Society for Empowerment, Education & Development (SEED)

PROJECT – 1: Developing Public-Private Partnership (PPP) for urban TB Control: A model for Bangladesh (Pilot Phase).

Aim and Objectives: The overall aim of this project was to develop an appropriate public-private partnership model for effective involvement of PMPs (Private Medical Practitioners) in service delivery of the TB control programme in Bangladesh.
Research Methodology: The study methodology was a combination of exploratory design and action research.
Study Areas: The project activities was implemented in four areas of Dhaka City (Mirpur,Rampura, Dokkhinkhan, Kamrangirchar)
Outcomes:

• Towards policy and practice: This research was aimed to gain new knowledge about developing a public-private partnership model and also about what made a public-private partnership work and suggest ways to put it into practice.
• Towards service provision: This project assisted the NTP to involve private health care providers to improve access to and quality of urban TB care.

PROJECT – 2: Scaling Up of Public-Private Partnership (PPP) model in Urban Settings: Involving Private Medical Practitioners (PMPs) in TB Control in Bangladesh (Phase I).

Aim and objectives: The overall aim of this project was to assist and assess scale up of the public-private partnership (PPP) model for effective involvement of PMPs in the TB control programme in urban settings of Bangladesh.

Specific objectives were to:

• Develop practical guidance for scaling up
• Refine and finalise PPP guidelines;
• Document the process of introduction and use of tools and ACSM(advocacy, communication and social mobilisation);
• Evaluate the interventions to assess TB control outcomes.

Methodology: The study methodology was an operations research. In phase 1, the project activities will be implemented in two Divisional cities: Chittagong and Sylhet.

Outcomes:

• Improved PMPs capacity to manage TB cases appropriately and thus improved treatment outcome.
• Improved access to effective treatment and reduced cost for patients.
• Increased case detection.
• Improved collaboration, trust and commitment to effective TB control.

PROJECT – 3: TB at the workplace: Developing Partnerships with the Bangladesh Garments Manufacturers and Exporters Association (BGMEA) and garments industries (Pilot Phase)

Aim and Objectives: The overall aim of this initiative was to develop an operational mechanism for effective, sustainable TB control programme in the workplace situations in Bangladesh.

Specific Objectives were to:

• Review and understand the current service provision of TB care in the selected business sector organisations e.g. garment industries in Bangladesh;
• Develop a process to establish a mechanism for involving the management of the business sector with the NTP;
• Develop appropriate protocols, guides and tools for workplace TB control activities through participatory process;
• Assess the effectiveness of the mechanism in terms of case findings and treatment success rates.

Methodology: This was an operations research initiative, which has been implemented within the context of the NTP

Outcomes: The project has developed an operational framework for effective TB care in garment factories. It has also influenced the NTP in deciding on the policy for scaling up of such partnership model to improve access to and the quality of TB control programmes in workplaces in Bangladesh.

PROJECT – 4: Developing Effective linkages between Public and Private sector Providers for the prevention, care and support of STIs and HIV in Bangladesh

Aim and Objectives: The overall aim of this project was to develop an appropriate public-private partnership model for the effective involvement of PMPs in service delivery of STI/HIV prevention and control programmes in Bangladesh.
Specific objectives were to:

• To review and understand the current practices of PMPs in STI/HIV care in urban settings in Bangladesh;
• To develop a process to establish a mechanism for involving PMPs with the National STD and AIDS Programme (NASP);
• To develop appropriate protocols, guides and tools for the effective service linkages of PMPs with NASP in STI care;
• To assist NASP in strengthening private sector participation in the NASP.

Methodology: A systematic process has been applied to develop partnerships with PMPs in order to establish a sustainable service linkage with NASP activities. Mapping of the PMPs was conducted in those areas where NASP and other partner NGOs were already implementing a joint STI/AIDS programme. A situation analysis was carried out, using semi-structured questionnaire and interviews, to assess the extent of the STI problem in the private sector, existing diagnostic and treatment services being practised, and facilities available to collaborate with the NASP. The questionnaires and guidelines for interviews were developed and field-tested prior to data collection. An implementation plan was then jointly prepared involving all stakeholders, based on the situation analysis. Participatory approaches were used to develop protocols and guidelines, tools, and advocacy materials.
Study Areas: The project activities were implemented in four areas of Dhaka City(Mirpur,Rampura, Dokkhinkhan and Kamrangirchan).

Outcomes: The outcome of this project was an operational model approach for the STI care activities in urban settings. The study helped the policy makers and relevant NGOs in deciding on the policy for wider application of such collaboration in improving the access to and the quality of STD and AIDS control programmes in Bangladesh.

PROJECT – 5: Quality Assessment of Directly Observed Treatment (DOT) under National TB Control Program (NTP), Bangladesh.

Aim: To assess the quality of DOT at the Upazila level under the NTP, Bangladesh.
Research Questions were:

• What was the actual care process, including DOT in practice, of the TB patients?
• What was the level of knowledge of TB patients about the TB disease and its treatments?
• What was process for diagnosis of TB?
• What was the actual treatment by practitioners?

Methodology: This was a qualitative cross sectional study. It was conducted in 6 districts.
Key Milestones achieved:

• Developed tools and questionnaires for the survey
• Piloted the tools and guidebook
• Developed relevant, effective advocacy and communication materials
• Tools and guidelines were drafted for the NTP
• Finalised the operational framework for DOT under the NTP
• Disseminated the project results both nationally and internationally.

PROJECT – 6: Quality Assessment in smear sputum microscopy at a district level under the National TB Control Programme (NTP), Bangladesh

Aim: To assess the quality of AFB (Acid-Fast Bacillus) at the District and Upazila levels under NTP, Bangladesh.
Specific objectives were to:

• Assess the performance of existing EQA (External Quality Assurance) labs;
• Develop an operational mechanisms for involving the Lab Supervisors in the quality assurance of AFB under the national TB control programme;
• Develop, implement and evaluate the tools, guidebook and other guide materials for Lab Supervisors working at district and Upazila levels;
• Assist the NTP to refine the guidelines and materials, and to prepare for scaling-up.
• To disseminate the results to wider interest groups, within and outside Bangladesh.

Methodology: The study was conducted in 10 Upazilas selected from 5 districts. A pre-tested semi-structured interview schedule was used for data collection.

Outcomes: The project assisted the NTP to make efficient use of available resources for countrywide strengthening of district level AFB quality control.

PROJECT - 7: Stigma and discrimination associated with TB in Asia including Bangladesh

Aims and objectives: The overall aim of the project was to gather new empirical evidence and further the theoretical understanding of the causes of stigma and discrimination associated with TB in developing countries.

Specific objectives were to:

• Gain an in-depth knowledge of the causes of stigma and discrimination associated with TB from the perspective of patients; patients’ families; people likely to discriminate against people with TB; institutions (health facilities, employers, government offices); and the general community.
• Gain an understanding of the types of people most likely to discriminate against people with TB
• Develop improved theories to explain the causes of TB-related stigma and discrimination

Methodology: The overall research design is a multi-method and multisite comparative qualitative analysis, following a step-wise research process.

Study sites: The research was carried out at the selected sites in Bangladesh, Nepal and Pakistan.

Outcomes: This project gathered new empirical evidence and further theoretical understanding of the causes of stigma and discrimination associated with TB  using multiple research methods. Based on the findings, strategies to address stigma and discrimination have been formulated.