Community Based DOTs

Community involvement in TB control is known to improve management of TB cases leading to favourable outcomes and reduction in stigma. It is one of the stop TB stategies under empowerment of communities.
World Health Organization piloted Community TB Care initiatives in 7 sites in Sub-Saharan Africa in 1997. In Kenya, the pilot project was carried out in Machakos district in 1997-2000 and demonstrated marked improvement in treatment outcomes, acceptability, quality of care and cost-effectiveness. Since then, community interventions in TB care has been scaled up to 41 districts in Kenya.

Main Objectives

  1. To contribute to the increase of TB case detection rate from the current 50% to 70% by 2008
  2. To contribute treatment success rate from the current 82% to 85 % by 2008
  3. To increase citizen ownership of their health
Specific Objectives
  1. To decentralize the provision of TB diagnostic and treatment services beyond health care facilities into the community
  2. To increase knowledge/awareness of tuberculosis in the community
  3. To involve communities in all aspects of delivery of TB control services including case finding, treatment support and default retrieval
  4. To reduce the combined default and transfer out rates to 5% by 2008
  5. To minimize reliance on the few fixed health facilities and therefore overcome limitations of access due to logistical, geographical and other barriers.
  6. To include community TB care component in the DLTLD’s strategy in line with MOH community strategy

Approaches to CB-DOTS

Activities for community involvement in TB control are based at primary health care facilities, in particular dispensaries and health centres, which are close to communities and where communities either own or are heavily involved in the management of these facilities.
At the national level the involvement of communities in the provision of health care, including TB services has been identified as key intervention that needs to be vigorously promoted and pursued. However for this intervention to be successfully implemented and for it to have the intended impact, district teams, with the support of central level, must embrace it and operationalize it.


Tasks that may be decentralized into the community


Tasks that should be considered for decentralization to the existing and selected community groups include, but are not limited to the following:

  1. Promotion of information about TB.
  2. Referral of TB suspects to health facility for investigation.
  3. Social support to TB patients to ensure adherence to treatment by directly observing treatment.
  4. Defaulter tracing of patients who have defaulted from treatment.
  5. Referral of TB patients on treatment for follow up sputum smears.
  6. Recording necessary information in DOTS cards.
  7. Referral of TB patients who have adverse drug reactions
  8. Feedback of information about treatment outcome to the TB team
Achievements
  • Scale up to 41 districts (implementation at different stages)
  • Activities done in the implementing districts
  • Sensitization meetings(DHMTs,HFCMs,Local opinion leaders)
  • Identification and training of CHWs
  • Empowering the community to participate in TB care
  • Motivation of CHWs through provision of bicycles, bags and badges

Lessons learnt

The trained CHWs Carried out the assigned tasks and their impact is being realized in some districts (e.g. Case finding through referral of Suspects; Defaulter tracing, Health /Education )

Most communities are appreciative of the roles of the CHWs

The MoH Health Care Providers in several districts are recognizing the CHWs and working well with them in their facilities

Challenges:

Weak Linkage between the communities and the facilities

Poor supervision of the CHWs

Poor Documentation of the activities done by the CHWs

Lack of Incentives to motivate the CHWs for the services they offer