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Advocacy, Communication and Social Mobilization (ACSM) for TB

The Global Fund / Stop TB Partnership WorkshopGeneva2 February 2007

Thaddeus Pennas, EdelmanSiri Wood, PATH

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Effect of Communication on BehaviorHow much will Coke spend on advertising for a 1% How much will Coke spend on advertising for a 1% increase in Coke purchases?increase in Coke purchases?

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Module 1:

Introduction to ACSM

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ObjectivesCommon definition of ACSM.How does ACSM work and where do I spend my GAFTM money? Review tools and techniques for developing and implementing evidence-driven ACSM strategies?Provide an opportunity for participants to understand how ACSM can contribute to greater effectiveness of the Stop TB Strategy in the context of GFATM grant?Define critical elements to planning and implementing an ACSM program?

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A Common Framework

360 degree loop360 degree loop

Advocacy: Activities designed to place TB high on the political and development agenda, foster political will, increase financial and other resources on a sustainable basis.

Communication: Increase knowledge among general public about TB and TB control services, improve interpersonal communication between patients and program providers contributing to behavioral change.

Social Mobilization: The mobilization of communities and civil society for action to fight stigma and eliminate TB as a public health threat.

Bottom

Up

Bottom

UpTo

p D

own

Top

Dow

n

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More Effective Advocacy

More Effective Communication

Gov’t makes TB control high priority

Civil society works with Gov’t ,and households to eliminate TB in the community

People with symptoms seek health care

Gov’tprovides quality DOTS services

Gov’t, community, households team up to eliminate TB stigma

Gov’tensures adequate drug supply

Providers, community and people team up to encourage correct treatment regimen

# Cases drop long term

Gov’t, community, civil society and households integrate into culture appropriate health values and practices

Social Mobilization

Households learn about TB symptoms, transmission and treatment

# of TB free communities increase

Possible Contributions of ACSM To Desired Outcomes to

Civil society allocates resources and nurtures appropriate environment to eliminate TB in community

Providers, community and people team up to detect potential cases and diagnose correctly

STOP TB

STOP TB

Monitoring

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More Effective Advocacy

More Effective Communication

Gov’t makes TB control high priority

Community works with Gov’t , households to eliminate TB in the community

People with symptoms seek health care

Gov’tprovides quality DOTS services

Gov’t, community, households team up to eliminate TB stigma

Gov’tenlsuresadequate drug supply

Providers, community and people team up to encourage correct treatment regimen

# Cases drop long term

Gov’t, community and households integrate into culture appropriate health values and practices

Social Mobilization

Households learn about TB symptoms, transmission and treatment

# of TB free communities increase

The Vietnam Case Study 2001-2002

Community allocates resources and nurtures appropriate environment to eliminate TB in community

Providers, community and people team up to detect potential cases and diagnose correctly

STOP TB

Monitoring

80% know symptoms65% know transmission80 % know TB is curable 100% know that

detected case of TB should seek medical care

80% cases detected

93% completed treatment

89% cured

Gov’t declatedTB high priority in 1995

All forms of media used to educate people

High level of community mobilization

Partnerships created at all levels

Gov’tachieves almost 100 coverage in 1998

Peer education used fully recovered patients

Quality ensured through effective monitoring

Four program levels of TB control activity

Wide range of advocacy activities conducted

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ACSM has lots of toolsThis is just a short list…

Mass media to reach large audiences

InternetPSA’s: TV/Radio

Social Marketing to audience segmentation and build demand

Posters

Building social networks to increase outreach

Churches

Enhancing community empowerment for case detection.

