Field stories

Acknowledgements
Over the past five years, many consultants, organisations and governments have collaborated with The Union and contributed to the success of the FIDELIS programme. We would like to acknowledge their commitment and endeavours here which have made FIDELIS such a success. FIDELIS is supported by the Government of Canada through the Canadian International Development Agency.

Testimony by Ezra Shimeles, FIDELIS-Union consultant (20-03-2008)
“In my experience FIDELIS has played an important role in the global fight against TB, in line with the six elements of the Stop TB strategy. I believe FIDELIS has addressed at least four of these key elements in its various projects.

1. Pursue quality DOTS expansion and enhancement, improving case-finding and cure through an effective patient-centred approach to reach all patients, especially the poor.
Most FIDELIS projects have significantly improved TB case finding and case holding activities by reaching the unreached segments of the society especially the poor. The projects I visited applied various modalities of innovative approaches to establish a bridge between the patients and the service they deserve. A typical example of pursuing high quality DOTS expansion through patient centred approach is FIDELIS round 6 project contracted by Tanazania NTP. This project aims to increase case detection rate to 32.6-68% and successfully treat at least 85% of them. Almost all projects have achieved improved case detection and treatment success compared to their previous record.

2. Contribute to health system strengthening by collaborating with other health programmes and general services, for example in mobilising the necessary human and financial resources for implementation and impact evaluation, and in sharing and applying achievements of TB control.
FIDELIS has contributed to health system strengthening in various aspects. All FIDELIS projects have a component of human resource development which includes training in TB control for several cadres of health workers and paramedical staff. Many of the projects had infrastructural improvement of health service delivery units such as the renovation of DOT clinics, establishment of AFB laboratories in areas where there were no sputum microscopy services (eg. Afghanistan, Pakistan, Tanzania, Sierra Leone, Tajikistan, Ethiopia, Somalia). It has been an impressive experience to observe that some of the initiatives of FIDELIS projects were taken over after the end of the project period, by the NTP as well as partners. For instance, in some projects, laboratory technicians recruited by FIDELIS project were transferred to their government payroll as permanent staff. Some FIDELIS tested ideas were replicated to other sites as they were proven more effective.
FIDELIS has been an opportunity to improve the administration capacity of TB programmes by building improved financial management systems. For instance, the accounting system in the FIDELIS project in Bangladesh has been upgraded from a manual to a computerised system following FIDELIS monitors’ recommendations. Projects in Tanzania improved their financial documentation for a fund tracking mechanism.

4. Involve all care providers, public, non-governmental and private, by scaling up approaches based on a public-private mix (PPM), to ensure adherence to the International Standards of TB Care.
Several FIDELIS project have introduced the concept of public private mix, for instance a round IV project, in Pakistan has introduced and strengthened DOTS in four districts of Punjab, through public-private partnerships. Another project in Pakistan in round V, tried achieving comprehensive urban DOTS coverage for TB control through the involvement of general practitioners. The FIDELIS project in Sudan introduced TB-DOTS in health facilities of the Minister of Defense, to be supported by public/private health workers to provide access to an additional six million employees, their families working in defense, and the police force and jail inmates in prisons and the surrounding population.

5. Engage people with TB and affected communities to demand, and contribute to, effective care. This will involve scaling up community TB care; creating demand through context-specific advocacy, communication and social mobilisation; and supporting development of a patient’s charter for the tuberculosis community.
FIDELIS has supported country initiated projects which aimed at engaging communities in TB care. For example, in Sierra Leone, the project has worked to build the community response capacity in TB treatment and prevention in rural and slum communities. This project trained DOTS volunteers and conducted many advocacy and community mobilisation activities which improved the community’s contribution to effective TB care. A project in Myanmar has trained many community volunteers as supporters for TB case detection and treatment. BRAC’s community based TB control programme in rural Bangladesh has worked to scale up the role of the community in TB control by providing orientation to school students, orientation to cured patients and conducting a TB awareness campaign through theatre and other community activities.