O vercoming Barriers to TB Control The Role of Advocacy, Communication, and S ocial Mobilization ( ACSM) Training Curriculum August 2011 Acknowledgments This curriculum is a collaborative effort of PATH, the World Health Organization (WHO) Stop TB Partnership Secretariat, and the United States Agency for International Development (USAID). It was developed by Svitlana Okromeshko, Hara Mihalea, Barbara Crook, Charlotte Colvin, Amie Bishop, and D’Arcy Richardson. Special thanks to Mayra Arias, Mohammed Makame, Zainabu Kitembe, Lisa Mueller, Susan Kingston, and Holly Greb (PATH); Young-Ae Chu (WHO Stop TB Partnership Secretariat); David Berger (Global Reach Network, Inc.); Chibuike Amaechi (The Good Neighbour, Nigeria); and Susan Bacheller, Amy Piatek, and Carolyn Mohan (USAID) for their support and contribution to this work. For more information Please contact Svitlana Okromeshko Program Officer Advocacy, Communication, and Social Mobilization [email protected] This document was produced for review by the United States Agency for International Development (USAID). It was prepared by PATH for USAID Tuberculosis Task Order 1, Contract No. GHN-I-00-09-00006-01, with funding from USAID. Contents Abbreviations..............................................................................................1 Introduction.................................................................................................2 Guidelines for Trainers................................................................................3 PowerPoint Presentations, Information Handouts, Worksheets, and Trainer’s Guides at a Glance ......................................................................6 Overview of Agenda .................................................................................11 Day 1: The Role of ACSM in TB Control: Understanding Advocacy..........14 Day 2: Understanding Communication and Social Mobilization ................35 Day 3: Planning ACSM Activities to Address TB Control Objectives, Challenges, and Barriers ..........................................................................60 Day 4: Planning for ACSM........................................................................81 Day 5: Going Forward...............................................................................90 References...............................................................................................96 Annex 1: Trainer’s Guides Annex 2: Information Handouts Annex 3: Worksheets Abbreviations ACSM advocacy, communication, and social mobilization AIDS acquired immunodeficiency syndrome CHW community health worker CSO civil society organization DHS Demographic and Health Survey DOT directly observed therapy DOTS the internationally recommended TB control strategy Global Fund Global Fund to Fight AIDS, Tuberculosis and Malaria HIV human immunodeficiency virus KAP knowledge, attitudes, and practices MDR-TB multidrug-resistant TB NGO nongovernmental organization NTP National TB Program PATH Program for Appropriate Technology in Health TB tuberculosis USAID United States Agency for International Development WHO World Health Organization XDR-TB extensively drug-resistant TB 1 Introduction Much has been achieved in tuberculosis (TB) control with technical and medical interventions. To meet the Stop TB A C Partnership target of detecting 70 percent of new cases and successfully curing 85 percent of these cases, however, we must go beyond technical fixes (diagnostics, drugs, and vaccines) and address the many social, economic, legal, and political SM dimensions of TB that have an impact on TB control outcomes. Advocacy, communication, and social mobilization (ACSM) refers to a set of interventions that supports TB control goals and objectives at international, national, and local levels. These include advocating for sufficient resources, promoting healthy behaviors and attitudes, and engaging affected communities in the fight against TB. ACSM activities also can battle stigma, correct misconceptions about TB, and identify new funding mechanisms to support TB control—all of which are essential to sustaining and increasing the gains that we have made in TB control over the past several decades. This curriculum is designed for training TB control professionals and civil society activists at national and local levels who are involved in ACSM efforts. It is designed to provide country- level staff with the specific knowledge and skills to plan, implement, and evaluate effective ACSM interventions linked to specific TB control objectives. The curriculum structure and methodologies proposed by PATH were approved by the Stop TB Partnership ACSM Country Level Core Group members for global use. The original version of the curriculum was significantly refined and modified in response to partners’ comments and to meet participants’ needs. The training objectives are to: • Orient participants to the basic concepts of advocacy, communication, and social mobilization for TB control. • Provide country-level staff with specific knowledge, skills, and resources to plan, implement, and evaluate effective ACSM interventions linked to specific TB control objectives. • Draft action plans specific to their settings and create follow-up technical assistance plans for moving forward with ACSM. Participants will: • Understand the concepts of advocacy, communication, and social mobilization, their differences and interlinkages, and benefits of incorporating ACSM activities into TB programs. • Understand how ACSM activities support the Stop TB Strategy and TB control objectives. • Review specific TB program performance data, identify TB control challenges and contributing factors (barriers), and design ACSM activities to address those barriers. • Be able to use a systematic process of program gap identification and barrier analysis to develop feasible and appropriate ACSM action plans. 