The Health Promotion Handbook

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Basic skills and steps in advocacy, communication and social mobilization, particularly in relation to the tuberculosis (TB) control program.

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The

Health Promotion Handbook

A Guide to Doing Advocacy, Communication, and Social Mobilization for the TB Control Program in the Community

This publication was produced for review by the United States Agency for International Development. It was prepared by the National Center for Health Promotion of the Department of Health, Philippines, through the TB LINC (Linking Initiatives and Networking to Control Tuberculosis) Project under the terms of Cooperative Agreement Number 492-A-00-06-00032-00. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID or the United States Government.

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ISSN 978-971-9064-08-4 Printed in Manila, Philippines 2008

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Table

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Contents

Foreword v oreword-------------------------------------------------------v Acknowledgment -------------------------------------------- v i i List of Abbreviations and Acronyms ---------------- x i Glossar y - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - x i i i How to Use the Handbook -------------------------------- 1 Introduction ----------------------------------------------------- 1 Features of the Handbook ---------------------------------- 2 Overview of Chapters in the Health Promotion Handbook ---------------------------------- 3

Chapter 1 The Essentials of TB and DOTS -----------------7 Introduction ----------------------------------------------------- 7 Facts on Tuberculosis ------------------------------------------ 7 Magnitude of TB Problem Globally and Nationally ------------------------------------------ 10 The National Tuberculosis Control Program (NTP) ------------------------------------------ 12 DOTS Strategy ------------------------------------------------ 13 TB DOTS Certification and Accreditation ----------- 15 Hospital-based DOTS -------------------------------------- 17 TB in Children ------------------------------------------------ 17 Comprehensive and Unified Policy to Control Tuberculosis in the Philippines ---------------------- 19 Public-Private Mix DOTS ---------------------------------- 20 Frequently Asked Questions ----------------------------- 21 About TB ------------------------------------------------- 21 About Treatment --------------------------------------- 22 Summary -------------------------------------------------------- 25

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Chapter 2 Introduction to Health Promotion 2 9 Introduction --------------------------------------------------- 29 Health Promotion Defined ------------------------------- 29 Principles of Health Promotion ------------------------- 31 Five Action Areas of Health Promotion-------------- 32 Health Promotion in the Context of NTP ---------- 36 Health Promotion for Behavior Change in TB Control -------------------------------------------- 39 Summary -------------------------------------------------------- 40 Chapter 3 A dvocacy , Communication, Advocacy dvocacy, and Social Mobilization (ACSM) ----------------- 4 1 Introduction --------------------------------------------------- 41 ACSM for TB Initiatives ------------------------------------ 41 Advocacy for TB Control --------------------------------- 43 Communication for TB Control ------------------------ 48 Social Mobilization for TB Control -------------------- 53 Summary -------------------------------------------------------- 59 Chapter 4 How to Apply ACSM in the Five A ction Areas of Health P r omotion ----- 6 1 Action Pr Introduction --------------------------------------------------- 61 Building Healthy Public Policy -------------------------- 62 Creating Supportive Environment --------------------- 67 Strengthening Community Action --------------------- 69 Developing Personal Skills -------------------------------- 73 Reorienting Health Services ------------------------------ 85 Summary -------------------------------------------------------- 92 Chapter 5 How to Develop an ACSM Plan ----- 9 5 How to Develop an ACSM Plan ------------------------ 95 Practical Steps for Designing an ACSM Plan -------- 95 Sample ACSM Plan ------------------------------------------ 98 Answer Keys --------------------------------------------------- 1 0 5 References ------------------------------------------------------ 1 1 0

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Foreword

H

ealth Promotion is a process of enabling people to take action to improve health. Within the context of primary health care, health promotion is critical to improving outcomes in the prevention and control of both chronic and communicable diseases, particularly tuberculosis. Health promotion has a crucial role to play in fostering healthy public policies and health supportive environments, enhancing positive social conditions and personal skills, and promoting healthy lifestyles. Local Government Units (LGUs), communities, non-government organizations and the private sector often lead in initiating, shaping, and undertaking health promotion. They need to have the right resources and opportunities to enable their contributions to be amplified and sustained. In less active communities, support for capacity building is particularly important. In order to address the capability building concern, a draft Health Promotion Handbook was developed in 2005 by the National Center for Health Promotion (NCHP) and the National Tuberculosis Control Program (NTP) of the National Center for Disease Prevention and Control (NCDPC). The Philippine Tuberculosis Initiatives for the Private Sector (PhilTIPS) provided technical and financial assistance.

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The draft handbook then served as the basis for the development in 2007 of the The Health Promotion Handbook: A Guide to Doing Advocacy, Communication and Social Mobilization for the TB Control Program in the Community. This was supported by the USAID-funded TB LINC (Linking Initiatives and Networking to Control Tuberculosis) Project. Congratulations to all who shared their time and expertise for this accomplishment. This is a milestone document for the National TB Control Program that will help boost our control efforts against TB in our communities.

FRANCISCO T. DUQUE III, MD, MSc Secretary of Health

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Acknowledgment
The Health Promotion Handbook is the product of wide consultation between and among health professionals from different parts of the country. These dedicated health workers consist of officials from the Department of Health’s Central Office and Centers for Health Development, local government units, TB LINC (Linking Initiatives and Networking to Control Tuberculosis), and the Philippine Business for Social Progress.

DOH Central Office
Dir. Yolanda Oliveros Dir. Angelina Sebial Dir. Jaime Lagahid Dr. Rosalind Vianzon Dr. Ernesto Bontuyan, Jr. Dr. Anna Marie Celina Garfin Ms. Luz Tagunicar Ms. Rosemarie Aguirre Mr. Anthony Roda Ms. Edna Nito Dr. Jessica De Leon Ms. Alegria Gablan Ms. Evelyn Perez Ms. Ellen Gisala Ms. Ma. Victoria Madura Mr. Manuel Jacob Mr. Ferdinand La Puebla Ms. Ma. Arlene Rivera

Centers for Health Development
Dr. Ma. Leticia J. Macaranas Mr. Floro Orata Mr. Renato Franco Mr. Romulo Buenaventura Ms. Therese Malubag Ms. Noemi Bron Ms. Helen Rivera Ms. Consuelo Briones Mr. Augusto Tapia Mr. Noland Sabling Mr. Gerald Basaca Ms. Marites Garcia Ms. Regina Siojo Ms. Mary Divine Hilario Ms. Jenelyn Ventura Ms. Soralde Amilat