Civic Groups

Media advocacy to gain support and validate the relevance of TB control effort

NewspapersMagazinesBroadcast Journalism

Popular/folk media to generate dialogue and activate informational networks

Street Theatre

Interpersonal communication to improve services delivery

Counseling

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Module 2:

The Global Fund: Application to Implementation

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Review of the Global Fund

Overview of process

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Global FundApproval

Technical review

Screening

There are multiple partners to the Global Fund’s grant program arrangements

Secretariat

Sub- recipients Trustee

(World Bank)

Instruction to disburse

Grant agreementAdvice

Reports

Government

Multi-/Bilateral Development Partners

NGOs/CBOs

PLW Diseases

Private sectorReligious/

Faith-BasedOrganizations

Academic/ Educational Sector

Country Coordination Mechanism

Provides technical and capacity building support

Proposal

Prepares and submits

proposals

Assessment

FundsReports

Oversees implementation

Contract

PrincipalRecipient (s)

Selects Principal Recipient(s)

Requests continued funding from the Global Fund for 3-5 years

Technical Review Panel

Board

Local Fund Agent

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During implementation, the Global Fund disburses tranches of the grant based on program need and performance

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Disbursements linked to performance and program needs: cash requirements for one disbursement period (e.g., one quarter) + one additional quarter

Board approval

Grant Agreement Global Fund decides

on continued funding based on review of performance & financial accountability

Total amount disbursed to granteeUSD

Time (months)

Disbursements linked to program performance and accountabilityResults

Financial management

Program implementation

First disbursement normally based on program requirements for first two quarters

Disbursement Requests and Progress Updatesfrom PRs and advice from LFA trigger disbursements

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Critical Elements to ACSM Implementation in GFATM

Start Grant Negotiation

1. Conduct an ACSM Needs Assessment

2. Design a Strategic PlanGrant Approval

3. Develop a work plan and implementation time line

Grant Signature

4. Implementation 5. Monitoring and Evaluation

Planning →Im

plementation

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Module 3:

Needs Assessment

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Conduct a Needs Assessment

Do I really have to do this?

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Level 1: The Needs Assessment DesignWho are theaudiences?

What are behavioralgoals to be addressed?

What are the barriers?

What are your past experiences and current activities? (Lessons Learned)

Who are the stakeholders and what are the assets?

List responses List responses List responses List responses List responses

Level 2: Strategic PlanningUsing the responses in level 1, what are your priority goals? (Behavioral)

What should be your impactindicators?

What interventions are needed to address behavior and barriers?

Who are the implementers?

What are your collective weaknesses?

What are your collective strengths?

What are your targets?

How are you going to monitor and evaluate? (Process)

List responses List responses List responses List responses List responses

List response List response List response

Level 3: Activity PlanningWhat are your Targets?

What are your Activity?

Who is doing what (Role identification)?

What resourcesare available?

What resourcesare needed?

What is budget?

List responses List responses List responses List responses List responses List response

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Critical Elements to ACSM Implementation in GFATM

Start Grant Negotiation1. Conduct an ACSM Needs Assessment2. Design a Strategic Plan

Review epidemiological dataIdentify priority populationsIdentify desired behaviors

Grant Approval3. Develop a work plan and implementation time

lineGrant Signature

4. Implementation 5. Monitoring and Evaluation

Planning →Im

plementation

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Module 4:

Knowledge, Attitudes and Practices

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Where to Begin?

Is there any such thing as data for ACSM?

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Accurate DataTB data and analysis:

EpidemiologySituation analysis, Barriers, SWOT

Data to inform ACS:Socio-behavioural

healthcare seeking patterns, KAP, socio-economic status, stigma…

Administration-/policy analysisfinancial analysis, policy barriers, stakeholders analysis, power/influence…

Education-Media analysisliteracy rates, media penetration, advertisement…

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Critical Elements to ACSM Implementation in GFATM

Start Grant Negotiations1. Conduct an ACSM Needs Assessment2. Design a Strategic Plan

Review epidemiological dataIdentify priority populationsIdentify desired behaviours

Grant Approval3. Develop a work plan and implementation time

lineGrant Signature

4. Implementation 5. Monitoring and Evaluation

Planning →Im

plementation

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KAP SURVEY AND BASELINE DATA

What is it and what does it tell me?