2 Guidelines for Trainers Selection of Participants The success of the workshop and the sustainability of its outcomes depend crucially on how deeply participants are engaged in their local in-country TB ACSM activities. To the extent possible, make sure that the most engaged and committed staff are sent from each participating area. Participants will ideally include people who fit the following profiles: • Represent a cross-section of relevant stakeholders at different levels (e.g., national, provincial, and local). • Directly responsible for managing, planning, implementing, or evaluating ACSM activities on a day-to-day basis (e.g., ACSM focal point at the National TB Program [NTP] or the Global Fund to Fight AIDS, Tuberculosis and Malaria [Global Fund]). • Civil society representatives, including affected groups (e.g., nongovernmental organizations [NGOs] implementing ACSM activities at the community level, TB patient organizations). • Others who are critical to breaking identified roadblocks (e.g., NTP managers, media representatives, policymakers, Global Fund project managers). • Individuals most likely to take specific action as a result of their participation in the workshop. • Individuals who will be in their current positions for at least two years. Pre-training Arrangements The availability of detailed TB control data (at national, regional, and district levels) ensures a practical and satisfying outcome of the workshop. Useful documents include NTP, national, and regional strategies and reports; knowledge, attitudes, and practices studies and Demographic and Health Survey reports; assessments (formative surveys, key informant interviews); and impact evaluations of activities. Ask participants to submit electronic versions and carry both hard and electronic copies of these files to the workshop. Number of Trainers A minimum of two trainers is recommended in addition to the lead trainer. If possible, having up to five staff members with some level of facilitation skills will be useful, as they will play the role of group mentors. Each trainer will mentor a specific country group through the team exercises, which are an integral part of this training. The group mentors’ duties include repeating and clarifying instructions for group work sessions and guiding the discussion when necessary so that it stays focused on the objectives and outcomes. This group’s active involvement in all stages of selection and administration is essential to the success of the workshop. 3 Curriculum Review and Adaptation Prior to the workshop, the trainers should gather background information on participating countries and review their epidemiological data and plans/strategies for TB control. The co- trainers will work closely with the lead trainer to review and adapt the training materials to address specific country needs, and they will assist the lead trainer in the day-to-day facilitation of the workshop. The lead trainer and co-trainers should examine this curriculum, make adaptations as needed to customize the sessions to the local settings and participants’ expressed needs, and prepare ACSM case studies/examples that are appropriate for the region. This should be among the first activities in the preparation. Trainers should be assigned to specific sessions well ahead of the training, to give them adequate time to familiarize themselves with the materials, content, and process, and to smooth out any potential problems. Venue Make sure that the venue is spacious enough to provide extra space for about five or six breakout groups of five to six people each. Materials Each participant should ideally receive a CD containing complete copies of ACSM resources as part of their registration packet. The CD should also contain digital copies of the agenda, all handouts, and the presentations that will be used in training sessions. Participant Contributions Identify TB specialists willing to attend and present on the status of the national/regional TB control program for each country (see Day 1). Computer Logistics Include a field on the registration form that asks whether the participant will bring a laptop computer and whether he or she has Microsoft Office installed. It is a training preference that each group has at least one laptop computer equipped with Microsoft Office to facilitate compilation of training products. As part of workshop preparation, procure a USB flash drive for each work group as well. This will be used during sessions to transfer files and presentations between laptops and the main presentation computer. Materials and Equipment Trainers should familiarize themselves thoroughly with the curriculum content before initiating the training and prepare copies of the agenda, handouts, and any other resources necessary. The following materials should be assembled before the training begins: 1. Copies of the registration form and needs assessment analysis. 