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Local Government Units
Quezon City Ms. Felisa Tang Bulacan Dr. Emma Agustin-Bartolome Ms. Rosemay Fernandez Ms. Darlene Ivy Losa-Zafra Ma. Lourdes Alborida Ms. Lolita D. Ramos Ms. Evelyn Aduna Pangasinan Ms. Prescilla Bersamin Dr. Paz Mejia Ms. Norma Soriano Ms. Celsa Alaras Albay Ms. Gay Gloria Berango Ms. Mari-Ann Esquivel Dr. Marie Jane Revereza Ms. Vivian Revilla Ms. Helen Ricafort Dr. Joana Limos Ms. Marilyn Secillano Ms. Maria Tablato Bohol Ms. Polizena Rances Ms. Leoncia Lao Ms. Pacita Castrodes Aklan Ms. Adelfa Cordova Dr. Levens Maravilla Ms. Araceli Regalado Ms. Yolanda Crispino Dr. Marilyn Tabang Ms. Lourdes Cielo Tabang Ms. Salvacion Garino Negros Occidental Ms. Lorna Garde Dr. Nelly Añonuevo Ms. Virginia Dawa Ms. Babette Mahilum Ms. Marilou Caballero Ms. Liezl Gumban Mr. Jacinto Talebrico Cagayan de Oro City Dir. Julito Sabornido, Jr. Ms. Regina Patricia Bernad Siojo Bukidnon Dr. Inocentes Dagohoy Ms. Emmanuelita Barrera Ms. Gloria Sitoy Ms. Teresita Ilustrisimo Compostela Valley Dr. Jeorgie Arvin Legaspi Ms. Pilar Marin Ms. Nobleza Ang Ms. Loida Cruz Mr. Daniello Rublibos Ms. Lourdes Andan Ms. Velita Alemania

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Maguindanao Dr. Elvis Crispino Ms. Jean Gisela Señase Ms. Clara Fe Chiong Ms. Lutgarda Beltran Cotabato City Dr. Manuel Dulay, Jr. Ms. Julie Villadolid Lanao Del Sur Ms. Edna Rosas Ms. Amina Macud Ms. Emelyn Alvarez Ms. Gloria Limitares Basilan Dr. Vicente Yu III Ms. Lilia Paterno Ms. Edith Casinillo Sarangani Dr. Israel Peralta

PhilTIPS
Dr. Juan Antonio Perez, III Mr. Jose Ibarra Angeles Ms. Elaine Umali Dr. Paz Diaz, Consultant

TB LINC
Dr. Dolores Castillo Dr. Mariquita Mantala Dr. Arthur Lagos Ms. Nenita Ortega Ms. Rosario Nolasco Dr. Rogelio Ilagan Dr. Pilar Mabasa Dr. Lydia Rogando Ms. Lea Jordan Ms. Lorna Flores

PBSP
Mr. Eric Camacho Mr. Rino Naida Ms. Rowena Cañete

PhilCAT
Ms. Amelia Sarmiento Mr. Angelo Concepcion

HealthPro
Dr. Napoleon Juanillo Dr. Jeanne Valderrama Mr. Ronald Jabal

World Vision
Mr. Tito Rodrigo Ms. Grace Gayoso

Publications Staff
Dr. Ma. Theresa Velasco,
Technical Editor

WHO
Dr. Michael Voniatis

Mr. Bernabe Remoquillo,
Layout Artist

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List and
ACSM BCG BHW CBMIS CDR CHD CHO CUP DOH DOT DOTS DSSM FAQs FDC GO HEPO HMO IEC ILHZ IO IPC IRR LCE LGU LOR MDR-TB MHO MOA MOP

of Abbreviations Acronyms
Advocacy, Communication, and Social Mobilization Bacillus Calmette Guerin Barangay Health Worker Community-Based Management Information System Case Detection Rate Center for Health Development City Health Office/Officer Comprehensive and Unified Policy to Control Tuberculosis in the Philippines Department of Health Directly Observed Treatment Directly Observed Treatment, Short Course Direct Sputum Smear Microscopy Frequently Asked Questions Fixed Dose Combination Government Organization Health Education and Promotion Officer Health Management Organization Information, Education, and Communication Inter-Local Health Zone Information Officer Interpersonal Communication Implementing Rules and Regulations Local Chief Executive Local Government Unit Locus of Responsibility Multi-Drug Resistant Tuberculosis Municipal Health Office/Officer Memorandum of Agreement Manual of Procedures for the National Tuberculosis Control Program

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NCDPC

National Center for Disease Prevention and Control NCHP National Center for Health Promotion NGO Non-Government Organization NTP National Tuberculosis Control Program PhilCAT Philippine Coalition Against Tuberculosis PhilHealth Philippine Health Insurance Corporation PHN Public Health Nurse PHO Provincial Health Office/Officer PLWD Person Living With Disability PPMD Public-Private Mix DOTS RHM Rural Health Midwife RHU Rural Health Unit RMT Registered Medical Technologist SB Sangguniang Bayan TB Tuberculosis TBDC TB Diagnostic Committee TB LINC Linking Initiatives and Networking to Control Tuberculosis TNA Training Needs Assessment TWG Technical Working Group WHO World Health Organization

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Glossary
Accreditation A process done by PhilHealth to enable a facility to avail itself of the PhilHealth Outpatient Anti-Tuberculosis/DOTS Benefit Package Activities designed to place TB control high on the political and development agenda, foster political will, increase financial and other resources on a sustainable basis, and hold authorities accountable to ensure that pledges are fulfilled and results achieved; the act of persuading people – using either verbal or non-verbal, oral or visual communication – to bring about a voluntary change in judgment so that they will support a cause and adhere to a belief they may not have held before

Advocacy

Alliance-building Coalition building with community organizations in support of advocacy for health Certification The process that assures the public and payers of health care that TB DOTS centers are capable of providing safe and effective services An overarching term which refers to the process people use to exchange information about TB; the process of establishing common understanding between and among the parties involved Policy (embodied in Executive Order no. 187 s. 2003) to harmonize and unify TB control efforts in the Philippines

Communication

CUP

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DOT

A trained DOTS facility worker (or treatment partner) personally observes TB patient take anti-TB medicines everyday during the whole course of treatment A comprehensive strategy recommended by WHO to detect and cure TB patients; DOTS services include sputum microscopy for TB symptomatics, free drugs for TB patients, sputum follow-up to monitor the status of patients, and ensuring daily drug intake through a treatment partner. Entertainment-education; the deliberate inclusion of socially desirable messages in popular entertainment vehicles (e.g., television soap operas, songs, concerts) to achieve some social and behavioral change objectives Frequently Asked Questions about TB and DOTS, most of which spring from misconceptions A process of enabling people to take action to improve health. It is anchored on five pillars: building healthy public policy; creating a supportive environment; strengthening community action; developing personal skills; and reorienting health services. Encompasses information delivery, training/human resource development, and awareness/motivational campaigns in support of the NTP

DOTS

Enter-educate

FAQs

Health Promotion

Information, Education, and Communication

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Lobbying

A focused form of advocacy that shares public policy in arenas of influence at the barangay, municipal/city, provincial, national, and even at international levels; persuading individuals or groups with decision-making powers to support a certain position/issue The process of linking up diverse individuals or groups, bringing about their mutual agreement to share one another’s resources and competencies as a way of serving mutual interests A strategy adopted by DOH that integrates private practitioners into the NTP through referral of TB patients to PPMD units or through provision of services

Networking

PPMD

Social Marketing A process that adopts marketing principles in developing, implementing, managing, and evaluating behavior change programs to improve health or benefit society Social Mobilization The process of bringing together all feasible and practical intersectoral allies to raise awareness of and demand for a particular program, to assist in the delivery of resources and services, and to strengthen community participation for sustainability and self-reliance; the process of engaging people in action, redirecting existing or creating new resources to achieve society’s or the community’s social goals

TB (Tuberculosis) An infectious disease, caused by Mycobacterium tuberculosis or tubercle bacilli, that primarily affects the lungs

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How to Use The Handbook

Introduction
This introductory part of the Health Promotion Handbook should enable readers to: Identify the intended users of the handbook; Explain the purpose of the handbook; Identify its features; and Describe briefly the contents of each chapter.

he handbook is for frontline health workers in health facilities at local levels directly providing Directly Observed Treatment, Short Course (DOTS). Health workers include doctors, nurses, midwives, and microscopists. Health facilities include rural health units (RHUs), Public/Private Mix DOTS (PPMDs), hospitals, health centers, and clinics of nongovernment organizations (NGOs) and other government organizations (GOs). The handbook is an easy-to-read standardized guide written to equip users with knowledge to plan, implement, and monitor Advocacy, Communication, and Social Mobilization (ACSM) activities for the TB Control Program.

