WHO report 2008
Global tuberculosis control
2.6 Empowering people with TB, and communities
2.6.1 Advocacy, communication and social mobilization
An ACSM strategy involves three distinct sets of activities: advocacy aimed at changing the behaviour of leaders or decision-makers, communication channelled to individuals and small groups, and social mobilization to secure support for efforts in TB control from civil society and the community as a whole. There has been progress in the effective implementation of ACSM activities at country level, often facilitated by grants from the Global Fund (grants for ACSM amounted to US$ 85 million in rounds 6 and 7). In general, however, progress remains uneven. Several HBCs have advanced in all three areas (advocacy, communication, and social mobilization), while 13 have conducted knowledge, attitudes and practice (KAP) surveys to better target their ACSM activities and 14 have involved patient-centred organizations or networks in advocacy and/or implementation of DOTS. Monitoring and evaluation of ACSM activities remains problematic, as countries continue to struggle to identify useful measures of implementation and impact.
Most HBCs still need to build local capacity to improve implementation of their ACSM strategy. For example, 20 of the 22 HBCs have requested assistance to refine their ACSM strategies in 2007–2008, and 17 have requested help to develop appropriate ACSM indicators.
Data collection in 2007 focused on the 22 HBCs and for this reason we do not provide information for other countries in this report.
2.6.2 Community participation in TB care
Among the 22 HBCs, 20 reported that there was community involvement in TB care (Figure 2.20). Only one (Ethiopia) stated that there was no involvement of communities in TB care, while one did not respond (Thailand). At regional level, community involvement was most common in the South-East Asia Region (82% of countries), followed by the Western Pacific Region (67% of countries) and the African Region (65% of countries). In the African Region, community involvement in TB care is recognized to be a key mechanism for expanding access to high-quality TB care as well as improving awareness and understanding of the disease. In the other three regions, community involvement was reported to exist in only around 40% of countries (Figure 2.20). This suggests that community involvement in TB care is not yet a strategic priority for many countries in these regions, even though in the Region of the Americas the level of community involvement in PHC services as a whole is high.
A better understanding of how communities are currently involved in TB control is required to make full use of their potential contribution. For example, despite the fact that 20 HBCs report community involvement in TB care, little is known about the specific roles or functions for which communities have taken responsibility.
2.6.3 Patients’ Charter
The Patients’ Charter provides the foundation for a human rights-based approach to the involvement of patients and communities in TB care and prevention. To date, only four HBCs have used it. This probably reflects the fact that it was only published in 2006, and as such there has been limited time for its adoption and use.