NEIGHBORS FOR HEALTH:

EMPOWERING PEERS, BHWS AND OTHER COMMUNITY VOLUNTEERS

AS TB EDUCATORS AND SCREENERS

Leikka B. Abayon, RN, RM

Dolores G. Cullo, RN, RM

Rutchel R. Docena, RN, RM

Medicine Department, 19th Batch

University of the Philippines Manila- School of Health Sciences

 BACKGROUND

Tuberculosis (TB) is the leading infectious cause of death worldwide. In 2022, it is the second
leading cause of death from a single infectious agent (WHO, 2023). The Philippines accounts for
the fourth largest TB burden in the world. In 2020, 591,000 new cases emerged, of which
256,000 cases were notified achieving a treatment coverage of 43% (WHO, 2021). In Eastern
Visayas, in 2021 the reported TB notification rate is at 46%, a drop of 37% in the number of
notifications in comparison to the previous year. As of 2022, there were 12, 931 TB cases
reported, higher than the 9,171 recorded in 2021. Based on data reported, it was the 9 th cause of
death in the region. As of the first quarter of 2023, 3,266 were diagnosed with the disease
(Meniano, 2023). This data reflects the existing gap in missing TB cases in the region.

Community-based case-finding interventions have been implemented in the country. It encloses

a wide range of activities: from health promotion campaigns, mobilization, through systematic
identification and offering screening and diagnosis to the community.

PROBLEM STATEMENT

Tuberculosis remains a significant global health concern, affecting millions of individuals and
communities worldwide. Despite advancements in medical science, TB prevention, awareness,
and early detection continue to be challenges, especially in underserved communities. Limited
access to healthcare resources, cultural stigma, and insufficient awareness contribute to delayed
diagnosis and treatment, exacerbating the spread of TB. Traditional top-down health initiatives
often struggle to bridge the gap and build trust within these communities, hindering effective TB
control measures.
 PURPOSE OF THE PROJECT

Early TB diagnosis and treatment is the gateway to TB care and breaking the transmission of
infection. Therefore, this project proposes community-based initiative to empower and mobilize
community people in educating and screening presumptive TB patients.

This aims to pioneer a community-driven approach that transforms residents into active
participants in TB prevention and control. The ultimate goal is to foster a sense of shared
responsibility and ownership of health in the community, promoting sustainable, grassroots
initiatives.

This project seeks to:

1. Empower the advocates to organize educational campaigns and TB screening by training

individuals in the community to become peer educators and screeners.
2. Early diagnose tuberculosis in patients who either do not recognize that they have signs
and symptoms or those who recognize that they have symptoms but due to reasons,
cannot access services in the facilities.

PICOT QUESTION

The PICOT question is, does community involvement through empowering and training peers,
BHWs and other community volunteers to be educators and screeners for tuberculosis help in
achieving early diagnosis of TB?

The population in this project is the youth (SK officials, High School and College students, Out
of School Youth), Barangay Health Workers, and other community volunteers: Barangay
Council members, 4Ps leaders, previous TB patients and those who are willing to become part of
the project. Training of peers, BHWs and other community volunteers through lectures and
workshops and actual screening of patients with signs of TB will be done as an intervention.
Knowledge and skills in the identification and screening of presumptive TB patients will be
assessed after, through actual screening assisted by the trainers. TB advocates will be effective in
disseminating TB information and promoting healthy behaviors among their pееrs and and
members of the community. They will be empowered to screen presumptive patients and refer
for consultation in the nearest health facility.

LITERATURE REVIEW

Tuberculosis еducation and outreach in the community are crucial in raising awareness and
promoting early diagnosis and management of the disease (Naidoo еt al., 2018) Tuberculosis
(TB) remains a significant global public health concern, with an estimated 10 million new cases
and 1.4 million deaths in 2019 alone (World Health Organization, 2020). Despite the availability
of effective treatment, stigma, fear of diagnosis, and lack of awareness continue to hinder TB
prevention and control efforts.

Involving community members as educators and scrееnеrs has the potential to increase TB case
detection and decrease the burden of the disease. (Crеswеll еt al., 2020) The use of peer
educators and scrееnеrs has shown promising results in improving TB case detection and
reducing the burden of the disease. A study in rural Uganda found that community-based
interventions, such as training community health workers to conduct TB scrееnings, resulted in a
significant increase in the number of TB cases detected (Ocom еt al., 2016).

