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TB Notes 3, 2003


Stop TB Partnership Advocacy and Communications Assessment of the 22 High-Burden Countries

Background: Tuberculosis (TB) rates have been increasing in a number of regions of the world owing to poverty, rapid population growth, ineffective TB programs, and the HIV pandemic. In 2001, the World Health Organization (WHO) laid out a global plan to stop TB; the plan is known as the Stop TB Partnership. The first phase of this plan, to be carried out during 2001-2005, involves (1) expanding the currently available anti-TB strategy, known as directly observed treatment, short-course (DOTS), to allow all people with TB to have access to effective diagnosis and treatment; (2) adapting this current strategy to meet emerging challenges of HIV and drug resistance; (3) improving existing tools by developing new diagnostics, new drugs, and new vaccines; and (4) strengthening the Stop TB Partnership in order for proven TB-control strategies to be effectively applied.

The Stop TB Partnership developed a cross-cutting Advocacy and Communications Strategy to help achieve these first-phase objectives. A Task Force for Advocacy and Communications was established in January 2002 to oversee implementation of the Strategy. At a Task Force meeting in April 2002, members recommended undertaking a comprehensive baseline assessment of advocacy and communications for TB control in the 22 high-burden countries (HBCs) to better inform subsequent activities. The assessment was initiated in July 2002 and is ongoing. This article summarizes the findings reported to date.

One objective of this assessment is to improve the Strategy by assessing current National Tuberculosis Programme (NTP) advocacy and communications capacities and activities in the 22 HBCs and by providing a baseline against which the subsequent impact of this Strategy can be progressively measured. Another is to begin documentation of national and subnational advocacy and communications activities, leading to identification of best practices.

The methods used in this assessment were rapid desk analysis of HBC TB control plans and relevant documents, in-depth review of HBC TB control plans, and key informant interviews with NTP teams from Kenya, South Africa, Cambodia, Indonesia, Philippines, Uganda, United Republic of Tanzania, Myanmar, India, China, as well as with WHO staff.

Following are the main findings of the 10 in-depth country reviews together with pertinent issues for all 22 HBCs.

Current advocacy activities: Six out of the 10 HBCs included in the in-depth assessment have established reasonably strong national advocacy mechanisms. However, advocacy for TB in Myanmar, UR Tanzania, Uganda, and China is either limited to urban centers or is extremely weak, especially at the district level. All 10 HBC program teams requested assistance in strengthening advocacy activities at national levels but especially at the district level where, as a consequence of health reforms, many budgetary and human-resource decisions are now made.

Current communications activities: The 10 HBCs included in the in-depth assessment varied in terms of the intensity and reach of communications activities currently taking place. All countries, apart from Uganda, celebrated World TB Day 2002 at various levels of society. World TB Day 2002 produced the following reported results: new alliances between government departments and between governments and NGOs (Philippines and Myanmar); an increased awareness in the general public (Cambodia and UR Tanzania); and an anecdotal increase in the number of new TB patients presenting for treatment (Kenya). Other countries reported no specific impact resulting from World TB Day 2002. Only Philippines, India, UR Tanzania, and Cambodia reported any communications activities outside World TB Day (excluding the ongoing work of health staff in their consultations with suspected TB patients and patients currently on treatment).

NTP capacity to conduct advocacy and communications: Capacity to conduct advocacy and communications activities depends upon having the following: (1) designated managerial staff with appropriate qualifications and experience; (2) access to appropriate agencies from which technical advice can be regularly sought and to which specialized work can be subcontracted; (3) a well-researched strategic plan with a precise behavioral goal by which activities can be properly coordinated, monitored, and evaluated; and (4) sufficient financial resources to implement planned activities.

Managerial staff: Of the 10 HBCs assessed in-depth, only Kenya, South Africa, and UR Tanzania report having a designated advocacy and communications manager. The other countries report using combinations of other staff and/or institutions.

Technical assistance: All 10 HBCs had access to Ministry of Health and WHO Regional Public Relations Officers. Only India and South Africa reported contracting with private-sector agencies to assist with their advocacy and communications activities.

Strategic planning: All 22 HBCs have prepared plans to address barriers to expansion of the DOTS strategy. Few of these plans detail any comprehensive approach to advocacy and communications activities. Of the 10 HBC countries assessed in this baseline, only UR Tanzania reported having developed a definitive plan to manage, monitor, and evaluate advocacy and communications activities.

Financial resources: A few HBCs have been successful in securing financial support through the Global Fund for AIDS, TB, and Malaria (GFATM). Others receive support through the Global Drugs Facility (GDF). A range of donors are actively supporting several NTPs. NTP capacity to process external funds has proved problematic in some HBCs.

