HIGHLIGHTS_RET POUR PDF 17/10/01 11:34 Page 1

GUIDELINES for SOCIAL MOBILIZATION World TB Day 2001 Highlights

Political Awareness

Social Mobilization

Increased Access to TB Care

Sustainability

Media and Community Events

Best Practice HIGHLIGHTS_RET POUR PDF 17/10/01 11:34 Page 2 Preface

p.5 Political Awareness Pakistan Australia United States India, Punjab Democratic Republic of the Congo Yemen he theme for World TB Day 2001— p.9 Social Mobilization T DOTS: TB cure for all—suggests that Oman we can eliminate tuberculosis from this Togo planet. A cure for all from tuberculosis (TB) is part Nigeria of the mission of the World Health Organization 3 India, Mumbai (WHO) and its Member States to allow access to The former Yugoslav Republic health services for all. of Macedonia Albania A first milestone occurred when Ministers of ACKNOWLEDGEMENT: Federal Republic of Yugoslavia Health, Development, and Finance Planning from Haiti 20 countries with the highest burden of TB met in Slovakia Amsterdam in March 2000 for the first summit THE STOP TB PARTNERSHIP WOULD LIKE TO THANK THOSE Maldives WHO TOOK THE TIME TO COMPLETE THE WORLD TB DAY against tuberculosis. 2001 QUESTIONNAIRE AND TO SUBMIT TO US REPORTS AND p.15 Increased Access Great progress has since been made as a result of ILLUSTRATIONS ABOUT THEIR ACTIVITIES. to TB Care the mobilization of the high TB burden countries India: supported by the international community as a Andhra Pradesh Rajasthan whole. This was reflected in World TB Day on 24 Tamil Nadu March 2001. Bihar This document brings to the fore the Uttar Pradesh accomplishments of World TB Day 2001, reports on Lebanon what has been achieved, underlines the remarkable Philippines events and initiatives, and analyses how the global p.19 Sustainability movement to stop TB is progressing towards its India goal of eliminating TB as a global public health Russian Federation problem. Peru Israel This year, World TB Day events were analysed on the basis of five themes: political awareness, social p.23 Media and mobilization, increased access to treatment and Community Events care, sustainability, and media and community Russian Federation events. The analysis was drawn from a structured Swaziland questionnaire developed by the Stop TB Kenya Partnership Secretariat. This document is based on Sri Lanka the many replies from all of you, out there, Egypt Czech Republic working in the field: from government officials, Gambia WHO outposts, medical professionals, TB This document may be freely reviewed, abstracted, reproduced and translated in part or in whole, but not for sale nor for use in conjunction with commercial purposes. Somalia advocates, and leaders of nongovernmental The mention of specific companies or of certain manufacturers’products does not imply United Kingdom organizations (NGOs). that they are endorsed or recommended in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are Best Practice World TB Day was, for the first time, launched distinguished by initial capital letters. The views expressed in documents by named from a poor community social centre in Africa by authors are solely the responsibility of those authors. p.27 Nepal p.29 South Africa His Grace Archbishop Desmond Tutu. It was innovative and highlighted the empowerment of p.32 Global Credits people—without which there can be neither Photos: WHO/TDR, Louise Gubb – Designer: Gilles Vérant Achievements development nor TB control. HIGHLIGHTS_RET POUR PDF 17/10/01 11:34 Page 4

PAKISTAN Pakistan to Fight TB Political The Chief Executive of Pakistan issued a message to the nation on World Tuberculosis Day, March 24, Political Awareness in which he called upon all concerned "to take up the stand Awareness against TB on an emergency footing until we succeed in significantly reducing the incidence of the disease THE ISLAMABAD DECLARATION TO STOP TB (Excerpts) in the country." "With political commitment and I. THE MINISTRY OF HEALTH OF THE GOVERNMENT THUS AN ACCELERATED response to TB founded broad social support, we can and OF THE ISLAMIC REPUBLIC OF PAKISTAN NOTES on an increased level of efforts is now 4 WITH GRAVE CONCERN THAT: required in Pakistan to match the political 5 must expand access to health THE MAGNITUDE of suffering and death caused commitment currently available. services for treatment of by tuberculosis is both alarming and unac- ealth programmes the world over have III: WE AFFIRM THAT: tuberculosis. We must act now to ceptable; always benefited when national leaders TUBERCULOSIS exerts a toll of three hundred […] THE WHO-recommended strategy of DOTS H halt the further emergence of and fifty thousand new sufferers and 26% of to combat tuberculosis is the internationally have come forward to adopt them. A multidrug-resistant strains of TB. all the avoidable deaths every year, including accepted set of core practices required to con- many children. front the disease and prevent the emergence AUSTRALIA strong statement by a top leader sensitises the

[email protected] National TB Control Programme The government of Pakistan has of drug resistance. […] NO OTHER disease in Pakistan more direct- media, encourages social and volunteer groups, already taken several steps to TB CONTROL Australia does not ly blocks the development of families, com- represents a global public good. mobilises the bureaucracy and builds personal translate its commitment into munities and resultantly our national econo- […] have the massive TB my. concrete actions by implementing IV. WE COMMIT OURSELVES TO ACCELERATE ACTION burden of its Asian neigh- commitment. THE LEVEL of public awareness concerning AGAINST TUBERCULOSIS THROUGH : the National TB Control tuberculosis remains inadequate. bours, but the mobilization EXPANDED coverage of our population with on World Tuberculosis Day Programme based on the DOTS DOTS providing for at least 70% detection of II.WE RECOGNIZE THAT : Measuring political will can be a difficult task. Strategy.(...). Every one of us has a infectious cases throughout Pakistan by 2005. centred on what the country […] CONFRONTING TB requires collaboration Only with the passage of time will the effect of crucial role to play in TB control. across government sectors and action across ENSURING that sufficient human and financial could do to heighten political resources are available... society; commitment to control TB, political representatives’ talk about TB, and professed We must all join our forces..." IMPLEMENTING, monitoring and evaluating our THERE exists a cost-effective cure; however the not for itself, but for the [email protected] Health and Anti-TBCommunity Association commitment to the TB programme, be measured. access of the population to safe and effica- national tuberculosis programmes in line with cious first-line drugs remains a point of con- internationally-accepted WHO standards; region as a whole. Other important questions include: cern in Pakistan and needs to be grossly V: WE CALL ON PARTNERS: The Community Health and improved. […] We call upon our partners to join...in the Anti-Tuberculosis Association To what extent are the health services well Moreover efforts need to be made to avert Stop TB Initiative to actively participate in equipped in both human and technical resources and contain the potential threat of multidrug- building new momentum against TB as a (CHATA) fronted a media cam- resistant tuberculosis which will have tremen- means towards ensuring better health for all paign focused on World TB to implement DOTS? To what extent are they dous social and economic costs; in the new millennium. Day. “We developed our own informed? To what extent do they have the means message highlighting the rel- to reach the entire population? Identitity, Merge and Action (AIM), a Pakistani NGO, evance of the Asia-Pacific have gathered TB patients under treatment to celebrate World region’s TB problem to To what extent are NGOs and community groups TB Day. During the meeting, they distributed certificates to the persons who has completed their treatment. Australia,” Kathryn Dinh of aware of the TB situation and are able to apply [AIM: [email protected]] CHATA wrote. ”The pressure on elected officials and bureaucrats so Association urges the that TB becomes a political issue? Government to continue to increase its commitment to fighting TB in the region In Burkina Faso some years ago, a well known TB while there is still an oppor- medical expert, Dr Guy Auregan, told an assembly of tunity to bring this epidemic media people that to get elected and maintain under control.“ popularity for life, a politician in that poor African The press releases stressed country should run his campaign on just one issue: the fact that Australia plays an important role in south- TB. He suggested that getting rid of TB presents an east Asia, and TB cannot be unique opportunity to address the issues of poverty kept out of Australia. The comprehensively: to help people rise out of poverty, organization distributed facts, to increase labour and farm productivity, to decrease video clips, and photographs the burden of disease, to improve municipal services to the media for general edu- funding, to increase school attendance and cational purposes, but also to indirectly raise the issue of performance... To this day, no politician has taken up TB in the Australian the challenge. government. HIGHLIGHTS_RET POUR PDF 17/10/01 11:35 Page 6 Political Awareness

