1. Firma A. Kisika 1, Duncun Ndimbo 1, Rhoda Kunzugala 2, Richard Mkinga 3, Nolasco Ngoloka 2,, DMOs& DCDOs Iringa 1, Kilolo 2 and Mbinga 3 District Councils Affiliation: 1:Iringa, 2:Kilolo and 3:Mbinga DCs

2.  Background  Rationale  Methods  Results  Lessons leant  Conclusions  acknowledgement

3. MAP OF TANZANIA Iringa DC & Kilolo DC MBINGA

4.  Iringa, Kilolo, and Mbinga district councils have high TB/HIV burden  There are an average of 5 TB diagnostic centers in each district. The Diagnostic Centers are about 50 km apart  There is delay in health seeking behavior among TB patients due to long distance, stigma and financial constrain  HIV prevalence is 15.7% compare to 5.7% national prevalence  TB/HIV co-infection rate is 53% compare to 37% national prevalence  TB case fatality rate is at 21.3% compare to 4.8% national (NTLP Annual Report, 2010

5.  Despite of several National efforts in tackling the TB disease, Iringa, Kilolo and Mbinga districts TB remains a public health problem, strongly linked to poverty  Due to high TB/HIV co-infection morbidity and mortality a PHC/commumity collaborative model was introduced in 2010 in these districts  Community participation was identified as a strategy that will contribute in reducing the TB/HIV co-infection morbidity and mortality  Beneficiaries were involved in the process of quality improvement to promote sustainablity and ownership.

6. There was a need to promote community involvement and participation in TB control activities to enhance:  health seeking behaviour  address stigma  facilitate identification of TB suspects,  contact tracing  early diagnosis,reduction of defaulters and death rates

7. The RCQHC have worked as team to support the three district in introduction of PHC collaborative with focus to TBHIV. Expart meeting with the national TB program officers to identify priority problems in implementation of TB/HIV collaborative activities conducted Sensitization meeting with key stakeholders from three districts on familiarization of PHC/Community collaborative Output  The team agreed on structure (District→Ward→Village) based on existing government structure  Agreed on coordination mechanism  Agreed on QI team composition District (9) Ward level,All members of ward development committees (10) Village level Health facility governing committee(8)

8. Developed an PHC/Community collaborative plan 2011/12 focused on Infection control Reduce burden of TB among PLHA (CTC,PMTCT & VCT)  Screen all PLHAs for TB by using TB screening tool.  Introducing intergrated HIV pregnant woman, partners, Under fives and post delivery mothers to promote TB Screening  Tracing all contact smear positive TB cases in household by using community based health workers and X-TB patients Increasing community awareness about TB screening  Elaborating key messages on TB screening to community members through video show.  (Community leaders members, Secondary schools,Specific group (PLHAS& X-TB Patients )  The community make follow up of sustainability of health care services to the health facility and bring feed back to the meeting in quarterly basis.

9. Improve coodination  Quarterly meeting with key implementers from special clinics (PMTCT,CTC,VCT,TB to share progress.  Joint supervision (DACC,PDCH CO, LABO Tech, CHACK,DTLC,DMO). Learning Session meetings incountry from collaborative sites conducted meet to share progress on plans made,better practices and lessons learned ) PIA is used as the tool for the performance of improvement process. Regional best practices meeting conducted annually in which countries meet to desseminate results after 12-18 months of the implementing the QI process and award are given to the best three performing countries. Advocacy for adoption and scale up is shared better practices is done

14. Health promotion in chronic diseases prevention requires the inclusion of people from diverse background and displines and therefore a community collaborative approach was in order. Working in partnerships/collaborations can be challenging, but is a powerful tool for mobilizing individuals or groups to take action and bringing public health issues to prominence Involvement of the key stakeholders particularly the the politicians and community members is an essential for facilitating the uptake of PHC/ Community collaborative and ensuring sustainability.

15. PHC/Community Collaborative for TB control activities has shown improvements in TB indicators. With adequate financial suport the model can be scalled up

16.  MOHSW ( NTLP)  Regional Centre for Quality Health Care  DED: Iringa, Kilolo, and Mbinga DCs  RHMT Iringa,  Implementing partners: CUAMM, EngenderHealth  CHMT: Iringa, Kilolo, and Mbinga DCs  Health care providers'  Communities

17. THANK FOR YOUR ATTENTION Welcome for discussion