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What is a KAP survey?

Knowledge, Attitudes and Practices surveyStatistically-representative study of a given population.Uses a pre-determined questionnaireCollects data that can be used for evidence-based decision-making in program planning.

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What does a KAP survey help you find out?

KAP surveys can …Identify cultural beliefs.Determine behavioral patterns that may pose problems or create barriers for TB control efforts. Identify information that is commonly known and attitudes that are commonly held. Identify knowledge gaps (things that are not known to most people).

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KAP survey data: case studyKnowledge about TB in Indonesia

0102030405060708090

Heard/TB TB Curable TB/ secret TB Cure/ free

SumatraJava+BaliKTINational

76.2% 85.1%

13.2%

19.1%

Source: Indonesia KAP data, Dec2004, linked to prevalence survey

• Indonesians know about TB (76%) and that it is curable (85%)• Stigma is low (only 13% keep TB a secret if a family member had TB)• But people do NOT know treatment is free (only 19%)• Misconceptions on TB dissemination thru drinks/food, air-pollution• Only 16% can mention three or more correct symptoms

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Health-seeking behavior If they have TB symptoms, the Indonesian population intends to go to…

55.8

66.1

53.449.4

77.2

41.9

9.614.3 14

10.7 8.2 8.9

1.6 3.7 1 0.30

10

20

30

40

50

60

70

80

PuskesmasPriv Pract Gov Hosp Priv Hosp Midwife Self-treatm Trad.Healer

Nothing

Central-JavaJava-BaliNational

Source: TB prevalence survey/ KAP study, Dec2004, Central-Java respondents: 1347

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Source of TB informationUrban-Rural differences in Indonesia

58.1

66.1

35.7

1620.5

11.414.2

9.9

3.69.7

13

8.1

13.8

35.6

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56.2

0

10

20

30

40

50

60

70

Friend/family

TV Healthofficer

Radio Magz/newsp

Relig/ commleader

Teacher Poster/leaflet

NationalUrbanRural

Source: Indonesia KAP data, Dec2004, linked to prevalence survey

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Source of TB informationGender differences in Indonesia

56.4

36.3

13.8

12.7

6.3

11.5

55.8

12.5

7.3

12.8

15.9

16.135

58.4

55.7

11.7

0 10 20 30 40 50 60 70

Friend/ family

TV

Health officer

Radio

Magz/ newsp

Relig/ comm leader

Poster/ leaflet

Teacher FemaleMaleNational

Literacy rates in IndonesiaLiteracy rates in IndonesiaMale adults: 92% (87% in 1990) Female adults: 83% (73% in 1990) (2002 data Human Dev’t report)

Source: Indonesia KAP data, Dec2004, linked to prevalence survey

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Module 5:

Program Implementation

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Critical Elements to ACSM Implementation in GFATM

Start Grant Negotiations1. Conduct an ACSM Needs Assessment2. Design a Strategic Plan

Review epidemiological dataIdentify priority populationsIdentify desired behaviours

Grant Approval3. Develop a work plan and implementation time

lineGrant Signature

4. Implementation 5. Monitoring and Evaluation

Planning →Im

plementation

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Complementary qualitative research activities

Qualitative research can answer questions about how and why; motivations for behaviors.Can be conducted as formative research before the KAP survey to better design the survey. Can be conducted after the KAP to complement or further refine the data collected. Using several of the methods together allows a program to triangulate results. This helps check for consistency, reveal key themes, and draw out additional issues that need to be addressed in the ACSM strategy.