UNITED STATES PUNJAB (NORTH INDIA) National Action to Maintain “The Punjab government has succeeded in generating Political Will a community-level movement in The American Lung Association (ALA), the main organization the State to focus public attention Political Awareness concerned with tuberculosis and lung diseases in the United on the ensuing TB epidemic [email protected] Lung Association American States, and the American Thoracic Society, the scientific society for in the country,” according US pulmonologists, used materials distributed for World TB Day in to the Health Initiative, a

preparing briefings for congressional representatives in [email protected] Health and Development Initiative nongovernmental organization United States: TB education session for nurses Washington. Lobbying in support of a bill proposed by US (NGO) in India. District TB control in the occasion of World TB Day 2001. Congressional Representative Sherrod Brown to fund TB committees have been set up 6 programmes, these NGOs spoke to 100 congressional staff members. with NGO participation to ensure 7 Last year, Representative Brown proposed a bill for US$ 100 that people take their drugs million dollars to fight TB. Only US$ 60 million passed. Although [email protected] Results USA properly. the Clinton administration was supportive of efforts to fight TB, The Health Minister from Punjab There is some hope that things are changing. The there was not the political vigour to pass the full bill. This year, addressed a meeting of city Chief Executive of Pakistan issued a speech on World Representative Brown's proposed bill upped the ante to US$ 200 officials on World Tuberculosis TB Day 2001 calling for an extensive programme to million for the year 2002. The money would help fund a new TB Day in Amritsar. He emphasized fight TB and implement DOTS. The Prime Minister facility at the World Health Organization, with a separate bill to that over the next ten years, of India talked about TB in his national independence promote TB awareness and programmes in the United States. “perhaps 30 million people will day address. One of the first official field trips of the Other NGOs also joined in the efforts to pass this bill. RESULTS USA die of tuberculosis. In Punjab ran a national media lobbying campaign in support of the TB alone, 46 000 people develop TB President of the Democratic Republic of the Congo, legislation. RESULTS is a grassroots lobbying organization working every year.” Joseph Kabila, was for World TB Day as he visited a to create the political will to end hunger and the worst aspects of He said, “The inclusion of five TB clinic in Kinshasa. In TB programme success poverty. It organizes its numerous volunteers in monthly "national more districts of the State in the stories such as in Nepal, it was the combination of the town meetings" held by telephone. The town meetings are used to Revised TB programme by the international involvement of donors and technical educate, prioritize and set strategies for effective action. RESULTS WHO and the Government of experts, such as Japan and the Netherlands, together worked on all levels for this year's World TB Day, encouraging India has further strengthened with local and international NGOs, which gave the volunteers to write both to their Congressional Representatives in the efforts of the State to control Washington and to their local newspaper. the TB epidemic.” He pleaded necessary backbone to fulfil the mobilization drive of RESULTS reports that newspapers published over 75 articles about that all districts be included by the National TB Programme leadership. These efforts TB, reaching an estimated 48 million readers, on or next World Tuberculosis Day in are a step in the right direction. Their action should near World TB Day. Of these, 18 were editorials 2002. also be monitored: Is the true commitment there? Are endorsed by the paper. The Washington Post, The Both sides appreciate the these politicians backing up their talk with money? Boston Globe, The San Francisco Chronicle, and The innovative approach, which Houston Chronicle all published editorials in support implicates NGOs in the Sustaining political will, and thus sustaining the of the TB legislation. implementation of the State’s TB fight against TB, requires mobilization from the The editorials echoed the press release of the lobbying programme. bottom-up, within and across networks of concerned organization which stressed the importance of TB both A district TB control committee as a global disease and as a threat in America. “Since (modelled on the AIDS Control NGOs, community groups, citizens, and ground to epidemics show little respect for borders, it’s definitely committee) has been set up in mid-level bureaucrats. The United States did not pass time to worry [about TB],” wrote the Minneapolis Star each district to ensure a regular funding for the fight against TB globally until year Tribune. The Houston Chronicle editorialised that drug supply. 2000 when a network of grassroots organizations “world travellers run TB risks every time they step on The Health Initiative NGO plans mobilised for the cause. In the Netherlands, on the an airplane.” The Washington Post reported 16,372 to refurbish its website with other hand, widespread education and information cases of active TB in the United States in 2000, and information and advocacy campaigns by NGOs mean that the country has long that “more and more people are dying of it,” implying material on TB the need for action. Every article (not just the (www.healthinitiative.org). The been an international leader in the global TB editorials) used statistics to show that TB was a NGO notes that there is a paucity campaign. problem. of information on the TB Every editorial supported Representative Brown's bill, situation in India, notably on with words like, “This is a bill that deserves to pass multidrug-resistant tuberculosis, straight away” from The Star Tribune. The San as well as the performance of the Francisco Chronicle concluded "that bill could save the Revised National Tuberculosis lives of millions." Control Programme (RNTCP) in districts implementing DOTS. HIGHLIGHTS_RET POUR PDF 17/10/01 11:36 Page 8

DEMOCRATIC REPUBLIC OF THE CONGO From a meeting with the Director of the National TB Programme, Dr. Henriette Wembanyama. Social “We are a country at war,” says the Director, not mincing her words, "and therefore our situation is very difficult”. Political Awareness “World TB Day meant an opportunity to publicize our Mobilization results in case-detection. We had a two fold objective: use advocacy and information to expand voluntary detection

and to improve the quality of that detection. After all, a [email protected] National TB Programme good DOTS programme does not start with the 8 administration of drugs, it begins with the efficiency of the Sultanate of Oman: 9 programme in identifying cases that must come under Football match organized for World TB Day. ocial mobilization requires treatment. Once this is accomplished, then the proper Information Education treatment can succeed.” S and Communication (IEC) “Besides, we were very lucky on World Tuberculosis Day,” she added. “Our new President Joseph Kabila chose to Democratic Republic of the Congo: come to Kinshasa General Hospital to administer drugs to Congolese President Joseph Kabila As it was understood at the United Nations at the Kinshasa General Hospital. OMAN TB patients, on his first official field trip after General Assembly Special Session on HIV and moving into the Presidential office. Health officials in AIDS held in June 2001 in New York City, effective Oman supplemented As a result, TB got much coverage in the social mobilization against a disease requires infor- press.” World TB Day outreach to hospitals, schools, and com- mation, education and communication (IEC). However, each country has to refine these concepts The Health Minister also visited a Kinshasa munity centres with a foot- [email protected] of Health Ministry prison on the day, ball match, adapting the to apply it to its own cultural paradigm for it to to stress the difficulties in access to global theme to: “DOTS: The work. treatment and the need for speedy remedy. Winner,” which was printed on the contestants’ T-shirts, “WHO organized a workshop with TB control is not that different from HIV/AIDS and officials gave educational journalists and a press conference. There folders (see below) to the control, even if the former is an airborne disease with has been a lot of TV coverage, with a 2 000 spectators. Press cov- an easy cure, and the latter a sexually or blood borne special spot on the topic.” erage further multiplied out- disease with only lifelong treatment and no cure. “Essential to the sustainability of our efforts, we have reach. Oman officials established a partnership with the Association des stressed the importance of In both cases, people, especially including Communicateurs en Santé, the Health Communicators DOTS, and said the word “all” preliterate, semiliterate people and disadvantaged Association, a group of people who are actively engaged in in the theme was very impor- health education. They operate around the idea that we tant. “All countries,” they groups, must be informed in ways comprehensible to YEMEN must reach deep into the population by visiting people and wrote, “should give free and their specific culture as to the disease and the available bringing to them knowledge about health in general and One aspect of Yemen’s equal treatment services to remedies. “DOTS: TB Cure for All” is a wonderful TB in particular.” Anti-TB Association's nationals and non-nationals slogan if people understand the meaning of it. (YATA) World TB Day “World Tuberculosis Day saw the launching of Stop TB Fax:967 1 252189 Yemen Anti-TB Association without any discrimination.” campaign featured an hour- mobile teams, which will foster TB case-detection, carry out long TV roundtable interview Community leaders, rural leaders, slum dwellers identification of sputum positive cases, and set up with TB experts aimed at or refugee camp representatives also must be supervised treatment throughout the land, even in remote decision-makers, donors, and informed. This has been understood in those States of rural areas, thanks to the mobile prevention teams that NGOs. Their overall media have operated with success against other diseases such as India undergoing rapid DOTS expansion. campaign aimed at the sleeping sickness.” community and patients. The Stop TB mobile team is the core activity of Although faced with a lack of The press, both local language press and national development NGOs such as the 'Centre for Integrated budgetary resources and little media, must communicate the message constantly. A Development', a group operating with assistance from the time to prepare, YATA felt the network of health care providers and information Belgian government and international NGOs. multi-media campaign, using relays must exist to radiate and penetrate deep into the “Even though we are very poor with, at times, extreme posters, TV, radio, and population and keep the public informed, motivated limitations in resources, we have been able to make strides newspapers, did raise and disease conscious. in improving DOTS by using innovative and participatory awareness of TB. concepts from the community, such as the roving mobile The stigma must be removed from both TB and detection and information health teams.” HIV/AIDS for control to become effective. HIGHLIGHTS_RET POUR PDF 17/10/01 11:37 Page 10 Social Mobilization

