Community Based TB Care Experience From Temeke - Tanzania

THE UNITED REPUBLIC OF TANZANIA
MINISTRY OF HEALTH AND SOCIAL WELFARE
Community Based TB Care: Experience from Temeke, Tanzania

Empowerment and involvement of former Tuberculosis patients in Tuberculosis control
P. O. Box 9083
Dar es Salaam
Tel : 255 22 2124500
Fax : 255 22 2124500
E-mail:tantci@intafrica.com
January, 2010
Community Based TB care through former TB patients social clubs
Table of Contents
List of Abbreviations .................................................................................................................................. ii
Acknowledgement ..................................................................................................................................... iii
Dr. Saidi. M. Egwaga ....................................................................................... Error! Bookmark not defined.
Foreword ..................................................................................................................................................... iv
Executive summary ................................................................................................................................... vi
1.0
NATIONAL TUBERCULOSIS AND LEPROSY CONTROL PROGRAMME .................................... 1
1.1
Organizational structure of NTLP ............................................................................................................ 1
1.2
Temeke Region ......................................................................................................................................... 1
1.3
Community Based TB care ...................................................................................................................... 2
2.1
COMMUNITY BASED TB CARE IN TEMEKE................................................................................. 3
2.2
Background ................................................................................................................................................ 3
2.3
MUKIKUTE ................................................................................................................................................. 3
2.3.1 Objectives of MUKIKUTE..................................................................................................................... 4
2.3.2 Organizational structure of (MUKIKUTE) .......................................................................................... 4
2.3.3 Membership ........................................................................................................................................... 6
2.3.4 Activities/tasks implemented by MUKIKUTE .................................................................................... 7
2.3.5 Support from Temeke Municipal Council........................................................................................... 8
2.3.7 Sources of funds for MUKIKUTE ........................................................................................................ 8
2.3.8 Monetary management within the organization .............................................................................. 10
2.4
Collaboration between TB clinics and MUKIKUTE............................................................................. 10
2.5
Benefits obtained ..................................................................................................................................... 11
2.6
General Achievement ............................................................................................................................. 11
3.0
LESSONS LEARNT AND RECOMMENDATIONS ........................................................................ 14
3.1
Lessons learnt .......................................................................................................................................... 14
3.2
Recommendation .................................................................................................................................... 15
References ................................................................................................................................................. 17
Annexes ..................................................................................................................................................... 18
Annex 1: Terms of Reference (TOR) ................................................................................................................. 18
Annex 2: MUKIKUTE membership form ............................................................................................................ 21
Annex 3: Referral form to be used by traditional healers ................................................................................ 22
Annex 4: Phases for TB club establishment ..................................................................................................... 23
Annex 5: Job description for former TB patients in specified areas .............................................................. 25
Annex 6: MUKIKUTE registration certificates ................................................................................................... 27
Experience from Temeke
Page i
List of Abbreviations
AIDS
Acquired Immune-deficiency syndrome
CBTC
Community Based Tuberculosis Care
CTC
Care and Treatment Centre
DAS
District Administrative Secretary
DED
District Executive Director
DMO
District Medical Officer
DOT
Direct Observed Treatment
DOTS
Directly Observed Treatment Strategy
DTLC
District Tuberculosis and Leprosy Coordinator
HBC
Home Based Care
KNCV Dutch Tuberculosis Association
LHL
Norwegian Heart and Lung Patients Association
PASADA
Pastoral Activities and Services for People Living with HIV/AIDS, Dar es Salaam
Archdiocese
MDR-TB
Multi-Drug Resistance of Tuberculosis
MoHSW
Ministry of Health and Social Welfare
MUKIKUTE Mapambano dhidi ya Kifua Kikuu na Ukimwi Temeke (fight against
Tuberculosis and HIV/AIDS in Temeke)
NTLP
National Tuberculosis and Leprosy Programme
PLHIV
People Living with HIV
PMTCT
Prevention of Mother to Child transmission
RAS
Regional Administrative Secretary
RMO
Regional Medical Officer
RTLC
Regional Tuberculosis and Leprosy Coordinator
TOR
Terms of Reference
TB
Tuberculosis
VCT
Voluntary Counseling and Testing
Page ii
Acknowledgement
This document, Community Based TB Care, Temeke experience is one of the outputs of the
National Tuberculosis and Leprosy Programme (NTLP) implemented in Temeke, Dar es Salaam
by Temeke Municipal Council through TB control programme in partnership with the Norwegian
Heart and Lung Patients Association (LHL). NTLP would like to thank all those who contributed
in one way or another to the success of the programme. Special thanks go to Dr. Eliud
Wandwalo who gave Community based TB care a priority in his PhD thesis and the LHL who
funded the research and later keeps on financially support former TB patients in Temeke.
The NTLP would also like to extend more thanks to the DMO, DTLCs, health workers in TB
centres in Temeke and MUKIKUTE administration for their cooperation during the
documentation. Likewise, the contribution of all MUKIKUTE members in the whole process of
supporting TB patients and community sensitization cannot go unmentioned.
Last but not least, more thanks are extended to the Temeke RTLC, Wailes TB/HIV officer and
the DTLC for their valuable contributions towards documentation of best practice of community
Based TB care in Temeke Municipality.
Page iii
Foreword
Tuberculosis (TB) is among the top ten causes of global mortality and morbidity accounting for
about 26% of all preventable deaths. TB is the third leading killer of adults behind Malaria and
Acquired Immune-deficiency syndrome (AMMP, 2003). In Tanzania more than 63,000 new TB
patients are notified annually and this is mainly fuelled by HIV epidemic. Other factors like
population growth and urban overcrowding have also contributed to this increase. Case
detection has remained below 50% compared to WHO estimates of 70% (Global report, 2009).
This under reporting could be due to low community sensitization, stigma, and passive case
finding approach.
In Tanzania, TB patients are treated under health facility or community based Directly Observed
Treatment (DOT). Community based DOT includes choosing a local treatment supporter to
supervise the patient when taking medications and encourage them to comply in the whole
course of treatment. This approach goes beyond the existing health services and enhances
more allies including cured TB patients. Community-based approach also empowers and
involves former TB patients in their capacity to help other TB patients to overcome difficulties
during treatment.
Successful TB treatment requires at least 6-8 months of treatment to ensure cure and prevent
the development of multi-drug resistant TB (MDR-TB). Thus compliance throughout the course
of treatment is of paramount importance.
Various studies on involvement of local TB treatment supporters conducted in different areas
worldwide including Temeke, Tanzania. In Temeke the study involved former TB patients.
The effectiveness of this approach revealed in 2004 in a randomized controlled trial conducted
in Temeke region of NTLP where by the effectiveness of community-based DOT using
guardians and former TB patients was done to compare hospital-based DOT in an urban setting
in Tanzania. The findings from both DOT options gave similar treatment outcomes at a reduced
cost. It was therefore concluded that community-based DOT was as effective as health facilitybased DOT and can achieve good treatment outcomes (Wandwalo et al, 2004).
Another study conducted in the same region in 2005 to determine the cost effectiveness of
health facility and community based TB DOTS in an urban setting in Tanzania revealed that, the
total cost of treating a patient with conventional health facility based DOT and community based
DOT were $ 145 and $ 94 respectively. Cost fell by 27% for health services and 72% for
patients. Indirect costs were as important as direct costs, contributing to about 49% of the total
patient's cost. The main reason for reduced cost was less number of visits to TB clinics.
Community based DOT was more cost-effective at $ 128 per patient successfully treated
compared to $ 203 for a patient successfully treated with health facility based DOT (Wandwalo
et al, 2005).
These results persuaded NTLP in collaboration with the Norwegian heart and Lung Patients
Association (LHL) to establish former TB social club known as Mapambano dhidi ya Kifua kikuu
na UKIMWI, Temeke MUKIKUTE in 2005 for the purpose of strengthening community based
Page iv
DOT in Temeke municipal council. The club is implementing a lot of activities and it has shown
remarkable achievements concerning community based TB care.
In view of these achievements, the Ministry of Health and Social Welfare (MoHSW) through
NTLP decided to document Temeke experience, best practices and lessons learnt on
community based TB care and share with different stakeholders. This document will also be
used as the base for development of Terms of Reference (TOR) and training package for
establishment and management of former TB patients clubs in other districts across the
country.
Page v
Executive summary
Empowering and involving former TB patients in improving community TB care revealed to be
an effective method of increasing TB case detection rates as well as improving TB treatment
outcome. It is clearly connected to other priorities in TB control.
In regards of involving former TB patients in community based TB care, Temeke was the first
district to establish and maintain a successful former TB patients group, as the initiative of
implementing community based TB care (CBTC) in the district. This document presents the best
practices of community based TB care in Temeke.
Multiple strategies were used to obtain relevant information for this document. The strategies
included interviewing the regional TB and Leprosy Coordinator of Temeke, health workers in TB
clinics and administration of MUKIKUTE (former TB patients organization). Available published,
grey literature and reports on the empowerment and involvement of patients and former patients
in TB control were also reviewed. The interview covers the general information of the
organization, activities implemented by the organization, roles and responsibilities of members,
source of funds as well as on how health workers including Regional and District TB
coordinators work with and support the group.
Cured TB patients from MUKIKUTE have been working in collaboration with health workers in
Temeke NTLP region. They have been involved in social mobilization, providing treatment
support to patients under home based DOT, shared their experience with TB patients under
treatment brought suspected cases to the TB centre and assist TB patients to correctly follow
their treatment. Norwegian Heart and Lung patients Association has been providing financial
support, while Temeke Municipal Council provides financial and technical support.
The major lessons learned include community involvement through former TB patients groups
created and strengthened the sense of an individual, family and community responsibility in TB
control. This also empowered the ex-patients to take on an active role in the fight against TB;
enhancing community awareness through the use of former TB patients as informants and
treatment supporters has contributed towards reducing default rates and improving cure rates. It
has also contributed towards reducing stigma and discrimination of TB patients in the family and
community. Former TB patients groups hardly ever empower themselves but need the
involvement of stakeholders other than the TB programme.
The document recommends the establishment of former TB patients club for community TB
care with major activities of conducting sensitization gatherings and trainings; defaulter and TB
contact tracing; and supervising patients under home based DOT. Only committed former TB
patients are recommended for enrolment. A joint plan for CBTC activities between the Councils
and TB clubs is also recommended. Health workers are recommended to provide technical
assistance and a maximum cooperation for capacity building among the former TB patients for
taking up an active role in the fight against TB. TB control programme at district level advised to
allocate funds, and looking for donors to support former TB patients. However, the Councils
advised to assist clubs in establishing income generating activities for their sustainability.
Page vi
1.0 NATIONAL TUBERCULOSIS AND LEPROSY CONTROL PROGRAMME