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How to Use This Handbook

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Through ACSM activities applied in the five areas of health promotion, health workers in turn hope to contribute to the overall goal of the National Tuberculosis Control Program of increasing case detection rate (CDR) to 70 per cent or more and cure rate to 85 per cent or more. The five areas of health promotion are: building healthy public policy; creating supportive environment; strengthening community action developing personal skills; and reorienting health services. This handbook should enable users to: 1. cite key points on TB and DOTS; 2. correctly answer FAQs on TB; 3. discuss how health promotion, through its five pillars, could help increase case detection rate and cure rate; 4. design ACSM activities that could help promote behavior change among major stakeholders; For TB symptomatics to consult at RHUs For TB patients to complete treatment and the required sputum examination; and For local chief executives to allocate resources for TB control.

Features of the Handbook
For easy reading, the Health Promotion Handbook carries a standard format featuring three sections in each chapter: introduction, body, and summary.

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The Health Promotion Handbook

The introduction contains the explanatory part at the start, as well as the objectives of each chapter. The objectives spell out the learning competencies that readers will acquire upon completion of the chapter. They give the readers an overview of the topics covered in the chapter. The body gives in detail the contents of the chapter. Wherever appropriate, step-by-step procedures, as well as examples, are given. These are written in simple, easy-tounderstand, and generally user-friendly style. The summary highlights key points taken up in the chapter. It allows readers to review what they have learned in a fun, non-threatening way. All answer keys may be found on pages 105109. Other helpful sections are : 1) Glossary, a listing of special terms with their corresponding meanings; 2) List of Abbreviations; and 3) References, which lists the authors’ sources. The References section may also lead the readers to sources of additional information which may not be found in the handbook.

Overview of Chapters in the Health Promotion Handbook
The handbook contains five chapters: Introduction How to Use the Handbook Chapter 1 The Essentials of TB and DOTS Chapter 2 Introduction to Health Promotion Chapter 3 Advocacy, Communication, and Social Mobilization
How to Use This Handbook

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Chapter 4 Chapter 5

How to Apply ACSM in the Five Action Areas of Health Promotion How to Develop an ACSM Plan

How to Use The Handbook guides readers on how to find information in the handbook. It explains the purpose of the handbook, identifies its intended readers, enumerates the features of each chapter, and walks the readers through the contents of each chapter.
Chapter 1 gives readers the basic facts about tuberculosis – the nature of the disease, its signs and symptoms, modes of transmission, prevention, and cure. It explains fully the DOTS strategy, which is the global strategy for TB cure recommended by the World Health Organization (WHO). Chapter 1 also emphasizes the magnitude of the TB problem both from the global and national perspectives. Readers are introduced to the key points about the National Tuberculosis Control Program (NTP) in this chapter. Chapter 1 also lists not only the Frequently Asked Questions (FAQs) on TB and DOTS but also the scientifically-based answers to these questions. Most of the FAQs undoubtedly spring from misconceptions. Chapter 2 defines the broad concept of health promotion and situates it in the context of the NTP. The chapter also discusses in detail the principles and five action areas of health promotion. The last part explains the desired behavior change from each target group of the TB Control Program.

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The Health Promotion Handbook

Chapter 3 discusses how advocacy, communication, and social mobilization activities can be carried out for the NTP. Various activities under each of the ACSM are also given. Chapters 4 and 5 are essentially the “how-to” portions of the handbook. Chapter 4 tackles the application of ACSM in the five action areas of health promotion on the NTP . More importantly, this chapter guides readers on how to use the various techniques of ACSM to increase success rate in carrying out activities under the five action areas. Chapter 5, on the other hand, gives a concrete example of an ACSM plan under each of the five action areas. The sample plans are community-based plans relevant to the intended readers’ situation.

How to Use This Handbook

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S ummary
Supply the missing words in the review questions. The words, in jumbled letters, are in the blue box. Answers may be found on page 105.

1. The Health Promotion Handbook is meant for: a. Doctors b. Nurses c. Midwives d. ______________ 2. The NTP’s goal is ___% CDR and ___% cure rate. 3. The _____________is the part of the Health Promotion Handbook that lists special terms and their meanings. 4. The ______________ section is also important because this may be able to supply sources of additional information for readers. 5. ______ is the strategy currently implemented worldwide to address the TB problem.

gsaol 70%

yrs

oc issspt c r o i m resefc rnee 85%

DSTO

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The Health Promotion Handbook

Chapter

The Essentials of TB and DOTS

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In t r o d u c t i o n
A whole chapter is devoted to the facts about tuberculosis (TB) – cause, mode of transmission, prevention, and control, among others. Chapter 1 is deemed an important part of the handbook because this is where the health worker will get the answers to most questions about the disease and its cure. The contents of this chapter will enable readers to: Discuss the facts on TB; Describe the TB situation globally and nationally; Identify the NTP strategies; Explain the elements of DOTS; and Enumerate frequently asked questions (FAQs) from patients/the community and answer these correctly.

Facts on Tuberculosis

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hat is tuberculosis? Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis or tubercle bacilli. The disease primarily affects the lungs and this condition is known as pulmonary tuberculosis. Other parts of the body may also be affected by tuberculosis; this is known as extra-pulmonary

Chapter 1 The Essentials of TB and DOTS

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tuberculosis. It may affect the bones, meninges, joints, genito-urinary tract, intestines, liver, kidneys, and the heart. How does one get tuberculosis? A person gets infected with TB if he or she inhales the bacteria released from air droplets when a person with TB coughs or sneezes. Generally, the bacteria will be killed in five minutes after direct exposure to sunlight. But these bacteria can survive for up to one year in a dark, moist, and poorly ventilated area. A Pulmonary TB patient whose sputum is positive for TB bacilli may spread the disease to about 10-20 persons in a year for two years. Once the patient starts on taking anti-TB drugs, sputum will become negative within two weeks in most patients. But he or she needs to take the drugs completely for six months to eliminate all the TB bacilli in the lungs and be cured. What are the signs and symptoms of TB? Cough for two weeks or more is the most common symptom of tuberculosis. Other signs and symptoms are fever, chest or back pain not referable to other diseases, loss of weight, and blood-streaked sputum or hemoptysis. How does one know if he or she has TB? Direct sputum smear examination should be done for persons with cough of two weeks or more. Direct Sputum Smear Microscopy (DSSM) is the primary diagnostic tool because: 1) DSSM is specific; 2) the procedure is simple and economical; and 3) it can be done even in remote areas. Chest x-ray

