Presentation to the ACSM Subgroup at Country Level Session 8

1. Advocacy, Communication and Social Mobilization Sub Group at Country Level: Building a Technical Assistance Network Presentation to the ACSM Subgroup at Country Level Session 8

2. Outline • ACSM 10-year Strategic Framework for Action • Utilization of ACSM • Discussion and decisions

3. Utilization: Rapid growth in ACSM 2002 data as gathered from ACSM Needs Assessment Survey of HBC's 2006-2007 data gathered from HBC DOTS Expansion survey *Planned

4. Funding: HBCs with GFATM funding via rounds 1-5 for ACSM activities 2002 data as gathered from ACSM Needs Assessment Survey of HBC's 2006-2007 data gathered from HBC DOTS Expansion survey *Approved grants from 5th round GFATM

5. Funds at Country Level via GFATM Successful 5th round for ACSM: $35 million over two years $63 million over five years (Some TA budgeted for in some 5th grants) Challenge #1: How to access resources to maximise the impact of available GFATM funding and to achieve the targets as detailed in the GP2 and ACSM Strategic Framework for technical cooperation among partners and countries.

6. Afghanistan Congo Rep Eritrea Ethiopia Togo Zambia Egypt Iraq Morocco Pakistan PNG Vietnam Botswana 6th round GFATM supported by partners and using ACSM framework

7. Improving funding for ACSM Technical Assistance Lagging (as of Sept 2006) Note: USAID is the largest single donor for ACSM technical support US$9 million gap in ASCM projected TA needs at country level In millions

8. Previous discussions on TA • 2004—CB meeting Beijing: Endorsement of ISAC to respond to shortage funding for TA • TB/HIV: Requested funds for operational research and policy monitoring • 2005—CB meeting Addis Ababa: Agreement to support countries with technical assistance to prepare 5th GFATM Proposals • Jan. 2006—Partners TA meeting Geneva: discussed the growing need for TA for all of technical issues • Feb. 2006—Coordinating Board presentation. • TBCTA, ISAC and other channels provide needed TA but ACSM access to those funds is limited

9. Session 8: Status Report on ACSM at Country Level Presentation to the 2nd Meeting of the Sub-group on ACSM at Country Level Tanya Siraa/Stop TB

10. What was the survey about? • Annual survey sent to 22 HBC's to assess needs and progress of NTP's which feeds into Global TB Control Report. • 2006 was the 2nd edition to include questions on ACSM: • Type of messages communicated • Media types used • Activities of patient-centred organizations • Availability of ACSM monitoring and evaluation data • Barriers to ACSM implementation

11. ACSM activities are focused primarily on public education; less on advocacy.(Average, in order of importance): • Educating on signs and symptoms of TB • Educating on where to go for TB testing and treatment • Encouraging care seeking behaviour • Increasing knowledge of risk factors for TB • Combating stigma • Calling for increased political and financial support • Encouraging community action • Providing a channel for the afflicted to voice their concerns Public education Advocacy Source: 2006 Stop TB strategy questionnaire (Q.N3a) from Afghanistan, Bangladesh, Brazil, China, India, Indonesia, Kenya, Myanmar, Nigeria, Pakistan, Philippines, Russia, Tanzania, Uganda, Vietnam, Zimbabwe. No data from Cambodia, Congo, Ethiopia, Mozambique, South Africa or Thailand.

12. Countries use a wide variety of media for their ACSM activities:(Average, in order of importance): • Electronic and print media • Interpersonal communication • Community mobilization • Point of service promotion • Folk media Source: 2006 Stop TB strategy questionnaire (Q.N3a) from Afghanistan, Bangladesh, Brazil, China, India, Indonesia, Kenya, Myanmar, Nigeria, Pakistan, Philippines, Russia, Tanzania, Uganda, Vietnam, Zimbabwe. No data from Cambodia, Congo, Ethiopia, Mozambique, South Africa or Thailand.

