Group discussion Urban Slums Rapporteur: Joseph K Sitienei Facilitators: B. Squire, I. Onozaki

Current situations/constraints High TB burden (some prevalence studies: Uganda; high case notification though denominator is uncertain) Different service providers without communication/coordination (v.s TB service through public sector) lead high Pt expenditure and diag delay Lack of pro-poor policies/implementations Moving populations and providers as well, different ethnic groups, origins, culture ->fragmentation Moving slums: development forces slum people displaced or moved -> new slum in peri-urban Few infrastructure compared with a large population Disconnected with providers Insecurity, Violence, Criminal activities, Drugs… Medical risk factors: High HIV, poor nutrition… Lack of infrastructure (basic sanitation, hygiene, education)

Existing initiatives Coordination/ networking of stakeholders –Potential providers and communities: NGOs, CBOs, religious organizations/facilities, churches, schools, governments, (police) Manila. International, local NGOs Lima. Out reach work for MDR Rio. Community HW supported by Local Gov. Pakistan. Linking with GPs. Green Star (NGO) Other examples of franchising Many: Support access to diagnosis: transportation of sputum samples, TB suspects.. –Is NGO better driving force to coordinate? Several good practices & GF projects

Actions: Improving case detection Assure Quality DOTS – Interaction of provider and patients bring more patients, engaging ex-patients –Home based provision linked with HIV service- CBOs Training of providers: Challenge - licensed or not, registered or not ? Service opening hours: late night and mid-night clinic Active CD, mobile clinic where applicable –Can CD assure quality Tx?: Follow up, notification, access service outside of slum Subsidizing cost on diagnosis

DEWG technical partners need to support NTP 1. Mapping 2. ACSM to make momentum, awareness 3. working with local partners to improve access to diagnosis and treatment 4. developing capacity of local partners such as NGOs, CBOs and existing HR such as out- reach workers (Urban Basic Health staff, CHW) and strengthening existing system including referral mechanism, supervision and M/E 5. Building evidences (operational research, piloting innovative approach, documentations)

NTP needs to Focus on mobile population and people living in urban slums by itself Assessment, Situation analysis (mapping) Health System Strategy: Urban health Policies, Action plan Budget allocation for urban TB care and control Advocacy to the Ministry and other agencies Engaging key actors in slum Community leaders All care providers NGOs, CBOs, FBOs, Associations Seek/Promote innovative approach with partners Try something new and document success and failure