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 toFocus on mobile population and people living in

urban slums by itselfAssessment, 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