Advocacy, Communication and Social Mobilization Working Group

Sub Group on ACSM at Country Level - GFATM Resources

GFATM/ACSM 6th Round Resources
Background

In April 2005, just before the 5th round of the GFATM, the Stop TB Partnership Secretariat (WHO/HTM/STB/TBP), WHO Regional Office for the Eastern Mediterranean (EMRO), and John Hopkins University (JHU) Centre for Communication Programs organized a training workshop in Cairo, Egypt to train a group of freelance consultants in developing ACSM components for TB proposals to the GFATM. The result was an unprecedented success. Twelve out of thirteen countries using the GFATM/ACSM framework submitted ACSM components to their TB proposals and ten of the twelve were awarded more than $31 million over two years and $65 million over five years for ACSM activities.

GFATM announced a call for 6th round proposals on 28 April 2006. The deadline is 3 August 2006. Based on the EMRO experience, the WHO Regional Office for Africa and the ACSM Sub Group at Country Level held a training workshop in Harare for consultants from partner organizations; country offices and programmes that will be deployed to assist countries develop ACSM TB proposals during the 6th round of the GFATM. This workshop followed the WHO Stop TB Department GFATM Preparation Workshop the third week of May 2006 in Geneva.

Workshop Materials in powerpoint format: Notes from consultant missions
GFATM/ACSM 5th Round Resources
Notes from consultant missions

Mischa Heeger, KNCV, Mission to Ethiopia

Outline of GFATM proposal

Goal: Increase health seeking behavior among individuals and communities, in order to increase TB case detection and treatment success.

Coverage indicators:
% of increase in case detection in targeted population (with ACS interventions)
% of increase in treatment adherence in targeted population (with ACS interventions)

Objective 3: To strengthen the political and community support to TB control in Ethiopia through effective Advocacy, Communication and Social Mobilization strategies.
Inadequate political and societal commitment and poor levels of public awareness and stigma on Tuberculosis contribute to low case detection and treatment compliance rates. Advocacy, Communication and Social Mobilization can build stronger political and societal commitment and enhance maximum use of accessible, affordable and effective diagnosis and treatment outcomes. ACS can mobilize communities and individuals through a participatory approach toward early health seeking behavior, by increasing knowledge and awareness among the public on early signs and symptoms of Tuberculosis. It will also contribute to successful TB control and reducing stigma. The main target audiences are decision makers at all levels, opinion leaders, care providers, schools, community and faith based organizations and households. The beneficiaries include the community at large, with special attention to vulnerable groups, TB/HIV co-infected patients, women and youth. Sizeable number of people in the country will be addressed and reached by outreach work through community volunteers and by targeted IEC campaigns, like broadcasting spots and dramas on radio and TV.

Service delivery area 3.1: The establishment of a TB communication mechanism in Ethiopia at all levels through situational analysis, planning and intra and intersectoral collaboration.

Coverage indicators:
Level 0:
Availability of National strategic communication framework for TB control
# of communication focal points appointed at different levels
# of meetings with Task Force on ACS
# of provinces with qualified ACS officers
# of consultation meetings with journalists and editors

Level 1:
# of participants in the sensitization workshop (stakeholders and TB-staff)
# of communication focal points trained on ACS and IPC

Level 2:
# of behavioral and KAP studies commissioned

Targets:
To build a solid foundation for sustainable and continuous Advocacy, Communication and Social Mobilization activities
To increase institutional capacity and political and societal commitment to TB control
Development of a national strategic communication framework for TB control. making use of all organization’s experiences in TB control, share experiences, best practices and lessons learned

Activities at regional/ district level:
8) Recruitment (in close collaboration with the NGOs) of a total of 11 dedicated regional communication officers for the period of 4 to5 years for the regions
9) Training of regional communication officers on ACS strategy, IPC, interventions and supervision

Service Delivery Area 3.2: Implementation of Advocacy, Communication and Social Mobilization activities.
All activities and interventions are depending on the outcomes of the studies and the strategic plan. Activities hereunder mentioned are therefore subject to changes.