1.1 Organizational structure of NTLP
The NTLP is based on the central- local government structure of the MoHSW and that of the
Prime Ministers Office Regional Administration and Local Government (PMORALG). The major
activities implemented by the NTLP is to mainstream TB control activities at lower levels from
the region, district to community, basing on the stop TB strategy including community
involvement and patient empowerment.
Prime Ministers Office
Regional Administration and Local Government
Ministry of Health and Social Welfare

Directorate of preventive services
(TLCU)
RAS
RMO (RTLC)
DAS/DED
DMO (DTLC)
In-charge
Health centre
In-charge
Dispensary
Community
Fig 1: Organizational structure of the Tuberculosis and Leprosy control programme
1.2 Temeke Region
Temeke is the largest Municipality among of the three Municipalities in Dar es Salaam city,
covered 656 sq. km, with the population of 927,310. According to the NTLP, these Municipalities
are taken as regions. Temeke region is located on southern part of Dar es Salaam city, and it
has seven (7) NTLP districts namely Wailes, Mbagala (Kizuiani), Tambukareli, Kigamboni,
Yombo Vituka, Keko and Rangi Tatu. Economically, the population in the rural part of Temeke is
engaged in small scale farming, petty trading and fishing. A small proportion of urban
inhabitants are employed by either government, parastatal or informal sector.
Page 1
The population in Temeke region is served by 116 government and non-governmental health
facilities. A region has two TB/HIV Officers who are stationed at Temeke Hospital and at Rangi
Tatu dispensary. Each district has a TB/Leprosy Coordinator.
There are fourteen (14) diagnostic centers for AFB microscopy located at different levels of
health facilities. Diagnostic centres owned by the government include Temeke, vijibweni
hospitals; Kigamboni H/C; Kizuiani, Tambukareli, Yombo Vituka and Rangi tatu dispensaries.
Private facilities include TOHS, Consolata sisters and PASADA. Keko prison, police kilwa road
dispensary and JKT Mgulani belong to the military, while Bandari H/C is a para-statal health
facility. There are thirty seven (37) treatment centres providing TB services and treatment is
almost 100% ambulatory. Directed Observed Treatment (DOT) is provided in both facility and
home based approach. The smear positive patients get treatment under health facility DOT for
the first two weeks before transferred to home based DOT.
Tuberculosis and TB/ HIV planned activities implemented by Temeke Municipal in collaboration
with PASADA, MUKIKUTE and LHL. LHL provides financial support to MUKIKUTE in
implementing community TB care in Temeke Municipal council. In the year 2008 the region
notified 3,952 of patients of all types of TB cases of which, 1,464 (37%) were smear- positive
(Regional report, 2008).
1.3 Community Based TB care
Community involvement and patient empowerment is one of six components in Stop TB
strategy. Community involvement in the context of TB care implies establishing a working
partnership between the health sector and the community, particularly TB patients, both
currently on treatment and the cured. Experience and documentation from different countries
reveal that TB patients play central role in helping fellow-patients to cope better with their illness
and working closer with NTPs in delivering services responsive to patients needs. Community
involvement ensures that patients and communities are informed about TB and enhances
general awareness about the disease and sharing responsibility for TB care which ultimately
result to effective patient empowerment and community participation and hence increasing the
demand for health services and bringing care closer to the community.
Page 2
2.0 COMMUNITY BASED TB CARE IN TEMEKE