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Qualitative research activitiesFocus group discussionsIn-depth individual interviews (i.e.; with TB patients or medical providers) Observation of patient-provider interactionsExit surveys with TB patientsKey informant interviewsStakeholder meetings

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Cough to Cure

An ACSM Pathway

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Critical Elements to ACSM Implementation in GFATM

Start Grant Negotiations1. Conduct an ACSM Needs Assessment2. Design a Strategic Plan

Grant Approval3. Develop a work plan and implementation

time lineIndicators, baselines and work plansOrganizational structureEvent sequencing / time line

Grant Signature4. Implementation 5. Monitoring and Evaluation

Planning →Im

plementation

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Next Up: Indicators

Why bother? Global Fund requires it

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Examples of ACSM Indicators

Examples of Coverage Indicators (Advocacy): 1) Percentage increase of national budget spent on TB control activities over time.2) Percentage increase of national budget spent on advocacy, communication, and social mobilization for TB control.

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Examples of ACSM IndicatorsExample of Coverage Indicators (Communication):% of population who know that a chronic cough could be a sign of TB. % of population who know TB testing and treatment is free.% of the population who know TB is curable. % increase in client satisfaction with TB program services over time. % increase of TB suspects presenting themselves for testing over time.

Examples of a Coverage Indicator (Social Mobilization):

% of people expressing accepting attitudes towards people with TB. % of communities active with social mobilization action plans. % of districts/provinces that have an active de-stigmatization program.

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Sample Range of Indicators Example: Use of radio, TV, print

mediaPossible indicator: # of TV, radio and print programs producedPossible indicator: # of broadcast time or newspaper spaced purchased

Example: Information campaign to encourage treatment seeking behaviorPossible indicator: # of districts/provinces with an active informational campaign

Example: Treatment compliance educational programs Possible indicator: # of districts/provinces with an educational program

Example: Patient information cards

Possible indicator: # of cards distributed

Example: Interpersonal communication skills development

Possible indicator: # of service providers trained in IPC

Example: Peer educators Possible indicator: # of service providers trainedPossible indicators: # of peer educators active

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Module 6:

ACSM Work Plan

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Building a work planPart 1

Using the GFATM application to build a workplan

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Service Delivery Area: Communication

Definition: Increase knowledge among general public about TB and TB control services, improve interpersonal communication between patients and program providers contributing to behavioral change.

Example of Coverage Indicators:% of population who know that a chronic cough could be a sign of TB. % of population who know TB testing and treatment is free.% of the population who know TB is curable. % increase in client satisfaction with TB program services over time

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a) Activity: Mass MediaExample: Use of radio, TV, print media as a distance learning tool

(Public Service Announcements)Possible indicator: # PSA's producedExample: Point of service promotion Possible indicator: # brochures listing location of DOTS centersdistributed

b) Activity: Information Education and CommunicationExample: Patient information cards Possible indicator: # of cards distributed Example: Interpersonal communication skills development Possible

indicator: # of service providers trained in IPCExample: Peer educators

Possible indicator: # of service providers trainedPossible indicators: # of peer educators active

Service Delivery Area: Communication

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c) Activity: Civil Society EngagementExample: TB in the workplace/community

programsPossible indicator: # of organizations reachedPossible indicator: # of organizations active

Example: Community outreach programs to distribute TB symptoms and treatment information

Possible indicator: # community-based organizations distributing information

Service Delivery Area: Communication

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Service Delivery Area: Social Mobilization

Definition: The mobilization of communities for action to fight stigma and eliminate TB as a public health threat. Examples of a Coverage Indicator:

% of people expressing accepting attitudes towards people with TB. % of communities active with social mobilization action plans. % of districts/provinces that have an active

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a) Activity: Mass MediaExample: Use of radio, TV, print media

Possible indicator: # Public service announcements produced

b) Activity: Information, Education and CommunicationExample: Information campaign to encourage treatment

seeking behaviorPossible indicator: # of districts/provinces with an active informational campaign

Example: Treatment compliance educational programs Possible indicator: # of districts/provinces with an educational program

Service Delivery Area: Social Mobilization

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c) Activity: Civil Society EngagementExample: TB educational program for community leaders

Possible indicator: # number of community workshops/forums

Example: TB patient activismPossible indicator: # of TB support groups Possible indicator: # of workshops for public/private/professional and NGOs advocating for TB patient-centered care.

d) Activity: De-Stigmatization Activities Example: school, church, and/or workplace education programs

Possible indicator: # of school, church and/or workplace-based organizations with an educational

Service Delivery Area: Social Mobilization

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Exercise 1

Critique this Proposal

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Building a work planPart 2

How do you know what you are going to do and when?

