Report Submitted to Asia Foundation on January 7, 2008

Executive Summary

The TB Awareness Project was initiated in District Mansehra in December 2007. The Asia Foundation is providing financial and technical support to Helping Hand for Relief & Development for the project. It is a 5 months project starting from December 2007 and ending by April 2008. Total 6 union councils are selected for the project.

We were able to hire the staff and their training. Besides, the field work was also initiated in 6 union councils.

Total 12 Community Health Workers were hired (6 males and 6 females).

The field work was initiated in 6 union councils. The details of the union councils are as under:

1.Kewai
2.Ghanool
3.Balakot
4.Showhal Maazullah
5.Garlat
6.Garhi Habibullah

The Community Health Workers were able to conduct 154 dialogues. Total 28 patients were identified out of 125 suspected cases.

We came across the following issues:

Staff Hiring:

The First step in practical implementation of project was the hiring of staff. A male and female Community Health Worker had to be selected from each of the selected Union Councils. For this purpose, the interviews were conducted in the Mansehra Office of the Helping Hand. We were able to select all 12Community Health Workers (CHWs) from six union councils. The details of which are as under:

The goals can be achieved only if the human recourses are skilled enough not only able to understand:

* What have to do?
* How to do?
* Which can be a suitable strategy according to the geographical and social circumstances of that particular locality to be adopted?
* Importance of time factor.

So after hiring of staff, the second and key stage is to train the hired staff according to the specified objectives of the project.

To achieve this objective, it was decided to arrange a two days training workshop for selected CHWs with the coordination of Asia Foundation and Helping Hand. The workshop was successfully held the detailed report of which is:

The TB awareness workshop was conducted by Helping Hand with the support of The Asia Foundation on November 26, 2007 in U/C Showhal Tehsil Balakot. Mr. Irfan Afridi was the Lead Resource Person with the assistance of Mr. Azmat Akbar.

They introduced the participants with Global Fund for Aids, TB and Malaria (GFATM) and provided them the printed material regarding the project.

Lectures were delivered to Community Health Workers on the following topics:

What is TB?
What are causes of TB?
What are the symptoms of TB?
What are precautionary measures in prevention of TB?

The CHWs were also briefed about the importance of TB awareness among the community and how they can conduct the discussions successfully.

At the end of the workshop, Mr. Azmat Akbar planned the field activities with the CHWs. The CHWs decided to conduct 15 Community Dialogues per CHW with in a month. The Performa of dialogues was also handed over to them.

Progress of Field Work:

CHWs were able to conduct 141 dialogues with the communities. Total 112 TB suspects were identified out of which total 26 patients are verified as TB suspects.

All The CHWs started their work according to given schedule. They conducted the community dialogues in the specified union councils. They discussed different issues related to TB with communities and mobilize community for active participation in the dialogs. Details of each dialog received on the report form.

A summarized report extracted from the report forms submitted by Community Health Workers is as follows:

Planning for Volunteer Training Program:

To utilize the skills of those persons who are willing to work voluntarily in TB awareness program, a volunteer training program is also planed. In volunteer training program a training workshop will be arranged on the monthly basis. The key purpose of this program is to train the maximum number of community members to fight against TB in their localities.

First volunteer Training workshop:
A training workshop for the volunteer will be held on Thursday 11th January 2008 at Shohal in Tehsil Balakot.

Annex 1

Objectives of the Project:
The main objectives of the project are as under:

To conduct dialogues through the selected trained community health workers on the different places and mobilize the local community to make active participations in dialogues to make them enable to share their views and problems related with TB.
To identify the problems which are the obstacles in TB diagnosis a and take the suggestions from community about;
How the community can be facilitated in order to solve their problems TB specific.

Reporting Process and Formats:

The reporting process of the project is as follows:

The target of conducting 15 dialogues in a month is assigned to each of community health worker. The report of each dialogue must be submitted to Helping hand regional office Mansehra by every CHW. Regional office Mansehra is responsible to summarize the data from the Report forms and to submit it to Helping Hand head office Islamabad which will be further submitted to Asia Foundation.