2.1 Background
Temeke Municipal Council has been involved in community TB control particularly former TB
patients since 1st July 2003 to date. The collaboration started during the study conducted by Dr.
Elliud Wandwalo in the year 2003 which was done collaboratively with Temeke Municipal
Council and PASADA. In the study a total number of twenty (20) former TB patients recruited
(two per district) for the study and later were oriented on TB and TB/HIV management including
supervising patients under home based DOT. Each of them was given allowance of 2000/- Tshs
per week making a total of 8000/- Tshs per month. The study showed a nice treatment outcome
among the patints who have been supervised by former TB patients. The study funded by LHL.
Following these remarkable achievements, Temeke region facilitated the formation of former TB
patients organization known as MUKIKUTE in 2005.
Responding to the recorded study results, in year 2006 the region increased the number to 40
former TB patients. As the demand increased, in year 2008, the region increased the number
up to 60 former TB patients. Fifty (50) former TB and TB/HIV patients out of 60 are currently
involved to support 230 (11%) TB patients under home based DOT. According to Temeke
regional annual report (CBTC report, 2008) 2,912 patients were registered as new cases and
out of this, 2,180 (%) were supervised under home based DOT (Temeke region annual report,
2008).
The Council allocates about 7,000,000/- Tsh. per year to support community TB care activities
in Temeke.
2.2 MUKIKUTE
MUKIKUTE is a nongovernmental organization working in the community of Temeke Dar-esSalaam to combat further spread of TB and HIV; and mitigate its impact among the community
members who are infected.
MUKIKUTE was established on 22nd February 2005 with 20 members who participated in the
study in 2003 as mentioned earlier. Through the support of Temeke Municipal Council and
PASADA in 2007 the organization was legally and officially registered, as a non-governmental
organization aimed at increasing community knowledge/awareness on TB and TB/HIV and
promoting positive attitude and support towards people living with HIV (PLWHIV) and
Tuberculosis. MUKIKUTE stands for Mapambano ya Kifua Kikuu na Ukimwi Temeke,
meaning fight against Tuberculosis and HIV/AIDS in Temeke. The organization has a
constitution which it operates on and currently, there are 60 registered members.
Page 3
2.2.1
Objectives of MUKIKUTE
The main objectives of MUKIKUTE are:

To create awareness on TB and HIV/AIDS among the community members.
To work against TB and HIV/AIDS stigma in the community.
To supervise patients who take TB drugs under home based DOT.
To assist/encourage TB patients to comply and complete treatment.
To create awareness in the community on the proper care of TB patients and PLWHIV
Support formation of TB clubs in the community.
2.2.2
Organizational structure of (MUKIKUTE)
Board of Directors
General Assembly
Executive
Committee
President/ Directors
Secretary
General
Management Team
Former TB and
TB/HIV patients
a)
Supporting staff
Treasurer
Committee
Former TB and TB/HIV patients

Supporting staff
b)
Fig 2: a) Organizational structure; b) Leadership chart of the club (MUKIKUTE)
i)
Board of Directors
This consists of 2 Doctors including RTLC and any other doctor interested with the club
Duties:
- Advisory body
- Provide technical Support
ii) General assembly:

This involves all MUKIKUTE members
Duties
- Main decision making organ - approving policies, financial plan, budget and
report.
- Selection of six (6) members to form the executive committee
- Selection of three (3) signatories of the organization
- Approve contributions proposed by the executive committee
Page 4
Meetings
The organization has three types of meetings namely annual general meeting, special
general meeting and extra ordinary meeting. The General meeting is held at least once
in every calendar year usually in the first quarter where by all MUKIKUTE members
attend the meeting. In the event of urgency, the secretary in consultation with the
Chairperson may call an extra ordinary general meeting of the organization. Special
general meetings convened when there is a special issue to be discussed.
All these meetings need a quorum of 50% of eligible members.
iii) Executive committee
The executive committee consists of:
o Management team
o Six members selected by the general assembly
Duties:
- Run day to day affairs of MUKIKUTE
- Prepare annual budget and other budget
- Employ and deploy staff
- Review of financial reports
- Accountable on the organization assets including those hired by the organization
- Prepare agenda for the General assembly
The executive committee meetings take place at least four (4) times per year.
iv) Management Team
These are office bearers and is comprised of three (3) members who are
o
Chairperson
o
Secretary
o
Treasurer
These are elective positions to run the office for 5 years. Re-election of a member is
acceptable. These also are the members of the executive Committee by virtue of their
titles.
Duties:
a) Chairperson
- Spokesperson of the organization
- Convene special and emergence meeting as deemed necessary
- Preside meetings and casting votes
- Topmost official in the organization who deals with all matters pertaining the
organization and rules
b) Secretary
- Chief executive
- Prepares and keeps records of all activities of the organization
- procure goods and services for the organization
c) Treasurer
- Accounting all funds belonging to the organization
- One of the four signatories of the organization.
Page 5
Issue all cheques

Keeps all financial records.
Prepare annual statement of accounts for the organization
v) Former TB and TB/HIV patients

Duties:
- Active case finding
- Defaulter tracing
- Support treatment to TB patients under home based DOT
- Community sensitization as informants
vi) Supporting staff
These include office attendants and driver
Duties:
- Provide support in various office activities
2.2.3
Membership
(i) Criteria:
Anybody who has been treated and cured from Tuberculosis with/without living with HIV/AIDS
and has:
To be ready to give a testimony on being diseased and cured from TB.
To be ready to give services/support to TB patients
Arleady exposed his/her HIV/AIDS seral status to the community.
To be acceptable by the community
To be ready to learn about various issues concerning TB and HIV/AIDS.
(ii) How to apply
An applicant has to do the following:
Write an application letter
o The letter should describe briefly the reason of why he/she want to join.
Fill a membership form under supervision of the secretary general.
Pay an application fee of 10,000/- Tshs
Pay a membership fee is 1,000/- Tshs per month.
Pay any other contributions agreed by the organization (any contribution has to be
discussed by the executive committee and approved by Annual General meeting)
(iii) Termination of membership
Member is eligible for termination on the following reasons:
Death
Resignation or retirement in writing
If convicted of criminal offence
Proved mentally un-fit
Misuses of organization money, assets and anything belongs to the organization