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Workplan Example: Political CommitmentDistrict governments are committed to increase funding for TB control leading to increased budget allocations.

Activities1. District campaign in 15 districts 2. Socialization to Forum of Parliamentarians in Central Level and further policy debates3. Advocacy to stakeholders (Professional, Micro credit groups, MDG Campaign, etc)

Identify TB ambassadorsAdvocacy Material Development

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Workplan: Informed DemandIncrease the number of TB patients seeking and completed the treatment with appropriate support and care

Activity Areas1.Stop TB Campaign nation wide:

TB Day 2006 in every levelTV Spot, Radio Spot, Chief Editor (Mass Media) workshop and journalist forum2. Patient information, education and communication productsPrototype and procure: Leaflet, Poster, stickers, patient/ provider education tool kitDistrict level IEC campaigns with NGO partners

3. Developing website4. Develop Logo/Brand for TBIndicators:Knowledge of population Suspect-rates Drop-out ratesCoverage of advocacy activities/ campaigns at districts

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Workplan ExampleHealth Care Provider Capacity

Increase capacity of health providers and outreach workers to provide patient-centered quality care and promotion of DOTS.

Activity Areas1. Training on Advocacy/Communication for province/district

Develop module and curriculumTraining

2. ACSM guidelines for districts/provinces

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Workplan ExampleSupporting SocietyMobilize public support and resources for TB control and community level services

Activity Areas1. Stop TB Partnership National Level

Regular partners forum meetingRegular partnership news Partners directory/ profiles

2. Partnership in district/provinceCoalition in district/province

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Workplan ExampleResearch and MISEstablish an evidence base to support, plan, monitor, and

evaluate advocacy and communication programs.

Activity Areas1. Policy research: evidence base on policy, financing and human

resource barriers that may be overcome through advocacy 2. KAP research: evidence base on TB knowledge and patient,

provider, public behaviors 3. Economic and poverty analysis

- Social economic status of TB patient and suspect (SUSENAS data)- Financial mapping of districts/province budget allocation to TB program

4. Media analysis

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Critical Elements to ACSM Implementation in GFATM

Start Grant Application1. Conduct an ACSM Needs Assessment2. Design a Strategic Plan

Grant Approval3. Develop a work plan and implementation

time lineIndicators, M&E system and BaselineOrganizational structureEvent sequencing / time line

Grant Signature4. Implementation 5. Monitoring and Evaluation

Planning →Im

plementation

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Module 7:

Case Studies

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What are countries doing with their GFATM Funding for ACSMPhilippines

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Philippines Social Mobilization ProjectMicro-level engagement of civil society

Question: How to increase case detection through community engagement?CCM turned to community-based NGOs.

Partner Profile: World Vision: faith-based NGO with strong community level visibility

Project: Formation of community-based TB "task forces".

Active TB case referralHouse-to-House communication and education for TB

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Project Description

Community involvement in the prevention and treatment of TBFormation of TB Task Forces / treatment support groupsPartnership with DOH, Local Government Units, and WVDF's Area Development Program (ADP) at provincial municipal and barangay levels

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Goal

Increase community awareness and improve health seeking behaviour via organized community groupsPromote accessibility of DOTS services

Phase 1: Launched June 2003 in 6 cities and 5 provinces

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Result: Increase in detection of TB suspects as a result of civil society engagement

020406080

100120140160

no. of symptomatics no. of TF referrals no. of new smearpositive

no. of new smearpositive from TF

referrals

2001 2002 2003 2004 2005

Barangay Pangobilian, Brooke’s Point, PalawanCase Finding Activities

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Unforeseen benefit!

