Advocacy, Communication, and Social Mobilization (ACSM) Strategy

Egypt National TB Control Program
Advocacy, Communication, and Social

Mobilization (ACSM) Strategy
Advocacy, Communication, and Social Mobilization (ACSM) Strategy
INDEX
ABBREVIATIONS ..................................................................................................... 3
FOREWARD ............................................................................................................... 4
WHERE TO FROM HERE? ..................................................................................... 5
EXECUTIVE SUMMARY ......................................................................................... 6
1. INTRODUCTION ................................................................................................... 7
1.1 Advocacy Communication and Social Mobilization............................................ 8
2. SITUATION ANALYSIS ..................................................................................... 10
2.1 Country Data ...................................................................................................... 10
2.2 Knowledge Attitudes and Practices ................................................................... 13
2.3 ACSM Needs Assessment Findings................................................................... 14
2.4 Program Strengths, Challenges and Opportunities............................................. 15
3. ACSM STRATEGIC FRAMEWORK ................................................................ 17
3.1 ACSM Strategy Goal 20092014- ........................................................................ 17
3.2 Strategy Terminology ........................................................................................ 17
3.3 Campaign Phases ............................................................................................... 17
3.4 Streams of ACSM Activity ................................................................................ 18
3.5 Development of ACSM Program Core Competencies ....................................... 18
3.6 ACSM Strategy Management ............................................................................ 19
4. STRATEGIC ACSM PLANNING CYCLE ........................................................ 20
5. AUDIENCE SEGMENTATION.......................................................................... 22
5.1 Primary Audience Segments .............................................................................. 22
5.2 Secondary Audience Segments .......................................................................... 22
5.3 Influencing Groups............................................................................................. 22
6. ACSM STRATEGY OBJECTIVES .................................................................... 23
6.1 TB ACSM Strategy Objectives .......................................................................... 23
INDEX
6.2 Audience-Based Objectives ............................................................................... 23

6.3 Service Delivery Objectives .............................................................................. 24
6.4 Community Based Objectives............................................................................ 24
3
7. MESSAGE DEVELOPMENT ............................................................................. 25
7.1 Potential Message Themes ................................................................................. 25
8. ILLUSTRATIVE ACTIVITIES .......................................................................... 27
8.1 Community Level Activities .............................................................................. 27
8.2 Population Health Approaches .......................................................................... 30
9. MONITORING AND EVALUATION ................................................................ 36
9.1 Performance Indicators ...................................................................................... 36
10. ACSM STRATEGY PRIORITIES .................................................................... 40
10.1 ACSM Year One Priorities - 20092010- ........................................................... 41
11. DOCUMENTATION & DISSEMINATION .................................................... 47
CONCLUSION ......................................................................................................... 47
INDEX
4
ABBREVIATIONS

AAR After Action Review
ACSM Advocacy Communication and Social Mobilization
AIDS Acquired Immunodeficiency Syndrome
BCC Behavior Change Communication
CCM Country Coordinating Mechanism
CRIS Communication Resource Information System
DCT Diagnosis Counseling and Testing
DPM District Program Manager
DTC District Tuberculosis Centre
DOT Directly Observed Treatment
DTM District Tuberculosis Manager
EMR East Mediterranean Region
GFATM Global Fund Against AIDS TB and Malaria
HEO Health Education Officer
HIV Human Immunodeficiency Virus
KAP Knowledge, Attitudes and Practices
KPIs Key Performance Indicators
LHW Lady Health Worker
LOE Level of Effort
NTP National Tuberculosis Program
MDR-TB Multi Drug Resistant TB
MOHP Ministry of Health and Population
OPD Out-patient department
PHC Primary Health Centre
PPM Public - Private Mix
QA Quality Assurance
TA Technical Assistance
TARPs Target audience rating points
TDI Trade Development Index
ABBREVIATIONS
TOR Terms of Reference

XDR –TB Extreme Drug Resistant TB
Data Sources:
The following key data sources were utilized in the development of this strategy: Ministry of Population and Health (2007) National
Tuberculosis Control Program Egypt Strategic Plan 20072011-.WHO- EMRO (2006) Diagnosis and Treatment Delay in Tuberculosis
- An in-depth analysis of the health-seeking behaviour of patients and health system response in seven countries of the Eastern
Mediterranean Region. WHO–Stop TB Partnership (2006) Advocacy, Communication and Social Mobilization to fight TB - A 10-
year Framework for Action. WHO–Stop TB Partnership (2006) The Stop Tb Strategy - Building on and enhancing DOTS to meet
the TB-related Millennium Development Goals WHO–Stop TB Partnership. WHO–Stop TB Partnership (2008) TB Regional Profile.
Sourced from: http://www.emro.who.int/stb/TBSituation-RegionalProfile-TBburden.htm WHO (2008) WHO Report 2008 - Global
Tuberculosis Control, Surveillance, Planning, Financing. NTP (2008) GFATM Round 6 ACSM proposal and ACSM Workplan. Verver,
S., (2002) Evaluation of Anti Tuberculosis Campaign - Egypt 2002. USAID funded report. World Health Organization, (2004) A guide
to monitoring and evaluation of TB/HIV activities. Field test version. Geneva. Strategy
5
FOREWARD
The National TB Control Program has recently completed its second National Strategic Plan to
take the TB strategy forward from 20072011-. In line with enhancements in the overarching TB
strategy, it is clear that the value of advocacy, communication and social mobilization (ACSM) is
becoming of increasing importance in TB control. ACSM can act to raise awareness and increase
knowledge of TB in the community, encourage early health-seeking behaviour and treatment
adherence, and reduce stigma associated with TB.
It is therefore a positive step to see that NTP has now developed an ACSM strategy in line with
the National Strategic Plan to inject greater strategic coherence to these activities. A cornerstone
of the approach is that an integrated programming model required for incorporating timely,
intensive, single-minded ACSM messages and programs operating synergistically at a number
of levels. In order to achieve important health gains in the longer term, programs will need to
evolve that are realistic, achievable and measurable. This NTP ACSM Strategy 20092014- has
been developed to address these unfolding challenges.
The Strategy has also been developed in line with the Global Plan to Stop TB Strategy (2006-
2015), and the WHO–Stop TB Partnership ACSM 10-year Framework for Action to Fight TB (2006).
The Strategy is not an end in itself, but rather an instrument for expanding and promoting
partnerships amongst all stakeholders in the field of TB control. It presents broad principles and
a strategic framework for guiding ACSM programs that are facilitated by, or supported under the
auspices of the National TB Control Program and its multisectoral partners including; NGOs, faith
based organisations, civil society and public private partnerships in ACSM.
On behalf of the Minister of Health and Population in Egypt, I endorse the National ACSM Strategy
to all TB and HIV/AIDS stakeholders in the hope that it will provide a road-map for TB and other
health promotion programming in our country in years to come.
Signature
Prof. Dr. Abdelrahman Shahin

Media Advisor for the Minister of Health & Population
FOREWARD
7
WHERE TO FROM HERE?
Egypt is ranked by WHO as a low burden TB country. It has managed to reduce its TB burden in
recent years and has a current estimated incidence of 24 TB patients per 100 thousand populations.
Despite these successes in program delivery, this is no time to be complacent in moving forward
to eradicate TB as a health problem in Egypt, through more systematic approaches.
Advocacy Communication and Social Mobilisation (ACSM) has been identified by WHO as a
critical component in TB control and has been utilised effectively in earlier years of the program
with significant funding provided through the Global Fund for AIDS, TB and Malaria (GFATM).
However, it is now time to develop a more integrated approach to the ACSM program, in line
with strategic developments in the clinical program delivery. A cornerstone of the planning
approach is that a more integrated approach to ACSM programming is required involving all
program partners working in unison to achieve measurable behavioural impact.
The NTP is grateful to the wide number of stakeholders who have contributed to the drafting of
this strategy through the provision of independent advice or attendance at the ACSM planning
workshop conducted in August 2008. I would also like to acknowledge the support of WHO
(EMRO) especially Mr. Wasiq Khan for their assistance in developing this strategy through Tahir
Turk - WHO ACSM Technical Advisor, as well as ACSM Team of NTP Egypt (Dr. Nadia Badawy, Dr.
Amr Bakr, Dr. Sherry Victor, and Ms. Taghrid Akl) who assisted with project coordination and the
needs assessment.
ACSM stakeholders will be invited to attend the Campaign Planning Workshop develop programs
and District Action plans in readiness for the first integrated ACSM campaign to be launched
on the World TB Day on 24th March 2009. We look forward to working with all our public and
private sector partners in the future implementation of the Egypt NTP - ACSM Strategy and
related activities.
Dr. Essam Elmoghazy