Page 6
Failure of paying membership fees consecutively for more than 6 months without any
notice
2.2.4
Activities/tasks implemented by MUKIKUTE
Currently MUKIKUTE is implementing the following activities:

Community mobilization/sensitization
o Conduct meetings and community gatherings in which TB, TB/HIV and HIV/AIDS facts
provided using former TB patients testimony and pamphlets, brochures, leaflets.
Gatherings conducted at least once per year per ward. Edu-entertainments are used
including drama, performance talks, role plays, testimonial from former TB patients and
PLHIV addressing TB control; TB/HIV; HIV/AIDS and stigma.
MUKIKUTE drama group,
performing during
community sensitization
event in one of the wards in
Temeke.
The MUKIKUTE Chairperson (Mr Joseph

Mapunda), sensitizing the community about TB
and TB/HIV in one of the wards in Temeke.
o
o
Sensitize community members/leaders to understand and accept TB patients and

PLWHIV in the community.
Sensitize TB suspects; and refer them to health facility for screening and laboratory
investigations.
Page 7
Visit TB patients and their contacts for education on TB signs and symptoms; and
encourage the contact to attend at health facilities for screening whenever they show the
signs and symptoms.
Orient and work with traditional healers in identifying and referring patients with TB signs
and symptoms to health facilities. The former TB patients expedite the process of patients
accessing health facility and discourage TB treatment by traditional healers.
Support and supervise TB patients under home based DOT
Defaulter tracing - this has been done in collaboration with District TB and leprosy
Coordinators.
2.2.5
Support from Temeke Municipal Council
MUKIKUTE gets support from Temeke Municipal council in the following areas:
Collaboration in trainings for community empowerment including refresher training to
MUKIKUTE members twice a year on TB and TB/HIV
Community sensitization
o Temeke Municipal through RTLC and DTLCs collaborates with MUKIKUTE in
community sensitization. Sensitizations conducted in the presence of the Coordinators
for responding on technical questions posed by the community.
o The RTLC facilitate the training on TB and TB/HIV to influential people including
traditional healers, Councilors, wards executive officers.
The council has been receiving funds from partners and disburses them to MUKIKUTE till
when MUKIKUTE registered as legal operating organization. To date the funds from
partners goes direct to MUKIKUTE.
The Council and MUKIKUTE conduct a joint plan for community based activities to be
conducted during a respective financial year.
2.2.6
Collaborating partners
MUKIKUTE works collaboratively with the following national and international organizations:
Norwegian Heart and Lung Patients Association (LHL)
National TB and Leprosy programme of MOHSW Tanzania
KNCV (Dutch TB foundation)
PASADA
Temeke Municipal Council.
ICAP
2.2.7
Sources of funds for MUKIKUTE
The organization derives funds and income from fees, contributions from members, sale of
publications/properties, gifts, grants, aids from donors.
Application and monthly fees from members (explained above in 2.2.3 ii)
Contributions from members
Page 8
Sometimes members agree to pay some money for development activities. For example,
Kigamboni club contributed the initial cost for flower garden development.
Economic and income generating activities

MUKIKUTE has created different projects for income generation. These include:
o Drama club which has been used for community sensitization and also it usually lent out
in different occasions
o Lend out generators, modern music system and amplifiers
o The organization makes tie and die clothes (batiks) and sell them for generating
income
MUKIKUTE members looking
at the tie and die clothes
(batiks) developed by the club.
Donation from other partner organization

LHL has adopted and active supportive role and used a combination of methods and
approaches in its cooperation with MUKIKUTE. These include:
o Skills enhancement through seminars, workshops, and training,
o Involvement of patients, former TB patients and service providers in development of IEC
materials,
o Consultative visits by LHL officials to observe the programme activities and meet
stakeholders and patients,
o Provision of on-site advice, support and mentoring,
o Facilitating opportunities for participation in seminars and conferences locally, regionally
and internationally,
o Nurturing and promoting local talent/expertise such as in the production of locally
responsive IEC materials (TB booklets).
Page 9
2.2.8
Monetary management within the organization
Bank account
Bank account opened by the name of the organization. There are four signatories of the
organization. All revenues of the organization are deposited to the bank. All cheques and orders
for payments from the account have been signed by at least two signatories. The organization
financial year ends on 31st December, every year.
2.3 Collaboration between TB clinics and MUKIKUTE
During community sensitization, MUKIKUTE works hand in hand with health personnel including
DTLCs. Before sensitization is done MUKIKUTE and health care providers work together to
prepare massages for drama and talks. During the course of sensitization, health care providers
have the role of clarifying and responding to issues rose from community members.
Orientation/training community leaders
During training/orientation workshops of influential people which are organised in collaboration
between MUKIKUTE and Temeke Municipal, health personnel facilitates the trainings.
Selection of treatment supporters
Smear positive patients who opt for home based DOT and those who have no relative to
support them during treatment, health care providers have to communicate with MUKIKUTE
leaders for select the treatment supporter from the organization who is living closely to the
patient for easy accessibility.
Health education
This is provided to treatment supporters who come for refill of medications. In Temeke, is
provided on Tuesdays and Thursdays (drug refill days). This helps to remind treatment
supporters their responsibility and to properly handle patients in different situations. The
education is provided by health care providers and one or two selected member(s) from
MUKIKUTE.
Intensified Case Finding (ICF)
MUKIKUTE brings TB suspects obtained by either screening TB contacts or identifying them
from the general community (active case finding forms available). Health workers facilitate
investigations for diagnosis.
Defaulter tracing
Health workers provide a list and addresses of defaulters to MUKIKUTE leaders. The former TB
patients have been given the responsibility of tracing them basing on their residential locations.
The health workers usually accompanied the former TB patient and use that opportunity to
educate the whole family and other TB contacts.
Health talks
Health workers support former TB patients to conduct health talks and give their testimony to
TB patients at diagnostic and DOT centres. Former TB patients assign themselves at least two
Page 10
per centre. Prior to the talk, topics are prepared and during the talks Health workers assist
former TB patients in responding to questions raised from TB patients.
Health care providers in Temeke Municipal are positively recommending MUKIKUTE and other
small former TB patients clubs in TB control strategy. They also recommends some more
motivations to them especially some allowances, means of transport like bicycles for those
supporting patients under home based DOT as well as financing their projects for their
sustainability. For instance, Kigamboni former TB patients club has established vegetable
garden as income generating activity for the club, but they need funds for buying bicycles for
vegetable distribution.
2.4 Benefits obtained
Temeke Tuberculosis Programme:
Apart from community sensitization and training, the council work together with MUKIKUTE in
defaulter tracing and active case finding. MUKIKUTE members bring TB suspects for sputum
examination and defaulters for treatment. The intensified case finding forms are available in TB
clinics and MUKIKUTE office.
MUKIKUTE the first ever former TB patients organization in Tanzania

