In July 2013, Fanny Voitzwinkler of Global Health Advocates, was part of the World Health Organization team as TBEC representative and Advocacy, Communication and Social Mobilisation (ACSM) expert, which reviewed the Tajikistan National TB Programme (NTP). As part of the review, TBEC met with half a dozen NGOs, international partners such as Project HOPE, USAID, and KNCV, health workers, former patients as well as community and religious leaders in Dushanbe the capital city but also in the Khatlon region/oblast in the southern part of the country.

Tajikistan has a high burden of multidrug-resistant tuberculosis (MDR-TB), and is one of 18 countries in the WHO European Region in which TB control is the highest priority. Of the 6850 total cases registered in Tajikistan in 2012, 80% (5484) were new cases. The case-detection rate has improved over recent years, but remains low: 47% (39–57%).

Civil society involvement in TB care and control is quite impressive in Tajikistan. 37 local non-governmental organisations (NGOs) have been working on TB projects. Most of them have started their activities in the past five to ten years and rely on 3096 volunteers trained on outreach activities around health issues. NGOs are providing crucial services to patients and communities in the areas of prevention, case findings and treatment adherence, which would otherwise be nonexistent. Their activities include: awareness raising on symptoms and free treatment of TB, distribution of Information Education and Communication (IEC) material as well as condoms, referral to TB facilities, DOTS, harm reduction, treatment follow up, psychosocial support as well as incentives such as food and motivation packages.

However, sustainability of funds for NGOs is an issue. NGOs in Tajikistan are entirely dependent on international funding from USAID, Aids Foundatio

n East West (AFEW) and the Global Fund. These grants are mainly allocated for shorter term pilot projects and are therefore implemented in different target populations and areas. The work of NGOs in the Khatlon and Sugd oblasts is mainly targeted at vulnerable groups such as migrants, prisoners, sex workers, injected drug users (IDUs) and men who have sex with men (MSM). NGOs function with a few administrative staff and a variable number of outreach workers or volunteers who are carefully selected among the community (teachers, leaders, imams etc.) and are well-trained. These volunteers visit households in their communities, and raise awareness of TB at schools, mosques, or during weddings and ceremonies. Considering the high level of stigma around TB, affected population tend to hide in fear of arousing suspicion within the community. In this regard, volunteers have a better access to communities and households than health workers, whose presence can increase stigma. Training of religious leaders is particularly efficient, due to their influential position in society and the amount of people that they can reach.

Partnership between stakeholders is mainly occurring through the CCMs at national and oblasts level. Upon a request from the Global Fund in 2012, NGO involvement in the CCM has recently increased from 20% to 40%. Coordination among NGOs as well as between NGOs and local authorities is existing in Khatlon oblast. Memorandum of Understanding have been signed between local NGOs active in Kulyab as well as between NGOs and local authorities in

Kulyab district where local authorities often provide space for conferences or sociocultural activities but also in Kurgan Tube district, where for instance the police department is allegedly referring female sex workers to the NGO Orzu Plus working on HIV prevention. Local NGOs are well aware of the importance of involving local authorities in discussions. In Khatlon, NGOs are also trying to push local authorities to provide food incentives to ambulatory patients from government-owned gardens.

After a ten day review, TBEC together with the WHO team had the opportunity to present its recommendations on ACSM, civil society and patient involvement in TB care and control to the Ministry of Health. A report with all recommendations is currently in the making.