General Director of Chest Diseases
Executive Director of NTP -Egypt
WHERE TO FROM HERE?
August 2008
9
EXECUTIVE SUMMARY
The challenges of reducing the burden of TB in Egypt are significant and complex. ACSM is an
important feature of any comprehensive TB program to raise awareness and build knowledge
of TB in the community, encourage early health seeking behaviour and treatment adherence,
and reduce stigma associated with TB. However, in order to achieve program success, more
systematic, strategic approaches to the ACSM program roll-out need to take place.
This document proposes the Operating principles and a strategic planning framework to guide
a holistic and sustainable ACSM program. It encompasses the establishment of a Technical
Sub-Committee comprised of key ACSM stakeholders with core competencies in ACSM
programming, and the utilisation of a four-stage, Strategic ACSM Planning Cycle. This Planning
Cycle incorporates program planning, development, implementation and evaluation stages.
The process provides for optimum stakeholder involvement, with feedback loops at every
stage of the cycle. Also identified are the country challenges, target populations overarching
programming objectives, as well as a number of illustrative ACSM activities. A key feature of the
approach is that a more integrated, multilevel, program will be required with larger scale, more
intensive activity periods. If achieved, the approach may show measurable behavioural impact
evaluated through a monitoring and evaluation framework.
This impact will be achieved by expanding the current network of program partners including
NGO, Community Based Organisations (CBOs), faith-based organisations (FBOs), as well as
building private public partnerships to leverage program activities. As well as more effective
utilization of existing human resources for ACSM, the program will aim to build on core
competencies for ACSM programming through the establishment of ‘centres of excellence.’ for
community based and media programming, and monitoring and evaluation of ACSM.
A cornerstone of the strategy is the recognition that community ownership involvement and
participation must drive program activities. TB stakeholders and targeted beneficiaries should
be consulted and involved in the planning and development process. Given the need to address
priority populations in the short-term, a range of specific activities and ACSM channels have
been identified. These include more intensive interventions in targeted areas, capacity building
through training and technical transfer with public and private partners, the development of
EXECUTIVE SUMMARY
a range of advocacy communication and social mobilisation activities and events, mass media
resources, and a monitoring and evaluation framework to measure program key performance
indicators (KPIs) through behavioural determinants.
11
INTRODUCTION
In 1993, the World Health Organization and other emerging challenges.

(WHO) declared TB a global emergency in
There is now a growing realization that the
recognition of the growing importance of
expansion and enhancement of high quality
TB as a public health problem. About one-
DOTS in isolation of more intensive ACSM
third of the world’s population is infected
efforts, will not achieve the ambitious targets
with Mycobacterium tuberculosis. Worldwide
in reducing TB in Egypt. Whilst advocacy
in 2000, there were about 8.7 million new
must continue to ensure high-level political
cases of TB disease with 1.9 million deaths. M.
commitment and the flow of adequate
tuberculosis kills more people than any other
resources, much more needs to be done to
single infectious disease agent. Deaths from
improve ACSM skills of the front-line health
TB account for 25% of all avoidable deaths in
workers and field staff as well as building
developing countries.
capacity of clinical staff to understand the
Advocacy, Communication, and Social importance of interpersonal communication
Mobilisation (ACSM) has been identified by (IPC) approaches.
WHO as a critical component in TB control.
Concentrated ACSM efforts are also required
Although ACSM has been utilised to good
to continue for communities which may have
effect in Egypt in the past, a more systematic,
remained distanced socially, economically
strategic approach to ACSM program roll-out
and geographically, from the mainstream of
is yet to evolve, in line with the clinical delivery
development.
of the program.
Also evident from recent consultations is
Much has already been achieved in Egypt
the pressing need for greater integration
with good patient treatment adherence and
and coordination of ACSM efforts across
successful treatment outcomes of more than
the country through the creation of more
87% being achieved above the required
strategic alliances, to create behavioral impact,
targets of 85%.
given the limitations in human and financial
One of principal TB control strategies is to cut resources. More attention is also needed to
the chain of transmission, in order to have a address the underlying causes of low referral
generation of children free from TB. In order rates from private practitioners and university
to achieve this target much more needs to hospitals to the NTP facilities.
INTRODUCTION
be done to continue to build momentum for

This ACSM Strategy refers to the National
TB control in an environment of competing
Tuberculosis Strategic Plan and the WHO–
health priorities. This requires building greater
Stop TB Partnership’s 10-year Framework
ownership within communities for TB control
for Advocacy, Communication, and Social
to increase case detection, early health seeking
Mobilization. It is hoped that the strategy will
behaviour, to further reduce TB incidence with
provide a more cohesive platform for program
all risk groups, as well as mitigate the impact
planning, development, implementation and
of TB/HIV co-infection, multi-drug resistant TB
evaluation as well as providing practical steps
(MDR-TB), extreme drug resistant TB (XDR –TB)
13
to operationalise the strategy. This Strategy is selecting ACSM tools and channels, and
designed to expand ACSM activities to help developing a management and monitoring
address four key program challenges: system. Common features of successful social
• Continuing to mobilize political marketing campaigns gleaned from the
health communication literature indicate that
commitment and resources for TB.
the most successful programs are:
• Improving case detection, referral,
holding, and treatment adherence. • Strategic, Collaborative, & Participatory;
• Combating stigma and discrimination • Targeted and Audience Focused;
• Empowering people affected by TB • Behavior Centered;
• Multi-level & Integrated – IPC supported
1.1 Advocacy Communication, by media resources;
and Social Mobilization • Monitored and Evaluated with research
The World Health Organisation views each informing decision making;
component of Advocacy, Communication,
ACSM activities include:
and Social Mobilization as follows;
• Advocacy - Advocacy is a dynamic process
• ACSM training, capacity building, and
institutional strengthening;
that includes activities designed to place
TB high on political and development • Community Advocacy – activities and
agenda, foster political will, increase and events;
sustain financial and other resources. • Developing ACSM tools and materials to
• Communication - Exchange of information support community advocacy;
about TB between patients/families/ • Developing distribution mechanisms to
providers and communities. A two-way get programs, materials and products,
participatory process of dialogue. Using where and when they are needed, and;
interpersonal communication (IPC) skills
aimed at changing behaviour, shifting
• Developing methods to monitor
community program performance and
social norms & removing barriers to assure quality.
behaviour change.
• Social Mobilization - Mobilizing a force Growing evidence and experience from a
number of countries shows that when strategic
of different groups in civil society for
joint action to fight stigma & eliminate ACSM approaches are applied effectively,
TB as a public health threat. Not isolated and in the appropriate context, they can
but collective efforts for sustainable be powerful tools for achieving protective
behaviour/social change and the behaviour change. However, WHO, Stop-TB
development of a more supportive partnership identifies that:
attitude to patient care1.
Such approaches have not been prioritized
ACSM approaches have evolved to incorporate by NTPs internationally, either in terms of
a comprehensive range of audience-focused strategic emphasis or in building capacity to
processes in which insights from dialogue
INTRODUCTION
implement effective ACSM programs.” (WHO

