The ENGAGE-TB Approach: Integrating community-based TB activities into the work of NGOs and other CSOs
Tuberculosis (TB) affected an estimated 8.7 million people and caused 1.4 million deaths globally in 2011, including 0.5 million women and at least 64 000 children. About 13% of TB occurs among people living with HIV, and TB causes almost a quarter of AIDS deaths. There is evidence of links between TB and noncommunicable diseases such as diabetes mellitus and with determinants of ill‐health like tobacco and drug use, alcoholism and malnutrition. TB mostly affects the productive segment of society in their prime.
One third of people estimated to have TB are either not reached for diagnosis and treatment by the current health systems or are not being reported. Even in patients who are identified, TB is often diagnosed and treated late. In order to reach the unreached and to find TB patients early in the course of their illness, a wider range of stakeholders already involved in community-based activities needs to be engaged. These include the nongovernmental organizations (NGOs) and other civil society organizations (CSOs) that are active in community-based development, particularly in primary health care, HIV infection and maternal and child health, but have not yet included TB in their priorities and activities.
NGOs and other CSOs are non-profit organizations that operate independently from the state and from the private for-profit sector. They include a broad spectrum of entities such as international, national and local NGOs, community-based organizations (CBOs), faith-based organizations (FBOs), patient-based organizations and professional associations. CBOs are membership-based non-profit organizations that are usually self-organized in specific local areas (such as a village) to increase solidarity and mutual support to address specific issues. For example, these include HIV support groups, women’s groups, parent–teacher associations and micro-credit village associations. CBO membership is comprised entirely of community members themselves, so these organizations can be considered to represent the community most directly. NGOs and other CSOs engage in activities that range from community mobilization, service delivery, and technical assistance to research and advocacy
The strengths of NGOs and other CSOs active in health care and other development interventions at the community level include their reach and spread and their ability to engage marginalized or remote groups. These organizations have a comparative advantage because of their understanding of the local context. Greater collaboration between NGOs and other CSOs and local and national governments could greatly enhance development outcomes (2). A more decentralized approach that formally recognizes the critical role of NGOs and other CSOs as partners addressing gaps through support to community-based actions will expand TB prevention, diagnosis, treatment and care activities.
Examples of community-based TB activities
- awareness-raising, behaviour change communication and community mobilization
- reducing stigma and discrimination
- screening and testing for TB and TB-related morbidity (e.g. HIV counselling and testing; diabetes screening) including through home visits
- facilitating access to diagnostic services (e.g. sputum or specimen collection and transport)
- initiation and provision of TB prevention measures (e.g. Isoniazid preventive therapy, TB infection control)
- referral of community members for diagnosis of TB and related diseases
- treatment initiation, provision and observation for TB and co-morbidities
- treatment adherence support through peer support and education and individual follow-up
- social and livelihood support (e.g. food supplementation, income-generation activities)
- home-based palliative care for TB and related diseases
- community-led local advocacy activities