Retention of all 19 founder members to date in the organization (one died).
Good relationship with partners -LHL, PASADA, Temeke Municipal Council and ICAP
Good reputation- internationally, nationally and the community at large
The organization is able to generate income through hiring of motorcycle, 2 generators,
modern music system and amplifier
MUKIKUTE members have been getting some allowances as TOTs in which some amount
have been paid to the organization.
Individual benefits
Earned respect from health workers and community at large by being TOTs in CBDOT, and
home based HIV management
More knowledge and skills on TB and TB/HIV control
Some of members do attend international conferences outside the country
Members have acquired knowledge and skills in income generating activities including
making of tie and die clothes.
2.5 General Achievement
Temeke Municipal
The first district to establish former TB patients organization in Tanzania.
Increased case notification rate (average of 3% of cases per year)
Cure rates increased from 78% (2004) to 87.5% (2008)
Note: This should be understood that former TB patients involvement in community TB care
has contributed to the above achievements align with other TB control activities in Temeke
municipal council.
Page 11
MUKIKUTE:
Up to the end of the year 2008, the organization has been implementing the following
community TB care activities: Tracing TB contact of smear positive patients
Prepare and print referral forms to be used by traditional healers
Organize training on TB and TB/HIV to 40 traditional healers and 480 other influential
people in 16 wards out of 24 wards in the district.
Organize refresher trainings to 320 former TB and TB/HIV patients on TB and TB/HIV.
Conducted community sensitization in all 24 wards in Temeke. More than 6500 people
sensitized.
Provided community DOT to more than 200 patients
Conducted active case finding, and they managed to bring 601 TB suspects for diagnosis
where by 43 among those were new smear positive TB cases.
Developed 5000 booklets to impart knowledge about TB among to patients, which have
adopted by the Ministry and other organizations in different countries including Zambia and
Namibia.
Promoted TB agenda locally and internationally
Other 3 TB clubs to including Ilala, Kinondoni Municipalities and Kisarawe district in Pwani
region have been formed under guidance of MUKIKUTE.
Spear heading establishment of National former TB patients clubs referred to as MKUTA
2.6 Opportunities
MUKIKUTE has managed to achieve its objectives by using the available opportunities to
include:
Good collaboration with Temeke Municipal Council
National and world commemoration days such as World TB and HIV days
Readiness of media organs to work with MUKIKUTE to include TV/Radio talks
Good cooperation with health care providers in conducting Health talks at health facilities
Willingness and availability of partners/stakeholders to work with MUKIKUTE
Political will at different levels to work with MUKIKUTE
Readiness of the community to work with MUKIKUTE
2.7 Challenges facing Community based care in Temeke
Temeke Municipal
Still low community awareness in about TB and this has been contributed by the fact that
some community members do not want to attend the sensitization gatherings.
Stigma to TB and TB/HIV patients is still high in Temeke
Some treatment supporters send patients to collect weekly drug supplies whenever patients
show improvement.(identify reasons/ causes of this problem)
Some treatment supporters just provide the drugs for the whole week to the patients for selfsupervision. (state the reasons for this problem)
Some relatives (treatment supporters) think that they are wasting their time when waiting for
the refill of drugs for their patients
Shortage of health care providers results to limited visits to home based DOT patients
Page 12
Some patients under home based DOT, move to other regions, and hence difficulties in
supervising them
Shortage of food among TB and TB/HIV patients
MUKIKUTE:
Mistrust among traditional healers and health care providers

Low economic status among members
Poverty among TB and TB/HIV patients to include shortage of food and money
Inadequate motivation among former TB patients
Difficulties in tracing patients due to incorrect addresses
Insufficient funds to cover more patients and communities
Poor recording system difficult to trace data about the activities conducted.
13.0
Future Plans
MUKIKUTE in collaboration with Temeke Municipal council is planning to work on the following
strategies to address the fore mentioned challenges:
Temeke Municipal Council
Exploring more partners to support former TB clubs in Temeke

Strengthening municipal support to the organization
Trainings of more treatment supporters on home based DOT
Strengthening referral system among the home based DOT patients to health facilities
MUKIKUTE
Expand MUKIKUTE activities including counseling and testing for HIV to TB patients
Expediting formation of National former TB patients organization known as MKUTA
Mapambano ya Kifua kikuu na Ukimwi Tanzania meaning, fight against TB and HIV in
Tanzania.
Assist other districts across the country to form TB clubs
Innovate new income generating activities and strengthen the existing ones for sustainability
of the organization
Advocacy and promote activism for patients rights to e- TB patients and community at large
Strengthen referral system of TB patients from traditional healers
Strengthening recording system within the organization
Page 13
3.0 LESSONS LEARNT AND RECOMMENDATIONS

3.1 Lessons learnt
Major CBTC activities implemented by MUKIKUTE in Temeke

Conducting sensitization gatherings, trainings and health talks; defaulter and TB contact
tracing; and supervising patients under home based DOT have played the major role in the
scaling up of CBTC in Temeke.
Ccommunity responsibility in TB control

The involvement of former-TB patients as treatment supporters in the program has
significantly contributed to empowerment of former-patients to take active role in the fight
against TB. Community involvement through former TB patients groups is effective in
creating and strengthening the sense of individual, family and community responsibility in
TB control. Testimony of a person who has experienced signs and symptoms of TB and
cured builds a kind of trust among TB suspects to early seek for care from health facilities.
Enhancing community awareness through the use of former TB patients as informants and
treatments supporters has significantly contributed towards reducing default rates and
improving cure rates. It has also contributed towards reducing stigma and discrimination of
TB patients in the family and community as observed in Temeke
Edu-entertainments have revealed to be very important for creating people gathering. It has
been also observed that edu- entertainments are good methods to convey messages
concerning TB and TB/HIV to community. They portray the message that people have been
cured from TB with or without HIV can live normally and engaging him/herself in any kind of
activities.
Referral system of TB suspect

A number of patients seem to be kept by traditional healers. Conducting training and
working with traditional healers with the emphasis of referring TB suspects for diagnosis is
much considered as a potential point of entry to reach many TB patients and hence
increased case detection rate in Temeke Municipal.
Funding former TB patients clubs

Former TB patients groups hardly ever empower themselves but need the involvement of
stakeholders other than the TB programme. These stakeholders might be nongovernmental
organizations, activists for PLHIV and academic institutions. Temeke region has been
allocating funds for community based TB care activities. The CBTC activities have been
planed and implemented in collaboration between the Council through TB programme and
former TB patients organization, MUKIKUTE and LHL.
Nutritional support
Most of the TB patients revealed to have positive altitude in drug taking, but the problem has
been shortage of food. The club in collaboration with the Council and other stakeholders can
Page 14
organize the funds of which some poor patients can be provided with food for better
treatment results through referral and linkage systems.
Collaboration between health workers and former TB patients in TB control