TOGO INDIA/MUMBAI It is no accident that both the Nepal and the Inspired by the last Conference of the International A “KARM Union Against Tuberculosis and Lung Disease African DOTS CENTRE” Indian State TB Control plans copy the AIDS control Region in Conakry, which placed emphasis on social society strategy, creating a “TB control society”

KARM is a nongovernmental [email protected] RNTCP mobilization , the Togolese Association for a Sustainable [email protected] APDFD which, as in AIDS, brings together politicians, TB Social Mobilization Promotion of the Disadvantaged Woman (APDFD) social welfare organization experts, health staff, NGOs, and community made extensive plans to mobilise community involved in school assistance representatives. representatives on the TB issue in a series of meetings. and eye problems surveil- One such meeting brought together female rural lance that has recently community leaders to carry out advocacy campaigns in become involved in a com- The private sector must be made to stop the poor the rural areas, informing people about symptoms of munity programme on DOTS. medical practices largely responsible for multidrug-

10 [email protected] ASTODEC 11 TB and how it is easily cured when treatment is It has opened a "KARM DOTS resistant forms of the disease, and public/private properly followed. Their theme was "Together against centre", distributing informa- collaboration is a must. TB in the rural areas", and participants heard from the tion and guidance, and oper- But to do that, a DOTS control centre must take person in charge of TB and Leprosy in the Kpalimé ating a referral centre for it upon itself to propagate the DOTS-related area, a journalist, a public information representative people who think they may and two development NGO leaders. have contracted TB. information to the middle class or lower middle class A large demonstration was medical practitioners, while placing emphasis on the For those meetings, skits were prepared in local organized on World languages from which a videocassette was made for proper training of medical students very early in the Tuberculosis Day (see pic- use in TB advocacy. Audio interviews and educational curriculum. Nepal and India have developed ture) with a "Tableau Mobile material about TB were also prepared in local initiatives of this kind, South Africa has become aware Campaign"—street education- languages, to be played on local radios. of the problem and the need for mass social al with theatre—travelling APDFD suggests that it was important to mobilise through the city, that was mobilization . concerned United Nations organizations, starting with inaugurated by the State’s As Archbishop Desmond Tutu said, in the fight the World Health Organization, but also the Food and Welfare Minister. against TB, as against all social ills, “you are all Very Agriculture Organization, the United Nations Special Persons, each one of you is a VSP! Each Development Programme, the United Nations Togo: role play organized by the APDFD, one of us! ” It depends on every one, regardless of a trained volunteer observes the patient Population Fund, etc., so that they become involved locally taken her medications. in advocacy and support for TB. class status or country, to partake of that disease ASTODEC, the Togo Association for the Defence of consciousness, so that the old WHO Alma Ata Consumers (Association togolais pour la défense du “Health for All” Declaration will some day be real. consommateur), member of the reputed international NGO "Consumers International", celebrated World TB Day with the theme "DOTS : Tuberculose, Guérison pour tous" (Cure NIGERIA for All) with the participation of all its members and TEEPAC, a voluntary supporters, and representatives of both the government and NGO, was the main the health services. organizer of World The mobilization entailed a press conference with the Tuberculosis Day events in Human Rights Commission of Togo on "improving Nigeria. Holding events in five life in prisons". districts, the organization helped found a government action committee on TB in Togo: role play organized by Togo: Anambra. The largest rally was PO Box 312 Hiala Research Unit the APDFD, launch in Njaba, where there was a the patient is of World TB Day among truck motorcade, a 3 kilome- completely cured after DOTS disadvantaged ter march and a rally that was treatment. women in a rural reported to include a "Who's area. Who" assemblage of state government and NGO offi- cials. Elsewhere, TEEPAC organized rallies that included local government officials, school children and market women. HIGHLIGHTS_RET POUR PDF 17/10/01 11:38 Page 12 Social Mobilization

HAITI THE FORMER YUGOSLAV REPUBLIC OF MACEDONIA Haiti is small in population, widespread participation but bears a heavy TB was the key to success Asking the NATO’s multinational army force (KFOR) in the for- and HIV burden. since treatment adherence mer Yugoslav Republic of Macedonia if it and observation require the use would be possible to fly a helicopter over Planning for World Tuberculosis of volunteers in this resource- Macedonia to distribute informational flyers Day brought together the direc- [email protected] Ditiu Lucica Social Mobilization poor country.

was not Lucica’s idea of how a smooth World tors of Haiti's health services, [email protected] National TB Programme TB Day should go. In the end she had to set- NGO representatives, and the In the northern part of the tle with the chopper only flying in Albania, but National TB Programme. Using country there was a meeting her TB day campaign received prominent information from the Stop TB with the press, while, in the news coverage. Organising a brainstorming Partnership, they decided they north- western part of the needed to capture the attention island, no less than 14 primary 12 meeting a month in advance “with all possible 13 stakeholders,” involving officials from all levels of the population at large. To and secondary schools took of government and schoolchildren, Ditiu do this, they utilised an educa- part in information sessions. To ensured that the tional song, called "Solityon se achieve sustainability, the media would take DOTS la" in Haitian Creole organizers have envisioned the notice. ("Solution? It's DOTS, there!"). use of continuous radio pro- Considering the importance of grams and interviews, regular TB in the country, emphasis community meetings, and they The former Yugoslav was put on free treatment. would like to "encourage deci- Republic of sion-makers to create a local Macedonia: Concomitantly, organizers branch of Stop TB." poster sought to communicate that distributed Macedonia: leaflet distributed for World TB Day. in shools for World TB Day.

ALBANIA SLOVAKIA In Albania, the helicopter Since Slovakia felt that spectacle was supplemented TB was under control in with a drawing exhibit by students the country, officials used MALDIVES at a local art school, a banner pro- the message that “ill people The Maldives, with one of South Asia’s claiming “TB Treatment is Free and [email protected] Ditiu Lucica need treatment. Care and Accessible to All,” and Miss Albania medicine are available for all.” benchmark TB control programmes, felt the handing out flyers. Lucica Ditiu’s need for social mobilization was with their chil- National Institute of TB and Respiratory Disease dren. The Ministry of Health of the Maldives, in addi- imaginative public awareness effort [email protected] also targeted government leaders: tion to a news campaign, turned to the country’s every member of the Parliament youth. Schools across the islands held work- Fax: 960 316598 National TB Program received an shops, parades, and TB quiz contests, and information there was a meeting with higher officials and packet on TB, secondary schoolchildren chaired by an Atoll the first lobbying chief. The next day, 74 schoolchildren attended effort of this a workshop on TB awareness so they could organize awareness campaigns in their own scope in Albania. FEDERAL The Maldives: REPUBLIC educational communities. schoolchildren have already OF YUGOSLAVIA poster on TB. effectively proved elsewhere their capacity as The Federal Republic educator of adult parents in smoking cessation of Yugoslavia had the campaigns or environmental issues, why not National TB Co-ordinator TB? Some work was also done to reduce the and Protection A3gainst TB, Municipal Institute for Lung Disease Albania: social stigma associated with TB patients and helicoper give a lecture on state TV disseminated and radio. While Yugoslavia to alert policy-makers to the continuing need educational has implemented a “DOTS- to fight TB. leaflets. like program” for many years, The health care system, adapted remarkably to this programme has not the scattered islands of this country, uses med-

worked well with the Roma [email protected] ical and political leaders (the Atoll Chiefs, who population. The government also serve as social advisers) to implement a committed to working with DOTS programme that effectively reaches 97% NGOs to target TB programs of the people. for the Roma. HIGHLIGHTS_RET POUR PDF 17/10/01 11:38 Page 14

INDIA/ANDHRA PRADESH Mahavir Hospital and Research Centre, TitleIncreased Hyderabad, organized an event with much media coverage. There, a public/private project started in 1995 and sponsored by the World Health

