Advocacy, Communication and Social Mobilization for TB Control in Kenya
Advocacy, Communication and Social Mobilization at Country Level
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Transcript of Advocacy, Communication and Social Mobilization at Country Level
2nd Meeting of the Subgroup on Advocacy, Communications and Social
Mobilizationat Country Level
Advocacy, Communication and Social Mobilization at Country Level
Presentation to the ACSM Subgroup at Country Level
2nd Meeting of the Subgroup on Advocacy, Communications and Social
Mobilizationat Country Level
Outline
1. What are the monitoring and evaluation challenges for ACSM?
2. What does the 10-year ACSM Framework prescribe?
3. What 5-7 indicators could be used in a country’s ACSM performance profile?
2nd Meeting of the Subgroup on Advocacy, Communications and Social
Mobilizationat Country Level
2. What has the ACSM Sub Group at country level achieved?
2nd Meeting of the Subgroup on Advocacy, Communications and Social
Mobilizationat Country Level
…but M&E not yet standardized
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2002 2005 2007
HBC's withNational ACSMPlans
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2002 2004 2006*
Countries
2002 data as gathered from ACSM Needs Assessment Survey of HBCs 2006-2007 data gathered from HBC DOTS Expansion survey (self reporting)*Approved grants from 5th round GFATM
HBCs with GFATM funding via rounds 1-5 for ACSM activities
Rapid Growth in Plans for ACSM utilization
Momentum Building…
$63 million over 5 years
2nd Meeting of the Subgroup on Advocacy, Communications and Social
Mobilizationat Country Level
3. What are the monitoring and evaluation challenges?
2nd Meeting of the Subgroup on Advocacy, Communications and Social
Mobilizationat Country Level
Currently, we have:Minimal dataOld dataUnsystematic data No centralized collection point
2nd Meeting of the Subgroup on Advocacy, Communications and Social
Mobilizationat Country Level
Colombia
2nd Meeting of the Subgroup on Advocacy, Communications and Social
Mobilizationat Country Level
The Philippines' story
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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
2nd Meeting of the Subgroup on Advocacy, Communications and Social
Mobilizationat Country Level
ACSM impact can be shown but the measurement can be disputed without standard measurement
Consultant report on Kerala November 2005
There were increases in all but one of the 14 districts in the State with half the districts (7 of the 14) registering increases of 13% - 41%.
The comparison between 4th Qrt, 2003 and 1st Qrt, 2004 showed an increase of 19%.
The comparison between 2nd Qrt, 2003 and 2nd Qrt, 2004 showed an increase of 7%.
RNTCP collected data
2nd Meeting of the Subgroup on Advocacy, Communications and Social
Mobilizationat Country Level
ACSM impact can be measured in carefully designed evaluation studies
However we have challenges: Validity, reliability, and repeatability Contribution analysis is not straightforward Contextualization Lack of uniformity of indicators across
countries Evaluation of ACSM studies not part of routine
TB M&E Need for participatory monitoring and
evaluation
Lessons
2nd Meeting of the Subgroup on Advocacy, Communications and Social
Mobilizationat Country Level
These challenges can be overcome,
BUT only with some retooling and investment in M&E
2nd Meeting of the Subgroup on Advocacy, Communications and Social
Mobilizationat Country Level
4. What does the 10-year ACSM Framework prescribe?
2nd Meeting of the Subgroup on Advocacy, Communications and Social
Mobilizationat Country Level
Five streams of evidence (at least)
Country-level ACSM develop their own M&E mechanisms (using Guideline as a starting point)
Regular ACSM evaluations commissioned by the Stop TB Partnership (akin to ACSM country case studies)
5-7 ACSM standard indicators for country-by-country reporting
Regular reports from ACSM agencies partnered to NTPs through Technical Service Contracts
Regular NTP reviews to incorporate ACSM measures
2nd Meeting of the Subgroup on Advocacy, Communications and Social
Mobilizationat Country Level
Work in ProgressMonitoring and Evaluating ACSM in National TB Programmes: A Guideline on Indicators ACSM capacity ACSM activity Sputum testing Treatment adherence Stigma and discrimination Monitoring and evaluating
advocacy Measuring significant
changes Measuring social change
communication TB social change
indicators
2nd Meeting of the Subgroup on Advocacy, Communications and Social
Mobilizationat Country Level
5. What 5-7 indicators could be used in a country’s annual ACSM performance profile?
2nd Meeting of the Subgroup on Advocacy, Communications and Social
Mobilizationat Country Level
Preface
Suggested indicators are illustrative Any standard set of indictors will need
country and partner consultation Based on more than 50 years of health
communication experience and study
2nd Meeting of the Subgroup on Advocacy, Communications and Social
Mobilizationat Country Level
Case detection
Inputs Outputs
InputsCase cure Outputs
Outcomes
Outcomes
Impact
Impact
Research,
plans,
resources,
supplies,
staff,
etc.