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may be used to establish the diagnosis of TB if the sputum is negative. Chest x-ray is secondary to DSSM because: 1) there are no shadows in the x-ray that are specific for TB; 2) it is more expensive; and 3) about 40 per cent of patients diagnosed by chest x-ray alone do not have active TB. Can TB be cured? Yes, TB can be cured if: 1) anti-TB drugs are taken regularly; 2) in the correct dosage; and 3) for the right duration. Treatment will last for a minimum of six months. The complete antiTB drugs for six months cost from P1,000 to P4,000. Since treatment for TB is expensive, the government provides free drugs so that patients will comply with the minimum six-month treatment, or eight-month treatment if they are re-treatment cases. If patients do not take the drugs regularly or if they will not complete their treatment, they will develop Multi-Drug Resistant TB (MDR-TB). This means that they will not be cured with the use of first-line drugs and they will continue to spread TB in the community. They will be using second-line anti-TB drugs, which: are more expensive; may not all be available in the Philippines; have more side effects; and require treatment duration of 18 months to 2 years.

Chapter 1 The Essentials of TB and DOTS

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The best prevention for MDR-TB is DOTS. If DOTS strategy is well implemented, every patient started on treatment will be cured and he or she will no longer spread the disease. How can the spread of TB be prevented? The best way to prevent the spread of TB is to find the TB patient early and provide treatment through DOT to cure the patient. It is best for individuals to adopt a healthy lifestyle to boost the immune system. Remember to: engage in physical activity or exercise regularly; get enough rest; eat a balanced diet; keep the living area well ventilated; and maintain personal hygiene. It is also best to cover the nose and mouth when coughing and sneezing.

Magnitude of TB Problem Globally and Nationally
Global Situation
Tuberculosis continues to be a major cause of death worldwide although the global epidemic is on the threshold of decline. In 2005, there were an estimated 8.8 million new TB cases, about 7.4 million of which were in Asia and sub-Saharan Africa. Also, 1.6 million people have died of TB, including 195,000 infected with HIV.

Source: http://www.worldlungfoundation.org/pics/map.jpg

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The Health Promotion Handbook

The Philippines is one of the 22 high-burdened countries under the World Health Organization (WHO) watch list. Ranking has improved from 7th to 9th. In the Western Pacific region, the Philippines ranks third in case notification rate.

National Situation
Tuberculosis continues to be a major public health problem in the Philippines. TB is the sixth leading cause of deaths and illnesses and TB accounts for 7 per cent of the total deaths. About 75 people die of TB everyday. The trends for morbidity and mortality rates are decreasing but these are still high compared to the target of decreasing them by half by 2015. Figures are still very far from the elimination level of one case per million population. What is the economic impact of TB? TB robs an average male worker of compensation worth P451 per day and the female worker P216 per day (Measuring the Burden of Disease and Economic Consequences of TB in the Philippines, 2003). The most affected group is the 15-54-year-old age group, the economically productive age group (1997 National Prevalence Survey). As such, the impact of the disease will be felt by their families, including children.

Trend of TB Morbidity and Mortality Rates per 100,000 population, Philippines, 1970 to 2000

Source: Philippine Health Statistics (1970 - 2000)

Chapter 1 The Essentials of TB and DOTS

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The National Tuberculosis Control Program (NTP)
Vision, Mission, and Goals
Vision: To make the Philippines a country where TB is no longer a public health problem and that is when the incidence of smearpositive cases is less than 1 per million population

Mission: To ensure that TB DOTS services are available, accessible, and affordable to the communities, in collaboration with the Local Government Units and other partners Goals: To reduce mortality due to TB and prevalence by half by the year 2015 in line with the Millennium Development Goals

Targets: To cure at least 85 per cent or more of the new smear-positive TB cases detected and to detect at least 70 per cent or more of the estimated new smear-positive TB cases Guided by these goals and targets, the NTP has embarked on several initiatives, in partnership with local and international partners. The overarching framework for TB control is the DOTS strategy. Other initiatives are: Comprehensive and Unified Policy to Control Tuberculosis in the Philippines (CUP); Public-Private Mix DOTS (PPMD); TB DOTS Certification and Accreditation; Hospital-based DOTS; and TB in Children.

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The Health Promotion Handbook

DOTS Strategy
DOTS is a comprehensive strategy recommended by WHO to detect and cure TB patients. All rural health units (RHUs), selected private clinics, city health centers, and selected government and private hospitals and health centers are offering DOTS services. DOTS services include sputum microscopy for TB symptomatics, free drugs for TB patients, sputum follow-up to monitor the status of patients, and ensuring daily drug intake through a treatment partner. DOTS strategy was implemented in 1996 in selected areas and in all public health centers by 2003. By 2005, the Philippines has reached the targets of 70 per cent case detection rate and 85 per cent success rate.

What are the five elements of DOTS?
1. P olitical commitment at all levels – Political This is the support given by the government to implement TB control activities nationwide. Political commitment is needed to foster partnership to address the TB problem in the community. Health staff should provide data to show the burden of TB and explain to the local government officials the needs of the community with regard to TB control. 2. Quality Sputum Microscopy – This is the diagnostic tool used to detect sources of infection among patients with TB symptoms. Sputum examination should be validated so that smearpositive cases could be identified correctly. Identified smear-positive cases should be started on treatment right away to stop the spread of infection. One smear-positive case can infect

Chapter 1 The Essentials of TB and DOTS

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10-20 persons in a year. Smear-negative cases are less infectious. They can infect 1-2 persons in a year. Sputum microscopy is more specific because TB bacilli can be seen in the sputum smear. There is no specific shadow for TB seen in the chest x-ray. Sputum microscopy is also more economical compared to chest x-ray. 3. Directly Obser ved T reatment (DOT) – Observed Treatment Treatment for TB is standardized and drug preparation has been changed to Fixed-Dose Combination (FDC) to facilitate adherence. Supervised treatment is done to ensure that patients are taking their drugs daily to achieve cure and to prevent the development of MDR-TB. Supervision of treatment should be based on the situation in the locality, as well as the patient’s status. 4. Recording and Reporting – Standardized records and reports should be in place to monitor the status of the patient. These documents can provide information that will be needed to monitor the treatment outcomes of the patients and to determine the problems identified in the areas. These will help the program manager determine the needs of the program. 5. Quality Drugs – Regular and adequate supply of quality drugs through procurement and delivery of drugs based on the number of cases registered must be ensured. There should be adequate supply of quality drugs to ensure that identified TB patients are started on treatment right away to prevent the spread of the disease. The DOTS strategy has been proven to: Cure TB patients and produce cure rates as high as 95 per cent even in poor countries; Prevent new infections among children and adults; and Be cost-effective.

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The Health Promotion Handbook

TB DOTS Certification and Accreditation
Certification is the process that assures the general public and payers of health care that the government can deliver safe and effective services to patients. With the PPMD strategy, there is a need for certification to ensure quality DOTS implementation. Certification aims to: 1. oversee quality DOTS implementation both in the public and private sectors; 2. provide a response to the capacity of the private sector to implement DOTS services; and 3. serve as a means for patients to avail themselves of the PhilHealth Outpatient Anti-Tuberculosis/ Directly Observed Treatment, Short Course (DOTS) Benefit (OPB) Package.