Organization and the Department For International [email protected] Mahavir Hospital, Dr. K.J.R. Murthy Access to TB Development of the United Kingdom is being carried out. This project currently reaches 500 000 population. Increased Access to TB Care The Hospital TB Unit individually contacted all the private practitioners in the area and requested them Care to refer their chest symptomatic patients to the chest India, Calcutta: the rally on World TB Day 2001 14 clinic. After an initial treatment in the presence of about to start. 15 family members, patients were moved to the n innovative approach to the celebration neighbouring DOTS centres, nursing homes in the of World Tuberculosis Day can promote catchment area. Conversion of acid-fast bacillius INDIA/RAJASTHAN A smears from positive to negative and cure rates are and expand access to treatment. In many now in the range of 95-98%. In the 13 Southern ways, this was demonstrated by the States in India, The newspaper the Hindu, said, “It was that same Districts of Rajasthan, a vast country of 1.2 billion inhabitants, 14 million hospital which shot into fame same day last year World Tuberculosis Day INDIA/ TB cases, 30% of the world’s burden. With a large was used as an opportunity TAMIL NADU when then United States President, Mr Bill Clinton, loan from the World Bank, India has embarked on visited and gave final dose of TB drugs to three to expand the DOTS [email protected] RNTCP In Erode, the District a vast initiative to revamp its National patients under DOTS.” programme through every TB Control society, Tuberculosis Control Programme (NTCP) into an Marking World Tuberculosis Day, three patients, a conceivable means. organized an event with young girl in traditional dress, a woman and a man, For example, Udaipur health and political leaders, efficient DOTS-based programme that goes by the who migrated to the city as construction labourers, organized the most extensive which served to train 160 name of the Revised National Tuberculosis Control

were administered their last dose of TB medicine by outreach efforts. Banners and physicians and 1,400 [email protected] RNTCP Programme (RNTCP). Mr Akkineni Nageswara, veteran movie actor, pamphlets were printed and paramedical staff, according Mrs. Shobba Naidu, noted classical dancer and Dr. widely distributed, in every to a local paper. The initiative presents both a technical and Nalini Krishnan of a Chennai-based community health post and public area. organizational challenge, at the same time as its speed initiative against TB. The New Indian Express For two days, one person in announced, “The World Bank and efficiency in execution depends on the awareness an auto-rickshaw and one on Mr Nageswara turned nostalgic and remembered the assisted Revised National TB of the poor population and of the public and private a Tonga (a transport vehicle) role he played as a TB patient in a film three decades Control Programme (RNTCP) distributed pamphlets to health sector. ago. That was the time when popular perception was will be commenced in 17 people, displaying a banner that TB meant death. But thanks to medical districts, including Erode from on the rear of the vehicle. The organizational challenge was met by advancement, the disease could be totally cured. But, May.” The unique programme modelling the District TB committee on the “this message should reach the poor and ignorant A morning rally was held in Erode is modelled on the masses,” he said, and offered to do his part in with 100 schoolchildren, AIDS Control Society. The successful AIDS Control Society, bringing together spreading the message through TV channels. holding banners and then training will allow one NGOs, health staff and District or Municipal political walking through town. microscopy centre per and administrative representatives. Planners met the In the middle of the slum 100 000 people, and one TB technical challenge with a star-like structure, with India, Orissa: area, a meeting was called centre for every 500 000. Patient-provider interaction meeting. every microscopy centre serving an array of treatment where a physician explained centres themselves advising other local health outlets DOTS. or public services corporations. Ajmer, Banswara, Bikaner, Chittorgarh, Churu, For advocacy, those Districts that are moving Dungarpur, Hanumangarh, Jhunjhunu, Nagar, Nagaur, ahead to bring DOTS to their population used an Rajsamand and Shirganga array of instruments to reach the WHOLE each had many events, from population. street puppet shows to a Town Hall meeting with Slum area meetings brought together several district and local officials, hundred people in each city; India, Tamil Nadu: slum area meetings with Invitation card for Rural people were also involved; banners and posters the World TB Day rally and hand bill everywhere. distributed during Large street rallies and marches involved many the rally. schoolchildren everywhere; HIGHLIGHTS_RET POUR PDF 17/10/01 11:39 Page 16 Increased Access to TB Care

Lucknow

INDIA/UTTAR PRADESH In Jayant, The Indian Banners, posters and flyers on DOTS were used in Medical Association, the street, on moving auto-rickshaws, in and Singrauli Branch sponsored an around public meetings, in the streets, around educational session on TB and treatment centres; multidrug-resistant TB. The Chief of Medical Services briefed Medical know-how meetings were abundant, medical staff and the general bringing together up to 1 000 people each and Increased Access to TB Care public on the importance of addressed a large body of private practitioners, educating people and treating students and teachers, representative of public TB, indicating the seriousness of services - such as Railroads and Defence - which 16 the TB problem in India. 17 were not sufficiently conscious of proper The audience was reminded that treatment procedure, such as the basic drug if an employee suffers from TB and is not treated, he not only combination for good treatment; causes harm to himself but also Political meetings with politicians and health to society and to the productivity services leaders were also held at times including of the company. Both public and private sector companies are movie stars and other celebrities, with plenty of now beginning to realise that TB media; poses a genuine threat to the Radio programs ware produced for media, India, Uttar Pradesh: World TB Day rally in Lucknow. workforce and the marketplace, and the only way to curb the briefings were prepared and local media guides in

spread of TB is through [email protected] Health and Development Initiative local languages. INDIA/BIHAR information, education, The Revised National TB Control Programme newspapers also gave extensive communication, and DOTS. The whole programme was centred on DOTS. (RNTCP) of the Vaishali District, organized an coverage to the World Tuberculosis Day The Director of the Health and 1) Politicians were solicited by officials from the event on “DOTS, a great success in Vaishali”. events. Development Initiative, an The State Government of Bihar sent About 800 people participated in four major National TB Programme to announce that new Indian NGO organized to representatives to the State event on World functions in Patna, Vaishali, and Muzaffarpur. Districts would come under DOTS. generate public support for early Tuberculosis Day, including Central government Overall there was 2) District TB Centres propagated both DOTS inclusion of the districts under representatives and NGOs. A WHO consultant the determination to the Revised National Tuberculosis training to local treatment centres and awareness noted that World TB Day “really helps us to involve every sector Control Programme based on DOTS: of the advantages of DOTS to the general gain publicity for DOTS and bring together of society to make “This was most appropriate for population. people from various forums to chalk out future DOTS available, World Tuberculosis Day since the strategies.” accessible and 3) Local treatment units informed surrounding revised programme at present acceptable to one populations of the free treatment. includes few districts and it was A full-page four-colour supplement was and all, in spite of 4) Private practitioners were reached to modify their necessary to expedite benefits of published in the Hindustan Times, the largest the adverse DOTS to the country as a bad practice. English circulation newspaper in Bihar, using conditions existing in this “poorest part of whole,”said Dr Dinesh Kumar, 5) Community meetings in the middle of slum areas the World Tuberculosis Day information pack India”. The TB district leaders have plans to [email protected] Dr. Rajendra Yadav the NGO director. informed thousands of very disadvantaged poor prepared by the Stop TB Partnership. Other train rural Anganwadi workers, traditional practitioners and community Elsewhere, the newspaper people that DOTS was there, what to do and who leaders, as DOTS providers to Sunday Pioneer reported that in to see in case of symptoms. achieve decentralization of DOTS. Uttar Pradesh each district will A microscopy cum DOTS Centre have a DOTS centre. At a seminar This initiative to improve and expand TB was inaugurated in the Nalanda in Lucknow, the state capital, the programs is much needed. WHO's Director General State Health Minister Medical college in the Patna Dr Gro Harlem Brundtland has warned that global district, and one in the announced plans for the Muzaffarpur District in the expansion of DOTS. efforts to control TB would be futile unless the presence of hundreds of disease were contained in Asia. Proper practice as teachers and students, followed regards treatment needs can be disseminated on by a seminar. World TB Day and beyond. Factors such as the spread of HIV/AIDS, spread of multidrug-resistant TB and an increase in migration within and among countries further indicate the importance of rapid DOTS expansion. HIGHLIGHTS_RET POUR PDF 17/10/01 11:39 Page 18

LEBANON The Health Ministry proudly reports Sustainability that TB cases have fallen from 33 to 15 per each 10 000 inhabitants thanks to DOTS. The percentage of cured patients has gone from 70 to 97%. This represents the highest success rate in the Middle East, going over WHO's target of