All the activities concerning TB control implemented by MUKIKUTE have been planned
before in collaboration with the Council through TB control programme. The health workers
including the programme coordinators should be present especially during sensitization
meetings and trainings, to ensure the correctness of the messages provided by former TB
patients as well as responding to the technical issues rise. In trainings, the coordinators are
mostly used as the TOTs in all issues of TB control at district and community levels.
Health workers accompany with former TB patients of the respective area in defaulter
tracing. This collaboration provides the testimony that TB is a curable disease as long as the
whole course of treatment has taken as instructed. This has also providing the opportunity of
educating the whole family and other TB contacts, showing them that they are also
responsible in TB control.
Health education and talks at the centres have been successfully conducted by former TB
patients with the guidance of health workers. The sessions have to be short like 30 minutes
to avoid boring the patients. The topics have to be well pre-planned.
The sharing out of former TB patients for home based DOT patients support is usually base
on the residential areas of the patient and the supporter for easy supervision. One former
TB patients is allocated to not more than three patients.
3.2 Recommendation
All districts are recommended to establishment former TB patients clubs to be involved in

community based TB care, basing on the MUKIKUTE experience. The major activities for
the clubs are recommended to include conducting sensitization gatherings and trainings;
defaulter and TB contact tracing; and supervising patients under home based DOT.
Only committed former TB patients have to be enrolled to the club. This is recommended
basing on the fact that, most of the time especially in initial stages, they will be volunteers
and they will be needed to contribute for the club as well. This could be successful only if
former TB patients are well informed and trained on TB control activities without promising
for any incentives.
Club registration is recommended for easy management, functioning and for acceptability
by the partners and the community at large.
Former TB patients have to be involved in community TB care activities at community,

district and regional levels. It is better for the CBTC activities to be planned together
between the Councils and TB clubs. Health workers are recommended to provide technical
Page 15
assistance and a maximum cooperation for capacity building among the former TB patients
for taking up an active role in the fight against TB.
TB control programme at district level is recommended to allocate funds through CCHP for
former TB patients support to strengthen community based TB care in their respective
districts Councils should also assist the formed TB clubs in establishing income generating
activities for their sustainability. The programme at district and regional level should also
assist them in mobilising resources from donors. Edu-entertainments is important to
establish as them can be used both for sensitization and hired in different occasions as a
strategy for income generation.
Conducting training and working with influential people like traditional healers is
recommended. There should be a defined mechanism for capturing data of TB suspects
referred by traditional healers and their sputum examination results.
Conclusion
The involvement of former TB patients as informants and treatment supporters revealed to be
effective in TB control. Empowerment of TB patients has enabled them to be ambassadors in
public gatherings and has increased their importance and become role models in combating the
disease through their testimony. This situation has motivated other TB patients to participate in
TB control activities. Involvement of ex- TB patients has impacted the reduction of stigma and
hence encouraging early care seeking behavior among TB patients.
In view of this experience from Temeke, all councils across the country are encouraged to adopt
this approach for effective scaling up of community TB care.
Page 16
References
Global Tuberculosis Control report (2009)
Temeke Annual Community TB Care Report (2008)
The constitution of the Non-Governmental Organization of MUKIKUTE (2005)
Wandwalo, E., Robberstad, B., Morkve,O. (2005). Cost and cost-effectiveness of community
based and health facility based directly observed treatment of tuberculosis in Dar es Salaam,
Tanzania. J Pub Med 3
Wandwalo, E., Robberstad, B., Morkve,O. (2004). Effectiveness of community-based directly
observed treatment for tuberculosis in an urban setting in Tanzania: a randomised controlled
trial.
Page 17
Annexes
Annex 1: Terms of Reference (TOR)
UNITED REPUBLIC OF TANZANIA
MINISTRY OF HEALTH AND SOCIAL WELFARE
NATIONAL TUBERCLOSIS AND LEPROSY PROGRAMME
Terms of Reference: Documentation of Community Based TB Care in Temeke district
1.0 Background
1.1 Tuberculosis (TB) is among the top ten causes of global mortality and morbidity
accounting for about 26% of all preventable deaths. In Tanzania, more than 62,000
new TB patients are notified annually and TB is the third leading killer of adults
behind Malaria and Acquired Immune-deficiency syndrome (AIDS). The rapid
increase of TB in Tanzania is mainly attributed to the HIV epidemic, but factors like
population growth and urban overcrowding have also contributed. However the
number of cases decreased as it compares with 65,665 cases in 2004 and 62,092
cases in 2007.
1.2 Successful TB treatment requires at least 6-8 months of treatment. Compliance

throughout out the whole course is important in order to ensure cure and prevent the
development of multi-drug resistant TB. Traditionally, patients were admitted to
hospital for the first 2 months of treatment (intensive phase) and then discharged
home with tablets for the next 4-6 months (continuation phase). However there are
several problems to this approach, which can actually contribute to increased spread
of TB. The problems include:
Increasing rates of TB have resulted in many hospitals overflowing with TB
patients.
The resulting overcrowding increases the chance of TB being spread amongst
hospital patients.
On discharge, many people felt that they were cured and stopped their
continuation phase too early, resulting in later recurrence and increasing rates of
multi-drug resistant TB.
If the hospital is full, patients are crowded together and a person with sputum
positive TB may pass the infection onto others before his treatment starts.
In order to tackle these problems the WHO has recommended a community-based
approach to TB programmes called DOTS which includes appointing a local
treatment supporter to supervise the patient taking their tablets and encourage
compliance for the whole course.
1.3 The National Tuberculosis and Leprosy Programme (NTLP) in collaboration with the
Norwegian Heart and Lung Patients Association established Ex TB Social Club
known as Mpango wa Kuzuia Kifua Kikuu na Ukimwi Temeke (MKIKUTE) in
Temeke district to strengthen community based DOTS.
Page 18
Effectiveness of community-based directly observed treatment for tuberculosis in an

