Case Study: Collaboration
Bristol-Myers Squibb Foundation-World Health Organization ENGAGE-TB Project, Bristol-Myers Squibb
Leveraging the legacy and infrastructure of its landmark SECURE THE FUTURE® program to help communities in sub-Saharan Africa address HIV/AIDS, the Bristol-Myers Squibb Foundation is collaborating with the World Health Organization (WHO) to help HIV patients who are also developing tuberculosis (TB). Even though TB is the leading killer of people living with HIV/AIDS in Africa, efforts to combat the disease in developing countries are often fragmented or ineffective. The ENGAGE-TB Approach demonstration project, which began in May 2011, uses WHO’s brokering role to connect non-governmental organizations in South Africa, Tanzania, Kenya, the Democratic Republic of the Congo, and Ethiopia to the National TB and HIV programmes to promote TB prevention, care and control. The ENGAGE-TB Approach demonstration project leverages the SECURE THE FUTURE® Technical Assistance Program faculty and health care infrastructure that the Bristol-Myers Squibb Foundation and its partners in Africa have developed since 1999. During Phase I (May 2011-April 2013), the project focused on defining the global policy and program environment while also accelerating implementation of successful community models for tracking and treating people living with HIV who developed or are at risk of TB. The goal of Phase II (May 2013-April 2016) is to develop and nurture the institutions, mechanisms and gains achieved in Phase I while refining, expanding and sustaining the models of integrated community-based TB and TB/HIV activities. The emphasis will be on expanding technical assistance, learning and sharing lessons, and systematically communicating these lessons to stakeholders at country, region and global levels in order to replicate the ENGAGE-TB approach around the world.
Key insights generated:
- community-based approaches to integrating TB supported by active collaboration and coordination between NGOs and government help improve TB outcomes;
- technical assistance at the initial stages to both the implementing NGOs and the national TB programmes is essential for success of this multi-stakeholder integrated model;
- community-based action increases demand for services, particularly diagnosis. Health systems must be strengthened to meet the demand in terms of human resources and laboratory and other equipment and supplies.
How the program evolved over time:
- working together, BMSF/STF and WHO were able to review and select NGO proposals to operate as pilot projects. Technical assistance by both institutions was useful to help initiate implementation after careful design;
- this collaborative success helped WHO and BMSF/STF to agree that the TAP Faculty would be trained on the ENGAGE-TB approach to ensure continuing support to future capacity building of NGOs and national TB programmes beyond the current set of pilot projects. This will help provide additional trainers to support the ENGAGE-TB model as it spreads to other countries and NGOs.
Results to Date
- National multi-stakeholder consultations with NGOs, governments, BMSF/STF TAP Faculty and WHO were held in all 5 focus countries;
- NGO Coordinating Bodies were established in 4 countries and are meeting regularly with the government, which demonstrates interest to improve TB outcomes through a new, collaborative approach;
- 6 NGOs are engaged in integrating TB into their ongoing community based health programmes for improved TB outcomes through pilot projects in 4 countries;
- Initial results from 2 NGO projects show increase in TB detection. The first project integrates TB into community-based cancer screening. 10 new TB cases were confirmed from 1400 persons screened for cancer. The second integrates TB into a community-based HIV programme. 360 new TB cases were diagnosed in the first 2 months of implementation
National TB programmes are beginning to work collaboratively with stakeholders from civil society. Trust and mutual respect between both groups was established at the outset and is yielding good levels of cooperation and collaboration. Civil society organizations were formally consulted and with their input national operational guidelines were agreed in three countries.
Additional qualitative information: NGO coordinating bodies are meeting regularly with governments for improved collaboration (meetings are documented); implementing NGO plans have been developed with input from government on TB needs; NGOs are supervised and supported by WHO and government; all implementing NGOs are collecting data in line with WHO-recommended indicators and these are being shared. WHO is promoting the integration of community-based TB in international forums and in events that help to develop National TB Plans. 2 out of the 6 ENGAGE-TB pilot projects are working with vulnerable pastoralist populations in Ethiopia; lessons learned from these experiences will help scale-up beyond the pilot projects.
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