Where is TB in maternal & child health? September 7-9, 2016

Friday-September 9: Effective conversations for TB and MNCH collaboration

Welcome to the final day of our seminar!

Disease control and service delivery

Today we would like to identify how we bridge the gap between service delivery realities and disease control expectations. We have seen how disease control programs such as TB and integrated programs such as MNCH need to collaborate to produce the best possible outcomes for children.

Vertical programs tend to want to maximize activities and outcomes while MNCH and primary care programs need to optimize activities since they provide a diverse range of services. This implies that MNCH/primary care programs can effectively incorporate only a limited set of TB activities as part of the larger package of primary care activities.

The discussions from the last two days have highlighted the emphasis on prioritizing select TB activities that, if implemented within the context of childhood TB, are likely to increase case detection and treatment. We discussed active case-finding of children who are contacts of adults with active TB, especially sputum positives. Similarly the role of IMCI,and iCCM has been emphasized for screening children at risk of TB – with all of these activities requiring functioning referral and back-referral systems (and documentation thereof) as well as capacity at referral sites.
It is clear that we know what to do.

Less clear is how we transition from ideas to a concrete set of activities that are provided through the MNCH platform and are linked to services overseen by the NTP, requiring effective communication, coordination and collaboration.

For instance – how do CHWs that are most likely managed through the MNCH platform actually conduct active case-finding in a consistent and sustainable fashion and without a separate management system set up and monitored/supervised by the NTP? How do we duplicate the model from Ethiopia as suggested by Muluken?

Or as in the instance of Brazil how do we prioritise HW responsibilities and if appropriate include TB in these priorities? Betina stated it powerfully: “I agree with you that the community health worker has many tasks, but there are priorities. In Brazil and in Paraná, tuberculosis is a priority”.

Similarly, how do we change the behaviors of providers to routinely conduct risk assessments of children for TB? Does the example of the Nigerian Minister of Health serve as an example of providing the political will for revamping of Primary Health Care delivery that includes TB?

Day 3 Discussion Question

D3: How can we bridge service delivery realities & disease control expectations?

Who are key stakeholders that need to become part of this conversation – and who is responsible for initiating and managing it? What advice should be provided to participants involved in this conversation, and what factors should be considered?

Day 3 Resource

  1. KNCV benchmarking tool for childhood TB Policies, Practice and Planning.
    This tool is meant to help country level policy makers and implementers to assess and monitor implementation of childhood TB activities

Conclusion

Dear all,
We are concluding three days of interesting and engaging discussions with over 150 people joining the conversation – congratulations and thank you to everybody!

We would like to know whether you liked this seminar and whether you have recommendations for future seminars, so please take a few minutes to fill out our brief survey.

A special thanks to our three discussants, Karen Waltensberger, Jon Rohde and Luis Tam, who so actively responded and helped to further stimulate our thinking.

Please know that the discussion threads will remain open and you can still read through and comment to any question on any day. We will certainly read your comments with interest.

Our final day helped towards a better understanding of the communication that is needed between health actors, the NTP as disease control program and MNCH, at global but especially at national and implementation level. The need for robust and strong data was highlighted again and again. Instead of a detailed summary of the day we will share a final summary of this seminar by the end of next week that will also be posted on the seminar page.

Please feel free to reach out to us if you have any specific questions, comments or ideas on how we continue to discuss this important issue of childhood TB in the context of maternal and child health and make it a reality of primary care.

We look forward to engaging with you in the future, online or in person,
Anne Detjen (adetjen@unicef.org) and Rudi Thetard (rthetard@msh.org)

Full Seminar Summary

Click to read the full seminar summary and view the revised graphic “Course of TB infection and disease in the individual: behaviors and activities that improve efficiencies of the pathway through care