urban setting in Tanzania revealed in 2004 through a randomised controlled trial
conducted in Temeke district. The Objective of the study was to evaluate the
effectiveness of community-based direct observation of treatment (DOT) using
guardians and former TB patients compared to hospital-based DOT in an urban
setting in Tanzania. Both DOT options gave similar treatment outcomes. It concluded
that Community-based DOT is as effective as health facility-based DOT and can
achieve good treatment outcomes (Wandwalo et al, 2004).
Another study conducted in the same district in 2005 to determine the and cost
effectiveness of health facility and community based TB DOTS in an urban setting in
Tanzania revealed that, the total cost of treating a patient with conventional health
facility based DOT and community based DOT were $ 145 and $ 94 respectively.
Cost fell by 27% for health services and 72% for patients. Indirect costs were as
important as direct costs, contributing to about 49% of the total patient's cost. The
main reason for reduced cost was less number of visits to the TB clinic. Community
based DOT was more cost-effective at $ 128 per patient successfully treated
compared to $ 203 for a patient successfully treated with health facility based DOT
(Wandwalo et al, 2005).
It is envisaged that when such initiatives are well documented, they will form the
basis for scaling up the approaches to cover the whole country in future. In order to
achieve the goal, the NTLP seeks to hire a consultant who will develop the
document.
2.0 Objectives of the proposed assignment
The objective of the proposed assignment is to document community based-care practices in
Temeke district.
3.0 Scope of work
3.1 In documentation process, the team will carry out the following tasks:
a) Visit MUKIKUTE office and Selected TB clinics in Temeke with the particular
attention of:
Interviewing the administration of the organization, the health workers
working in TB clinics in Temeke and the community.
Go through the important documents of MKIKUTE such as constitutions,
reports, etc
Identify the best community based care practices
b) Document the best practices on MUKIKUTE and Temeke TB clinic
c) Prepare a document and submit it to the Programme Manager of NTLP.
3.2 Format of the Document
Cover page
Table of contents
Page 19
Executive summary
Introduction
Structure of the TB Control Programme (staring with head quarter to community)
Description of MUKIKUTE as a social support club/group including:
- Its information
- Structure of the club
- Roles and responsibilities of members including leaders
- Functioning of the organization including engaged activities
- Source(s) of funds.
- Benefits (individual and as organization),
- Collaboration with the Government and other organizations.
- Development of IEC materials including:
i.
The source of the idea to develop such materials
ii.
The process of development
iii.
The acceptability of the materials by the patients and community in
general.
Progress made in improving TB case detection and treatment outcome in relation
to the functioning of the organization (MUKIKUTE).
Lessons learned and recommendations
References
Annexes
3.3 Professional requirements for the assignment

The team will work in close collaboration with the Regional TB and Leprosy
Coordinator (RTLC) of Temeke.
3.4 Level of effort

This work is supposed to be finished in 10 working days. It will be done as an office
work.
3.5 Reporting
3.5.1
3.5.2
3.5.3
3.5.4
The draft shall be available within two weeks (1 week, field work and
another 1 week, report writing) for review and comments from
Programme Manager of NTLP.
The team will make necessary corrections responding the comments
which might arose from Programme Manager..
The team will prepare and submit a final document, both in soft and hard
copy to the programme Manager of NTLP.
The obtained information will be disseminated in a form of presentation
aimed at facilitating the development of TOR for former TB patients
social support clubs/groups establishment and TOT training manual for
the groups.
4.0 Expected Output

The documenters are expected to yield a document (with the format outlines in 3.2 above)
describing the issues outlined in 3.1 above.
Page 20
Annex 2: MUKIKUTE membership form
P.O BOX 45232 DAR ES SALAAM TANZANIA EAST AFRICA.

TEL: 022 -2856512 MOB: 0756 - 934750, 0784 505637
Email: MUKIKUTE@yahoo.ca
MAOMBI YA UANACHAMA
Jina kamili
Umri
Elimu yako
Nimeolewa/ Sijaolewa (kata isiyohusika)
Je, uliwahi kuumwa Kifua kikuu? Ndiyo/Hapana. Kama ndiyo taja mwaka.
Je, Unaishi na virus vya Ukimwi? Ndiyo/ Hapana. Kama ndiyo, taja jina la Azaki
yako.
Je, utakuwa tayari kutoa ushuhuda mbele ya jamii kwamba wewe unaishi na virusi vya ukimwi
ama uliwahi kuumwa TB? Ndiyo/Hapana
Nitashirikiana na wenzangu katika shughuli za chama bila kulazimishwa.
Nitajielimisha na kutoa elimu mpya nitakapopewa nafasi ya kujiendeleza.
Nitatoa mchango wa chama bila kukosa.
Nitakuwa mwminifu na mwadilifu katika kutunza mali za chama.
Nitaheshimu na kutekeleza majukumu yote nitakapopewa na uongozi.
Nitaheshimu maamuzi wa kikao cha juu cha kikatiba bila kulaumu.
Nitashiriki tendo lolote la uvunjaji wa amani wa chama.
Nitatunza siri za vikao na sitakuwa tayari kuhujumu asasi.
Mimi nakubaliana na yote.
Sahihi ya mwombaji
Tarehe.
Jina la aliyepokea..
Sahihi .
Page 21
Annex 3: Referral form to be used by traditional healers
P.O. Box 45232

Dar es Salaam Tanzania East Africa
Tel: 022 -2856512 mob: 0756 - 934750, 0784 505637
email: MUKIKUTE@yahoo.ca
.
27/OCT/2009
MPANGO WA TAIFA WA KUDHIBITI KIFUA KIKUU NA
UKOMA.
FOMU YA RUFAA KUTOKA KWA MGANGA WA JADI/TIBA MBADALA.

Jina la mgonjwa
Umri.SikuMwezi.Mwaka.
Mahali anapoishi mgonjwa, WilayaMkoa.
Namba ya nyumba
Jina la Mjumbe/Mwenyekiti wa Serikali za Mtaa..........................
Sababu ya rufaa:
Kifua Kikuu/Mengineyo
Anatumwa kwenda kituo cha tiba cha.tarehe.
Tarehe mgonjwa alipofika Kwa mganga wa jadi
Jina la mganga wa jadi/tiba mbadala
Anwani..
Marejesho
Jina la mganga wa jadi.
AnwaniNamba ya simu
Jina la mgonjwa.tarehe ya kupokelewa..
Matokeo ya uchaguzi..
Jina la Mratibu.................................
NB: Mgonjwa aonane na Mratibu wa Kifua Kifua Kikuu na Ukoma
Page 22
Annex 4: Phases for TB club establishment
TE