Coverage indicators:
Level 0:
Resource center established
# of regions/ district with micro ACS-plans
# of pilot-sites identified
# of regions that carried out mini- KAP –studies, client satisfaction surveys and interviews with service providers

Level 1:
# of service providers trained in DOTS, quality assured, client centered approach, ACS and IPC.
# of community workshops

Level 2:
# of schools with IEC material on TB present
# of television broadcasts
# of radio broadcasts
# of IEC materials produced and distributed, divided to different levels and special groups

Recording and reporting formats revised, including ACS component
# of supervision visits carried out to and from different levels
# total number of mini- KAP –studies, client satisfaction surveys and interviews with service providers carried out, and reported
# of identified, trained and active volunteers

Targets:

  • Inform target audiences on TB, and improve knowledge, attitudes and practices
  • Increase engagement and involvement of communities and households in analysis, planning and implementation of activities
  • Increased quality assured, client oriented approach among service providers
  • Destigmatization of the disease among broad population

Activities at National level:
1) Establishment of resource center with TB material in close collaboration with experienced partners in the field of HIV/AIDS, like the AIDS Resource Centre. Inclusion of TB information into HIV/AIDS information schemes and vice versa. At smaller scale mini-media will be used in primary and secondary schools for the purpose of TB prevention and control. This will link to already existing efforts in communicating information and mobilizing school community against HIV/AIDS. TLCT will provide logistics and materials to the schools and support them technically.
2) Regularly inform journalists and editors, provide them with fact sheets and regular update by TLCT on recent developments in the field.
3) Developing, pre-testing, production and dissemination/ distribution of nation-wide IEC materials (television, leaflets, campaigns, events and radio) in close collaboration with various organizations.
4) Inclusion of ACS activities and (process- and change) indicators in Recording and Reporting formats at all levels, revision of R&R formats.
5) Ongoing assistance, support and supervision by central ACS focal point to all levels.

Activities at regional/ district level:
6) Identification of one pilot-site within each region, based on criteria like vulnerable groups, TB/HIV burden, rural and/or urban, access to health facility and geographical diversity. This site will get special focus, while activities in the region/districts are ongoing.
7) Development of regional/ district micro-plans, that are culturally appropriate, according to the outcomes of mini- KAP –studies, client satisfaction surveys and interviews with service providers.
8) Development of regional- and district IEC materials and events with patient groups and the community in a participatory approach. Special attention will be given to youth (schools), women, the difficult to reach and vulnerable population. This calls for an innovative and creative approach.
9) Sensitization workshop for district- and community level service providers on DOTS, quality assured, client centered approach, ACS and IPC.
10) Identification of community volunteers, linking to already existing efforts and groups, like the AIDS program and CBOs and FBOs.
11) Development of tools to measure impact at community level, by involving the community.
12) Training of community volunteers and other community stakeholders (midwives, traditional healers, community leaders) on ACS, suspecting and referral of patients
13) Ongoing assistance, support and supervision from regional/ district level to community level.

Service Delivery Area 3.3: Monitoring and Evaluation, re-plan and scale up

Coverage indicators:
# of evaluations carried out by external consultants
% of population targeted who are aware that a chronic cough could be a sign of TB.
% of population targeted who know TB testing and treatment is free.
% of the population targeted who know TB is curable.
% increase in client satisfaction with TB program services over time.
% of people expressing accepting attitudes towards people with TB.

Targets:
Guarantee a sustainable base for the activities implemented
Scaling up of activities and geographic areas, depending on outcomes

Activities:

  1. Monitoring and Evaluation of ACS activities and interventions, integrated in the regular bi-annual meetings of the TB-control program. Sharing of experiences, best practices, identification of gaps and next steps.
  2. Reporting at quarterly basis as part of the TB-control program reporting system.
  3. One review mission per year by external consultants
  4. Evaluation of pilots and impact-studies by independent consultants.
  5. Based on outcomes of the studies, identification of strengths and weaknesses, re-plan activities and scale-up interventions to more sites.

Khandaker Haque
Bangladesh National TB Program

Dear Thad,
Greeting from Bangladesh. Sorry for the infrequent response as we still busy we the GFATM proposal ( also providing support for the other components... Cairo workshop was very helpful for helping the country for the proposal... we are thankful to STOP TB partnership for technical support regarding this).

The following ACS components for the proposal have been selected through extensive discussion with Ministry of Health, CCM memebers, NTP and partner NGOs.