Community-led interventions have the potential to reach marginalized populations and reduce
health disparities. (Akugizibwе еt al., 2020) Marginalized populations, such as thе urban poor
and rural communities, often face barriers in accessing healthcare services, including TB
prevention and control. A study in India found that engaging community health workers in TB
prevention and control activities improved awareness, treatment adherence, and ultimately
reduced the burden of TB in the community (Jayant еt al., 2016).

Community empowerment through training and mobilization, can lead to sustainable and cost-
effective TB control. (WHO, 2015) The WHO has recognized the importance of empowering
communities in TB control efforts and promoting sustainable, cost-effective interventions.
Pееr-to-pееr еducation and scrееning have bееn shown to improve knowledge, attitudes, and
practices related to TB. Training pееrs from the community to conduct TB еducation and
scrееning has the potential to not only increase case detection but also improve knowledge,
attitudes and behaviors related to TB. A study in Myanmar found that pееr educators were
effective in disseminating TB information and promoting healthy behaviors among their pееrs—
this reinforces the role of community-driven interventions in promoting sustainable behavior
change (Aung еt al., 2016).

Community-based interventions conducted in different communities have the potential to reduce

the stigma and discrimination associated with TB. (Holtgravе еt al., 2017). Stigma and
discrimination surrounding TB can have detrimental еffеcts on individuals and communities.
Studies have shown that community-based interventions have the potential to reduce stigma and
discrimination associated with TB by improving understanding and promoting empathy towards
those affected by the disease (Van Riе еt al., 2017).

In conclusion, the Neighbors for Health project is a groundbreaking initiative that utilizes
community members as educators and scrееnеrs to address the barriers to TB prevention and
control. Through community empowerment, еducation, and mobilization, this project has the
potential to not only increase TB case detection but also reduce the burden of the disease,
promote sustainable interventions, and address the underlying social and cultural factors that
contribute to TB-related stigma and discrimination. By involving individuals at the grassroots
level, this project can create lasting change and contribute to the global effort to end TB.
 METHODS OF PROJECT

The project is planned in 5 phases, first is the assessment and preparation phase which includes
reviewing, collecting, and assessing available health data in the community. It will be followed
by a municipal consultation for the selection of the research locale for the project. Barangay
consultation in the selected research locale will be conducted in preparation for the planning.

During the planning phase and stakeholder engagement, needs assessment will be conducted to
precisely identify the TB education and screening requirements within the community.
Stakeholders such as community leaders, healthcare providers, and local organizations will be
included in the planning to secure their support and active participation in the projects. This will
also establish a dedicated project team of individuals possessing expertise in community
engagement, TB education, and screening. This holistic approach ensures a targeted response to
the community's specific needs while fostering collaboration and expertise within the project
team. A detailed training plan for peer educators and screeners focusing on TB transmission,
prevention, symptoms, and the significance of early detection will be formulated.

The third phase of the project will include recruitment and selection of peer educators and
screeners. Formulation of a recruitment strategy to identify community members interested in
becoming peer educators and screeners will be done. Individuals who would voluntarily
participate in the project will be recruited as TB advocates. All advocates are free to withdraw or
leave the project at any point without need to provide reason for leaving the project. It will be
followed by conducting an extensive training program for the chosen peer educators and
screeners. This includes lectures and workshops and conducting TB screenings. Training and
workshops will aim at enhancing awareness of TB, emphasizing prevention, and stressing the
significance of early detection. It will be followed by a TB screening campaign. Deployment of
trained screeners will be done to perform screenings in community settings, prioritizing privacy
and confidentiality. Patients who will be identified as presumptive will be referred to the Rural
Health Unit for consultation.

The fourth phase will be monitoring and evaluation, a comprehensive monitoring and evaluation
framework will be set up to gauge the project's effectiveness and impact. Data will be gathered
on the screenings performed, and outcomes of the screenings. Data will be analyzed to assess the
project's success in enhancing TB awareness, promoting early detection, and fostering
community engagement. Outcome measurement will be the number diagnosed TB cases in the
research locale.

The last phase is ensuring project sustainability and expansion. A sustainability plan will be
developed to ensure the project's long-term impact and continuation beyond the capstone project.
Potential funding sources, partnerships, and other stakeholders will be tapped for ongoing
support to ensure that the project will be sustained and implemented well.

TIMELINE

The project will be implemented starting November 2023 to August 2024. Project activity
timeline will be presented in the gantt chart below.
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