with stakeholders and research findings 2006)
inform decisions about the best ways to affect
behaviour change. Some of the approaches This document lays out a 5-year roadmap to
include identification of problems and rectify this situation and optimize delivery
populations at most risk, defining program of the TB control program services in Egypt
objectives, identifying an overall strategic through ACSM approaches.
approach, articulating key messages,
1 Adapted from WHO (2006) ACSM 10 Year Plan.
14
2. SITUATION ANALYSIS
A situational analysis was conducted for highly fertile agricultural lands of the
the development of this ACSM strategy Delta.
incorporating desk research and a needs 2. The Western Desert (approx. 681,000
assessment. The needs assessment Km2); which extends from the Nile
process included Consultations with key Valley in the East to the Libyan borders
informants from NTP, MOHP, supporting in the west, and from the Mediterranean
non-governmental organizations (NGOs), in the north to the Egyptian southern
health-care providers and private sector borders. It is divided into - The Northern
partners. Site visits were also conducted Section: which includes the coastal
to TB treatment facilities including a Chest plain, the northern plateau and the
Hospital and Primary Health Centre (PHC). Great Depression, the Natroun Valley
and Baharia Oasis. The Southern Section:
Discussions were conducted with health
which includes Farafra, Kharga, Dakhla
workers and program beneficiaries including
oases, and El-Owainat in the far south.
drug sensitive and drug resistant TB patients.
3. The Eastern Desert (approx. 325,000
An ACSM workshop was also conducted
Km2); which extends from the Nile Valley
with a number of public sector and NGO
in the West to the Red Sea, Suez Gulf, and
stakeholders to explore the key elements of
Suez Canal in the East, and from Lake
the ACSM strategy. Manzala on the Mediterranean in the
North to Egypt's southern borders with
2.1 Country Data Sudan in the south. The Eastern Desert
The Arab Republic of Egypt is located in the is marked with the Eastern Mountains
northern corner of Africa. It is bounded by the that range along the Red Sea with peaks
international frontiers of the Mediterranean that rise to about 3000 feet above the sea
Sea in the North, the Red Sea in the East, level. This desert is a store of Egyptian
natural resources including various ores
Libya in the west and Sudan in the south. The
such as gold, coal, and oil.
total area of Egypt is 1.01 million Km with the
principal geographic feature of the country 4. Sinai Peninsula (approx. 61,000 Km2);
Sinai has a triangular shape having
being the Nile River.
its base at the Mediterranean in the
Egypt is geographically divided into four North and its apex in the South at Ras
main divisions: Mohammed, the Gulf of Aqaba to the
INTRODUCTION
1. The Nile Valley and Delta (approx. 33,000 East and the Gulf of Suez and Suez Canal
Km2); which extends from the North to the west. It is topographically divided
Valley to the Mediterranean Sea and is into three main sections:
divided into Upper Egypt and Lower 5. The southern section; includes extremely
Egypt, extending from Wadi Halfa to the tough terrain composed of high-rise
south of Cairo and from North Cairo to granite mountains. Mount Catherine
the Mediterranean Sea. The River Nile in rises about 2640 meters above sea level,
the north is divided into two branches, thus making it the highest mountaintop
Damietta and Rachid embracing the in Egypt.
15
6. The Central section; comprises the area 2.1.1 Health Indicators
bounded by the Mediterranean Sea to
Average life expectancy of Egyptians is 71
the North.
years of age. Adult literacy for males is 71%,
At-Teeh plateau to the south; is a plain area and is 50% for females. The infant mortality
having abundant water resources derived rate is 23 deaths per 1000 live births.
from rainwater flowing from southern heights
Latest figures on the TB estimated incidence
to the central plateau.
rate are 24 cases (all types of TB) per 100
The capital of Egypt is Cairo with an urban thousand population, with an estimated
population of more than 15.5 million people. 17,200 new cases per year and 11 sputum
Arabic is the formal language. English, the first positive cases per 100 thousand population,
foreign language, along with French, are used or an estimated 7850 new positive cases per
in business activities. Egypt ranks 16 out of year. Multi-drug resistant TB is 2.2 % of new
the 20 mid-level developing countries in the cases and 38.4 % among re-treatment cases.3
Trade Development Index (TDI)2 but, with a
per capita gross national income of US$1350, 2.1.2 Communications Environment
it is only second to Iran in TDI, in the EMR. Egypt is one of the most pivotal nations more
Egypt is divided into 29 governorates (singular popularly recognized by the media as ‘the
muhafazah) and 1 self-governing city. Middle East.’ The strategic position of Egypt in
Egyptian governorates are at the top tier of the this region is even more important because
five-tier jurisdiction hierarchy. Governorates it is the most stable country in the region -
are administered by a governor (muhafez) economically, socially and culturally.4 As Egypt
appointed by the president of Egypt. Most seemingly controls the stability in the region,
governorates have a population density of the country commands a good deal of media
more than one-thousand people per sq km, attention. As a result, Egypt media landscape is
while the 3 largest have a population density rich and diverse, and increasingly challenged
of less than two thousand per square km. by a growing generation of independent
media outlets.
Governorates are either fully ‘urban’ or else
they are a mix of ‘urban’ and ‘rural.’ The official Electronic and Broadcast Media
distinction between urban and rural is reflected There are 98 television stations in Egypt with
in the lower tiers: i.e., fully urban governorates more than 8 million television sets in the
have no regions (markazes), as the markaz country and over 3 million satellite users.
is a conglomeration of villages. Moreover, Egyptians also own over 20 million radio sets
governorates may comprise just one city, as in with 42 AM and 14 FM radio stations around
the case of Cairo or Alexandria. Hence, these the country. The Egyptian Radio and Television
one-city governorates are only divided into Union (ERTU) works in affiliation with the
districts (i.e. urban neighbourhoods). Two new Ministry of Information to operate the eight
governorates were created in 2008 - Helwan government-owned TV stations in Egypt, as
and 6th October.3 well as two satellite stations, as well as 19 local
INTRODUCTION
and regional stations.
Egypt has also launched NileSat, the Arab

world's first broadcast satellite, to carry
2 L., Reem (2008) Redrawing the Map. Al Ahram Weekly (On-
line). Retrieved on: 200819-05-.
Egyptian TV and radio from North Africa to
3 Ministry of Population and Health (2007) National Tuberculosis the Persian Gulf.5 The launch of NileSat 101
Control Program Egypt Strategic Plan 20072011-. satellite in April 1998, delivered more than
4 BBC News (2008) Egypt Report. Available from http://news.
bbc.co.uk. 100 digital TV channels as well as radio and
5 The Central Intelligence Agency (CIA) (2002) World Factbook multimedia services to more than five million
2001. Directorate of Intelligence, http://www.cia.gov.
16
homes across the whole of North Africa from Information Service of Egypt.8 Overall there
Morocco to the Persian Gulf. A second satellite, are 18 primary newspapers and periodicals
NileSat 102, was launched in 2000, and the within Egypt. Some of these include: Akhbar
NileSat system now broadcasts to more al-Adab, Akher Sa'a, Al-Ahali, al-Arabit and Al-

than 150 digital TV channels and provides Ahram Hebdo, with the Egyptian government
additional services such as data transmission, owning a controlling interest in the three
turbo internet and multicasting applications.6 major daily Egyptian newspapers: Al-Ahram,
Al-Akhbar, and Al-Gumhuriya. Al-Ahram is
NileSat is helping stimulate change in the the largest Arabic newspaper in the world
region especially in terms of the women’s with the Al Ahram Regional Press Institute
movement, which has seen rapid shifts in now established, who, according to the
clothing attire and social customs. In 2001 International Journalists' Network, helps
a second privately-owned satellite network Egyptian and Arabic journalists learn more
was also launched called Dream TV ensuring current trends in journalism.
increased coverage of media services across
the region. Outdoor Media
Egypt also has a vibrant outdoor media market
Mobile Phones with many sophisticated billboard hoardings
The number of mobile phone users in Egypt and supersites carrying removable, vinyl skins
rose by 34% in 20056- to reach 18.2 million with the latest photo-printing technologies.
people representing a penetration rate of 25%. There are also a wide number of small-sheet
By March 2007 this figure had risen to 20.3 posters located in shopping malls, train and
million, or a penetration rate of nearly 28%. bus terminals around the country.
However, penetration rates are still relatively
low in regional terms, but the prospect of
further government deregulation ahead will 2.2 Knowledge Attitudes and
ensure the mobile phone access expands Practices
rapidly incoming years.7 Formative research on the behavioural
determinants of knowledge, attitudes
Internet and practices (KAP) toward TB prevention,
Egypt has also made relatively good progress treatment and care are pre-requisites for
in providing Internet access to the population, the implementation of any effective ACSM
with more than 50 Internet service providers strategy. However, baseline information on TB
for approximately 300 thousand users who are KAP in Egypt is sporadic with no national KAP
now able to view a range of news and current baseline surveys conducted to date and the last
affairs issues online. quantitative KAP surveys (operational research)
conducted in 2002 to measure the impact of an
Print Media
intervention carried out in Egypt9.
There are currently over 200 independent
print media sources in Egypt today with most Although stakeholder feedback indicates that
of them published off-shore. Most of Egypt awareness of TB may be adequate, its health
media is government owned through the State
INTRODUCTION
priority with population segments and front-

line field staff is low, with comprehensive
6 NileSat (2008) Available from:http://space.skyrocket.de/
index_frame.htm?http://www.skyrocket.de/space/doc_sdat/ knowledge on TB symptoms, treatment and
nilesat-101.htm care, yet to be established with the general
7 Euromonitor (2007) Egypt Mobile Phone Market. Sourced on: population and especially with vulnerable
http://www.euromonitor.com/More_growth_in_store_for_
Egypts_ mobile_phone_market and marginalized groups.
8 Committee to Protect Journalists (2001) Middle East and North
Africa Country Report: Egypt. Available from http://www.cpj. Main sources of TB information in the
org/attacks01/mideast01/Egypt.html.
communities identified from patient interviews
9 Verver, S.,(2002) Evaluation of Anti Tuberculosis Campaign
(Egypt). Report tabled to Government, KNCV-Netherlands. are other TB patients despite the large network
17
of Lady Health Workers (LHWs) accounting for effort (LOE) on TB during intensive
one LHW for each 10 thousand population, programming is reasonable, with the
as well as Health Education Officers (HEOs) other 30% of time spent on continuous
involved in TB awareness activities. The lack programming.
of comprehensive data on TB KAP, through • Media programming should be a major
population health approaches, will continue activity with the development of a ‘media
to hinder the development of strategic, umbrella’ to support community based
evidence based ACSM programs. programming.
It is gratifying to note that the NTP has

