment) and improve
   interpersonal communication between patients and program providers contributing to
   behavioral change or to meet a particular behavioral goal.
 Social Mobilization: In the national and sub- national contexts, social mobilization is a
   process of generating public will by actively securing broad consensus and social
   commitment within civil society to fight stigma and eliminate TB as a public health threat.
   That is, social mobilization seeks to convert knowledge into demonstrable action.


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                                           Stop TB Depart ment, World Health Organization, March 2007


Moving Forward: ACSM planning and implementation
The NTP and the CCM should consider the following as a step-by-step guide for
planning, design, implementation, monitoring and evaluation of ACSM programs.

Step 1) Using the CCM, create specific ACSM committee/task force/partnership charged
with planning, implementi ng and evaluating all operational and programmatic activities
at the national and sub-national level. (Disregard Step 1 if such an entity already
exists.)

Step 2) Conduct a systematic needs assessment to determine behavioral goals, target
audiences, social-behavioral barriers to treatment seeking or treatment compliance
behavior, identify stakeholders and available resources. Conduct analysis of media
viewership, listernership and readership trends and habits of segmented audiences.

Step 3) Using the results of the needs assessment, develop national strategic
communication workplan and budget for TB where behavioral goals, targeted audiences
and activities are matched with appropriate coverage and indicators. In developing a
national ACSM workplan and budget, efforts should be made to encourage the
establishment of baseline indicators and the use of qualitative and quantitative technical
and behavioral data in the planning, implementation and evaluation of the overall
national strategic workplan.

Step 4) Direct the development of district and/or pro vincial level advocacy,
communication and social mobilization workplans and budgets targeting sustainable
behavioral change. Workplans must be evidence-based and results-driven. Once
approved, workplan budgets should be fully funded.

Step 5) Secure qualified communication focal point(s) in the NTP at the national and
sub-national level to coordinate and implement national/sub-national workplans.

Step 6) Develop, pre-test and produce ACSM materials. Implement advocacy,
communication and social mobilization activities according to established and approved
national and sub-national workplans.

Step 7) Establish ACSM benchmarks and baselines and incorporate process and
impact indicators in district/provincial/national TB reporting formats. Establish tracking
mechanisms to review progress on an ongoing basis.

Step 8) Develop and implement a communication capacity/competency-building plan to
improve human resource skills and institutional capacity.

TIP: Ask for technical assistance when needed.

Please visit the ACSM at Country Level website for more information.
http://www.stoptb.org/wg/advocacy% 5Fcommunication/acsmcl/



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                                       Stop TB Depart ment, World Health Organization, March 2007


REFERENCES:
Experts' Consultation on Communication and Social Mobilization: A Report (September
2003) Stop TB Partnership, Cancun, Mexico.
Llanos-Zavalaga, F, et., al. (September 2004) The Role of Health Communications in
Peru's Fight against Tuberculosis. Communication Insights. Baltimore: Health
Communication Partnership based at Johns Hopkins Bloomberg School of Public Health
/ Center for Communication Programs.

Parks, William. (February 2003) Developing Social Mobilization & Communication
Indicators for Use in TB Program Monitoring: A Working Document. Social Mobilization
and Training Team, World Health Organization. Geneva, Switzerland.

Pennas, Thaddeus, Petra Heikamp, Dr. Elizabeth Fox. (September 2004) The Needs
Assessment Matrix. Needs Assessment Training Workshop. Stop TB Partnership.
Geneva, Switzerland.

Thuy D.O. et., al. (September 2004) The Role of Health Communications in Vietnam's
Fight against Tuberculosis. Communication Insights. Baltimore: Health Communication
Partnership based at Johns Hopkins Bloomberg School of Public Health / Center for
Communication Programs.

Waisbord, Silvio. (2004) Behavioral Barriers in Tuberculosis Control: A Literature
Review. The CHANGE Project/Academy for Educational Development. Washington
DC.

Waisbord, Silvio. (2004) Assessment of Communication Programs in Support of Polio
Eradication: Global Trends and Case Studies. Academy for Educational Development,
Washington DC. 2004

WHO Global TB Control Report (2004). World Health Organization. Geneva,
Switzerland.

Report of the 2nd ad hoc Committee on the TB Epidemic, (2003) Stop TB Partnership.
Geneva, Switzerland.




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