2. Copies of the pre- and post-tests. 3. Copies of the final workshop evaluation form, handouts, and worksheets. 4. Welcome packets for participants—folders containing the training agenda, a notebook, and a pen. 4 5. Markers. 6. Flipchart paper. 7. Small, blank sheets of paper or index cards for daily participant evaluations. 8. Post-it notes. 9. Tape. 10. Name badges. 11. LCD projector(s)—one is essential, two would be ideal. 12. Two dedicated workshop laptops. 13. One USB flash drive per group. 14. Extension cords and adapters, as needed. 15. Certificates of Participation for each participant. Workshop Guidelines Full participation by each group and its members is absolutely critical to the success of the training. Sessions are designed to be interactive and participatory to maximize discussions and sharing between individuals and groups. Trainers must be especially attentive to encourage this and ensure that sessions do not turn into lectures. The strength of this training lies in its ability to be responsive and flexible to the capacities and needs of its participants. To this end, it is necessary to emphasize quality and depth of output over adherence to the time plan. Some teams may move more slowly than the rest. It is recommended that even if a five-day agenda is shared with the participants, it is presented as a draft agenda that will be subject to change from day to day. Secure prior agreement and understanding for this so that no one feels disoriented by rearranged agenda items. If possible, each table should have at least one laptop computer and at least one PowerPoint- literate participant or trainer. Participants should be provided templates for their laptops in which to enter data from various group discussions. Because the training is long and demands engagement, trainers should prepare a variety of short (5- to 10-minute) energizers to use between sessions or to break up sessions as they see fit. Alternatively, one or two participants each day can serve as “mood monitors.” These volunteers can be responsible for leading the group in a song, dance, or energizer exercise at least twice during the day when they sense that participants’ energy is low. The following resource provides excellent ideas for energizer activities: 100 ways to energize groups: Games to use in workshops, meetings and the community. Brighton, United Kingdom: International HIV/AIDS Alliance; 2003. Available at: http://www.medicalteams.org/sf/Libraries/Learning_Zone/100_Ways_to_Energize_Groups.sflb.a shx. The trainers should plan on a meeting every evening to review the day and make decisions about adjusting the next day’s content and agenda to meet participants’ needs. This meeting is crucial to successful training outcomes. 5 PowerPoint Presentations, Information Handouts, Worksheets, and Trainer’s Guides at a Glance Day 1 Handouts Worksheets Session PowerPoint Presentations Trainer’s Guides (HO) (WS) Session 1 Registration Session 2 Welcome and Greetings • HO 1.1: Overview of Roadmap for Using Trainer’s Guide 1: Agenda Worksheets Pre-/Post-workshop Session 3 Objectives, Agenda, and Norms • HO 1.2: Pre-workshop ACSM Quiz Answer Sheet ACSM Quiz Why Is ACSM Essential to the HO 1.3: ACSM and the Stop Session 4 Stop TB Strategy? TB Strategy Presentations by participants on Session 5 NTP and ACSM status in their countries HO 1.4: From Cough to Cure: WS 1.1: Barriers that Cough-to-Cure Pathway of Ideal Session 6 A Path of Ideal Behaviors in Prevent Ideal TB Behavior Behaviors in TB Control Tuberculosis Control • HO 1.5: Differences Among • WS 1.1: Barriers that ACSM Concepts Prevent Ideal TB Behavior Session 7 Understanding Advocacy • HO 1.6: Effective Advocacy Skills • WS 1.2: Advocacy Activities • HO 1.7: ACSM Case Studies Session 8 Daily Evaluation and Closing 6 Day 2 Handouts Worksheets Session PowerPoint Presentations Trainer’s Guides (HO) (WS) Session 1 Review of Day 1 and Agenda for Day 2 • HO 1.7: ACSM Case • WS 1.1: Barriers that • Trainer’s Guide 2: Studies Prevent Ideal TB Instructions for • HO 2.1: Key Elements Behavior Knowledge, Beliefs, and Practices Exercise of Effective • WS 2.1: Session 2 Understanding Communication Communication Communication • Trainer’s Guide 3: • HO 2.2: Effective Activities Statements for Communication Skills Knowledge, Beliefs, • HO 2.3: Developing and Practices Exercise Effective Messages • HO 1.7: ACSM Case • WS 1.1: Barriers that Studies Prevent Ideal TB Understanding Social • HO 1.8: Ways in Which Behavior Session 3 Mobilization Communities Can • WS 2.2: Social Potentially Contribute Mobilization Activities to TB Care • Trainer’s Guide 4: Session 4 Statements for ACSM Summary Exercise Session 5 Daily Evaluation and Closing 7