• The Campaign will be from 46- weeks
commencing in late January, building-
identified this gap in evidence on KAP and up to World TB Day (depending on
moved forward with the development of advice from media planners and budget
instruments and research methodology for availability).
a national KAP survey. The methodology
incorporates a multi-stage, random sample
• The 24th of March (World TB Day) should
be the end of the campaign. Partners
of the population in both urban and rural should agree to launch activities at
areas in a number of governorates across the commencement of the intensive
the country. The survey report, which was programming period - at national and
conducted during august 2008 and analyzed governorate levels - as well as conducting
during September, will be available to all a number of other public relations (PR)
stakeholders before the end of the year to events (earned media as opposed to paid
provide essential program intelligence for media), during the campaign period.
planning evidence based ACSM programs in
Program Integration Recommendations -
future years of activity.
• We need to develop a planning
‘Organogram’ to include the NTP with a
2.3 ACSM Needs Assessment national coordinator from each program
Findings sector as well as a peripheral coordinator
from each program sector.
The following recommendations were
provided by stakeholders at the ACSM Strategy
• A central coordinating committee as well
as peripheral coordinating committee
Planning Workshop held in August 2008. should be established from each sector
Program Strategic Approach with appropriate job descriptions.
Recommendations - • The campaign should be divided
into phases – Possibly three phases
• It is better to have a concentrated
- pre-campaign – capacity building,
campaign of up to 46- weeks than a
continuous campaign. preparation of materials, campaign
intervention – implementation, and post
• This can be achieved by creating campaign – monitoring and evaluation.
partnerships with each sector partner
to provide feedback to a Central • The Pre campaign phase will include
Committee on their actual activities for a technical committee for developing
INTRODUCTION
the concentrated 2 month programming materials and programs consisting of

period. one person from each sector to define
essential materials and the capability
• It was also recommended that a plan of of each sector to define their programs,
continuous programming leading-up to materials, and pre-test methods.
and following an intensive programming
period as a number of agencies do Monitoring and Evaluation
programming for a range of health Recommendations -
issues.
• A KAP survey is to be conducted after
• Programming of up to 70% level of every campaign, in line with the existing
18
KAP method and linked to the baseline program participation and impact.
survey currently being conducted. • Limited consideration of behavioural
• Process indicators should be included determinants when developing programs
in evaluations such as - number of – awareness, knowledge, attitudes and
participants number of seminars etc – perceptions or other biopsychosocial

This can be done following the seminars determinants of behaviour change.
and other activities etc.
ACSM Provider Side
• Recall of media spots should be part of a
• General lack of high ACSM technical
separate survey.
capacity and human resources for
• A monitoring feedback mechanism on
programming.
all activities should be provided from
all partners via quarterly meetings, or • Collaboration with the private sector in
according to needs. ACSM has not been established.
• A sub-Committee for M&E should be • Lack of IEC materials delivery to improve
established to ensure best practice. advocacy and education activities.
Beneficiary Side
2.4 Program Strengths, Challenges • Lack of awareness, knowledge and social
and Opportunities mobilisation for TB generally in the
The Egypt ACSM strategy takes into population.
consideration the following strengths, • Little or no involvement in TB ACSM
challenges and opportunities, with specific among "Omda" / community leaders, and
recommendations made in latter chapters to other potential TB control advocates.
address the issues identified. • Patient preference for private sector
services as a result of various underlying
2.4.1 Strengths factors.
• Systems and structures in place for • Refugees and internally displaced people
(IDPs) have higher rates of TB and are
continued gains in meeting targets.
harder to detect and treat.
• Strong commitment and leadership by
• Relatively little cured patient involvement
program management at National level
in TB advocacy and DOT provision.
to address the challenges currently
experienced by the NTP. • Continued TB stigma particularly in
groups marginalized through poverty,
• A broad motivated workforce of front-
ethnicity and gender causing treatment
line field workers – LHWs, HEOs, NGOs
delays and other psychosocial barriers
and community volunteers who could be
to early health seeking behaviour and
engaged more fully in ACSM activities.
treatment adherence.
2.4.2 Challenges
2.4.3 Opportunities
Program Side • Develop a participatory, strategic
INTRODUCTION
• Program is a low health priority in relation planning process to increase the potential
impact of the ACSM component on NTP
to other health priorities with front-line
field force. program outcomes.
• Some NTP public sector services are • Engage NTP partners and beneficiaries
heavily utilized which could create by involving them more fully in an
problems with further demand integrated program roll-out.
generation. • Identify lead organisations with core
• A diffracted approach to ACSM activities competencies in ACSM to establish centres
of ACSM programming excellence.
rather than a strategic approach reduces
19
• Establish a contracting protocol within • Refine the M&E framework - to measure
government or through NGO sub- KAP performance indicators for program
recipient that allows for facilitated impact.
contracting and partnerships with the
private sector agencies.
• Establish partnerships with HIV/AIDS
program for ACSM to build NTP technical
• Develop innovative and creative ACSM capacity.
approaches.
• Add value to ACSM program through
greater involvement from the private
sector.
INTRODUCTION
20
3. ACSM STRATEGIC FRAMEWORK
3.1 ACSM Strategy Goal 2009- ACSM plan for the first year (20092010-) of
2014 the ACSM strategy will be identified as the
“To establish a participatory, integrated, Phase One Campaign, with the second year
multi-level, evidence based ACSM program campaign (20102011-) identified as the Phase
to mobilize support for TB control in Egypt Two Campaign, and so on.
thereby achieving sustainable and measurable It is anticipated that at least one intensive
behavioural impact.” ACSM campaign will be conducted per annum,
with the possibility of additional strategic
3.2 Strategy Terminology ACSM campaigns implemented according
A number of ACSM terms and approaches are to the needs of the program. Stakeholder
utilised in the following chapters. Strategy is recommendations are for a 46- week intensive
defined as; an elaborate and systematic plan programming period for each Phase of the
of action or the branch of military science Strategy in the lead-up to World TB Day on
dealing with military command and the 24th March.
planning and conduct of a war. Although
the term originates from military science it 3.4 Streams of ACSM Activity
articulates well-defined procedures which, if Two Streams of ACSM activities are proposed
enacted according to strategic principles, will to address the overarching objectives of the
achieve specific, long-term goals. program as well as comply with WHO policy
Within the context of the ACSM Strategy requirements targeting most vulnerable and
a Campaign is seen as; exerting oneself marginalized population groups.
continuously, vigorously, or obtrusively to gain • Stream 1 ACSM Activities – Targeted
an end or engage in a crusade for a certain interventions focusing on vulnerable
cause. These terms suggest that impact can population – squatters, slum dwellers,
be optimized when a concentrated, intensive, refugees and populations in Governorates
currently not achieving their case
multi-level, campaign, utilizing a broad range
detection.
ACSM STRATEGIC FRAMEWORK
of ACSM approaches, which are designed

to be obtrusive, are effectively planned and • Stream 2 ACSM Activities – Targeting
general population segments of
implemented.
males and females including opinion
leaders and key influencers to facilitate
3.3 Campaign Phases the delivery of advocacy and social
Furthermore, the ACSM Strategy should mobilisation for TB to their constituent
be developed in line with the national communities.
TB Strategy campaign approach through
Phased Campaigns in accordance with 3.5 Development of ACSM
GFATM funding rounds. This will account for Program Core Competencies
the changing priorities of the ACSM program To ensure scaling-up of the program as a
over the next 5 year term of the project. The
21
result of limited resources, networks need to ACSM programming and further building on
be expanded and private public partnerships the ACSM capacity through the provision of
encouraged for the ACSM component, in line consistent, specialised, technical assistance
with the expansion of public - private mix (TA) with these agencies. The four Core
(PPM) in the clinical component. This can Competency Areas identified for the ACSM
be achieved by identifying private/public strategy are identified as follows:
agencies with competencies in core areas of
CORE COMPETENCY AREAS FOR ACSM PROGRAM DEVELOPMENT
CORE COMPETENCY AREAS
Media Materials
Capacity Building and Community Advocacy Monitoring Evaluation
Production and
Technical Assistance and Events and Research
Distribution
1 2 3 4
3.6 ACSM Strategy Management In line with stakeholder recommendations