What facilities may be certified? Health facilities, like RHUs, health centers, hospital-based clinics, Health Management Organizations (HMOs), factory clinics, church-based clinics, school-based clinics, and private facilities can be certified. The Department of Health (DOH) is the main agency responsible for certification. Certifiers are the staff at the Centers for Health Development. CHD staff may be joined by PhilCAT representatives if private facilities need to be certified.
Before a health facility can be certified, it has to fill out the self assessment tool provided by the Provincial NTP Coordinators. The coordinators can also help or provide technical assistance in filling out the form. Once the facility is ready, it will be assessed by the CHD staff and will be certified once it has complied with the 10 standards.

Chapter 1 The Essentials of TB and DOTS

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Ten Standards for Certification 1. The TB DOTS Center is easily located and patients have convenient and safe access to the Center. 2. The TB DOTS Center provides facilities for the comfort and privacy of its patients and staff. 3. The TB DOTS Center provides for the safety of its patients and staff. 4. All patients undergo a comprehensive assessment to facilitate the planning and delivery of treatment. 5. All patients have continuous access to accurate and reliable TB diagnostic tests. 6. A care plan is developed and followed for all patients. 7. Patients have continuous access to safe and effective anti-TB drugs throughout the duration of their treatment. 8. Policies and procedures for providing care to patients are developed, disseminated, implemented, and monitored for effectiveness. 9. Policies and procedures for managing patient information are developed, disseminated, implemented, and monitored for effectiveness. 10. The TB DOTS Center has an adequate number of qualified personnel skilled in providing DOTS services. Accreditation is done by PhilHealth. Once accredited, the facility can avail itself of the PhilHealth OPB Package. This is given to the

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facility for every new TB case it identifies and starts on treatment. 1. A flat rate of P4,000 per case, given in two separate payments, is paid to an accredited DOTS facility. This fee covers diagnostic work-up, consultation services, and anti-TB drugs. 2. The first payment of P2,500 is paid after the patient has completed the intensive phase of treatment. The final payment of P1,500 is paid to the DOTS facility after the end of the continuation phase.

Hospital-based DOTS
This strategy is undertaken to increase case detection and to enhance the delivery of DOTS services in the hospitals. It will ensure that TB patients are not lost from the NTP system even if they are initially managed at the hospitals, both for in- and out-patients. This will improve the referral system from the hospitals to the health centers.

TB in Children
The target group for childhood tuberculosis consists of children below 14 years old. A child shall be suspected of having TB and will be considered a TB symptomatic if he or she has any three of the following signs and symptoms: 1. Cough/wheezing of two weeks or more; 2. Unexplained fever of two weeks or more;

Chapter 1 The Essentials of TB and DOTS

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3. Loss of appetite/loss of weight/failure to gain weight/weight faltering; 4. Failure to respond to two weeks of appropriate antibiotic therapy for lower respiratory tract infection; or 5. Failure to regain previous state of health two weeks after a viral infection or exanthem (an eruptive disease, such as measles, or its symptomatic eruption). A child shall be clinically diagnosed or confirmed of having TB if he/she has any three of the following: 1. Exposure to an adult/adolescent with active TB disease; 2. Positive tuberculin test of 10 mm; 3. Any three of the signs and symptoms suggestive of TB; 4. Abnormal chest radiograph suggestive of TB; or 5. Laboratory findings suggestive or indicative of TB (histological, cytological, biochemical, immunological, and/or molecular). TB in children is usually non-infectious and the source of infection is the adult within the household or neighborhood. DOH shall provide anti-TB drugs, tuberculin reagents (2TU RT23 Tween 80), information/ education/communication (IEC) materials, and recording and reporting forms.

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The Health Promotion Handbook

Comprehensive and Unified Policy to Control Tuberculosis in the Philippines (CUP)
In 2003, Executive Order no. 187 s. 2003 was signed by the President of the Philippines to harmonize and unify TB control efforts in the Philippines. Government agencies and private organizations have been mandated to work together on the dissemination and training aspects of the Comprehensive and Unified Policy for TB Control in the Philippines. Public Agencies Department of Health Department of Education Department of Interior and Local Government Department of National Defense Department of Justice – Bureau of Corrections Department of Social Welfare and Development Department of Agriculture Department of Agrarian Reform Department of Science and Technology Department of Labor and Employment Philippine Health Insurance Corporation Overseas Workers and Welfare Administration National Economic and Development Authority National Commission on Indigenous Peoples Government Service Insurance System Social Security System Employees Compensation Commission

Chapter 1 The Essentials of TB and DOTS

19

Private Organizations Philippine Coalition Against Tuberculosis Philippine Medical Association Trade Union Congress of the Philippines Employers Confederation of the Philippines Association of Health Maintenance Organizations of the Philippines

Public-Private Mix DOTS (PPMD)
PPMD is a strategy adopted by the Department of Health, in partnership with the PhilCAT, to address the problems attendant to the disease. This strategy integrated private practitioners into the National TB Control Program through referral of TB patients to PPMD units or through provision of services. The primary objectives of PPMD are: 1) to increase case detection; and 2) to synchronize the diagnosis and treatment of TB.

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The Health Promotion Handbook

Frequently Asked Questions
About TB
Question Is TB hereditary? Answer TB is not hereditary. Bacteria causing TB come from air droplets from a person with TB when he/she coughs or sneezes. However, it is infectious such that household members of TB patients are at risk of acquiring the disease. Can TB be cured? Yes, TB is curable with the correct treatment regimen, plus nourishing food and adequate rest. Compliance with treatment duration is a must. Yes, if treatment is not started early enough and if a patient does not finish the treatment regimen. No. Everybody is at risk of getting TB. Those with higher risk are the malnourished, immunocompromised (HIV-infected, diabetic, cancer patients), and those in contact with patients who are sputum smear-positive. No. However, if heavy work leads to a lowering of body resistance, a person becomes susceptible to the disease. No, but excessive drinking or smoking may weaken a person’s body resistance, making him/her susceptible to the disease when he/ she inhales the bacteria. Sputum examination is more specific to TB diagnosis than chest x-ray. Chest X-ray may indicate lung conditions other than TB. A sputum exam determines whether the activity is contagious or inactive.

Can a person die of TB?

Does TB afflict only the thin, the elderly, or the poor people?

Can one contract TB from doing heavy work?

Can one contract TB from too much drinking or smoking?

Why is there a need to undergo sputum examination and not chest x-ray right away?

Chapter 1 The Essentials of TB and DOTS

21

About Treatment
Question Why is there a need to give three sputum specimens? Answer This is important to ensure accurate diagnosis. Three sputum specimens are collected to increase the yield of positivity for microscopic TB bacilli. Both results are considered. These are referred to the TBDC (TB Diagnostic Committee), which recommends the correct case management.

If x-ray results are positive but sputum examination results are negative, which result is adopted? Can an x-ray positive person avail himself/ herself of anti-TB drugs at the health center?