Community members lobby local government to increase TB servicesCommunity members involved in active case detection (based on clinical presentation)Engagement of businesses, schools, churches, civic organizations Beginning of a political health movement for wider health issues

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Mobilizing civil society to implement ACSM activities in Kenya

Case Study 2

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Journalists can advocate for equitable access to TB/HIV detection and treatment

TB/HIV and poverty often go hand in hand

A peri-urban area in Southern Africa.

Problem: NLTP's access to people living in urban slums

is limited because of resource constraints

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Cured TB patients on World TB Day in Kenya.

Local NGOs have access slum dwellers, but need training to deliver TB information to patients and need to become more involved in the planning and policy process

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9,000 registered NGOs and CBOs in Kenya out of which 6,000 are operationally active.

About 500 are members of the Kenya Consortium to Fight AIDS, TB and Malaria (KECOFATMA).

KECOFATUMA has used a GIS system to map and analyze its members countrywide.

The NLTP and its implementing partners work with KECOFATUMA and therefore more than 500 organizations that are members of this umbrella body.

…but civil society activities for ACSM are uncoordinated

There's no problem in mobilizing civil society in Kenya

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To engage local NGOs on ACSM

To develop the ACSM component of GFATM proposal in round 5…The NTLP manager put out an advertisement in national newspaperAll NGOs that were interested in ACSM could apply to join the process

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NLTP

PATH – lead agency on ACSM

Other agencies NGOs

…Flow of funds

Were discussed openly in the Task force at the outsetGiven to the lead agency for each component of the strategic plan

Lines of communication were already established

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Partners' Roles & Responsibilities

NEPHAK and IMC : train 100 first line health providers include religious, civic and cultural organizations

PATH, FHI and PSI: evaluation of communications needs

PATH, FHI, and IMC: use peer education etc in communities, schools and with health workers

PATH: develop community-linked mass media campaigns

PATH and NLTP: mobilize the media

PSI and AMREF: plan the mass media campaign

Kenya Medical Research Institute and NLTP: take out quarterly TB ads in national papers

FHI: review, upgrade and develop new IEC materials for mass pamphleteering

FHI, Min of Lab and Manufacturers Association etc: train on peer-to-peer education in workplace.

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Mapping of:The problemTarget audienceStakeholder expertise

…leads to improved coordination of activities and greater access to the urban poor

…but local NGOs still need support to build capacity to deliver services and to lead some aspects of the programme design and policy process

Conclusion

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Indonesia

Organizational Structure Case Study 3

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Indonesia: Support in societyIndonesia: Support in societySuccessful National Partnership (Successful National Partnership (GerdunasGerdunas))National partnership/Gerdunas (50+ partners) with active working groups supporting national planMobilized community support to TB control (10% across population), incl. treatment support, case detection, and advocacy for local political commitmentLarge community potential to tap into

BUTBUTLarge regional differences (cultural, social-economic) needs localized partnerships with DOTS teams as secretariats

PAP UA

RIAU

NA D

E. K A LIMA N TAN

C. KA LIMAN TAN

W. K ALIMA NTA N

JA MB I

S. S UMA TER A

E. J AV A

N. SU MATE RA

S. S ULA WESI

W. J AVAC. JA VA

C. SU LA WESI

NTT

NTB

LA MP UN G

W. SU MA TER A

S. K A LIMA N TAN

MALU KUS.E SULA WESIBEN GKU LU

BA BE L

N. MA LU K U

BA LI

BA NTEN

DIY

N. SU LA WESIGOR ON TA LO

DK I J AK A RTA

Mapping of NGO partners, 2005, NTP

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Type of partnershipType of partnership PartnerPartner--organizationorganizationTB Technical assistance

(CIDA & TBCTA through KNCV) Drug management & procurementHospital DOTSJoint Leprosy/TB activities