A critical component to the successful it is recommended that an ACSM Technical
implementation of the ACSM strategy, in line sub-Committee be established to manage
with ACSM competencies, is management the program roll-out. The sub-Committee
through a coordinated, multisectoral should be comprised of ACSM stakeholders
response. This takes into account the multiple within NTP and NGO partner specialists in the
risk factors and risk settings that contribute core competency areas. The sub-Committee
to TB prevalence and the need for effective should refer to NTP management and the
integration of TB ACSM activities across a wide country coordinating mechanism (CCM).
range of settings A sectoral approach also The ACSM Technical sub-Committee will be
provides due recognition of the increased primarily responsible for coordinating the
ability to affect change by working across range of policy and implementation aspects
a range of sectors and communities in a of the program. This will ensure integration
and capacity building opportunities for all
partnership against TB.

program partners. The technical programming
Partnerships should be extended to include areas required for the functional aspects of
other government ministries and the private program administration are identified in the
sector including advertising, market research Skills Organogram as follows.
agencies, and media proprietors, as well as
coalitions of patients and other program
beneficiaries. Building alliances with these
sectors will also facilitate the development
of guidelines, policies and ACSM programs
to create community environments that
are more conducive to social change in the
intermediate term.
22
ACSM TECHNICAL SUB-COMMITTEE SKILLS ORGANOGRAM.
ACSM Technical Sub-Committee

Capacity Building, Training &
Monitoring and Evaluation
Institutional Strengthening
Core Competencies for ACSM Programming
ADVOCACY COMMUNICATION SOCIAL MOBILISATION
• Advocacy for Political • Interpersonal • Advocacy for Political

Commitment. Communication (IPC) Commitment.
• Media Community – Patient and General. • Media Community
Advocacy and Events. Population Approaches. Advocacy and Events.
• Coalition Building. • Mass Media - Production • Coalition Building.
and Distribution.
23
4. STRATEGIC ACSM PLANNING CYCLE

It is recognized that for the successful Planning, Development, Implementation and
development and implementation of the Evaluation process with representation and
ACSM strategy at all levels throughout Egypt, a involvement from many different stakeholders
coordinated, participatory approach is required and helps to build capacity with implementing
with stakeholder feedback at every stage of agencies. A diagrammatic illustration of the
the ACSM program evolution. The Strategic Strategic ACSM Planning Cycle follows:
ACSM Planning Cycle provides a staged
FOUR-STAGE STRATEGIC ACSM PLANNING CYCLE
Identifying Problem
and Developing
1
ACSM Phase
Program Developing
& Pre-Testing
Concepts,
Messages,
Materials &
4 Activities
2
STRATEGIC ACSM PLANNING CYCLE
Evaluating
Program for
Future Planning
Implementing
3 the Program
25
The ACSM Strategy operates continuously Stage 3 - Implementation
within the annual 4-Stage Planning Cycle with
the following range of activities:
• Disseminate IEC materials to stakeholders
support community ACSM activities
through NTP Governorate offices, NGOs
Stage 1 - Planning and other community networks.
• Conduct participatory stakeholder
• Mobilize National, Governorate and
consultations with donors, government,
District level operatives for intensive,
civil society and the private sector.
concentrated ACSM programming
• Conduct formative research with target activities.
groups and rapid assessments to identify
risk settings for a comprehensive, • Execute supporting multi-media
umbrella, media advocacy and integrated
localized, situational analysis.
range of community-based activities to
• Utilise ACSM sub-Committee and facilitate clinical referrals and program
Governorate ACSM staff for coordination of delivery.
ACSM campaign planning, development,
implementation and review. Stage 4 - Monitoring Evaluation and
• Out-source services as required for Review
Training, Capacity Building, Community • Develop Market Research Brief for
and Media Advocacy, Media Production tendering of Qualitative (focus group) and
and Dissemination, and Monitoring and Quantitative (pre and post intervention)
Evaluation. research and integrate within Monitoring
• Develop ACSM Planning Documents and Evaluation Framework.
– Creative Communication and Market • Measure behavioural determinants
Research Briefs for approval by ACSM through KAP- knowledge, attitudes and
sub-Committee members and partner perceptions, behavioural intentions,
agencies, and seek consensus on the way actual behaviours, maintenance of
forward. behaviours and advocacy.
• Produce inclusive, participatory National • Establish process indicators - inputs and
and Governorate implementation work- outputs (internal measures of capacity,
plans that include delegated agencies, skill, program penetration, and resource
timing/phasing considerations, sub- distribution).
Committee inputs, approval points and
adequate budgets.
• Establish ACSM impact indicators
(audience-based measures of individual
KAP and population-based measures
Stage 2 - Development
relating to, service demand, referral,
• Conduct relevant training programs and treatment uptake and adherence).
capacity building to ensure effective
• Conduct operational research to generate
STRATEGIC ACSM PLANNING CYCLE
community based ACSM program

data for problem-solving and decision
delivery.
making;
• Develop singular communication
• Advocate the successes of the program
messages in line with Phase objectives
impact and elicit stakeholder feedback
and creative concepts for activities and
at Governorate and District levels, and
materials.
integrate comments into future planning
• Conduct ACSM pre-testing and report cycles (Phases) of the strategy.
results and recommendations to ACSM
sub-Committee members and partner
agencies.
• Amend and produce final resources
in accord with ACSM sub-Committee,
recommendations.
26
5. AUDIENCE SEGMENTATION

ACSM messages will only be effective if they support from these influential groups as part
speak directly to the needs of particular of the ACSM program community rollout
audience segments with similar attributes through multisectoral, coordinated, advocacy
and concerns. This can be best achieved initiatives supported by appropriate resources.
by looking more closely at those factors Key Influencers could include:
which mitigate TB risk behaviour patterns,
resistance to healthcare seeking behaviour
• Health professionals including Public
and Private Practitioners, Health workers,
and treatment adherence. As TB is linked to LHWs and HEOs, Pharmacists, Nurses and
biopsychosocial factors the focus of activity Doctors;
should be on lower income population • Head Teachers, School Health and other
groups which may be marginalized as a result Academic staff at secondary schools,
of geographic, socio-economic, psychological colleges and universities;
or gender determinants. The main audience
segments identified for this strategy in line
• Senior Public Servants, and Governorate
and District level administrators;
with the strategic plan are as follows: • Omda/Village Heads;
5.1 Primary Audience Segments

• Religious Leaders;
• Traditional Leaders/Healers/Quacks;
• TB patients, their families and communities • Successfully treated former TB Patients
with a history of TB prevalence. and their Families;
• Females and Males in lower-socio- • Sporting Heroes, Musicians, and other
economic categories including: slum Role Models.
dwellers, tribal populations, fishermen,
migratory, mobile and street populations,
prisoners in jails and correctional facilities
and other marginalized groups.
• Pre-marriage rural women.
5.2 Secondary Audience Segments

• General Population - females and males
1644- years of age in urban and rural
areas.
5.3 Influencing Groups