Even if a person is x-ray positive, he/she still has to undergo sputum examinations. If sputum examinations yield positive results, he/she will be given anti-TB drugs. If sputum results are negative, these and the x-ray plate will be sent to the TBDC for accurate diagnosis. The TBDC will evaluate the case and reach a consensus as to whether or not the patient needs treatment. Yes, but anti-TB drugs are available for free at the health center for the entire duration of treatment. No. Effectiveness does not depend on who prescribes the anti-TB drugs. Truth is, some of the anti-TB drugs prescribed by private physicians are the very same ones given at the health centers. A patient who is moving to another place may be given only two weeks’ supply of anti-TB drugs. He/she will be given an NTP Referral Form so that treatment regimen will be continued and completed in the new place of residence.

Are anti-TB drugs expensive?

Are the anti-TB drugs prescribed by private physicians more effective than the ones from the health center? Can a patient who is moving to another place be given complete antiTB drugs so he/she can complete the treatment regimen?

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Question Why can’t the patient be given at the start all the anti-TB drugs he/she will need for the entire duration of the treatment?

Answer In the DOTS strategy, it is very important to ensure that the patient takes drugs daily under a treatment partner’s supervision. The role of the treatment partner, who personally witnesses patient’s intake of TB medicines, is critical in this respect. Yes, but it would be better not to drink while undergoing treatment because alcohol may adversely affect the liver. It would also be good to refrain from smoking at this time. Hepatotoxic reactions to anti-TB drugs may be more common among patients with a history of excessive alcohol consumption.

Can a person drink alcoholic beverages while undergoing treatment?

Is a patient still infectious after taking anti-TB drugs?

Once the patient starts taking anti-TB drugs daily, the number of bacilli-- hence the degree of infectiousness-- decreases greatly within two weeks. But he/she needs to complete the six months of recommended treatment. There is no need to do so, because TB is transmitted through inhalation (not ingestion) of aerosol.

Is there a need to separate the personal belongings, especially utensils, of the TB patient? Can a patient breastfeed while on treatment?

A woman taking anti-TB drugs can continue to breastfeed. All anti-TB drugs are compatible with breastfeeding. Mother and baby should stay together and the baby may be breastfed in the normal way. A breastfeeding woman with TB should receive a full course of anti-TB treatment. Timely and correct treatment is the best way to prevent transmission to the baby. BCG vaccination should be given to the infant immediately at birth.

Chapter 1 The Essentials of TB and DOTS

23

Question What is the benefit of giving BCG vaccination?

Answer BCG (Bacillus Calmette Guerin) should be given to all infants because studies have shown that BCG can give 80 per cent protection against TB for as long as 15 years if given before the first infection (Crofton, et al. 1999). Most anti-TB drugs are safe for pregnant women, except Streptomycin, which can cause ototoxicity (deafness) to the fetus. A pregnant woman should be advised that successful treatment of TB with the recommended standardized treatment regimen is important for a successful outcome of pregnancy. A woman taking anti-TB drugs while on pills/ oral contraceptives has two options: 1) take an oral contraceptive pill containing a higher dose of estrogen (50), following consultation with a clinician; or 2) use another form of contraception. Rifampicin may decrease oral contraceptives’ protective efficacy against pregnancy.

Can pregnant women take anti-TB drugs?

Is it alright for a patient on pills to take anti-TB drugs?

Can a cured TB patient contract TB again? Can a patient engage in sex?

Yes, if he/she inhales TB bacilli when the body resistance is low. Yes. In most cases, a patient is no longer infectious after two weeks of proper medication.

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The Health Promotion Handbook

S

ummary
This is a multiple-method review of the chapter on facts about TB and the DOTS strategy. Have fun in following the specific instructions! Answers are on page 106.

ents are true wing statem llo fo e th r e wheth A. Indicate or false. cilli, is a y tubercle ba b d se u ca , TB . 1. _____ e lungs only disease of th g n p taki TB alright to sto is It nt feels _ _ _ _ 2. _ hen the patie w n tio a ic d e m the TB o months of tw r e ft a t a re g regimen. ve indicator is a conclusi y ra xst e h C 3. _____ TB. r all of pulmonary n is a must fo tio a in cc va G C B forms of TB 4. _____ vent serious re p to ts n fa in later in life. test results en diagnostic h w s se ca In Diagnostic 5. _____ usive, the TB are not concl er or not a ecides wheth Committee d ndergo atic should u TB symptom treatment.

Chapter 1 The Essentials of TB and DOTS

25

B. Choose which letter represents the correct answer. 1. The NTP’s target case detection rate is _____ % or more of the estimated new smear-positive TB cases. a. 70 c. 80 b. 75 d. 85 2. The NTP’s target cure rate is _____ % or more of the estimated new smear-positive TB cases. a. 70 b. 75 c. 80 d. 85 3. DOTS means: a. Directly Observable Treatment, Short Course b. Directly Observed Treatment, Short Course c. Directly Observable Training, Short Course d. Directly Observed Treatment, Short Chemotherapy 4. Which of the following is not an element of the DOTS strategy? a. Political commitment b. Quality Sputum Microscopy c. Quality X-Ray Examination d. DOT e. Recording and Reporting f. Quality Drugs 5. Certifiers of health facilities are staff from one of the agencies below: a. PhilHealth b. Centers for Health Development c. Bureau of Local Health Development d. World Health Organization

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The Health Promotion Handbook

Label the following statements M if you believe these are myths or T if these are the truths about TB. 1. The spoons, forks, plates, and glasses used by the TB patients, who are on regular medication, should be set apart from those used by other members of the family. 2. Rifampicin may reduce the drugs’ efficacy in protecting the woman from getting pregnant. 3. It is 100-per-cent safe to take alcohol while on TB medication. 4. A patient who enrolls in DOTS should be given two months’ supply of TB medication before he/she moves to another place of residence. 5. TB is hereditary.

Chapter 1 The Essentials of TB and DOTS

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The Health Promotion Handbook

Summary
By way of summarizing the contents of Chapter 2, do try out a more creative approach. Have fun in accomplishing the following Self-Assessment Exercise. Pick out the appropriate word/words from the “list” found in the blue box. Take note that the letters are jumbled. Answers are on page 107.