TEL: 022 -2856512 MOB: 0756 - 934750, 0784 505637
ESTABLISHMENT OF TB CLUBS
In order to establish TB clubs, the following phases should be followed.
PHASE ONE
To identify Former TB Patients (FTB) and People Living with HIV/AIDS (PLHIV) who will be
members of a TB Club (Strictly TB Club members must be either FTB or PLHIV).
Identification of those volunteers should be conducted in collaboration with the RHMTs
(Regional TB and Leprosy Coordinator - RTLC) and the CHMTs (District TB and Leprosy
Coordinators - DTLC, District TB/HIV Coordinators - DTHC, DMO and ICAP regional office)
Identification of FTB and PLHIV will be conducted according to the geographical area to be
covered with the education programme
FTB and PLHIV will be contacted; selection will ensure gender balance, it will prioritize
among those in good health and those motivated to ensure long term support
FTBs and PLHIV readiness to support the education programme will be assessed through
individual interview
Among those available FTB and PLHIV a list of volunteers will be developed with the
contact information
FTBs and PLHIV who are volunteer to participate to the education programme will be briefly
oriented by MUKIKUTE association central office from DSM
PHASE TWO
Interim Leadership of the TB club will be established (be sensitive on religion, political stand,
tribalism and gender)
Among the volunteer, the TB club coordinator will be identified and oriented on his/her tasks
Direct link between the volunteers, RHMT/CHMT, HCW focal person at HF level, ICAP
regional team and MUKIKUTE regional project assistant and MUKIKUTE site project
coordinator and MUKIKUTE Central office in Dar Es Salaam will be established
PHASE THREE
Introduction of TB Clubs and Recognition
Local Authority (RHMT/CHMT, ICAP) will be informed with an official letter from MUKIKUTE
central office DSM upon the establishment of TB club; the term of reference of the
volunteers will be attached to the letter
MUKIKUTE central office DSM will ensure that members of TB clubs are linked to local
Community Based Organizations (CBOs), village/religious leaders, school teachers and
traditional healers
Page 23
PHASE FOUR
Members of TB Clubs will be trained on the education programme and IEC material will be
distributed to support them during the education sessions and community and HF level.
The code of ethics of TB Club members will be provide them
MUKIKUTE central office will provide onsite support to the TB clubs during the initial phase
when the education programme will start to be rolled out
Page 24
Annex 5: Job description for former TB patients in specified areas

TEL: 022 -2856512 MOB: 0756 - 934750, 0784 505637
Tasks at Care and Treatment Centres (CTC)
- Provide health education on TB, HIV and TB/HIV.
- Provide proper education on prevention of TB spread through coughing technique.
- Provide advice on compliance of ART for HIV/AIDS patients and DOT for TB patients.
- Encourage and consol TB/HIV and HIV/AIDS patients.
- Advice HIV/AIDS patients on living with hope and being free to expose their health status
- Accompanying patients to various sections in health facility whenever necessary.
- Advice and bring TB contacts for investigations for TB and HIV infection.
- Assist in non technical activities with the guidance of health workers at health facilities.
- Address self stigmatization and hygiene among the clients.
Tasks at TB clinics
- Provide health education through health talks; providing leaflets, TB booklets, and testimony
on TB, HIV and TB/HIV.
- Sputum collection and follow-up the lab results for patients
- Support patients during treatment course by providing supervision under community DOT
approach.
- Advice and bring TB suspects and contacts for TB and HIV investigations.
- Provide education on side-effects of TB drugs and ARVs and how to deal with them.
- Encourage TB patients for voluntary Counselling and testing for HIV infection.
- Provide proper education on prevention of TB spread through suitable coughing technique
including the importance of enough light and adequate ventilation.
Tasks at PMTCT
- Provide health education on TB, HIV and TB/HIV.
- Assist in non-technical activities at PMTCT e.g. registration, accompanying clients to various
sections within the facility etc.
- Encourage and consol clients who are found HIV positive and/or TB smear positive;
providing education on how to live with HIV/AIDS (with testimony).
- Provide education on safe infant feeding and compliance of ARVs.
- Sensitize male participation on PMTCT activities and on the importance of investigating the
whole family members.
- Address self stigmatization and hygiene among the clients.
Tasks at community level
- Advice the patients to join groups and other services provided in the community.
- Defaulter tracing.
- Facilitate in establishment and management former TB patients groups.
Page 25
Community sensitization on TB and HIV/AIDS services.

Fight against stigma
Educate on proper coughing technique
Community sensitization on VCT and sputum examination fro Tb suspects.
Work with traditional healers in identifying and referring patients with TB signs and symptoms
to health facilities
Income generation activities
The selection of the villages/Wards where to conduct education is conducted in agreement with
the District AIDS Control Coordinator (DACC), District TB and Leprosy Coordinator (DTLC) and
District TB/HIV coordinator.
Other tasks
- Participate in meetings at health facilities and at regional/district level whenever necessary.
Page 26
Annex 6: MUKIKUTE registration certificates
Page 27

Community Based TB Care Experience From Temeke - Tanzania

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THE UNITED REPUBLIC OF TANZANIA

MINISTRY OF HEALTH AND SOCIAL WELFARE

Community Based TB Care: Experience from Temeke, Tanzania

Community Based TB care through former TB patients social clubs

Experience from Temeke

Community Based TB care through former TB patients social clubs

Experience from Temeke

Community Based TB care through former TB patients social clubs

Experience from Temeke

Community Based TB care through former TB patients social clubs

Experience from Temeke

Community Based TB care through former TB patients social clubs

Experience from Temeke

Community Based TB care through former TB patients social clubs

Experience from Temeke

Community Based TB care through former TB patients social clubs

1.0 NATIONAL TUBERCULOSIS AND LEPROSY CONTROL PROGRAMME

Ministry of Health and Social Welfare

Experience from Temeke

Community Based TB care through former TB patients social clubs

Experience from Temeke

Community Based TB care through former TB patients social clubs

2.0 COMMUNITY BASED TB CARE IN TEMEKE

Experience from Temeke

Community Based TB care through former TB patients social clubs

The main objectives of MUKIKUTE are:

Organizational structure of (MUKIKUTE)

Former TB and TB/HIV patients

Fig 2: a) Organizational structure; b) Leadership chart of the club (MUKIKUTE)

ii) General assembly:

Experience from Temeke

Community Based TB care through former TB patients social clubs

Community Based TB care through former TB patients social clubs

Issue all cheques

v) Former TB and TB/HIV patients

Resignation or retirement in writing

If convicted of criminal offence

Proved mentally un-fit

Misuses of organization money, assets and anything belongs to the organization

Community Based TB care through former TB patients social clubs

Activities/tasks implemented by MUKIKUTE

Currently MUKIKUTE is implementing the following activities:

The MUKIKUTE Chairperson (Mr Joseph

Sensitize community members/leaders to understand and accept TB patients and

Experience from Temeke

Community Based TB care through former TB patients social clubs

Support from Temeke Municipal Council

Sources of funds for MUKIKUTE

Contributions from members

Experience from Temeke

Community Based TB care through former TB patients social clubs

Economic and income generating activities

Donation from other partner organization

Experience from Temeke

Community Based TB care through former TB patients social clubs

Monetary management within the organization

Experience from Temeke

Community Based TB care through former TB patients social clubs

MUKIKUTE the first ever former TB patients organization in Tanzania

Experience from Temeke

Community Based TB care through former TB patients social clubs

Experience from Temeke

Community Based TB care through former TB patients social clubs