Another target group category, which should
be an important part of program ACSM efforts,
includes opinion leaders and key community
influencers who operate in community
social networks. It will be beneficial to elicit
27
6. ACSM STRATEGY OBJECTIVES
The following objectives are proposed for the • Increase behavioural intentions - toward
ACSM component. early detection, early health seeking
behaviour, treatment adherence and
patient support.
6.1 TB ACSM Strategy Objectives
The overarching objectives for the three year • Increase behaviour change and
maintenance - incidence of at-risk patients
program, in line with the Strategic Plan for TB attending clinics for screening, incidence
Control 20092011-, to: of health worker case detection, incidence
• Reach and thereafter sustain the global of successful treatment outcomes,
targets of achieving at least 70% case reduced incidence of MDR/XDR (Multi-
detection and over 85% treatment Drug Resistant, Extremely Drug Resistant)
success among TB cases under DOTS in cases, and incidence of successfully
all Governorates. treated patients advocating for DOTS.
• Reach the interim target of halving TB
death and prevalence by 2010 toward 6.3 Service Delivery Objectives
achieving the Millennium Development
The following objectives will ensure that
Goals set by 2015.
health service delivery systems and agencies
• Eliminate TB as a public health problem
operating on the supply side respond
by 2050.
proactively to program beneficiary needs.
6.2 Audience-Based Objectives • Increase ACSM capacity of clinical service

and DOTS providers to meet client
A number of audience based objectives are service expectations, advocate for early
proposed for all ACSM phases, to respond health seeking treatment, appropriate
to audience demand for TB screening and early referrals, contact tracing, treatment
treatment services, including the following: efficacy and adherence.
• Increase awareness – ever having • Increase ACSM capacity of other
heard of TB – and correct knowledge advocates, LHWs, HEOs, health providers,
– signs and symptoms of TB - modes of advocates, volunteers and other
ACSM STRATEGY OBJECTIVES
transmission and means of prevention, influential groups who interact with

need for early health seeking behaviour, target audiences.
location of DOT providers (public and
private), duration of treatment, cost
• Increase public and media advocacy
programs utilizing key influencers such
of treatment, treatment efficacy and as politicians, journalists, teachers, faith-
adherence. based and other opinion leaders.
• Change attitudes and perceptions • Support and scale-up TB ACSM programs
– stigmatizing attitudes toward TB being implemented by other agencies
patients, personal risk perceptions, self- and integrate wherever possible into the
efficacy perceptions toward early health ACSM strategy.
seeking behaviour, treatment adherence
and efficacy.
29
6.4 Community Based Objectives
The following objectives for delivery of the
ACSM strategy through community sources
are proposed as follows:
• Enable key influencers - community
leaders, LHWs, HEOs and other health
workers, teachers and faith-based leaders
to confidently answer frequently asked
questions on TB.
• Develop user-friendly ACSM aids to
support the training of community key
influencers.
• Create opportunities for dialogue on
TB prevention, treatment and care
through resource support and advocacy
initiatives - between health providers
and communities, between communities
and community leaders, between family
members, neighbours and youth.
• Strengthen partnerships with NGOs,
and other civil society organisations
and involve communities in planning
and implementation of TB prevention,
treatment and care programs.
• Set the program agenda, strengthen
the areas of sensitisation, social
communication networks, health
promotion, social marketing and
community mobilization.
• Utilise a range of ACSM channels and
places for dialogue.
• Protect the interests of the multisectoral,
national TB prevention, treatment and
care program by reinforcing the need
for collaborative efforts at a National,
Governorate, District and local levels.
ACSM STRATEGY OBJECTIVES
30
7. MESSAGE DEVELOPMENT
The process of developing effective messages the health problem, the objectives of the
to cut-through the communication clutter ACSM strategy, what we know about the
will be a key to the success of this ACSM audience, potential channels for reaching the
strategy. Messages must be based on well- audience, and opportunities and challenges
developed audience research and reflect in the communication environment. Most
the cultural, spiritual, socio-economic and importantly, the creative communication
gender determinants impacting on behaviour brief should state the main messages and key
change. The principal challenge is to identify benefits as to why the audience should act
a single key message point that will motivate on the messages being delivered, as well as
the audience to think or act differently and to addressing the stages of behaviour change
follow through on the call to action. Messages within the timing of the intervention.
for each campaign must be single-minded,
uniformly applied, pervasive, delivered in an 7.1 Potential Message Themes
engaging way, and sustained over time in
The literature shows that TB messages to
order to achieve the desired result.
promote understanding of the symptoms
An evidence based process of formative of TB and treatment efficacy, can have a
research and message pre-testing via significant impact on TB prevalence. Given
qualitative and quantitative techniques needs the focus on targeted interventions with
to be institutionalized to adequately inform marginalized populations and the need to
the message development process. This can promote early case detection through health
be supported through the population-based, seeking behaviour, the focus should be on
quantitative KAP surveys which will explore reducing stigma and building confidence
TB-related awareness, knowledge, attitudes, to seek screening and treatment as soon as
and practices following each campaign Phase. possible. Some potential message themes
These combined monitoring and evaluation to be considered for the ACSM Campaigns
(M&E) approaches, will ensure high quality, follow.
pre-tested messages, programs and materials
will be developed, which are responsive to 7.1.1 Messages to reduce Stigma
MESSAGE DEVELOPMENT
audience needs.
• Building TB Brand Equity - to improve
Private sector partner agencies will need perceptions of TB generally in the
to be selected to assist with the message community, in order to ensure adequate
case detection and treatment incentives
development and materials production
in risk communities through the creation
process. The Creative Communication Brief
of a range of tangible and intangible
is an important strategic planning tool for
benefits to health services user groups.
collaborating with communication specialists
on message and materials issues. The creative • Creating Positive Appeals – to stimulate
interest, build personal risk perceptions,
brief is completed by the client and articulates
graphically display treatment efficacy
the relevant background information on
and subsequent reduction in debilitation
31
thereby, reducing general community
stigma and increasing community • If you have a cough for more than 3
weeks go to your local health centre.
dialogue on TB.
• A simple sputum test will identify if you
have TB. Costly X-Rays are not required to
7.1.2 Messages to encourage early detect TB.
Health Seeking Behaviour and
Treatment Adherence • If you do have TB you will need to take
treatment through oral medicine for a 6
• Promoting the benefits of early health month period.
seeking behaviour - following cough for
more than 3 weeks, as well as treatment
• The TB treatment is available free of
charge at all Public Health Centres
efficacy – free treatment and successful whereas private sector providers you
cure if help is sought early. may need to pay for the medicines.
• Promoting the Improved Service Delivery • The quality of the free medicines is as
Network - through public private good as or better than those provided
providers and non-traditional service through the private sector.
providers in difficult to reach areas.
• Providing Complementary Messaging
• A DOT provider within your community
can assist you to make sure the medicine
– linking early detection, screening and is taken every day.
treatment to reduction in debilitation
of patient, infection of other family and • If you do not stick to the treatment for
the full period, your body can build up
community members.
resistance to the medicine, making it
Specific TB Messages more difficult for you to be cured.
• TB is a significant problem in Egypt. • Early detection, screening and treatment
can prevent long term disability or death
• A complete cure from TB is available if
from TB, as well as prevent spreading the
you seek help early.
infection to other family and community
members.
MESSAGE DEVELOPMENT
32
8. ILLUSTRATIVE ACTIVITIES

A number of Advocacy Communication and strategy. ACSM private sector communication
Social Mobilisation Activities are anticipated and research partners should also be engaged
as part of the strategy roll-out. in order to further build capacity with these
and other potential partners to support
8.1 Community Level Activities ACSM program implementation, and to build
skills and understanding of social marketing,
The focus of ACSM activity should be
BCC and other ACSM approaches. Capacity
centered on community, interpersonal,
building and institutional strengthening will
dialogue-based approaches, in conjunction
assist NTP in the efficient disbursement of
with efficient service delivery. In order to
program funds to achieve greater program
achieve these ends in the 5 year term of this
impact.
strategy, the following ACSM activities are
recommended. ACSM Activities to support Capacity
Building
8.1.1 Capacity Building • Support the establishment of an
There is a need to strengthen the capacity ACSM Sub-Committee comprised of
of a number of program partners to achieve multisectoral public and private sector
a greater understanding of technical partners including NTP staff, NGOs and
requirements of ACSM and the principles other civil society organisations, private
of behaviour change. Technical assistance sector ACSM partners, research and
clinical service providers.
and training is required to properly plan,
develop, implement and evaluate the ACSM • Provide additional specialized TA
strategy at a number of levels. Financial to support NTP and other program
stakeholders to further build ACSM
resources will be required to support the
capacity through strategic planning
programs technical assistance function to
processes.
ensure that program partners are properly
trained in ACSM processes in order to build • Capacity building in some cases will
need to include establishment of
institutional capacity over the duration
infrastructure and equipment including
of the strategy. A commitment of no less
ILLUSTRATIVE ACTIVITIES
human resources, computing hardware/