Increased Access to TB Care Bosnia and Herzegovina: educational poster and an 85% cure rate. leaflet produced for World TB Day. The WHO representative in Lebanon 18 reported that in 1995, only one country in 19 the region applied DOTS, while today 20 TB Control programme is sustainable if out of the region's 23 countries do. He the community, country, or world in reported that mobilization , and not A rejoicing, was required as there still were which it operates is continuously 650 000 people with TB every year in the The Russian Federation: motivated to make it work over the long term. winner of the children’ poster region, and 115 000 would die of TB. competition organized for World TB Day. What would happen in crisis and catastrophes if Some 43% of TB cases are in Pakistan and public assistance, relief, security forces and the like 12% in Afghanistan, a situation that is due INDIA were motivated one day a year? to the non-application of DOTS, he said. World Tuberculosis Day saw the launching of the Sustainability means a concerted effort for web site durability and depth of commitment. http://www.tbcindia.org and the PHILIPPINES publication of the Revised Sustainability is achievable when there is a crucial National Tuberculosis Control For us, DOTS TB Cure for All was (Kabalikat sa Programme Status Report TB mix of State and NGO partnership and a strategy that a very appropriate theme, Kalusugan), which will India 2001. The Deputy Director reaches deep into the poorer strata of the country and report people from The implement the DOTS-plus General of the TB division in New contributes to its empowerment. The Russian [email protected] Tropical Disease Foundation Philippines. “For our country, Pilot project for the Delhi commented that his plan Federation realises that mobilization must be of we emphasized two aspects of management of multidrug- was “to make it a campaign yearlong duration. TB: TB as a disease of poverty resistant tuberculosis. rather than a one time event”, and access TB treatment as a even though the national event basic human right,” wrote one The World Tuberculosis Day was quite successful and the The Democratic Republic of the Congo has official. “With the inauguration celebration included WHO, the news reached millions through developed sustainability through the use of a mobile of the DOTS Plus project, the Ministry of Health, the Partners the press. Stop TB team. This team goes to the population with national TB day mobilization in Health and TB medical The Indian Express newspaper health education, enhances voluntary detection of ensured greater access to officers, the PhilCAT reported, “The new TB programme treatment for multidrug- organization (Philippine cases and ensures the proper village-based will reach 400 million people by resistant tuberculosis patients.” Coalition Against Tuberculosis), implementation of DOTS. A model of this kind the end of the year” according to and main pharmaceutical originated in the struggle against sleeping sickness the Health Minister, who added “Meanwhile, more people have corporations. before second World War, and was brought into become aware of TB treatment that the DOTS-based programme had doubled the number of present day disease control by Belgian and Congolese as cheap and efficient, and we The Tropical Disease people reached from 136 million medical experts (with backing from the Belgian expect that the World Foundation and the Makati in 1999 to 360 million in 2001, Tuberculosis Day events will Medical Centre - the Centre government and international NGOs). spreading faster than anywhere serve to increase referrals from has a clinic-based programme else. both government and private providing supervised treatment To increase sustainability, the World Tuberculosis sector,” the official concluded. to both drug susceptible and On World Tuberculosis Day, the Day mobilization needs the private sector. For the multidrug-resistant TB cases Municipal Corporation of Delhi private medical sector to perform, it needs a solid A Memorandum of Agreement (DOTS and DOTS-plus) - have announced it would open DOTS public sector in partnership. This is increasingly the was signed on World formed a Partnership to handle centres in each of its 134 wards. Tuberculosis Day among DOTS-plus administration for Across the nation, local efforts to case in Nepal and in some States of India where participants for the launch of a multidrug resistant tuberculosis educate, implement DOTS, and DOTS is expanding. Without these links, treatment of Partnership in Health cases. train officials were under way. TB will never be possible, much less sustainable. HIGHLIGHTS_RET POUR PDF 17/10/01 11:40 Page 20 Sustainability

RUSSIAN FEDERATION The Russian Federation, day affair, but, that 2001, and prizes were formed a TB Organizing would mark the beginning of awarded during the TB Sustainability Committee to elaborate a a year long campaign of day press conference. strategy to improve TB sensitisation and thereafter,

treatment access and that special Day would just be For the press conference, [email protected] Wieslaw Jakubowiak awareness. The TB Committee a peak of a sustained drive to political awareness of the TB brings together government get TB under control. issue was exemplified by the representatives and NGOs presence of the Minister of around the concept that The organising committee Justice of the Russian World Tuberculosis Day is very agreed on the mechanisms to Federation who spoke of the 20 useful as a reminder of the develop a campaign of prison situation side by side 21 Sustainability means "no" to private practitioners' magnitude of the TB problem, awareness for the 2001-2002 with the Health Minister and for its capacity to draw period. the WHO representative. ignorance and poor treatment practice that fosters a attention to TB, to unite Participants also included the The Russian Federation: world-wide epidemic of multidrug-resistant TB. governmental and The Russian TB Organizing Director of the Research Press Conference for World TB Day 2001 organized jointly by the Moscow office of WHO, Médecins nongovernmental forces on Committee distinguished itself Institute of Phtisio- Sans Frontières, Russian Red Cross Society, The need for sustainability is even truer for poor MERLIN and Public Health Research Institute. the issue and to foster a by modifying the WHO chosen pneumology, the Central TB than for very rich countries. True, TB negligence in common understanding in the theme for this year “DOTS: TB Research Institute, the New York was overcome with thorough political, value of solving the TB Cure for All”, choosing instead International Federation of problem. “TB against Society, Society Red Cross and Red Crescent social and media mobilization, but at the cost of against TB.” Societies (representing almost one billion dollars. What developing country Consequently, it was decided the NGOs). city could afford this kind of expense when disaster is that World Tuberculosis Day A children’s poster evident? would no longer be just a one competition was organized ISRAEL The Israeli Health Yet it is possible to build and sustain a TB Ministry decided to programme anywhere, if the problem is dealt with extend WTBD into a two to holistically. The Maldives has built an exemplary three month campaign programme relying on public education programs among the primary health care staff and social workers and non-health officials. These programs work [email protected] Control Supervisor TB quality with regional and local because the Maldives also invested in an educational workshops and educationals. structure that is able to produce very high literacy rates. Peru has built a successful programme based on Since Israel has already the political will of leaders who viewed TB treatment achieved a low prevalence not just as a health problem but also as part of poverty rate, emphasis was placed on PERU alleviation. The Democratic Republic of the Congo, DOT - good compliance For World TB Day, national dedication at local through observation. The TB while poor and affected by war, is keeping the World organisers managed to levels to produce Control Programme noted Tuberculosis Day mobilization live by empowering successfully air messages on these effects. Peru has that it took some efforts to its people to request TB control. the TV, radio, and Internet, also effectively teamed with convince staff that TB was

as well as conduct meetings NGOs and international [email protected] National TB Programme indeed a priority. As seen in between national, local, and agencies like the World many developed countries, other organizations. Health Organization and the decrease in prevalence can Pan American Health lead to complacency which is Myanmar: Russian Federation: Over the past years in Peru, Organization. This World TB soon followed by a leaflets and poster produced bt the National TB Programme poster from the children’s the TB treatment Day, organisers sought to resurgence of the disease, as competition. for World TB day 2001. programme was seen as a maintain these ties, and was experienced, for part of the fight against further reach into the example, in New York. poverty, and 100% of the private sector. They estimate population has access to that their campaign reached In 2001, the TB Plan called DOTS. Strong political 30% of the population, and for a working network to be commitment and leadership that they charted a strategy established between TB at the top partnered with for better diagnosis at the specialist and community effective management and local level. leaders and representatives. HIGHLIGHTS_RET POUR PDF 17/10/01 11:41 Page 22

RUSSIAN FEDERATION The Contagious Concert Media and In Moscow, Doctors without Borders held a “contagious concert” in which young musicians performed works by composers who suffered from tuberculosis, such as Chopin, Community Liszt, Shostakovitch and Stravinsky.

Médecins sans Frontières Russia [email protected] Events Media and Community Events 22 SWAZILAND 23 The Ministry of Health KENYA he media undoubtedly are an important decided to prepare the The Mount Kenya Community (MKC) Health bridge for people fighting TB to spark country for World Days celebrated the struggle against diseases T Tuberculosis Day by holding and the promotion of good health and economic political will, reach out to the population a training session two days development from March 21-24, 2001. The MKC is a for social mobilization, convey information about before World Tuberculosis Swaziland: unique project combining TB advocacy, with global educational leaflet distributed TB, and stress the need for a sustainable effort. Day. This session trained advocacy against poverty alleviation in selected rural during World TB Day. Similarly, community events bring people together workers at all levels and also communities of Kenya and three of the greatest for a cause, triggering conversation and, thus, are stressed how important it diseases affecting mankind: TB, HIV and malaria. [email protected] Mr. Anson Zwane more likely to stay in memory than a newspaper was for health care workers The World TB week MKC Health Days were organized article. to involve the relatives of TB in a community with small scale farmers who mainly SRI LANKA patients. cultivate cash crops such as macadamia nuts and The media in Sri coffee and food crops such as maize, beans, bananas A media campaign or a community event must Lanka stressed the The day before World and a variety of vegetables. [email protected] Foundation Kenya DIP outbreak of multidrug- suit the situation where it is presented. In Somalia, a Tuberculosis Day, the Health The MKC Health Days consisted in the setting up of a resistant TB on the island and play was used because of the country's strong oral Ministry held a session for microscopy-screening centre at the Kimweas youth the need to complete the tradition; such a strategy may not be as effective in the journalists, since they have polyclinic. Sputum was collected and screening for entire six months of the drug an “inherent communication mycobacterium tuberculosis was conducted for three UK or USA. Somalia was able to take that program. Of the total 8 000 advantage” that allows them days making TB screening accessible to a rural community event and turn it into a media tool by TB patients in this country, 50 to educate the public. They community where access to medical services is videotaping it for later play on television. have multidrug-resistant TB. stressed to the journalists a difficult, and provisions were made for access to Elsewhere, medical seminars comprehensive picture of TB, have direct observation of treatment. People were were held for alumni of local Australia and the US both saw grassroots NGOs explaining its symbiotic also screened for diabetes. medical schools. These organize media campaigns specifically to influence destructiveness with HIV/AIDS On World Tuberculosis Day, the partners in the MKC seminars updated doctors on and the need for proper Health Days organized a march and a rally with each country's role in the international fight against the HIV/TB co-epidemic, and nutrition. The Health Minister speakers from all partners: the Mirichi organic TB. They both adopted a strategy which posed TB as stressed that all levels of the herself shared stories of her farmers association, the University of Nairobi’s Centre a problem needing a solution, stressing that no health care system need to experiences when she was for Behaviour and Health Studies, the Swiss DIP be informed about TB country is safe from TB. The UK, on the other hand, once treated for TB. Foundation, the Kenya Nut company, the Kenyan treatment. decided that its weakening health services for TB at Health Ministry, the Diabetes Information Centre home should be the most prominent message. Egypt On World Tuberculosis Day (DMI), the Medvantis group of Winterthur Insurance Organizers for World TB Day itself, information brochures (Credit Suisse, Switzerland), Roche Diagnostics, and combined the forces of anti-TB and anti-tobacco ran programs in 11 out of 25 (see picture page 23) were Cosmos Ltd of the United Kingdom. advocates to achieve the greatest possible media districts. These programs handed out at bus stops and There was street theatre, drama and music and many saturation. varied from displaying other busy places, and the festivities with the participation of the primary, banners and parades with A media strategy that saw little use was the government announced plans secondary schools and polytechnic school. schoolchildren bearing personal interest story. This is regrettable since the to build a TB hospital This event is part of a series in Kenya’s farming educational posters to health stories of individuals struggling against TB often are by 2002. communities, conducting Information, Education and camps screening patients for the stories that make a big impression on people. Communication (IEC) activities against TB, HIV, and TB. Nationally, World TB Day malaria, as a follow up to the Massive Effort Against Media outlets, with fierce competition for space or gained press coverage in the Diseases of Poverty meeting held in Winterthur air-time, may reward outreach efforts with only a national newspapers, TV in 2000. interviews with chest limited space, and thus use more succinct statistics to physicians and the telecast of tell the story. On the other hand, a "good" story will a docudrama on TB. command media attention. In the United Kingdom, HIGHLIGHTS_RET POUR PDF 17/10/01 11:42 Page 24