13. Activities of patient-centred organisations: • Community mobilization (100%) • Active case detection (89%) • Treatment support (78%) • Consultation with NTP regarding policy/programme implementation (67%) • Activism for national policy change or national resource mobilization (56%)

14. We must enable countries to gather data for monitoring and evaluation. • Only five out of 17 countries claim to have country-level data to evaluate the efficacy of ACSM strategic plan which will allow programme improvement and dissemination of information: • Brazil, China, India, Indonesia, Philippines • The remaining 12 countries claim to have no M&E system in place for ACSM: • Afghanistan, Bangladesh, Kenya, Myanmar, Nigeria, Pakistan, Russia, Tanzania, Thailand, Uganda, Vietnam, Zimbabwe. Source: 2006 Stop TB strategy questionnaire (Q.N3a) from Afghanistan, Bangladesh, Brazil, China, India, Indonesia, Kenya, Myanmar, Nigeria, Pakistan, Philippines, Russia, Tanzania, Uganda, Vietnam, Zimbabwe. No data from Cambodia, Congo, Ethiopia, Mozambique, South Africa or Thailand.

15. Countries face multiple barriers to implementing ACSM programmes. Top six reasons across countries: • Limited staff capacity • Limited resource availability • Geographic/linguistic/cultural diversity • Administrative or managerial constraints • Identifying and reaching priority target groups • Stigma Source: 2006 Stop TB strategy questionnaire (Q.N3a) from Afghanistan, Bangladesh, Brazil, China, India, Indonesia, Kenya, Myanmar, Nigeria, Pakistan, Philippines, Russia, Tanzania, Uganda, Vietnam, Zimbabwe. No data from Cambodia, Congo, Ethiopia, Mozambique, South Africa or Thailand.

16. Countries face multiple barriers to implementing ACSM programmes. Other top reasons (average across countries): • Lack of health sector coordination • Poor understanding of TB risk factors • Lack of commitment from health care providers • Lack of commitment from civil society • No action plan • Lack of political commitment from central government Source: 2006 Stop TB strategy questionnaire (Q.N3a) from Afghanistan, Bangladesh, Brazil, China, India, Indonesia, Kenya, Myanmar, Nigeria, Pakistan, Philippines, Russia, Tanzania, Uganda, Vietnam, Zimbabwe. No data from Cambodia, Congo, Ethiopia, Mozambique, South Africa or Thailand.

17. Questions?

18. Unique opportunity Technical assistance program

19. Unique Opportunity • USAID and Stop TB developed a TA proposal and secured $507K in funding from OGAC to support countries with rounds 1-6 ACSM implementation. • Funding is designed to remove obstacles and accelerate implementation. • Funding conditional on: • Type of TA need • Country needs

20. Examples of TA requeststhat could be funded • Formative behavioral/demographic/market research • Data interpretation • Project management strengthening • Monitoring and evaluation planning • Micro-planning

21. Program outline • Only countries with GFATM rounds 1-6 funding are eligible for catalytic TA • Component 1: Technical Assistance Mechanism • Component 2: Country-specific Program Evaluation • Component 3: Program Management

22. Monitoring and evaluation of TA • Two tier system • Tier one: Standardized matrix of ACSM elements as suggested in 10-Year Strategic Framework with respect to county TA needs • Progress towards implementation as detailed in GFATM Grant. • Increased NTP capacity • Tier two: Partner progress reports

23. Next Steps • Survey of country needs • TA applications from country • Subgroup to discuss/agree on basic standards for rendering TA. • Priority countries, utilization of the Framework, compliance with terms of the grant. • TA to be country/TA partner and coordinated by Stop TB

24. Recap • Challenge #1: How to coordinate effectively among partners to maximise gains, measure outcomes and advance the GFATM Grants in assisted countries? • Challenge #2: What should be the guiding principles governing the USAID-funded Technical Assistance program?

25. Proposed Guiding Principles • 1) TA for ACSM will be focused on assisting counties in the initial phases of their GFATM ACSM grants. • 2) TA for ACSM must accelerate the absorptive capacity and improve the performance of the ACSM component in those projects approved by the GFATM. • 3) TA for ACSM must be catalytic in nature and will be targeted to remove obstacles to successful ACSM implementation and build local capacity. • 4) TA for ACSM must be in alignment with the standards, methodologies, objectives as articulated in the component 5 of the Stop TB Strategy.

26. Recommendations