Financial partners

Inter-sectoral collaborationHealth care provider linkages

Government sectors

Prof ass: ARSADA, ARSI, IBI, IDI, IDAI, IKMI-HMI, IRSPI, PAPDI, PERSI, PDPI, PPNI

Dep. Justice, TNI, POLRI

Community based TB

Data analysis

Advocacy & Communication

TB/HIV collaboration FHI, HIV/AIDS NGOs

WHOKNCVMSHGORGAS (HDL)NLR

Dutch Govt, DFID, TBCTA (USAID), CIDA, GFATM, ADB, AUSAID, JICA

Aisyiyah, AWA, CARE, CCF, CRS, MSF, MSM, HOPE, IMC, Muhammadiyah, NU, PELKESI, Perdhaki, PCI, PGI, PKK, PPTI, Pramuka, Rio Tinto, WFP, World Vision Intnl, YSA

PATH, NIHRD

KUIS, YPIS

TB PartnershipsTB Partnerships

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Urgent ACSM Capacity strengthening at all

levels Management/ ImplementationNational:

Secure staffing in NTP/ GFATM secretariat to support implementation of plan and oversight for subcontracting agencies/institutes Broaden the Advocacy group with new partners, and hold regular meetings/ communication

District/provincial communication staffProvincial health offices to ensure ACSM capacity as part of DOTS teams

Liase with health promotion department and/or NGO partners‘buy’ time of qualified ACSM agencies on contract

Technical AssistanceEnsure and plan ACSM budget for technical assistance and support as part of the proposals and plansPlan for international technical assistance in guidance for new skills/ areas

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NTP Activity areas ACSM Partners in ACS Working Group

Political commitment/ Advocacy 15 districts ACSM - KUIS (GFATM subcontract)Political advocacy - ACTION/KuIS (started 2005)District financial mapping - Univ Indonesia (TA KNCV/WHO)

Healthcare provider communication

Healthcare provider kit -JHU (WHO contract)Promotion ISTC - KNCV (with national contractors)PR/Media Agency (contracted)Website/ information products (contracted)Training development (subcontracted GFATM)Indicator/ instrument dev’t (TA WHO/PATH)

Communication and social mobilisation

25 Operational NGOs support community TB

Technical support - WHO (Financing (BJ), ISAC (PH))- KNCV (TA local and TBCAP)- PATH (Socio-economic data-analysis)

ACSM Partners activities under GFATM R1 Phase-II

National TB program – STAFF ACSM- 1staff: ACSM, partnership, workplace, poverty- 1staff: ACSM/ Partnership- 1staff: Community/ NGO support- 1staff: ACSM (media campaign)-under recruitment- 1staff: Information (web, materials, newsletter)

5year strategic plan

Funded by GFATM R5

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Discussion

What features do each of these organizations have in common? What is different?What are the roles and responsibilities of each of the stakeholders? Think about the distinction between strategic and implementation activities. Which activities can be 'outsourced' and which cannot?

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Organizational Structure Case Studies

IndonesiaLarge regional differences (language, culture, geography)Highly decentralized structure

KenyaUse existing programs and structuresNTP gives central direction

PhilippinesUse of one single partner (WorldVision) with coverage from national to district level

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Critical Elements to ACSM Implementation in GFATM

Start Grant Negotiation1. Conduct an ACSM Needs Assessment2. Design a Strategic Plan

Grant Approval3. Develop a work plan and implementation

time lineIndicators, M&E system and BaselineOrganizational structureEvent sequencing / time line

Grant Signature4. Implementation 5. Monitoring and Evaluation

Planning →Im

plementation

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Module 8:

Challenges and Opportunities

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Where to begin and what are the challenges? Spending the money

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No One Size Fits All… but here is a good way to start

ResearchEpidemiological data and KAP data

PlanningNational work plan to district work plan

StaffingDo you have the staff you need?