SOMALIA Media and Community Events 2001 marked the third the outbreak of TB at a local school meant that year that World EGYPT national newspapers published long, in-depth, and Tuberculosis Day was personal stories with accompanying photos. Such Health officials in celebrated in Somalia. All three coverage certainly mobilises people to take action Egypt linked smoking days were celebrated only in the and tuberculosis for their northwestern Somaliland, with against TB; in these cases, the political will of people

World TB Day campaign, [email protected] Emmanuele Capobianco, WHO EMRO most activities limited to a single needs to be sustained.

making possible a thorough city. This year, the Mayor of [email protected] WHO Somolia media campaign. Among the Mongolia: Burao’s support for the Burao Local areas focused their outreach efforts more on activities were: a ceremony organized for World TB Centre brought the TB Day 2001 in the Chingeltei combating discrimination and emphasising that TB is Five TV spots run at prime celebration there instead of the district in the capital city. a curable disease, if treated properly. These more viewing times. city of Hargeisa as it was in past Media and Community Events Songs, dramas, and years. positive media campaigns were also popular in places 24 interviews played on the Limiting the activities to Burao, where TB is more of a burden. In these places, people 25 radio and a mobilization however, did not limit outreach generally know TB is a problem; but need campaign in the national to only that city. By videotaping encouragement to take action that will alleviate the newspapers stressing the all the events, they were replayed problem. Thus, media and community events were double burden of these on TV with narration for a wider primarily educational, not political. two scourges. audience. It was also a headline The display of cartoon event on the radio news posters designed by program. Activities included famous artists in public speeches, banners, and a drama areas. (a vital form of communication in The distribution of Somalia’s oral culture). informational leaflets to mosques and churches for UNITED KINGDOM reading at prayers. Nothing can attract the A few weeks before this in the National Health media’s attention to TB more outbreak, three charities, TB Service plan, free drugs World TB Day also marked than the disease itself. An Alert, Results United Kingdom, for treatment, and more aid the decision to start GAMBIA outbreak of a virulent, easily and Ryder-Chesire teamed to to fight TB abroad. They implementing DOTS in prisons spread strain of the disease at lead an all out media pointed out that there are still “I lost two sisters who were TB patients and did not and to ban smoking on all a school in Leicester a few outreach campaign on World not enough nurses trained to recover from it,“ wrote Abdoulie Cham, Coordinator of university campuses. weeks after World TB Day TB Day in the UK. By sending handle TB cases, and that a

the Society Against Tuberculosis, Lung Disease, [email protected] TB Alert attracted the attention of out press releases and lack of funding for TB resulted Tobacco and Drug Abuse of The Gambia. “This compelled

[email protected] SATLDTDA three major national information to media in health authorities failing to me to leave my job and mobilise people in my community newspapers (The members, over forty articles reach their targets. in the fight to eradicate TB.” This happened six years ago, Independent, The Times, and ran nationwide, with at least and Cham has been fighting TB ever since, whether holding The Guardian), which all ran eight significant articles in A few magazines also ran Egypt: meetings or giving talks in communities, or, as he is now, this poster in depth articles. The national newspapers lengthy articles about TB near as a field assistant for the Medical Research Council stresses the outbreak, reported to have (although none as large as or on World TB Day. The importance in the Gambia. infected 24 children, and those accompanying the Nursing Standard ran an of DOTS “I have decided to use the rest of my life in the fight to and its possibly a further 60, was the outbreak in Leicester). article detailing the countrywide eradicate TB wherever it may be,“ he stated. But his first major outbreak of TB in development of TB treatment implementation. idealism has hit reality: he received no funding whatsoever the United Kingdom (UK) Dr. Ormerod, of the British in the UK. While sighting a for his outreach efforts on World TB Day. Despite this, and in decades. Thoracic Society, stressed the “dramatic rise” in the number through the support of his office, friends, and volunteers neglect TB had experienced in of TB cases in England and (including TB patients) he managed to have an article in the The articles were the U.K. “The belief that TB is Wales, the article spoke well major national newspaper, radio coverage, and a TV accompanied by information a disease of yesteryear has of reforms under Frederick programme. A play dramatising the symptoms, treatment, on TB, and warned that TB led to complacency,“ he was Marais. Appointed the first and effects of TB was run on the radio and acted out in CZECH REPUBLIC may continue to grow as a repeatedly quoted as saying, TB/HIV clinical nurse specialist local communities. threat in the UK. The so health efforts are under in the UK, he was given the The DOTS strategy is Despite six years of working against TB, Cham reports, “I do Independent wrote, “what funded: cases are rising, responsibility for “developing reported to be not have much knowledge or training on TB, except what I alarms public health officials preventive measures are a nurse-led TB service for

[email protected] Unit National TB Surveillance completely integrated in read [in] papers and books [for] on-the-job training.“ He most is the onward march of inadequate. people co-infected with HIV.” the Czech Republic. Their feels formal training, whether long or short term, would new strains of TB which are The three charities pushed a media outreach campaign, help him to be more prepared and effective in the fight resistant to the antibiotic similar agenda in their media however, stressed that TB is against TB. drugs most used to treat campaign. They called for TB still a problem as both health It is committed people like Cham who can make the the disease.” to become a national priority and human rights concerns. difference in TB control. HIGHLIGHTS_RET POUR PDF 17/10/01 11:42 Page 26

NEPAL Best Practice FIGHTING TB: The Lesson from Kathmandu World Tuberculosis Day is a national affair in Nepal, unlike many NEPAL countries where it is a one-day event in a capital city. The National TB Program, Dr. D.S. Bam mobilization to raise awareness on TB and its cure is an event in Best Practice NEPAL [email protected] which the whole country participates and all sectors of society are involved. It is a day when festivities, such as parades, are held, for what is best learned but in fun? Only the naive may believe that children learn by being told. Similarly, activities involving both fun and day- Nepal, Kathmandu: Nepal, Birendranagar, Surkhet, Mid Western Region: 26 to-day work engage the adult population through a participatory students rally students rally for World TB Day 2001. 27 for World TB Day 2001. process, which helps them to acquire an understanding of TB for empowerment.