than 1% of ACSM program funds should be
software and audio-visual equipment.
committed to professional development of
staff to ensure the long term sustainability of • Provision of an ACSM training resource
to build NTP and other stakeholder
the program.
capacity to manage the increasing MDR/
As NTP is largely involved with coordination XDR caseload.
and setting policy direction, capacity building • As well building capacity at National
the program can be elicited with support levels, expand the capacity building
from NGO technical specialists, as well as process with public sector and NGO
private sector partners who have currently partners at Governorate and District
not contributed significantly to the ACSM levels.
33
8.1.2 Training ACSM Activities to support Training
Egypt has an extensive human resource • Develop effective training manuals for
network of lady health workers and HEOs ACSM training of field-staff, incorporating
and community volunteers located around key TB prevention, care and support
the country. However this workforce is often messages.
provided with too little training in TB ACSM, in • Conduct media training workshops at
relation to other health program priorities, and Governorate level (prior to and during
few refresher trainings. This reduced this field intensive programming periods.
staff potential involvement in TB activities. • Identify ACSM training needs within NGOs,
Although training is sometimes maligned as and provide training support to ensure
a process of never-ending workshops with coordinated, integrated, Governorate and
few meaningful outcomes, training can be a National ACSM priorities and planning
useful tool to instill understanding of ACSM approaches - problem identification,
audience segmentation, behavioural
processes in, what has been to date, a clinical
objectives, achievable interventions and
focus to the program.
performance monitoring.
Training activities to support the ACSM strategy • Review existing training programs and
development, implementation and evaluation training capacity and conduct training
process, can build institutional capacity and of trainers (ToT) to leverage program
a degree of sustainability with stakeholders activities.
involved in case detection and health promotion.
Continuous feedback and ongoing technical 8.1.3 Peer Education
support will be required to enable the process of
skills development and the effective utilization Lessons learned from peer education programs
of skills which focus on IPC approaches. Another have shown that the approach can reduce
aspect of the training could incorporate specific stigma, increase understanding, ownership
agreed upon activities with NGOs and other and involvement toward important health
stakeholders involved in training to ensure problems. Peer-led communication activities
integration and participation in all governorates ensure that messages disseminated are more
level ACSM campaigns. credible, and more likely to be heard and
acted upon by other peers.
ACSM training’s desired outcomes could
include the development of a range of local As well as cured patients, peer educators
level activities, events and materials with could also include Omda, village heads,
workplans and activities agreed upon by village doctors, school teachers, worksite
NGO management, prior to the training. representatives, and role models who are in
An aspect of the training should ensure an excellent position to discuss TB within their
that learning is translated into realistic and constituencies. Peers could be trained and
given appropriate resource materials to equip
achievable interventions in-line with agreed

upon deliverables, with monitoring and them with the information they need in order
evaluation being an integral component of to act as effective advocates for the ACSM
activities. Front-line field workers should be strategy.
provided with a broader training platform
The participatory process of dialogue within
which includes building IPC skills, confidence
targeted vulnerable and marginalized
and leadership development. It is also
communities, coupled with moderation by
important to instill a greater understanding
peer leaders can be a powerful behaviour
of the importance of IPC with Medical Officers
change tool. In order for these programs to be
(MOs) and other clinical staff as a necessary
successful, venues for peer led interventions
component of their clinical service delivery.
will need to be identified, and moderators
34
trained and supported with appropriate • Support advocacy through the
ACSM aids. identification and training of media
sector partners, to regularly disseminate
ACSM activities to support Peer Education proactive, structured media releases,
• Establish TB patient support groups incorporating accurate program

within risk areas. information including relevant research
• Identify NGOs, and other civil society findings and other points of interest.
organisations working with TB and cured • Contract public relations and media
patients and local leaders to review and private sector partners to provide support
scale-up peer to peer (PTP) training through public and media advocacy
programs in particular, with slum approaches – Community events, TV
dwellers, squatters, IDPs, transient and panel discussions, reality TV and radio
street populations, and other vulnerable talk-back programs.
groups.
• Build capacity and support for peer 8.2 Population Health Approaches
education by including incentives within
Mass media has the undeniable power to
training formats, and resource materials
inject changes into a society which has a good
support.
range of media communication channels and
effective reach to broad population segments.
8.1. 4 Advocacy As such, communication media are important
Advocacy is an important and integral aspect components, as well as indicators, to support
of the community sensitization process the development process. They are a means
already well utilized in Egypt through events, of teaching, sensitizing, carrying health
and advocacy conducted by role models such messages, and channeling reactions between
as the President’s wife and other community audiences and health workers.
leaders. These efforts should continue to add-
value to the ACSM process through more In NTP however, it is a challenge to present the
purposive advocacy approaches through information in a manner that will be credible,
community social structure channels as well understandable and acceptable, as well as
as media advocacy approaches. ensuring that the information flow remains
efficient. One major challenge is the large
Using advocates such as local leaders, religious and scattered populations in some areas,
leaders, sporting identities, musicians and particularly low-income communities where
members of the arts community can create media reach is more limited.
opportunities for dialogue with broad
population sectors, between health providers An effective approach to expanding impact at
and communities, between community population approaches is the utilisation of a
leaders and communities, among family range of media and the integration of strategic
communication. Strategic communication is a
members, neighbours and friends. The

process can also be a key feature in any powerful tool that strives for behaviour change
efforts to raise community awareness of TB and not for just information dissemination,
risk and prevention approaches and reduce education, or awareness-raising. In order to
community stigma. effect behaviour change, it is necessary to
identify the root causes of non-compliance,
ACSM activities to support Advocacy its manifestations and the most effective
• Support NGO partners to identify and communication channels for delivering
use community leaders, role models and messages to support population health
opinion leaders when planning ACSM approaches. The idea is to build consensus by
programs, and integrate advocacy as a raising public understanding and generating
key element of strategic planning. informed dialogue among stakeholders.
35
Well-conceived, professionally implemented, • Translate street theatre and other
strategic communication campaigns are of approaches for television broadcast.
particular need to the future success of the • Develop campaign (generic) brand and
NTP. campaign specific positioning (slogan) to
provide a cohesive, integrated range of
8.2.1 Television ACSM messages through national media
and community based resourcing.
Country data has shown that television
ownership and coverage, especially in urban
areas has been rapidly expanding with 8.2.2 Radio
the impact and viewing of TV particularly Although radio has the widest reach among
high. Television is already a well established the mass media in Egypt the greater impact
medium in Egypt urban and peri-urban areas of television may have ‘cannibalized’ radio
as well as many rural population groups. The listenership in some areas. However radio
other aspect of television is its relatively novel stations still have broad reach and listenership
appeal with low literacy groups and high with broad coverage by national as well
impact due to graphic imagery with rural as commercial FM broadcasters across the
population segments who have yet to become country. In more remote or low-income
fully immersed in this medium. communities, radio provides comprehensive
messaging opportunities to population
There has been a large growth in the number segments that do not have regular access to
of satellite TV channels and operators in Egypt television media. For these reasons radio is still
which make programming difficult across an important medium with illiterate groups
stations. However, a number of high rating who depend on oral based communication
programs with different audience segments for their health information.
indicate that effective media delivery can
be achieved within reasonable budgets. More interesting health and social
However, a greater level of technical support programming may renew interest in radio
is required from experienced media planners once the initial novelty of Television has
to identify effective reach and frequency waned. While the urban audiences are
indicators measured through target audience shifting to television and other media, there is
rating points (TARPS). still a need to strengthen radio reach to more
inaccessible rural and internally displaced
ACSM activities to support Television populations near border areas.
• Develop strategic approach to creative
ACSM activities to support Radio
message design and media placement
for television. • Develop synergistic messages for Radio
• Provide public service announcements and Television through public service
announcements and paid media
and paid media schedules featuring
key influencers and successfully treated schedules featuring key influencers

patients. on radio, and provide radio talk- back
opportunities on important TB issues.
• Provide training to television journalists
on advocacy approaches in support of TB • Establish linkages with existing popular
prevention. radio soap opera productions for the
provision of themes and storylines
• Conduct televised activities such as TV
to support TB messaging to set the
panel discussions with advocates and
ACSM program agendas and support
other opinion leaders.
community based IPC.
• Provide television current affairs and
• Fund the translation of street theatre and
news opportunities through PR and
other approaches into radio treatments.
earned media.
36
• Provide training to radio journalists on impact, memorability and longevity, and
advocacy approaches in support of TB is accessible to large numbers of people in
prevention treatment and care. both urban and rural areas. However, outdoor
media can be costly to purchase so its usage