Budgeting Roll outManagementMonitoring and Evaluation

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Exercise: Resource MaximizationPart I: In groups, develop a TB advocacy program proposal using a budget of $500,000. Include a program summary, implementation strategy, and budget outline which includes accounts for staffing, supplies, and expenses. (10 min.)

Part II: Congratulations! Your program proposal has been accepted, but can only been funded at 50% of the proposed budget. In order to be awarded the grant, you must demonstrate to the committee your ability to implement your proposal with a budget of $250,000. (10 min.)

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Challenges to Implementation, time, tools, staffing, etc.)Limited Access to Resources (fundsSolution: Resource MaximizationIdentify areas where resources can be pooled or stretched in order to maximize their reach. Is

there another path to the goal? Will implementing alternative measures allow you to save time, money, or eliminate the need for unavailable supplies? Flexibility in programmatic approach and resource allocation may mean the difference in your program being executed efficiently or cancelled all together.

Partnerships- Competing InterestsSolution: Goal MappingWhen partnering with an organization which may have similar program objectives but

competing internal interests, as is common in public-private partnerships for example, it becomes necessary to engage in open, candid discussion with the partner to identify both the programmatic goals and the internal goals of both parties. Once both parties are aware of the others stakes and expectations, values should be assigned to each internal goal and negotiations should commence on how best to meet the interest of both parties while ultimately serving the greater programmatic goal of the partnership.

Audience DisengagementSolution: Speak Their LanguageSometimes convincing audiences- be it the media, the general public, key influencers, etc- of

the urgency and inherency of a problem can be the greatest obstacle to successful program implementation. In these instances, it is important to grasp a thorough understanding of the “language” of the audience, i.e. their interests, concerns, and motivators. Identify ways to link your program into these points and present the information to the audience in a manner that they will easily understand and digest. If the audience doesn’t understand the need for the program, they will not be compelled to act.

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Critical Elements to ACSM Implementation in GFATM

Start Grant Application1. Conduct an ACSM Needs Assessment2. Design a Strategic Plan

Grant Approval3. Develop a work plan and implementation

time lineGrant Signature

4. Implementation5. Monitoring and Evaluation

Planning →Im

plementation

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Simple TESTS for ACSMA buyers' guide

What is the behavioural objective?Have they segmented the audience?Do they know the knowledge level of the target audience?Pre tested the message?How will the message be repeated?Are the indicators appropriate to the project. Demand generationDoes the project transfer/empower the audience to take action?Awareness does not equal knowledgeKnowledge is not enough. Buy the behaviour.Are there enough staff?—ACSM is human capital

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Do's

1. Do determine constraints and barriers. 2. Do take the ACSM Needs Assessment Tool and

survey counterparts. Fill in the blanks. 3. Do convert into ACSM/GFATM Planning

Framework4. Do match TB epidemiology with ACSM activities. 5. Do ask if there are local partners and NGO's who

can be party to the proposal.6. Do call/e-mail the Stop TB Partnership or trained

ACSM specialist for consultation. Expertise is available! Ask for it.

7. Do plan out your monitoring & evaluation system before you start program activities

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Don'ts

1. Don't just buy posters. Buy some to keep the politicians happy.

2. Don't begin implementing program activities without mandating and budgeting behavioural/demographic research BEFORE launching any campaign.

3. Don't budget activities that cannot be measured. 4. Don't allow ACSM activities to be uncoordinated.

Other technical elements need to be ready. 5. Don't think ACSM can increase SM+ rate. ACSM

can create demand or commitment.6. National campaign are expensive and untargeted

(no shotgun approaches!) Local/District activities

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How much will TB spend on ACSM to achieve its targets? How much will we ask for ASCM activities to How much will we ask for ASCM activities to achieve the 2005 process targets of 70% case achieve the 2005 process targets of 70% case detection? detection?

It is up to you!It is up to you!$2 billion +/$2 billion +/--