The Nepal TB Association estimated that the entire population "Information, Education and Communication" was involved one way or another in World Tuberculosis Day. There were street parades, involving elephants, and street theatre plays, IEC, a novel approach to fight TB games and quizzes in Kathmandu as well as in other cities, and celebrate World Tuberculosis Day. involvement of village development committees in community celebrations, TB events throughout the country, and prominent Nepal: attention from the print and audio-visual media. street drama organized by Yala Urban Health Programme a r Dirgh Singh Bam has been a long community group awareness to ensuring that Nepalese Nongovernmental Medical schools and others were enlisted as volunteers for DOTS Organization. time advocate of TB in south-east political leadership understands and is involved in expansion and education, fostering expanded partnership. D Asia. A very passionate man, the making the TB programme a success. Director of the Nepal National TB Centre has developed a campaign strategy that is very effective In Nepal, Dr Bam has also contributed to tbnet, in creating the proper environment for a an informal NGO network that has gained inter- functioning national TB programme. This has national prominence through use of the resulted in Nepal being a model to be emulated in internet for TB mobilization on the international south-east Asia. scene. Tbnet has held an NGO meeting on TB in Activities include: Kathmandu every year since 1997, a gathering that Exemplary collaboration between private and includes NGOs working on HIV/AIDS and NEPAL public health care providers for the proper care People Living With AIDS. International Governmental of TB patients with DOTS. Private sector workforce and management Nepal has developed one of the most sophisti- and NGO support enlisted for TB control. cated bodies of knowledge internationally in The exemplarity of the Nepal TB control strategy and Nepal, Kathmandu: School and community participation in TB regards to TB management. The Nepalese have official World TB Day event with Dr. D.S. Bam, mechanism has been strengthened by an array of key Director of the National TB Programme. international players who provide guidance and financial awareness activities throughout the year and built a unique partnership between state officials support. Norwegian AID (NORAD), supplies drugs, while the not just on World Tuberculosis Day. and NGOs with the concept that informing the Norwegian Heart and Lung Association provides funds for Lobbying and recruitment of political leaders at public was of paramount importance in stopping training, supervision, research, drug supplies national and local level. TB, not as a problem solely for pneumologists. and an Annual Review. Street visibility of the TB issue with World Tuberculosis Day parades, year-long events, Other agencies include JICA (Japanese International “Information, Education and Communication,” Cooperation Agency), WHO, the International Union Against street theatre, etc. IEC, a concept at the centre of the international Tuberculosis and Lung Disease (IUATLD), the United Kingdom (UK) Involvement of NGOs and use of internet strategy against HIV/AIDS as it evolved over the Department for International Development(DFID), The Britain technologies for international advocacy past 20 years, has been a core strategy utilised Nepal Medical Trust, The International Nepal Fellowship, the against TB in Nepal, which means this country's Netherlands Leprosy Relief group, the United Nations Mission Dr Bam’s activities stretch from media TB advocates, and especially Dr. Bam and NGO to Nepal, the German Nepal TB project, and the UK's Nuffield mobilization to one to one advocacy, from raising Institute of Health. personnel, have an international lead in "how to". HIGHLIGHTS_RET POUR PDF 17/10/01 11:43 Page 28

Nepal, Inf, Surkhet, Mid Western Region: NEPAL Best Practice Dr. D.S. Bam, administering TB treatment. TB FACTS 80 000 to 90 000 people have active TB. REPUBLIC OF 44 000 new cases per year. Republic of South Africa, Cape Town: Best Practice NEPAL 20 000 infectious cases Prof. Donald Enarson/Director of Scientific Activities of the International Union Against Tuberculosis and per year. SOUTH AFRICA Lung Disease, the Archbishop Desmond Tutu, Dr. Peter 8 000 to 11 000 deaths Moore /Medical Director of GlaxoSmithKline and Mr Nick Pr. Nulda Beyers NEPAL Koornhof/Provincial Minister of Health during [email protected] per year (a decline from the Launch of World TB Day 2001. NEWSLETTER OF THE NATIONAL 18 000 in 1996). 28 TUBERCULOSIS PROGRAMME TB is a major health problem 29 in Nepal. On the occasion of World Tuberculosis Day, Dr. Bam announced factor that greatly contributes to Treating the social and economic problems of TB Nepal has made excellent that Nepal was actually ahead of plans for DOTS expansion as each successful programme implementation by training people in job skills, the centre aims to progress with the DOTS A of the 75 districts of the country were each equipped with at least implementation since its is the multi-sectored approach. Major fund itself. one DOTS centre. introduction in pilot areas in and key stakeholders must be part and parcel of April 1996. the programme and be part of the By encapsulating all the necessary ingredients He wrote, ‘This year Desmond Tutu said, “Every person with TB has DOTS coverage is now of world TB advocacy, from political awareness to the right to be treated for his or her disease. TB can be cured, this implementation team. This includes people extended to 207 treatment scourge can be defeated. So let us stop denying them this basic infected with TB, and communities affected by media mobilization, the idea of starting World centres and 640 sub centres human right.” In Nepal, we estimate that over 80% of the TB. All stakeholders must have a sense of Tuberculosis Day in that fashion was a good in all 75 districts. population has access to DOTS and our national treatment success Strong political commitment ownership of the plans or the program. demonstration of what the Stop TB Partnership is rate has achieved the international target, however, we still have and active resource all about: using all the creative resources of further to go. mobilization have The opening of the Tyger Trade and Training partners. Will you join us in the fight against TB?’ contributed to the success of Centre (TTTC) brought together the crucial mix of DOTS implementation. The newsletter is a good sample of IEC work as regards TB. “TB stakeholders needed for sustainability: an affects more than just the patients. TB patients are often wage international NGO, local community organizers earners. While they are ill, their families suffer. Without treatment, and politician, prominent social figures, and private parents may die, leaving children as orphans.” companies. The sparkle of the Archbishop Desmond Tutu, the presence of the South African The Newsletter goes on to say that TB is increasing Health Minister, and the smiling faces of children globally because of HIV, and that while Nepal is not among the countries badly affected by HIV/AIDS, the served as an event to bring the community epidemic is “expected to increase in Nepal too”. together. SOUTH AFRICA The State Health Minister called upon individuals, Speech of His Grace the Archbishop Desmond Tutu The Archbishop Desmond Tutu called for the at the Tyger Trade and Training Centre Opening, communities and all other concerned agencies to be Uitsig, Cape Town, Republic of South Africa, World social cohesion that defeated apartheid to show Tuberculosis Day 2001 actively involved in tasks aimed at combating the menace of tuberculosis in Nepal. itself in the fight against TB. He also echoed the “ We have to hear about incidents “Tuberculosis is a killer disease in the country simply Health Minister’s political call: TB is more than a of racism to remind ourselves that it because of the ignorance of its causes and cure among health issue; it is economic, social, and cultural. still exists, even though we know the mostly illiterate and poor people in the remote and Reaching the entire population requires the that it still exists. Similarly, we have rural areas. As the government is committed to provide commitment of local government to alleviate the to hear about the incidents of TB. all the citizens of the country with basic and necessary blight of slums and the dedication of central Understanding can bring helping health care services, there has been a nationwide anti- and concern. In Uitsig, the tuberculosis drive in Nepal. Like in other countries in the government to expanding TB care throughout the community has not sat down and world, DOTS has proved successful in Nepal: However, nation. folded its hands. (…) tuberculosis is still a disease that afflicts many Nepali people.” Set in a developing country, in a high We can defeat it when we as a unemployment area, the event demonstrates what community want what is best, not Among the obstacles remaining are a lack of information needs to be done to reach all the people who need for ourselves, but for us. Not for me, and knowledge among many illiterate rural populations for all of us. We say, 'TB get out of and the tendency in certain communities to hide people to hear about TB. The centre approaches the the way. We want to be well. We suffering from the disease. Therefore, the need for information in problem of TB not just with a multi-sector want our people to be well. We the community is important. approach but also a multi-factorial approach. want our children to be well.” HIGHLIGHTS_RET POUR PDF 17/10/01 11:44 Page 30 Best Practice SOUTH AFRICA

