Kristin Palitza
DURBAN, Jun 4 2010 (IPS) – African medical experts have realised they need to make a much bigger effort to educate rural communities if they want to effectively contain the continent s tuberculosis (TB) epidemic.
TB patient in a Kenyan hospital: community-based care and treatment is extending the reach of limited facilities and personnel. Credit: Siegfried/IRIN
In sub-Saharan Africa, 1.7 million people are infected with TB each year, which is almost a quarter of all global TB cases, according to the World Health Organisation.
Until recently, TB testing and treatment was mainly offered in hospital settings, which meant that poor people who live in peri-urban or rural areas struggled to access those services. Moreover, many patients failed to adhere to the months-long course of treatment because they live too far away from their nearest hospital to go to regular follow-up visits and pick up their medication.
Responding with community-based care
To slow down infection rates, several Southern African countries have now launched community-based screening, treatment and care programmes, especially in remote areas where access to health education and care is limited.
In South Africa, for example, a group of 47 community care workers have been organising advocacy and community mobilisation events in 15 villages in KwaZulu-Natal s Sisonke district in the past five months.
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About a hundred people in each village attended the events, during which community care workers speak about the disease, but also about infant feeding and testing for HIV and other sexually transmitted infections (STIs). About a quarter of stepped forward to be counselled, screened for TB and STIs and tested for HIV on those days.
The campaigns were very successful because we invited traditional leaders of each village to be role models and lead the screening, Jeannine Uwimana, researcher at the School of Public Health of the University of the Western Cape, which manages the programme.
Support from traditional leadership also means that the community care workers who are supervised by a professional nurse and work in close collaboration with the home-based carers of the district are accepted and listened to.
The carers are employed by the Department of Health and paid a monthly stipend of $195, which Uwimana says will help to make the programme sustainable and address South Africa s health worker shortage. We hope the outcomes of this first part of the programme will inform health policy, she added.
Local committees strengthen research trials
The University Teaching Hospital (UTH) in neighbouring Zambia, has followed a similar approach. The Lusaka-based teaching hospital is making use of interactive learning to increase community participation in research trials of TB drug REMoxTB.
Since March 2009, district health management teams have set up community committees in all townships outside of Lusaka that have a primary health care clinic. One such committee is located in the informal settlement of Kanyama, where TB incidence is high due to widespread poverty, lack of adequate housing and sanitation as well as a shortage of health facilities.
Each community committee has 15 members, made up from local health board staff, teachers, police officers, church leaders and TB patients.
Committee members share one important function: their day-to-day contacts with residents and their ability to influence behaviour change in their various capacities, explained UTH community engagement coordinator Deborah Mushama.
The committee s goal is to establish community-based structures that directly link in with the hospital s TB drug development research department. We hope to build a mutual relationship that will benefit the community and at the same time help the researchers develop effective TB drugs, said Mushama.
Since the start of the programme, the community committees have organised several door-to-door awareness campaigns, advocacy workshops and build relationships with health NGOs. Medical staff and committee members also participate in radio programmes, where residents can call in or SMS if they have questions.
We find these to be very effective ways for us to hear from the communities what they know, what is working and what isn t and why, noted Mushama.
In addition, plays have been staged at local schools, markets and clinics to disseminate information about TB. The audiences are encouraged to ask questions about the disease and research after the performances.
Serving employment-based communities
Lesotho is taking a slightly different approach to community mobilisation. Apparel Lesotho Alliance to Fight AIDS (ALAFA) is an industry-wide TB and HIV outreach programme for the 42,000 workers of the garment industry, the country s biggest employer in the private sector.
ALAFA has established a clinic in each factory where workers can access testing and treatment free of charge. In addition, a team of private doctors volunteers their time to provide medical TB services to workers families in the communities they live in.
Before we started this programme, factory employees were a blind spot in the health system, because they didn t have time to access health services in their communities, yet experienced lots of health issues due to their working conditions, said ALAFA medical director Fred Asiimwe.
Now, they have much more rapid access to treatment because the workplace is usually the best time and place to reach them, he added.
According to ALAFA, 93 percent of the 42,000 workers have been screened for TB, but Asiimwe admits that reaching their families and communities has been a challenge. To overcome this, ALAFA has started to hold TB advocacy events on weekends in the communities where its workers live.
But this is only sustainable in the long-term, if we manage to team up with local health workers and non-governmental organisations, so that we can create firm links between factories and communities, said Asiimwe.