  1. 1.Technical assistance for developing ACS operational manuals
  2. 2.TA for annual monitoring of implementation and its results
  3. 3.Development of logo with slogan for TB services
  4. 4.Development and distribution of ACS operational manuals
  5. 5.Preparation of educational materials ( flip chart/flash chart, pamphlet), IEC materials(Billboard, leaflet, cinema slides)and TV spot /Radio spot/TV serial( enter-education program)
  6. 6.Contract out preparation, implementation of ACS activities and development and application of tools for monitoring the ACS activities
  7. 7.Advocacy workshop with policy makers/MPs
  8. 8.Advocacy work shop with mass media( electronic and print) people
  9. 9.Publicity/nation wide campaign through mass media
  10. 10.Disseminate of TB information through popular theatre/folk song/cinema hall/cable TV network/street drama/concert/sports men/sponsorship/celebrities
  11. 11.Conduct workshop with high level BCC (ACS) working group at MOH&FW, national expert ACS organizations and PA on how to stratigize , organize, implement and monitor key ACS strategies
  12. 12.Workshops for mobilizing civil society at national and district level to support NTP
  13. 13.Establishment of communication forum and arrange social mobilization meeting at upazilla with participation of different groups
  14. 14.Workshops/meetings for dissemination of TB information through micro-credit/women group/TB club members
  15. 15.Conduct quarterly meeting with involved organizations
  16. 16.Out sourcing of ACS activites( 10% of total cost)

These components are the outcome of experience of cairo workshop and existing TB situation in Bangladesh. Considering the amount of budget of other components of the proposal and existing ACS gaps, the Ministry of health, CCM members, NTP, WHO in Bangladesh, NGOs have come to a consensus to limit the budget to 4.5 million for ACS component.

Once again I congratulate and thank STOP TB Partnership, Center for Communication Program for their nice facilitation, guidance and all sorts of technical support to make a robust GFATM proposal ( not only ACS components...total proposal as well). Your further valuable input in this regard will be highly appreciated.

Michele Berdy

May 10, 2005

Hi -- working away here. After talking with you on Friday night, I got a bit concerned that our various groups might not be preparing docs in the same format, so really spent all Sat and Sun AM working with the group on overall application issues. A lot wasn't clear to them -- so we did Group Work filling out chart 4.4 b. (BTW also discovered discrepancies between the Russian translation and English application, which I queried the Global Fund about.) It was necesary, but it took us away from the group work on our part of the application.

Anyway -- I'm sending you two docs -- one is the overall strategy, SDAs, activities and indicators. A second doc is a "request for clarification" on the coverage vs outcome indicator issue. Am I the only one obsessed with this?

There may be some continued fiddling on activities. I noticed that there are some disconnects between the country situation-problem text that the group prepared for the "old" application (they did work last fall) and the new SDAs they are proposing, so need to discuss that and possibly add a bit.

The indicators may be a bit off.

Please comment! I've been living, breathing, eating, drinking and sleeping this stuff for days now, and you know how you can get lost in the forest and not see the trees. Let me know if there are any disconnects or anything that seems off, anything that should be improved or changed.

In particular -- you can divide the SDAs any number of ways. I did it by A-C-S and cross cutting, just because it seemed easier. But as the "how" part of the strategy indicates, I could group the SDAs by, say, Improving Patient Treatment Adherence, and then list activities by type, ie, patient-doctor IPC, support groups, social mobilization of volunteers, advocacy for higher patient subsidies. Would that be better? I did it the standard way, because I thought it would be more familiar to the reviewers and easier to understand -- but I need some feedback on whether that is okay, or if it reads as a disconnect between strategy and SDAs.

Cheers and Happy Victory Day from Almaty

Mickey

THAD'S RESPONSE: Mickey I will call and talk to you. But I think you are on the right track. However your coverage indicators for your service delivery areas need work. You need to place them in the context of coverage. How many oblasts will be serviced. How many people will be hired. Etc. I will call you with even more information.

Michele Berdy

Deployment: Kazakhstan
May 8, 2005

HI, Thad. Thanks for this(the HIV/ACS proposal). I've saved it on my disc, but the business center computer doesn't seem to have adobe, so will open it in my room and see if that will help me.