CHWs are provided the referral forms in order to refer the identified TB suspects or Patients to the nearby TB center. The format for referral form is given in format No: 1. And for getting the detailed report of each dialogue Report Forms are designed and given to CHWs the Format of the report form is given in Format: 2.

Format No 1:

Community Dialogue/Discussion
Reporting Form

A: Place /Address of discussion: _________________________________________

B: Date of discussion:__________________________________________________

C: Names of participants:_______________________________________________

D: Number of participants:_______________________________________________

E:Discussion conducted by: ____________________________

F:Issues raised by the participants:

TB specific:_________________________________________

General:___________________________________________

_________________________________________________

F: Names, address and contact no: (if any)of volunteers/Activists identified:

1.____________________________________________

2.____________________________________________

3.____________________________________________

G: Names and addresses of TB suspects identified:

4.____________________________________________

5.____________________________________________

6.____________________________________________

H: Names and addresses of defaulters (TB patient) if any.

7.____________________________________________

8.____________________________________________

I: Whom of contact in next follow-up meeting


J: Name of nearest DC/TC:________________________

K: Person of contact at DC/TC:_____________________________________________

Annex 2

Project Back Ground

TB is most common disease which, if not diagnosed at early stages, can become complicated to treat. The main difficulty in control of the disease is lack of awareness among the community. The ratio of TB suspects is relatively higher in backward and remote areas as compared to the urban developed areas. Those people struggling to earn the basic needs of life are not much usually concerned about their health due to limited resources and second and more importantly due to the low literacy rate. Large number of TB patients do not know even by themselves that they are suffering from TB. They rarely contact a doctor for their complete physical checkup. Although Government TB centers are working but they are not only few in numbers but they also do not work for awareness raising about TB among the communities.

It’s a severe need especially in backward areas to execute all-inclusive program which is responsible to create awareness among the local communities:

* What is TB?
* What are the major reasons of TB?
* What are the common symptoms of TB?
* What are the pre-cautionary measures to eliminate TB from society?

In addition to this program will also focus on the following:

* Identification of TB Suspects.
* Identification of TB Patients.
* Referring the identified Patients and suspects to nearest Diagnoses Centers or Treatment Centers.
* Identification of volunteers

Program Initiation:

General Manager, Helping Hand called a meeting of MHU team and gave them a task to explore funding for health & hygiene education services, a project of Helping Hand. Dr. Atifa, Medical Officer Helping Hand and her team visited the office of Asia Foundation in Islamabad. They met with Dr. Shabbir Chandio, Program Officer. They agreed to collaborate for the TB control project of Asia Foundation in District Mansehra.However, Asia Foundation will check the collaboration possiblities with Helping Hand on health & hygiene education services at any later stage.

Mr. Irfan Afridi from Asia Foundation visited Helping Hand Field Office Mansehra where he met with Mr. Azmat Akbar field support Officer Helping Hand. They have discussed to execute a TB awareness Program; funded by Asia Foundation and implemented by Helping Hand. After discussing different matters regarding to funding, staff hiring, staff training, program administration, implementation strategies and area selection it was agreed to start program to create awareness among the community to eliminate TB in the selected areas.

Memorandum of Understanding (MOU):

For this purpose the MOU is signed between Fazal ur Rehman General Manager Helping Hand for Relief and Development Pakistan and Jon L.Summers Country Representative The Asia Foundation. Through this MOU The Asia Foundation ask for to collaborate with Helping Hand for Relief and Development Mansehra in the provision of identification and selection of six male and six female Community Health Worker from among the existing workers of the NGO and then to train these selected CHWs on the community dialogues, introduction to TB, identification and referral of TB suspects.

Area Back Ground:

This program mainly focuses on the earthquake affected areas. Six Union councils are selected in Tehsil Balakot the most affected areas of District Mansehra and most of the union councils are not only remote, hard to access, in addition to this are much backward areas of district Mansehra. These areas include:

*Union Council Kawai
*Union Council Ganhool
*Union Council Garlat
*Union Council Balakot
*Union Council Shohal
*Union Council Garhi Habibullah.

Location Map