Health promotion means encouraging people to take ________ in order to improve their physical, mental, and ________ well-being. It is a proactive undertaking that enhances public ________ of health and its attendant dimensions. In health promotion, it is important to fire up the following sectors: communities; ________ ; professionals; and the general ________. The five action areas of health promotion are: 1. Building healthy public ________ 2. Creating a ________ environment 3. Strengthening ________ action 4. Developing ________ skills 5. Reorienting health ________ An important principle of health promotion calls for promoting ________ between and among various sectors, including those beyond health care. Among the approaches employed in health promotion is ________, along with education, legislation, fiscal measures, organizational change, community development, and spontaneous local activities against health hazards.

tcinoa ivoe rptuspr esric a sneseraw yplm s cilbup o s k r a e ceiv na i c se cs coima i cy po m i c o l alo ninutom m t y o u rl n p
ripocoetona

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The Health Promotion Handbook

Levels

Locus of Responsibility DOH – NCDPC, NTP, NCHP, NGO CHD-NTP, HEPO/IO,

Intended Stakeholders/ Target Audience Policymakers, government agencies or corporations, business sector, media organizations, other NGOs Local chief executives, Provincial Health Board, Sangguniang Bayan, civic organizations, academe, business sector, cooperatives, medical/professional societies, media organizations, other NGOs Local chief executives of member municipalities, chiefs of referred hospital

National Regional

Provincial/City

PHO/CHO, NTP, HEPO/IO

Inter-Local Health Zone

Chair of ILHZ Board

Municipality

MHO – NTP Core Team, PHN, HEPO/ IO

Chief executives, Sangguniang Bayan, Local Health Board, civic organizations, academe, business sector, cooperatives, other NGOs, leaders of faithbased religious organizations Local formal and informal leaders, people’s organizations, religious groups or faith-based organizations, community groups, small entrepreneurs, cooperatives, PLWD, cured TB patients and their families, TB support groups

Community

RHM, BHW, NGOs

Chapter 3 Advocacy, Communication, and Social Mobilization

55

encountered by the patients and their partners. Hold some role playing sessions, switching the roles of the patient and the treatment partner for both to better understand each others’ situation. Individual counseling by the doctor may be scheduled if patient fails to attend education classes or if a problem already arises. Regular follow-up by midwife could ensure that patients and their partners are doing the right thing. If they are not, then the visit becomes an opportunity to correct some mistakes. g. Patients’ Testimonials Identify patients with success stories or those who get cured of the disease despite the odds. Develop talking points or ideas the patients can discuss. These may include their struggles in complying with the treatment regimen, such as side effects, lack of money to regularly visit the health center, the pressure of going back to work to earn a living, and many more. Patients may also share the driving force or their motivation to be cured of TB and who helped them achieve their goal. Invite said patients to special events or media exposure opportunity to talk about their stories.

Chapter 4 How to Apply ACSM in the Five Action Areas of Health Promotion

81

Chapter

5

How to Develop an ACSM Plan

I ntroduction
Chapter 5 provides a guide for developing and carrying out an ACSM plan in each of the five action areas of health promotion. The reader may refer to this chapter for specific ACSM activities on TB that can be done at the community level.

Practical Steps in Designing an ACSM Plan
1. Defining the problem. This involves the identification of factors which cause a gap between the existing and desired behaviors of the target group. It can be a problem in knowledge/ information, skill, attitude, or resource. Problem identification methods include observation, KAP (knowledge, attitude, practice) surveys, group discussions, analysis of records, results of tests, and special studies. 2. Formulate communication objectives. Objectives are goals to aim for or desire to achieve within a time limit through the use of strategies and resources. It is

Chapter 5 How To Develop an ACSM Plan

95

important to have a clear idea of the health program to be communicated and the action the identified target audiences have to take.

3. Identify/analyze the audience. The extent to which a message is attended to, comprehended, and used by an audience is largely determined by the extent to which the source of the message understands the audience. It is also important to break down the audiences into sub-groups or what is called audience segmentation. Different subgroups have different needs, interests, and attitudes. Thus, different messages – or at least different message executions – should be tailored for different groups. 4. Design effective messages. A message should appeal to the target audiences and hold their interest. People pay more attention to messages that are in consonance with their needs and values. The message carries both the content and image of an ACSM campaign – not only what is said, but also how it affects emotions, perceptions, and attitudes. It is very important that the message and its approaches be pretested and revised before these are finalized and disseminated. 5. Use multiple channels. Multiple communication channels, both mass and interpersonal media, tend to have a complementary effect, and can carry different types of information. Consider the different types of ACSM activities discussed in this chapter. Moreover, determine if a mass medium is indeed justifiable in terms

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of costs and benefits compared with other types of channels. 6. Determine needed resources. Like other project activities, ACSM requires allocation of resources. An inventory of available resources in the organization should be done to determine what are available for ACSM. However, if the organization’s resources are limited, other agencies may be tapped for resource-sharing.

7. Document, monitor, measure and evaluate. Proper documentation is essential in any ACSM activity. If it is not documented, it did not happen. It is also important to carry out both outcome evaluation and process evaluation. It is best to remember that any kind of evaluation should be guided by the plan’s objectives.
A sample ACSM plan showing the activities in each of the action areas is given in matrix format. The sample also shows the different features of an ACSM plan, aside from activities -- tools, time frame, budget, locus of responsibility, and performance indicators.

Chapter 5 How To Develop an ACSM Plan

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SAMPLE ADVOCACY, COMMUNICATION, AND SOCIAL MOBILIZATION PLAN
ACSM Activities Tools Time Frame Budget LOR Success Indicators

Building Healthy Public Policy
Present in the regular LHB meeting the policy gaps of the TB Control Program Lobby with SBs to pass resolutions/ordinances to support the policy gaps which could be any of the following: * provision of funds, logistics and human resource to health programs specifically NTP * Philhealth Indigency program * Philhealth accreditation * Procurement of drugs for Category III and other logistics * Hiring of health professionals particularly RHMs and RMTs/Microscopists * Incentives for BHWs and TB Partners Arrange for interviews of the SB for Health or the MHO to discuss the merits of the proposed ordiance or resolution over the local radio or TV programs or to be featured in the local newspaper. Conduct public discussion of the proposed resolution/ordinance through community assemblies. Policy Gaps/Areas January 2008 LHB Chair / Vice Chair (MHO) MHO LHB members convinced on the need to issue new policies on TB Local Resolution/ Ordinance Passed

Draft Resolution/ Ordinance

February 2008

Position paper for the resolution/ ordinance highlighting its benefits and the draft of the resolution or ordinance Briefer on the TB Control Program proposed resolution/ ordinance and position papers of various stakeholders FAQs on the proposed resolution/ordinance

February 2008

MHO

Merits of proposed resolution/ ordinance discussed over the media

February 2008

MHO

Public opinion on the proposed resolution/ordinance created

Organize groups to attend public hearing to express their interest and support for the proposed resolution/ordinance.

February 2008

MHO/SB for Health

Organized groups attended and participated during public hearings

Chapter 5 How To Develop an ACSM Plan

SAMPLE ADVOCACY, COMMUNICATION, AND SOCIAL MOBILIZATION PLAN
ACSM Activities Tools Time Frame Budget LOR Performance Indicators

Creating Supportive Environment
Organize Technical Working Groups. Orientation materials NTP Briefer List of Functions and Responsibilities of each TWG member Manual of Operations TB logistics, reagents, supplies, and drugs March 2008 MHO, PHN, RHM Functional TWG

Provide continuous diagnostic and treatment services.

Throughout the year

MHO, PHN, RHM MHO, PHN, RHM

Continuous provision of diagnostic and treatment services PHILHEALTH accreditation of the health facility

Work for PHILHEALTH Accreditation.

PHILHEALTH accreditation procedures and requirements Documentation of best practices on TB in other areas Project Document, Documentation Report Forms

March 2008

Develop new initiatives to improve program implementation or delivery of TB services.

May 2008

MHO

Project design developed and implemented

Document best practices and share with other areas.

