Group discussion Urban Slums

1
Group discussion Urban Slums

• Rapporteur Joseph K Sitienei
• Facilitators B. Squire, I. Onozaki

2
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
  -gtfragmentation
• Moving slums development forces slum people
  displaced or moved -gt 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)

3
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

4
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

5
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)

6
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