Communities and patient-centric care are important elements in the End TB strategy and ACSM is reflected in the vision, principles, the pillars and components of the strategy. The vision is to achieve a world free of tuberculosis with zero deaths, disease and suffering due to TB. The principles include building strong coalitions with civil society, organizations as well as communities for protection and promotion of human rights, ethics and equity. The first of the three pillars of the strategy is integrated, patient-centric care and prevention while the second entails bold policies and supportive systems. It also emphasises the engagement of community, civil society and various organizations to ensure social protection, poverty alleviation and actions on other determinants of TB.
16. Advocacy Communication and Social Mobilization (ACSM)
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Tuberculosis is a communicable disease with significant medical and social aspects. The sixth element of the WHO Stop TB Strategy 2010-2015 emphasised the empowerment of people with TB and affected communities through advocacy, communication and social mobilization (ACSM) and the use of a patient charter developed to guide the patient and health workers on rights and responsibilities regarding TB care. ACSM is a package of strategies with the purpose of obtaining people-centric responses to the TB epidemic in a country. Bangladesh is one of the 30 high TB & MDR TB burden countries in the world. ACSM activities are essentially required for effective TB control in Bangladesh and to achieve target 3.3 of SDG goal 3.
Advocacy mainly comprises of policy advocacy, programme advocacy and media advocacy. Policy advocacy engages senior politicians and administrators on improving laws and policies. Programme advocacy is achieved by engaging with and involving community leaders. Media advocacy helps in the process of validating TB related issues in order to raise awareness of possible problems and solutions.
In healthcare and service, communication is a two-way process of exchanging information, views and opinions between service providers and recipients. Through communication, we can spread awareness on issues like symptoms of TB, how it spreads, testing, treatment and free of cost availability of these and other relevant services. NTP carries out a lot of communication related efforts on its own and/or with the help of NGO partners and other stakeholders.
Social mobilization involves and motivates relevant stakeholders such as general population, health workers, policy makers, etc. Organizing and taking action for a common purpose to assist delivery of resources and services to strengthen community participation for sustainability, self-reliance and resilience is the goal of social mobilization. The aims of social mobilization are to bring about a social change within the country and to build up partnerships. To achieve its goal, NTP has been working with more than thirty NGOs in the different TB control activities.
ACSM helps in the TB control process by improving case detection and treatment adherence, combating stigma and discrimination, empowering people affected with TB and mobilizing political commitment and resource for TB.
- Patient-centered quality services provided by public and private health facilities as well as through civil society organizations (NGOs, CBOs).
- Engagement of communities to find local and innovative solutions to the challenges faced by the NTP to strengthen early case finding, TB diagnosis, contract tracing, IPT intervention, increased adherence to treatment and reduce social stigma.
Effective communication strategies, address social factors including poor quality of life, poor housing, overcrowding, under-nutrition, smoking and abuse of substances, lack of education, large families, early marriage, lack of awareness regarding cause and transmission of TB and improve the quality of services.
Beside improving early case detection and treatment adherence, ACSM is now addressing components like TB/HIV co-infection, MDR-TB, childhood TB, contact tracing, IPT intervention, infection control and vulnerable groups such as prisoners, migrants, FDMN and others.
NTP is the lead implementing authority to coordinate and develop policies and oversee the management. The implementation arm (NGO) of the NTP is the ACSM Technical Working Group (TWG) in line with other working groups already established for DR-TB, Childhood TB, PPM, Lab, IC, M&E and Research. The ACSM Committee is policy oriented and has the responsibility of developing policy guidelines, finalize and endorse the ACSM Strategic Plan and monitor its overall implementation.