We broke early today to do "homework," so will try to give you a call. It's I think only 12:30 in your part of the world.

If I can't reach you, I'll probably email you later with some specific questions.

In general, we are making good progress. The blocks of work to be done were not hard to determine, but figuring out the nuts and bolts of the workplan is quite difficult. I would say that there is an excellent communications potential here -- there is an entire organization that does this, with branches in every oblast and about 1200 employees. That said, they've never done anything on this scale before, and need help figuring out the work plan (what's realistic, the order things get done in, etc.) and will need lots of TA (which we're writing in) in various aspects of administration. They will also need to hire more people who will be dedicated to the work. Some of them seemed to think they'd do this work "on the side," and so the workplan -- where they see that something like "KAP research" is actually 10 labor intensive steps from bid to completion -- is a sobering experience for them.

Today-tonight I will translate and send to you the basis of what we are planning. I will be eager for comments/input. We have a rather detailed sda and activities chart, and are finishing the workplan chart. People have homework to start sketching out the budget, and if all goes well, on Tuesday we'll have a more or less completed work plan and the raw material to do the budget. A specialist will be in all next week to help us with that, since there are all kinds of taxes and employment benefits to be put in.

We are working sat and sun (folks REALLY unhappy about that...). My homework by Tuesday is indicators (which I'll torture you with questions about), pulling info out the 19 kilos of materials to add to the text section on "problems and country description), and drafts -- however much I can get through -- of the narrative descriptions that go with the component part. I'll write that in English and together we'll translate/edit/fix in Russian next week. I will also have to help them develop the staffing needs section, since they seem to be drastically underestimating the amount of work involved.

I think we'll get through it all, with the possible exception of all of the budget. Their deadline is May 16 to get the full proposal draft in Russian to the MOH to look at. That leaves three weeks for changes and improvements.

So -- let me take a look at the proposal and give you a call later.

Cheers
Mickey

THAD'S RESPONSE: WELL DONE Mickey. I look forward to your call. Make sure you check the Monitoring and Evaluation Toolkit and Will Park's paper on indicators. There are many to choose from. Also please have a look at Petra's framework and my comments to her indicators.

Pakistan--Tahir Turk's GFATM framework and reports

Tahir Turk's mission is progressing well. Here is some of his most recent letter. "I am using the model for the ARV Communication Sub-Committee Thad that we formed to oversee the BCC campaign in Kenya. It is functioning very well.

Getting there with the prop after some deliberations yesterday. l have suggested that they break it down into components for ease of understanding. My counterparts here like the idea but it will mean rewriting the whole prop. Should have a reasonable draft by Friday for you to check out.

Regards
Tahir Turk
WHO - Stop TB Partnership
Advocacy Communication and Social Mobilisation Technical Advisor - GFATM
C/o Pakistan National TB Control Programme - Islamabad, Pakistan.
Tel +92 51 300 529 2862 Mob +92 030 1551 5631
A/h Holiday Inn - Room 112, Islamabad, Pakistan."

Here is Tahir's presentation to stakeholders

"Attached as mentioned is a BCC strategy l helped develop for the Kenya National HIV/AIDS programme. It is a little dated but has the basic framework and some of the elements of a communication strategy which could be adapted for TB ACS in Pakistan."

Kenya BBC (AIDS) Communication Strategy

Please give Carole my best Thad. Sounds like she will need it!

By the way l am currently evaluating the PNG HIV/AIDS communication strategy which l have worked on for the past 5 years. The data on the most important health issue, which we regularly collect at the start of the survey, is interesting as it showed relatively low priority for TB which is now growing as result of a campaign DOH ran here a couple of years ago, and l suspect a growing rate of HIV coinfection. The tracking waves have occurred annually since the baseline in 2001 and it shows what a big job is required to get these health issues on the national agenda.

Again this would be a good indicator for the success of TB advocacy in Kenya but l doubt if they have a large scale KAPB study to monitor this and other behavioural indicators.

Regards
Tahir Turk
Social Marketing Campaign and Materials Development Advisor
National HIV/AIDS Support Project
PO Box 5726 Boroko NCD Papua New Guinea
Tel 675 323 6161 Fax 675 325 7174 Mob 675 687 3566
Email tturk@cpimail.net

Phase 4 National HIV.pdf