Research,
plans,
resources,
supplies,
staff,
etc.
Social mobilization and communication activities,
knowledge,
policies,
laws,
incentives
Social mobilization and communication activities,
knowledge,
policies,
laws,
incentives
Sputum-testing,
reduced stigma,
reduced discrimination,
other significant social changes
Treatment adherence,
reduced stigma,
reduced discrimination,
other significant social changes
Increase case detection rates
Increase cure rates,
decrease TB incidence,
decrease TB mortality,
reduce risk of MDR-TB,
improve quality of life
ACSM Indicator Flow
2nd Meeting of the Subgroup on Advocacy, Communications and Social
Mobilizationat Country Level
ACSM 10-year Framework Action Areas (Illustrative) Increasing capacity and technical assistance
for ACSM Improving case detection and treatment
adherence Combating stigma and discrimination Empowering people and communities
affected by TB Mobilizing political commitment and
resources for TB control
2nd Meeting of the Subgroup on Advocacy, Communications and Social
Mobilizationat Country Level
ACSM Capacity Country has an evidence-based,
sufficiently resourced ACSM Strategic Plan
Composite measures: % districts/provinces with TB ACSM plans based on
recent formative research % national health budget devoted to TB ACSM (5-
15%) % districts/provinces with designated ACSM staff with
appropriate qualifications
Parks W. with T Pennas and J Deane. 2006. Monitoring and evaluating advocacy, communication and social mobilization in national TB control programs.: a guideline on indicators. Geneva, World Health Organization.
2nd Meeting of the Subgroup on Advocacy, Communications and Social
Mobilizationat Country Level
Case detection and case cure % of population who know that going to a
DOTS clinic is the best way to diagnose TB % of districts that have active pro-poor
incentive schemes for TB patients on DOTS
ACSM contribution to CDR and CCR could be produced through evaluation of “sentinel sites” (e.g. districts – pre/post, time series, intervention/control)
Parks W. with T Pennas and J Deane. 2006. Monitoring and evaluating advocacy, communication and social mobilization in national TB control programs.: a guideline on indicators. Geneva, World Health Organization.
2nd Meeting of the Subgroup on Advocacy, Communications and Social
Mobilizationat Country Level
Combating stigma and discrimination % of population expressing accepting
attitudes towards TB suspects, patients and survivors
Most Significant Change Stories (qualitative)
Davies, R & J Dart. 2005. The most significant change 'MSC' technique: a guide to its use. Version 1.00. http://www.mande.co.uk/docs/MSCGuide.pdf
International Centre for Research on Women. 2002. Understanding HIV-related stigma and resulting discrimination in sub-Saharan Africa.
2nd Meeting of the Subgroup on Advocacy, Communications and Social
Mobilizationat Country Level
Patient empowerment # of TB patients or survivors trained to
become educators, monitors or advocates Most Significant Change Stories
(qualitative)
The Global Fund to Fight AIDS, TB and Malaria. Monitoring and Evaluation Toolkit: HIV/AIDS, Tuberculosis and Malaria, Second Edition. 2006. www.theglobalfund.org.
Davies, R & J Dart. 2005. The most significant change 'MSC' technique: a guide to its use. Version 1.00. http://www.mande.co.uk/docs/MSCGuide.pdf
2nd Meeting of the Subgroup on Advocacy, Communications and Social
Mobilizationat Country Level
Political commitment
Multi-sectorial involvement exists at the national level for TB control
% national budget dedicated to TB control
Singhal A and E Rogers. 2003. Combating AIDS: communication strategies in action. New Delhi, Sage Publications: 351-353.
2nd Meeting of the Subgroup on Advocacy, Communications and Social
Mobilizationat Country Level
5. What is the Subgroup's counsel?
2nd Meeting of the Subgroup on Advocacy, Communications and Social
Mobilizationat Country Level
1. To what extent is it desirable to develop a standard set of ACSM indicators that are applicable across all programs and contexts to inform on the quality and progress of ACSM interventions?
2. How can M&E of ACSM be better integrated into current reporting structures?
3. How should WHO/ACSM Sub-Group advance this M&E work?
4. What is the best way forward?
2nd Meeting of the Subgroup on Advocacy, Communications and Social
Mobilizationat Country Level
Recommendations Should there be standard indicators? Need to communicate in better ways Standardized surveys Link to other surveys (DHS and others) Diagnostic delay needs to be included Need simplicity Everyone is not starting at the same place. Population based may not be the best way to go. Country based M&E needs to be enhanced Options:
Throw away the guide Circulate and comment Revise the guide and circulate.
Countries NEED some guidelines to base M&E plan. Reporting at global level and local level.
Develop a hierarchy for results or reporting Can we look similar indicators across countries and measure those? Look at the workplans to revise the guide to find common indicators To look at the beneficiary of the information. Develop circulation