Throughout project cycle

MHO, PHN, RHM

Documentation report prepared and shared with other areas

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SAMPLE ADVOCACY, COMMUNICATION, AND SOCIAL MOBILIZATION PLAN
ACSM Activities Tools Time Frame Budget LOR Performance Indicators

Strengthening Community Action
Organize TB Task Forces/TB Patrol / TB Watch sa Iskul. Orientation Materials, List of Roles and Responsibilities Posters, leaflets, flip chart, letter, MOA Certificates, incentives March 2008 MHO/ PHN/ RHM TB Task Forces/TB Patrol / TB Watch sa Iskul organized in each barangay / school TB Clubs organized and functional

Organize TB Support Groups/Clubs - Select members to share testimonies during TB club meetings. - Schedule meetings of TB Clubs. - Intensify H.E and focus on SP, follow-up and Tutok Gamutan. - Conduct regular meetings to get feedback on quality of service delivery and client satisfaction. * Document activities and meetings. * Provide awards and incentives. Recruit and train TB treatment partners.

Throughout the year

MHO/ PHN/ RHM

The Health Promotion Handbook

List of TB patients, Briefing materials on TB and List of Roles and Responsibilities

Throughout the year

MHO/ PHN/ RHM

Trained TB treatment partners provided to each patient

Chapter 5 How To Develop an ACSM Plan

SAMPLE ADVOCACY, COMMUNICATION, AND SOCIAL MOBILIZATION PLAN
ACSM Activities Developing Personal Skills
Conduct IEC Development Writeshop that will lead to the following outputs: - Identification of target audience - Crafting of specific messages per target audience - Development of prototypes of the materials Briefer on TB Control Program Documents/Reports of Knowledge/ Attitude/Practices/ Behaviors of the people being targeted for communication activities Questionnaires for pretesting of materials Canvass of Printers/ Suppliers Guidelines for Distribution and Utilization Number of IEC materials distributed to intended audience February 2008 MHO and other partner agencies Number of IEC materials pretested and produced

Tools

Time Frame

Budget

LOR

Success Indicators

Pretest IEC materials among target audience for clarity of messages and visuals used. Produce IEC materials.

Distribute IEC materials.

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SAMPLE ADVOCACY, COMMUNICATION, AND SOCIAL MOBILIZATION PLAN
ACSM Activities Developing Personal Skills
Conduct interpersonal communication activities. - Conduct health education classes. IEC materials developed or any appropriate available IEC material March-December 2008 RHMs and BHWs Number of health education classes conducted

Tools

Time Frame

Budget

LOR

Success Indicators

- Carry out counselling during home visits.

IEC materials

March-December 2008

RHMs and BHWs

Number of home visits conducted Number of counselling sessions conducted

- Conduct health education activities for patients and treatment partners.

IEC materials

March-December 2008

RHMs and BHWs

Number of health education activities conducted for patients and treatment partners Number of people who visited the TB Expo

The Health Promotion Handbook

- Organize health events, like TB Expo, to heighten awareness of the TB Control Program.

August (Lung Month) Posters, tarpaulins/ streamers, pamphlets, and other relevant IEC materials, List of media people to invite, Letters of invitation to key stakeholders, Exhibit materials

MHO and PHN

Chapter 5 How To Develop an ACSM Plan

SAMPLE ADVOCACY, COMMUNICATION, AND SOCIAL MOBILIZATION PLAN
ACSM Activities Tools Time Frame Budget LOR Performance Indicators

Reorienting Health Services
Conduct advocacy meeting with private practitioners. NTP Program brief, PPMD Guidelines NTP Protocols, Manual and materials, PhilHealth Guidelines, DOTS, CUP Guidelines Conduct scientific forum or orientation on DOTS. NTP program brief, PPMD Guidelines NTP Protocols, Manual and materials, PhilHealth Guidelines, DOTS, CUP Guidelines Send advocacy letters to private practitioners. Advocacy letter March 2008 MHO Private practitioners responded to advocacy letters Lakbay-Aral resulted in a new project development March 2008 PHO/MHO Memorandum of Agreement signed March 2008 MHO Advocacy meeting resulted in some agreements

Conduct Lakbay-Aral to learn new initiatives or best practices in other areas.

List of areas with best practices on TB program and itinerary of travel

April 2008

MHO

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Answer Keys

Answers (Introduction)
1. The Health Promotion Handbook is meant for: a. Doctors b. Nurses c. Midwives d. Microscopists 2. The NTP’s goal is 70% CDR and 85% cure rate. 3. The Glossary is the part of the HPH that lists special terms and their meanings. 4. The References section is also important because this may be able to supply sources of additional information for readers. 5. DOTS is the strategy currently implemented worldwide to address the TB problem.

Answers to Summary

105

Answers (Chapter 1)

A. TRUE or FALSE 1. False 2. False 3. False 4. True 5. True B. MULTIPLE CHOICE 1. a 2. d 3. b 4. c 5. b C. MYTHS or TRUTHS 1. M 2. T 3. M 4. M 5. M

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The Health Promotion Handbook

Answers (Chapter 2)

Health promotion means encouraging people to take action in order to improve their physical, mental, and social well-being. It is a proactive undertaking that enhances public awareness of health and its attendant dimensions. In health promotion, it is important to fire up the following sectors: communities; policymakers; professionals; and the general public. The five action areas of health promotion are: 1. Building healthy public policy 2. Creating a supportive environment 3. Strengthening community action 4. Developing personal skills 5. Reorienting health services An important principle of health promotion calls for promoting cooperation between and among various sectors, including those beyond health care. Among the approaches employed in health promotion is communication, along with education, legislation, fiscal measures, organizational change, community development, and spontaneous local activities against health hazards.

Answers to Summary

107

Answers (Chapter 3)

3 1

L

C O M

B O

B Y T I

I

N G

2

P R

R

O M U

O N

3

N

E

T

W O

K I

N G I C

4

M

4A 1D

A D V E R S A R

D

V

O

C A T I

A C Y O R

2

P O S I T

O N

5

P O L I C Y N

5

M O

B

I E S

L

I O N I N G

Z

A T

I

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The Health Promotion Handbook

Answers (Chapter 4)

1. Resolution 2. Ordinance 3. Advocacy Kit 4. Bingo 5. Task Force 6. ACSM 7. TBTWG 8. Press Conference 9. Texting 10. Lakbay-Aral

Answers to Summary

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REFERENCES
Coleman, Patrick L. and Rita C. Meyer. 1990. The enter-educate conference: entertainment for social change. Baltimore: Center for Communication Programs, Johns Hopkins University. Crofton, John, Norman Home, and Fred Miller, 1999. Clinical Tuberculosis 2nd Edition. Egger, Gary, Rob Donovan, and Rob Spark. 1993. Health and the media: principles and practices for health promotion. New South Wales: McGraw-Hill Book Company Australia Pty. Limited. 2003 Philippine Health Statistics, National Epidemiology Center - Department of Health. 2007. Piotrow, Phyllis T, Katherine A. Treiman, Jose G. Rimon II, Yun Sung Hee, and Benjamin V. Lozare. 1994. Strategies for family planning promotion (World Bank technical paper, ISSN 0253-7494; no.223). Regional Framework for Health Promotion 2002- 2005. WHO Regional Office for the Western Pacific (2002). UN Website for Millennium Development Goals, http://www.un.org/millenniumgoals/ World Health Organization, http://www.who.int/en/

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