SOUTH AFRICA Interview with Dr Andrew Robinson, Medical Adviser, GlaxoSmithKline, South Africa. SOUTH AFRICA Q: What was your participation in World TB Day? Speech of South Africa’s Health Minister Tshabalala Msimang John Kearney, Chief Executive Officer of our company, GlaxoSmithKline, (GSK), participated in the opening of the Tyger Trade and Training Centre (TTTC), along with the South African Minister of Health, Dr Manto Tshabalala-Msimang. The Tyger Centre is a model for an all-encompassing positive response to tuberculosis, both on the political level and in terms of a sustainable social mobilization. Effectively, the opening by the Best Practice SOUTH AFRICA 30 Archbishop Desmond Tutu ensured total community commitment 31 and involvement in the project and led to extensive media SOUTH AFRICA SOUTH AFRICA coverage. The Launch of Tyger Trade and Training Centre GSK’s financial sponsorship of the TTTC is part of a broader programme called the Action TB Initiative whose success depends World TB Day in The Tyger Trade and Training Centre was opened in Uitsig, in "Access to medicine is part of on community involvement. Cape Town the Western Cape Province of the Republic of South Africa, in an important struggle. We an area of very high unemployment. It is also a town where need community action, and For the first time, the launch Q: What is the Action TB Initiative? one in three households have at least one case of TB. The we need public/private of World TB Day activities The Action TB programme as a whole started in 1993, amounts to centre focuses on teaching skills to the adults of the partnership. This centre was came from a developing 20 million pounds (200 million Rands) and was started in several community, especially people affected by HIV/AIDS and opened by the community. country’s community centre, centres and medical teaching schools. In the Republic of South tuberculosis. Some of the skills taught are knitting, pottery, Community is critical in TB and not a developed country. Africa, the Action TB Initiative is a five-year programme started in dressmaking and vegetable gardening. control." 1998, running until 2003. Furthermore, the key speaker The Initiative focuses on five key areas: HIV/AIDS, children’s health, “This centre showed the was none other than the The Centre also offers workshops for adults on topics as primary health care, community involvement, and continued community, volunteers, famous Archbishop Desmond HIV/AIDS issues. Classes are offered in one of two shipping medical education. health workers all working Tutu, president of the containers donated by Safemarine for this purpose. Members The research principally involves three areas: new targets for anti- together. This is a good country’s Truth and often spend the day, and there is a facility for preparing meals TB therapies, identifying novel vaccine candidates and identifying example. I hope more Reconciliation Committee for children. The project aims to be self-sustainable; when surrogate markers for use in clinical trials. partners, both national and and long time fighter of members sell the products they have made or grown, a international, will follow this apartheid. portion of their profits goes to the centre. example." The Archbishop is an extraordinary personality. The audience was thrilled when he spoke of TB as a human SOUTH AFRICA right, stressing that all human Prof. Nulda BEYERS, University of Stellenbosch, Cape Town, Republic of South Africa. beings, whether rich or poor, Q: How did and to overcome the problems needed for micro-enterprises. are each and every one a the research of a low level of education. The idea is to train a few people “VSP” (Very Special Person). community “I am worth something, I can do and then have them train other become something.” people. The event brought together involved in the South African Health the Tyger Trade and Training Q: Where will the Tyger Trade and Q: Did World TB Day in your Minister, local Health and Centre (TTTC)? Training Centre go from here? country increase access to TB City Officials, the University of SOUTH AFRICA We always felt we needed to It is a long way to go in terms of treatment? Tygerberg and Stellenbosch, Cape Town City Hall give something back to the skill training; we need 2-3 years It is impossible to say whether the International Union Talk with Mr Kenny Newman community. We have initiated a before the micro-enterprise this event increases access to TB Against Tuberculosis and “One cannot fight TB merely number of projects, of which the support “business” centre can treatment, but it helped locally Lung Disease (IUATLD), the with drugs. Unless there are TTTC is the latest. We had the make it on its own. Computer to raise awareness about TB Chief Executive Officer of Republic of South Africa, improvements in the social idea that the creation of training will start with problems. Access to treatment is Cape Town: GlaxoSmithKline (GSK) South Dr. Refiloe Matji, National TB conditions of people, such as a job centre was wanted, but GlaxoSmithKline and we hope a political issue. Africa and community Programme Manager shaking access to decent housing, the request had to come from to be able to receive some Repeated events with many the Archbishop’s hand, with volunteers, not to mention Prof Donald Enarson from employment and training, the community and it did equipment. Then, we are going communities could increase TB the World Health the IUATLD and Ms Sharon the struggle against TB is two years ago. to get a business school to treatment by making more Organization. The meeting Alexander , chairperson of doomed to fail. Here, the 60% of the people here are teach the basics in accounting, people aware that TB is easy to the Uitsig TB Care Group. featured music and primary municipality has a major role unemployed; they are in and a driving school teacher to treat and there is no need to school pupils. to play.” desperate need to develop skills, teach how to drive, three skills discriminate against TB sufferers. HIGHLIGHTS_RET POUR PDF 17/10/01 11:47 Page 32

The Global TB Drug Facility obtains its first US$ 10 million

n World TB Day, the Canadian International Development Agency (CIDA) contributed US$ 10 Omillion to the Global TB Drug Facility (GDF), marking Canada as the first contributor to the fund. The facility intends to reduce the burden of TB by 50% by 2010 by providing needed drugs to poorer nations. However, the objective of this fund is not to replace a country’s own contribution. The GDF needs US$ 50 million a year over the next five years to treat 10 million people. THE GLOBAL ALLIANCE "TB has received too little attention," Ernest Loevinsohn, Director General of CIDA's Food Aid Centre said. FOR TB DRUG DEVELOPMENT “ It's so easy to cure and the economic and health ramifications are huge. This is a landmark project.” During the week preceding could capture a market of World TB Day, the Global “between $300 million and close Alliance for TB Drug to $400 million (US$)” annually. Development held a press con- Evidence shows that compliance ference in Brussels. Most major up to two months of treatment is pharmaceutical companies very good, but that after two develop drugs targeted for the months adherence rates drop. wealthier parts of the world, The Alliance, which was found- while diseases like TB get very ed to organize the development little attention, as evidenced by of much needed new TB drugs the fact that there has not been a to shorten treatment, combat new TB drug for over 30 years. multidrug-resistant TB, and The Alliance sought to point out facilitate treatment of latent TB, the flaw in this logic. Acting seeks to develop partnerships On World TB Day 2001 Médecins Sans Frontières CEO Dr Roscigno argued that between academic institutions, a new TB drug that shortened private research, and public (MSF) organized a special meeting in New York City. TB treatment to two months funding for drug development.

SF sponsored a panel president of the Global TB Drug terms of its efficacy and its ability discussion entitled Development stakeholders, laid to actually reach and treat people M“Defusing the Time out two objectives MSF seeks to with tuberculosis.” Bomb: The World’s TB Crisis” at put on the agenda concerning TB. Laurie Garrett, of Newsday and the City University of New York. First, along with the Global author of two books on TB, mod- The panel stressed the need for Alliance for TB Drug erated the panel which featured Dr cheaper, more effective TB treat- Development, it sees a need to Orbinski and Dr Giorgio ments, the confluence of TB and develop drugs that shorten or sim- Roscigno, acting CEO of the HIV, and the need to make treat- plify TB treatment and address Global Alliance for TB Drug ment more accessible to people in latent TB and multidrug-resistant Development. THE BILL & MELINDA GATES developing countries. Dr James TB. Secondly, he added, “There is MSF runs 13 programs specifically Orbinski, the former president of no question that DOTS is good, targeting TB, including programs FOUNDATION MSF International Council and however DOTS must get better in in Russia and Afghanistan. n the eve of World TB Day, the Tuberculosis Diagnostic O the Bill & Melinda Gates Initiative (TBDI), will speed Foundation awarded US$ 10 efforts to design new approaches million to the United Nations to detecting TB among patients Development Programme / with symptoms such as cough, World Bank / WHO Special so that they can have access to Programme for Research and curative treatment. Work is also Development in Tropical under way on simple and accu- Diseases (TDR) at the World rate methods to quickly detect Health Organization to facilitate bacterial resistance to treatment the development of new tests for and to uncover latent infection the diagnosis of tuberculosis. or incipient disease in persons The five-year grant, supporting without symptoms. HIGHLIGHTS_RET POUR PDF 17/10/01 11:48 Page 34

World TB Day 2002 Planner

November 2001 December 2001 January 2002 February 2002 March 2002 April 2002

1 1 1 1 1 1 2 2 2 2 2 2 3 3 3 3 3 3 4 4 4 4 4 4 5 5 5 5 5 5 6 6 6 6 6 6 7 7 7 7 7 7 8 8 8 8 8 8 9 9 9 9 9 9 10 10 10 10 10 10 11 11 11 11 11 11 12 12 12 12 12 12 13 13 13 13 13 13 14 14 14 14 14 14 15 15 15 15 15 15 16 16 16 16 16 16 17 17 17 17 17 17 18 18 18 18 18 18 19 19 19 19 19 19 20 20 20 20 20 20 21 21 21 21 21 21 22 22 22 22 22 22 23 23 23 23 23 23 24 24 24 24 24 24 25 25 25 25 25 25 26 26 26 26 26 26 27 27 27 27 27 27 28 28 28 28 28 28 29 29 29 29 29 30 30 30 30 30 31 31 31 Ref: “The Guidelines for Social Mobilization” “Planning World TB Day”, WHO 2000

Form a planning committee: 1 December Identify Partners: 1 January—24 January Collect Information: 1 February—1 March Establish media contacts: 1 February—24 February Contact sponsors: 15 January—1 March Develop a list of events/activities: 15 January—15 February Send thank you letter: begining 24 March

PRODUCED BY THE INTERNATIONAL UNION AGAINST TUBERCULOSIS AND LUNG DISEASE ON BEHALF OF THE STOP TB PARTNERSHIP

Stop TB Partnership Secretariat 20 avenue Appia CH-1211 Geneva 27 Tel; +(41) 22 791 2385 Fax +(41) 22 791 4199 http://www.stoptb.org