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Thursday, June 21, 2018
                
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TB Care & Prevention

TB Care and Prevention

TB care and prevention is rooted in the WHO End TB strategy that is endorsed by all governments. It outlines a shift from ‘controlling’ TB globally to ending TB as a public health problem by 2035, with ‘integrated, patient centered care and prevention’ as a central pillar. This module is subdivided into three interventions that are detailed below.


Active Case Finding

Finding the missing cases by targeting high risk groups

Demonstration of Screening Models developed in Phase 1
The TB case finding models will be implemented for two years to demonstrate, refine and document lessons. This activity is designed to create buy in, build capacity and mentor NTP personnel. This will precede adoption and transitioning of the models to country plans. The ultimate goal is for countries to adopt the models for TB case findings for the targeted KPs and incorporate into national systems and planning.

Index based contact tracing 
A shift will be made from generalized to targeted TB case detection through index case based contact tracing involving index cases of mineworkers and ex-mineworkers identified from mining houses and NTP databases. In ASM context, index cases will be identified through Active Case Finding. Community Health Workers will conduct targeted contact tracing of each index case. Civil society organisations, including those led by key populations will conduct contact tracing within and across borders and the CBRS will be utilised to identify receiving health facilities.

Strengthening referral and diagnostic capacity 
This funding request will support training on good quality sputum collection, sputum transportation using appropriate specimen storage and transport means, and results feedback to minimise patient loss. Sputum transportation will involve the full transport chain i.e. from community to clinic and from clinic to laboratories.

Engaging All Care Providers

Developing centres of excellence that deliver quality services
The 11 Occupational Health Service Centres (OHSCs) centres set up under the current GF grant provide TB screening and diagnosis services, HIV testing, silicosis screening and diagnosis; and linking ex-mineworkers to compensation funds. Since these centres are located at health facilities, they refer clients for treatment when needed. Through linkage of OHSCs to compensation funds and tracking and tracing of mineworkers21 have unlocked $31.8 million compensation funds for ex-mineworkers in South Africa, Lesotho, Malawi, Botswana, Mozambique and Swaziland for TB and other lung diseases between 2015-2017.

Transitioning management of OHSCs to governments
A transition plan detailing steps to be taken to transition the OHSCs to host governments will be developed to ensure services are not compromised or interrupted. This funding request will support staggered implementation of the transition as guided by each country’s status of preparedness. Human resources will be transitioned by end of year 1 and other operating costs transitioned by end of year 2. The aim is to have completed the transition process by the end of year two and use year three for mentoring.

Management of OHSCs
The grant will support continued operations of the OHCS to ensure efficient service delivery until transition. The management effort will be directed at improving the quality of service to create centres of Excellence on Occupational Health. KP-led organisations and other CSOs will be engaged under the Community Response and Systems (CRS) module to generate demand for services provided at these centres. Local forums will be established at each OHSC to consult stakeholders and advise OHSC management on broader issues affecting the mineworkers and ex mineworkers.

Capacity building for occupational health practitioners
This grant will support updating of skills and knowledge of current personnel and establish a regional expert technical panel to facilitate knowledge exchange. This proposed structure will collaborate with other technical formations in the region, such as the SATBHSS Community of Practice.
Strengthening linkages with Compensation Funds

OHSCs linkage to compensation funds will be operationalised at all OHSCs that see clients that have claims against the South African Compensation Fund. Other compensation funds in the region will be mapped out so that the claims process is fully understood. This will set the stage for electronic submissions to these funds as well. Strengthening linkages with other services

The OHSC will be used as a hub to access other services outside the scope of the grant. These include accessing treatment and compensation for other medical conditions and social conditionssuch as hearing loss, OH disabilities and link to provident funds. Support for additional services will be sought from mining companies, the SATBHSS project, national governments and compensation funds. This approach will strengthen the sustainability of these centres.


Removing Human Rights Barriers

Raising awareness and advocating for change

Awareness-raising for ASMs and communities
This intervention will improve ASM access to and awareness of a minimum package of OH services, which will cover TB, TB/HIV and silicosis. The intervention involves training regional trainers to train CSOs to implement activities that create awareness of OH services.Innovative outreach initiatives will be piloted in 3 countries with high ASM population; mobilising ASM communities and establishing a database of ASM persons reached.

Capacity building for the utilization of the basic Occupational Health and Safety Package
Standardized protocols will be developed to define a  minimum OH package that can be applied to ASM populations. The target audience will consist of key implementers such as civil society organizations (CSOs), inspectorate staff, ASM mineworkers and ex-mineworkers and ASM community leaders. This intervention will enable countries to allocate resources and develop capacity to provide what can be considered as minimum level of services which can be built on over time.

Advocacy for Policy and Legislative Reforms
Policy and legislative reform initiative is supported by the SATBHSS project. This funding request will produce policy briefs to inform policy change resulting from studies funded under the current GF grant and other initiatives.