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CHALLENGE FACILITY FOR CIVIL SOCIETY ROUND 7

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CHALLENGE FACILITY FOR CIVIL SOCIETY ROUND 7

In 2017 Stop TB Partnership, Tajikistan (STBPT) was awarded a grant under Round 7 of the Stop TB Partnership’s Challenge Facility for Civil Society (CFCS). CFCS is a competitive grant mechanism that supports innovative, community-driven responses to TB. In that round STBPT was one of ten applications from a pool of 252 eligible proposals to be awarded a grant. The funding was used to adapt and pilot OneImpact in ten districts with the highest rates of multidrug resistant (MDR) TB in the country. The overall aim of the grant was to strengthen community TB responses in Tajikistan.

To determine the community needs and potential relevance of integrating OneImpact into the STBPT community program for people with TB, STBPT led two separate but mutually informative processes.

Step 1: Between April and September 2017, using mapping tools developed by the Stop TB Partnership, STBPT identified all TB services (formal health and community-based services) and mapped them against the types of services they provide, geographic locations of services as well as the perceived gaps and barriers in service provision. STBPT also mapped the gaps and barriers preventing people from accessing services and completing treatment.

To gather this information STBPT worked closely with the NTP and the public sector, using the following tools and methods; online information, focus group discussions and in-depth interviews. STBPT subsequently used the information to create a Directory and service matrix of all available services as well as a geographical map of the locations of services. STBP also collected and documented information regarding the quality of services, identified key populations and helped pinpoint gaps and barriers in accessing quality services and completing treatment. According to the mapping exercise the most recurrent barriers to accessing services and completing treatment were: poor quality of services and challenges associated with administrative procedures, poverty and a lack of general information about TB.

Step 2: To further refine the community needs and discuss the feasibility of introducing OneImpact, STBPT held a multi-stakeholder workshop on 17-19 May 2017 in Dushanbe. The meeting was attended the people / organizations who assisted with the mapping exercise. Participants in addition to the Stop TB Partnership and Dure Technologies included; the Ministry of Health, the Republican Centre of Protection of Population from Tuberculosis /Republican TB Center, KNCV, Project HOPE, MSF, International Organization for Migration, Volunteer Support Groups and people who have been directly affected by TB. The workshop had 4 objectives.

  1. To refine the priority needs of people with TB in Tajikistan and to understand the current response mechanisms to address them.

  2. To demonstrate the potential of OneImpact to address any problems identified.  

  3. To discuss the feasibility of introducing digital health solutions.

  4. To develop protocols and plans to roll out OneImpact (adapted).  

To understand the challenges people with TB face along the cascade of care, from understanding symptoms, to accessing health services to completing treatment, people affected by TB and the VSGs led an exercise to identify the most recurrent problems faced by people with TB. They identified 130 interlinked / related issues, which they clustered and prioritized under 5 main headings. According to the community and in alignment with the initial mapping exercise the most recurrent challenges of people with TB in Tajikistan are:  

  1. Lack of information about TB

  2. Treatment side effects

  3. Trouble accessing services

  4. Stigma

  5. Poor quality of services

Current approaches to addressing these challenges, using the existing VSGs and formal health care response mechanisms were discussed as well as opportunities to enhance them, using digital solutions. The group felt that the digital solutions provided different opportunities at different levels. See table 1.  

 

Level Potential Advantages
Individual level

To improve treatment adherence and treatment outcomes

  • Responsiveness: Designed by for patients by patients, it responds to relevant needs, enhancing patient centered care.

  • Self-sufficiency:

  • People can easily access information about TB, including information on treatment, important for MDR-TB patients who struggle with treatment side effects.  

  • People can easily see what TB services are available, where to allocate them and see their opening hours.

  • Connecting: People can connect and be part of a community of other patients along with patient support group volunteers so they feel less isolated.  

Engaging: People can report challenge anonymously, for a faster response

Community level

  1. Patient Support Group

To enhance performance and accountability among VSGs

  • Designed by people with TB and VSGs the tool responds to relevant needs

  • The tool is intuitive and complements VSG work

  • Having a tool that provides people with information previously shared by the volunteers, alleviates and enhances the work of the volunteers.

The collection of systematic allows STBPT to see the extent and the frequency of the challenges being reported, which enhances accountability among volunteers and can provide an overview of the extent of work conducted by VSGs.

Community level

  1. STBPT Central Team

To enhance data-driven advocacy

  • Collecting data systematically and directly from people with TB validates the data and strengthens advocacy.

Service level

To inform, transform and strengthen service provision

  • The data collected could be used to alter or strengthen service provision.

Program level

To enhance patient and community driven responses to TB

It would establish lines of communication between affected communities, the VSGs and the national program.

Table 1: Added Value of introducing OneImpact in Tajikistan  

Read more from OneImpact Case Study Tajikistan