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TB & HIV interventions in Thyolo, Malawi An example of a role for NGOs ?

This study examines the role of NGOs in TB and HIV interventions in Thyolo, Malawi. The study highlights the methods used and the results achieved, as well as the constraints faced by the NGOs. Lessons learned and the importance of community involvement are also discussed.

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TB & HIV interventions in Thyolo, Malawi An example of a role for NGOs ?

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  1. TB & HIV interventions in Thyolo, MalawiAn example of a role for NGOs ? Dr R.Zachariah Thyolo district health services Medecins Sans Frontieres-Luxembourg

  2. METHODS - TB/HIV ACTIVITIES Thyolo: • TB patients registered in DTO office • Offered VCT • HIV+ve patients offered cotrimoxazole • Screening for opportunistic infections/STI • VCT - chronic cough ?

  3. METHODS - TB/HIV ACTIVITIES Home Based Care volunteers • Ratio 1 HBC volunteer: 5-7 patients • Home based Care kit  (supportive drugs / material) • Supervised by peer leaders, 2 nurses, a clinician and a HBC coordinator.

  4. METHODS – TB/HIV ACTIVITIES Community volunteers: • Supportive counselling • Referral - chronic cough • Income generation activities • Social mobilisation

  5. RESULTS Case registration: Jul 1999 - Dec 2001 • Total registered TB patients 2653 • Pre-test counselled 2547 (96%) • HIV tested 2414 (91%) • Post-test counselled 2335 (88%) • HIV-positive (% tested) 1859 (77%) • Placed on cotrimoxazole 1747 (94%)

  6. REFERRAL SYSTEM 96% of all patients referred from central level were integrated into the community network.

  7. HOME BASED CARE - MORBIDITY • Monthly average (HBC patients) 900 • TB / HIV positive 44% • AIDS related illness 43% • TB alone 10% • Chronic ailments/handicaps 3%

  8. COMMUNITY ACTIVITIES • 500 orphans in pre-school • 75 Orphans – carpentry, tailoring, bicycle repair etc. • 8 large community gardens / 2 fish farms • 2 Community mobilisation/Coordination centres

  9. CONSTRAINTS : HUMAN RESOURCES • Inadequate numbers / Brain drain • Low motivation (VCT, Clinical care, Supervision ?) NGO • Counsellors • Clinician/additional ward nurses • HBC nurses and coordinator

  10. Lessons learnt: Integrate NGO staff : • Employement - « Mixed Commission » • Avoid being Nationalistic – No MSF T-shirts Motivate MOH personnel ? • Performance linked incentives • Capacity building/exchange visits

  11. CONSTRAINTS: FINANCE • Dwindling Resources • Financial rigidity NGO • Infrastructure (VCT/clinics/community centers) • Drugs (hospital/HBC) • Food for malnutrition* • Logistics * Zachariah R, Harries AD, Spielmann MP et al.Trans Soc Trop Hyg 2002 96:1-4

  12. Lessons learnt • Flexibility + • Reduce implementation delay • Innovative actions

  13. CONSTRAINTS: ROLE OF THE COMMUNITY? • Communities isolated from interventions • Continuum in care ? • Impact mitigation ? • NGO • Community based associations • Catalyse community initiatives

  14. Lessons learnt Community involvement: • Enhances compliance (CPT-94%)* • Early case detection + • Encourages role of traditional healers/TBAs + • PLWA involvement + •  VCT * Zachariah R, Harries AD, Arendt et al. Int J Tuberc Lung Dis, 2001, 5:843-846

  15. CONSTRAINTS: HIV/TB DIALOGUE ? • TB & HIV programs work in isolation NGO (Support role): • District TB Officer • District AIDS coordinator • District HBC coordinator (Supervision/Monitoring/Evaluation)

  16. CONSTRAINTS: OPERATIONAL RESEARCH • Lack of operational research  Stagnation of responses • NGO: • 12 HIV/TB related studies.

  17. NGO – DANGERS • I have the money…so I decide! • I know it all … so we will do it my way! • Work in parallel

  18. CONCLUSIONS In a rural district in Malawi the NGO provided: • an opportunity for bridging existing gaps. • a new dynamic in TB/HIV • a decentralised political force - care/support

  19. ACKNOWLEDGEMENTS • Thyolo district health services • National TB Control Programme • National AIDS Commission • Medecins Sans Frontieres.

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