In Ethiopia, the first step in rolling out the ENGAGE-TB approach was a high-level meeting between WHO and the Ministry of Health. It was agreed that the initial focus would be on pastoralist areas of the country where TB services are particularly difficult to access and where the recent prevalence survey showed high rates of TB. Three NGOs were selected as ENGAGE-TB partners to pilot the implementation of TB services integration into their existing community based work:
- AMREF integrates TB into its community- and facility-based Maternal, Neonatal, and Child Health (MNCH) activities targeting remote pastoralist communities in the Afar region, using existing female community volunteers. Its main activities are increasing knowledge and awareness on TB prevention and treatment through IEC materials, radio messages, community dialogues, and family centred counselling, and improving the capacity of the health system to deliver effective integrated care and treatment. The project also developed innovative colour-based referral tools to be used by illiterate community volunteers. The volunteers are working closely with the existing health extension workers (HEWs) who are community-based civil servants.
- Save the Children USA integrates community-based TB and HIV services into existing MNCH programmes in remote pastoralist communities in the Somali region. Its strategies seek to increase community access to TB-related information and provide linkages for community referrals of presumptive TB patients. It helps increase community demand for TB prevention, diagnostic and treatment services. The project is being implemented through community volunteers who work closely with the existing HEWs who are community-based civil sevants. The project works on improving the social and policy environment for TB services. It emphasizes systematic program learning to inform policies and programmes. The project helps strengthen the TB diagnostic and treatment capacity of existing health facilities through dialogue with the national, regional, and district health authorities.
- CUAMM integrates TB and HIV into its community- and facility-based cancer screening services focusing on women of reproductive age. The project aims to improve facility-based HIV and TB care and treatment services through linkages between hospitals and health centres. It works to increase awareness and provide community-based treatment support. The project is being immplemented through community volunteers working closely with the existing HEWs who are community-based civil servants.
WHO ensures continuous dialogue with the government through its country office. It provides regular on-site technical assistance to each pilot project. It organizes periodic reviews to track progress and share lessons learnt during implementation across the three NGOs. It facilitated a national consultative meeting to discuss the ENGAGE-TB approach which was hosted by CCRDA and attended by almost 30 NGOs. It continues to support such gatherings to ensure wider dissemination of field experience and future scale up of similar activities through enhanced NGO engagement.
In Ethiopia, a draft Ministry of Health policy on public-private partnerships including NGO engagement is being finalized.