PLOS One: Innovative community-based approaches double TB case notification and improve treatment outcome in Ethiopia

News article 30 May 2013

Community health workers—known as health extension workers in Ethiopia—have teamed up with motorbike riders to dramatic effort in Ethiopia’s Sidama Zone, finding double the number of people with tuberculosis (TB) compared to a previous period and increasing their chances of survival.

The project, funded by the Stop TB Partnership’s TB REACH initiative and implemented by the Southern Region Health Bureau and the Liverpool school of Tropical Medicine (LSTM) in collaboration with the Ethiopian Ministry of Health and the Global Fund, engaged with some 1100 health and community workers to bring TB diagnosis, treatment and information materials to rural areas that previously had limited access to healthcare services. Working with motorbike riders, who play a supervisory role, the community health extension workers formed a bridge between these rural communities and far away healthcare centres.

The results from the project were published this week in PLOS One. The article by LSTM’s honorary research fellow Mohammed A. Yassin, with LSTM’s  Daniel G. Datiko, Olivia Tulloch, Luis E. Cuevas and Sally Theobald as co-authors, shows that more than 5000 people with infectious TB were found in the 15 months of implementation between October 2010 and December 2011. In the previous 15 months, the TB programme only reported finding 2500 people with TB.

“I am not able to go to faraway places to be treated because I don’t have money for transportation and food,” said one young woman who benefited from the project. “Here in my community, without going to the health centre, I am getting treatment. It is what makes me very happy.”

The project put a comprehensive package of measure in place to improve access to TB care. The health extension workers, supported by the supervisors, identified people who had been coughing for two or more weeks, collected sputum samples, prepared smears and supervised treatment, leading to a doubling of case detection and a 93% treatment success rate.

“The Global Fund framework on community systems strengthening clearly provides a road map to enhance and build community systems for better broad health outcomes,” said Lucy Cheshire, Global Fund Board Member representing the Communities Delegation. “We need to ensure that such initiatives take place more widely across countries with similar settings. TB REACH has clearly demonstrated the value of empowering and investing in communities.”

The project was of particular benefit to women and children, who formed a greater proportion of the people provided with TB care compared to control areas.

“To stop TB, we must bring quality TB care to poor and marginalized communities,” said Lucica Ditiu, Executive Secretary of the Stop TB Partnership. “This project has shown that we can capitalize on two of the world’s greatest resources—people and communities—to ensure that no one gets left behind. I am particularly pleased to see that this project has served as a pathfinder, encouraging further investment and scale up from the Ethiopian government and the Global Fund.”

The TB REACH initiative is funded by the Canadian International Development Agency.



Read the article in PLOS One.

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