EVENTS :

Advocacy, Communication and Social Mobilization: The Quality TB Care project in Lanao del Sur

The public stigma of tuberculosis (TB) is at times more dangerous than the disease itself, preventing infected individuals from seeking proper treatment and contributing to the spread of the disease. OIDCI through its Mindanao office implemented the project Sustaining Tuberculosis (TB) Control and Ensuring Access to Comprehensive Quality TB Care in Lanao del Sur from July 2012 to December 2013. The project reinforced the existing TB program in the barangay level through an Advocacy, Communication and Social Mobilization (ACSM) strategy. The message the TB Care project delivered through ACSM is that TB care is accessible, and diagnosed patients need to complete their treatment.

OIDCI-Mindanao implemented this project with support from the Philippine Business for Social Progress (PBSP) through the Global Fund – Tuberculosis Rolling Continuation Channel Phase 2 Grant. Prior to this project, OIDCI-Mindanao partnered with the PBSP and the Department of Health on another TB project.

The TB Care project was implemented in eight municipalities in the province. Overall, 33 Barangay TB Management Teams (BTBMT) were organized and provided with extensive capability training on community-based TB program management. The BTBMTs comprised of community health teams and other residents of the barangays; they helped in the detection of persons infected with TB and in supporting him/her in seeking correct diagnosis and completing treatment. During the period January to November 2013, the BTBMT members managed approximately 98% of the 373 cases enrolled in the rural health units (RHUs) in the eight municipalities. The combined membership of the BTBMTs totaled 499.

Information dissemination was also part of the BTBMTs’ activities in partnership with their respective barangay or municipal governments (LGU). The policy guidance and financial support for this activity required the passage of barangay resolutions or municipal ordinances. Twenty nine barangay governments approved such a resolution while three barangays in Marawi city are in the process of approving it; only one barangay did not pass a resolution.

Continuing ACSM even after TB Care

BTBMT members have already established rapport with patients, LGUs, RHUs, and other project partners. The skills and attitudes on how to deal with patients and their families have been ingrained in the BTBMT’s ways of working. Similarly, the LGUs have a better understanding of the social and economic costs associated with TB and how the spread of the disease could be stemmed by consistent policy support. The TB Care project experience has also encouraged the RHUs in seeking the help of barangay residents in the fight against TB.

Hence, a 2014-2016 Action Plan for each BTBMT has been formulated and a coordination/referral mechanism between the respective BTBMT and RHU is in place. It is with great anticipation that these BTBMTs will continue their work of fighting the spread of TB under the support of partner LGUs and RHUs.

The availability and willingness of members of the BTBMTs as treatment partners was a winning element in the successful conduct of the TB Care project. Over the course of the project, OIDCI-Mindanao recognized members who showed exemplary dedication to the project – in the various TB education sessions, house visits, case finding and case holding. They have been declared CBO/BTBMT champions, given the role of a volunteer health worker or para-community development worker (CDW), and given support in carrying out their new role. They are regarded as the instruments for sustained TB control activities even after the conclusion of the TB Care project.

In support of the work of the BTBMTs, OIDCI-Mindanao also organized and trained two patient groups: the Marawi City Community Support Group with 14 members, and the Wao Community Support Group with 12 members. These groups are composed of cured TB patients who, as volunteer health workers, give testimonies of their experiences as former TB patients.

The World Health Organization has noted that the Philippines is very likely to attain its Millennium Development Goal target for stemming and reversing the incidence of TB. According to its report, the country has had an average annual success rate of 90% in TB treatment from 2003 to 2011, exceeding the prescribed rate of 85%. WHO researchers cited the improvement in case detection and in making TB services accessible in remote and poor communities in the country as key reasons in the positive trend. However, the report noted rooms for improvement in the TB referral system, follow up examinations for patients under treatment, and information system for better surveillance and policy planning.

TB Care ACSM challenges

The delivery of the message of the TB care project met several challenges. The misconceptions, bad experience, poor knowledge, social norms, and religious beliefs of residents impeded the process.

Majority of the people in Lanao del Sur are Maranaos who follow Muslim beliefs and practices. The TB Care project had to counter the Maranaos’ practice of self-medication; some of them wholly entrust their health to Allah, believing that fervent prayers will keep them away from harm and sickness. Some also held the belief that free medicines from the government were not effective. The patients leaned towards practicing traditional medication where the introduction of treatment partner in the regimen of treatment was not yet fully accepted.

While the stigma on the disease remains strong in some communities, the BTBMTs have been encouraged by the fact that the residents still welcome them into their homes. OIDCI field staff working as CDWs observed the significant attendance in the communities in the TB education sessions as well. The BTBMTs also noticed a change in behavior among the residents: they are now willing to submit to sputum examination and undergo the X-ray procedure. Some are now less fearful to find out whether they have TB or not.