Field Notes

• Field Notes

Field Notes

In Malawi, tuberculosis is a major cause of morbidity and mortality, especially among people living with HIV/AIDS. Project HOPE initiated a five-year project in 2006 in the Mulanje and Phalombe districts of the country to support the National TB Program and improve TB case management and treatment outcomes. Working at the health facility and community level, HOPE is helping increase knowledge about TB, ensuring that people with TB get into treatment as soon as possible and reducing stigma associated with TB and HIV. The community has been a vital partner in the success of this program.

Saidi Nakhumwa is a community volunteer. He lives near Mulanje and serves as a volunteer at the Matipwiri Community Sputum Collection Point where he has been trained to carefully collect sputum samples from people who might have TB in surrounding villages and deliver those samples to a TB microscopy laboratory for testing.

Even with 60 community testing sites now available in the two districts, microscopy testing laboratories are still miles away. Without a car, or even a bike for transportation, it takes the 47-year-old Nakhumwa all day to walk the samples from the community collection site to the nearest TB laboratory and return home. “I love serving the community, but walking on an empty stomach especially during this lean period makes me feel tired when I arrive home,” he says.

Addressing the needs of community volunteers like Nakhumwa, “Bikes for Malawi” campaign is soliciting donations to provide bikes, spare parts and training to community volunteers serving the 60 village testing sites in Malawi. Rodrick Nalikungwi, the organization’s TB program manager in Malawi, believes that the simple introduction of bikes to the already successful TB program in the country will not only help cut volunteer time investment in half , but continue to build on the community support of the successful program.

Since the introduction of the program, the TB treatment success rate in the Mulanje and Phalombe districts has already increased from 60 percent in November 2006 to 89 percent in January 2010. And case fatality rate has steadily decreased from 20 percent to 13 percent during the same time period.

In addition to training dedicated volunteers, the program also includes the training of health-care workers, improving the quality of the laboratory network and mobilizing the community.

Health-Care Worker Training

Health surveillance assistants are the cornerstone of community health service delivery. The program continues to build local capacity by training and strengthening the capacity of health-care workers to diagnose and treat TB and TB-HIV co-infection. To date, 73 health surveillance assistants have been trained in the areas of case management of TB patients, as well as management of patients co-infected with both TB and HIV.

Laboratory Network Expansion

To strengthen and expand laboratory services, the number of laboratories in the two districts was increased, as were the number of trained health surveillance assistants on the use of microscopy for diagnosing TB. Coordination between the laboratory network, health facilities and communities, is leading to more rapid response time and regular supervision and mentoring visits to laboratories is ensuring the level of quality is sustained. To date, 10 health surveillance assistants have been trained as microscopists. Microscopy services in the two districts have also grown from four sites to 10.

Combined with more community sputum collection sites now at 60, the program has increased access to TB diagnosis. The percent of registered TB patients who are tested for HIV has increased from 49 percent to 87 percent from November 2006 to January 2010.

Community Empowerment

Mobilizing the community includes more than recruiting and training community volunteers. The program helped spread knowledge about TB through community education sessions, drama and dance performances and orientations for community leaders, traditional healers and shop keepers. Themes of the education sessions include important information on TB symptoms, diagnosis and treatment as well as details on the free testing and treatment services available in the community. More than 111,000 community members have attended health education sessions on TB, more than 800 traditional healers and shop owners have been oriented and mentored and more than 300 community volunteers have been trained and mentored.

With a year and a half left in the program, Project HOPE is not resting on its successes. The “Bikes for Malawi” campaign is just one example of innovative, cost-effective support that will help sustain the success of the program for years to come and continue to support dedicated community volunteers like Nakhumwa, who is so willing to volunteer his time, even from dawn to dusk, to help rid his community of TB.

Melanie Mullinax is a communications specialist and Rodrick Nalikungwi is the TB program manager in Malawi for Project HOPE.