Training and materials development needs: Representatives of each NTP from the 10 HBCs selected for this assessment stated they would welcome training on a range of advocacy and communications issues, including planning Information, Education, and Communication (IEC) campaigns, generating media coverage, spokesperson media training, communicating to public officials, creating coalitions and partnerships with community groups to impact elected officials, and producing brochures for general distribution, press kits or press releases, and briefing papers for elected officials.

Recommendations to Date

1. Additional effort must be made to assess the impact of World TB Day (in terms of specific indicators such as increased case detection rates and increased funding) given the quantity of resources dedicated to this exercise.

2. NTPs should ensure that the complex, multilevel advocacy and communications activities required to support DOTS expansion is managed by a designated, full-time, well-qualified staff member or team. If required, there should be further in-country assessment of the capabilities of designated staff and institutions.

3. More in-country advocacy is required to ensure adequate resources are available to support social mobilization and communication for behavioral impact, especially at sub-national level. NTPs should use local resources as thoroughly as possible, and only afterwards seek external resources – first elsewhere in the country, and finally internationally. Capacity building in financial management may be required for managers or teams responsible for implementing TB control at national and especially at subnational levels.

4. NTPs should be actively encouraged to seek support from multinational and national corporations, not just in cash or other resources but in terms of skills. These linkages may result in substantial benefits to NTPs as well as serve as a useful public relations exercise for the corporations concerned. Resource groups that are available within country to help plan, develop, and implement advocacy and communication activities need to be identified. These would include media professionals, production agencies, patient organizations, NGOs, and other professional bodies.

5. Comprehensive training programs are urgently required to build capacity in strategic social mobilization and communications planning, implementation, and monitoring. Training should also emphasize evaluation of advocacy and communications strategies, e.g., pretesting interventions, process evaluation, outcome evaluation, and impact evaluation. Training programs could include short courses, in-service distance education, and on-the-job technical assistance to field staff. Centralized or regional training teams could be established so that one or more teams of "master trainers" travel to various locations to deliver high-quality training.

6. More detailed assessment is required of the current and potential advocacy and communications linkages between NTPs and HIV/AIDS programs in the 22 HBCs.

7. Based on this present assessment, the Task Force for Advocacy and Communications recommended the following HBCs for Stop TB Partnership support to strengthen their advocacy and communications capacities and activities: Cambodia, Indonesia, Myanmar, South Africa, Uganda, and Tanzania.

Acknowledgments: This report was prepared by Scott McCoy (CDC), Tim Raftis (American Lung Association), Ninan Varughese (TBP/WHO), and Will Parks (SMT/WHO). The project was coordinated by Ninan Varughese and Michael Luhan (STB/WHO). Other WHO staff who assisted in compiling information for this report were Kraig Klaudt, Petra Heitkamp, Everold Hosein, and Elil Renganathan. A number of National TB Program managers, staff, and advisers also provided detailed data.

—Reported by Scott McCoy, MEd
Div of TB Elimination

TB Behavioral and Social Science Research Forum:

Planting the Seeds for Future Research

DTBE is pleased to announce plans for a Tuberculosis Behavioral and Social Science Research Forum to be held December 10 and 11, 2003, in Atlanta, Georgia.

The Institute of Medicine report, Ending Neglect: The Elimination of Tuberculosis in the United States, identified the need for further behavioral and social science research in a number of areas, including the determinants of health-seeking and treatment-adherence behaviors of patients, health care provider behaviors, and the organizational structures that affect the control of TB. The proposed Forum will build on the foundation of a previous workshop, Tuberculosis and Behavior: National Workshop on Research for the 21st Century, held in 1994. It will also bring together behavioral and social science researchers and health professionals interested in the enhancement of TB control and services.

The goals of the proposed TB Behavioral and Social Science Research Forum are as follows:

  • Establish an ongoing partnership among national, state, and local governmental and nongovernmental behavioral and social science researchers focusing on TB;
  • Create a mechanism for ongoing communication among TB behavioral and social science researchers;
  • Identify and prioritize TB behavioral and social science research gaps; and
  • Develop a feasible, goal-oriented research agenda that will guide TB behavioral and social science activities.

If you would like more information or if you have any specific questions on the Forum, please send an e-mail to, or contact Nick DeLuca at (404) 639-8988 or Robin Shrestha-Kuwahara at (404) 639-8314.

—Reported by Nick DeLuca, MA
Div of TB Elimination


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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