8.2.3 Newspapers should be strategic. There are a number
News-print media can provide ACSM of opportunities for targeted approaches
opportunities through ‘long copy,’ to billboards in higher risk areas such as
informational approaches and topical news slums and vulnerable communities. There is
stories generated through media advocacy somewhat limited experience with outdoor
activities. There are a broad number of Arabic media through stand-alone signage, painted
newspapers in the country which are widely on roadside barrier walls, and vehicle stickers.
read by opinion leaders and other members Given the fact that mobility is a characteristic
of the public. Although access to daily of a number of vulnerable population groups,
newspapers in rural areas drops-off rapidly, as outdoor media should be fully explored as
does the reading culture, the more remote the a potentially important means of message
area, print is an important medium for with dissemination through strategically placed
readership often far exceeding circulation. wall branding, as well as buses and public
The wide number of government and transport signage to provide reminders to
independent daily newspaper’s more open ‘captive audiences’ through TB messages
editorial policies are appreciated by readers, placed inside of the vehicles.
with the medium’s primary audience segments ACSM activities to support Outdoor
being policy makers and the educated elite. Media
Opportunities arise through working closely
with journalists, to stem the tide of negative
• Work with NGO partners to identify
potential, free, outdoor wall branding
or stigmatizing coverage of TB in order to sites (factory entry points, truck-stops,
generate more positive, purposive coverage bus-parks, hospitals and school-grounds)
for NTP. to be used exclusively for TB and other
public health, social marketing activities,
ACSM activities to support Print Media
and contract an agency to erect hoardings
• Support the focus of National and at the sites.
Governorate news-print media ACSM to
political leaders and key influencers – • Develop high-quality billboard messages
which synergise with other campaign
health workers, head teachers, religious
media activities.
and cultural leaders, to influence TB
advocacy behaviour within social • Develop an M&E program to also
structure channels. evaluate the outdoor strategy and make
recommendations for possible future
• Develop synergistic messages for paid
scaling up of activities.
print, radio and TV media to expand

coverage of key messages to opinion
leaders. 8.2.5 Community Materials
• Support NGOs through capacity building Development and Delivery
and training to develop greater interest A critical feature of any TB prevention efforts
and involvement in print journalism for is the need to build knowledge and change
TB and other health stories focusing on attitudes and perceptions of vulnerable
vulnerable populations. groups who are often fatalistic, and lacking in
confidence and skills to make effective health
8.2.4 Outdoor Media decisions. Community-based ACSM materials
Outdoor media can provide ACSM campaign in the form of publications, other print based
37
materials and merchandise can assist key network. TB stakeholders could be provided
influencers in supporting behaviour change with resource order forms to monitor resource
within these groups and mobilizing the call dissemination and minimize stockpiling.
to action. However, community materials are
often cited by stakeholders as being in short
ACSM activities to support Community
Materials Production and Distribution
supply. This includes publications to increase
knowledge on key modes of TB transmission • Technical committee to rationalise
and prevention, and the need for early health the existing range of stakeholder IEC
seeking behaviour, treatment adherence and resources into a core standardised set of
referral options. Other community materials quality assured publication materials.
will need to be produced in more user friendly • Design, pre-test, develop and distribute
formats to support health service providers to the core range of ACSM materials and
be more aware of the range of issues related merchandise to support community
to TB prevention, treatment services, and based dialogue on TB.
referral options. • Seek support from private sector
distributors to disseminate materials to
Although there may be a poor reading culture,
reduce costs and improve delivery times,
especially with lower literacy groups in rural
or integrate IEC materials distribution
areas, more visually based messaging such as
with medical resource supply to service
flip charts should be scaled-up. Publications
providers.
should be seen as predominantly supporting
advocates and other influential groups in their • Monitor the system to identify current
understanding and dissemination of important and future materials demand in all
health messages to their constituents through Governorates.
IPC approaches.
8.2.6 Quality Assurance
A key feature of any ACSM materials
Quality Assurance (QA) is a process of
development program is the timely and
establishing policies and guidelines to ensure
efficient delivery of materials, when and
that programs and products developed are
where they are needed. Therefore an ACSM
of the highest standard. This ACSM strategy
Communication Resource Information
feature can utilize QA mechanisms for
System (CRIS) utilising logistics similar to that
processes such as the International Standards
employed for TB medical supply distribution
Organization (ISO) standards for World’s
should be considered to minimize the current
best practice, WHO standards for ACSM
ad-hoc production and dissemination of
quality assurance, or develop continuous
these resources. A materials distribution
improvement mechanisms within the strategy
database could be developed incorporating
to ensure that ACSM programs, products
public sector distribution in non-traditional
and services are effectively delivered and
outlets, through pharmacies, schools,

continuously improved. QA processes could
hospitals, health facilities, community centers
include ACSM message and materials pre-
and administrative offices in urban and rural
testing, prior to materials production and
networks.
distribution, or quality-assured service delivery
The current medical logistic program could for the range of TB prevention programs and
also provide valuable distribution support activities currently being considered or scaled-
through existing networks at National up.
and Governorate levels. A demand driven
Effective monitoring and evaluation to assure
approach should be encouraged following
program quality is an essential component of
establishment of the IEC materials distribution
any ACSM strategy, which is often overlooked
38
in the desire to move to new and more
stimulating ACSM initiatives. As such it has
not been given enough emphasis to date to
ensure that a quality approach to program

development is adhered to, and a culture of
continuous improvement instilled.
ACSM activities to support Quality

Assurance
• Increase ACSM program efforts towards
more ‘customer focused’ approaches by
health service providers and incorporate
QA in all ACSM training activities.
• Incorporate customer satisfaction
surveys within formative, qualitative and
quantitative surveys and report findings
to program partners.
• Provide patient charter posters in all NTP
and Medical College facilities in line with
National Strategic Plan.
• Incorporate QA policy guidelines into
all program activities and materials
development to ensure ACSM strategy
best practice.
39
9. MONITORING AND EVALUATION
A monitoring and evaluation (M&E) program of ACSM program success and identify
of operational research for the National the changes in the primary behavioural
strategy already exists. However, a method determinants including the following:
to accurately measure the impact of specific Awareness, Knowledge, Attitudes and
ACSM interventions has been identified Perceptions, Behavioural Intentions and
as a gap in current ACSM planning and Behaviours.
development which needs to be addressed
through the technical support of program 9.1 Performance Indicators
research partners. Although the NTP currently has a rigorous
set of performance targets to measure
In line with the national TB strategy a
case detection, referrals, and treatment
technical steering committee comprised
outcomes, it is now timely to integrate
of the NTP research specialists including
these program indicators with ACSM
epidemiologists, demographers, statisticians,
behavioural determinants to provide a more
sociologists, and anthropologists could be
comprehensive picture for long-term program
considered for applying for research for
success. A range of Key Performance Indicators
ACSM. Research objectives could explore
(KPIs) should also be included as part of the
the development of an M&E program to
ACSM strategy M&E Framework including the
increase the levels of client entry, and assess
following process indicators:
involvement and satisfaction with health
service delivery.
9.1.1 Input Indicators
More importantly, the good work already
done on the national KAP survey should • Establishment of National and
Governorate ACSM Committees.
continue with the institutionalizing of annual
national level surveys with the next phase • Establishment of strategic private - public
partnerships for TB ACSM.
of the Strategy so the impact of the ACSM
component of the program can be assessed. • Development of Strategic Plans,
ACSM, Market Research and Creative
MONITORING AND EVALUATION
As well as national quantitative surveys, it is Communication Briefs.

anticipated that a number of other operational • National ACSM infrastructure established
monitoring mechanisms will be required for - Staff, equipment and other supplies.
ACSM including the following:
• Qualitative research – for formative 9.1.2 Output Indicators
elicitation surveys, and message pre-
testing. This type of research could take • Number of organisations and individuals
trained in TB ACSM.
the form of focus group discussions (FGDs)
with like minded groups, or one to one, • Number of community activities, events
in-depth interviews (IDIs) with program and promotions conducted and the
beneficiaries and key informants. coverage of these activities.
• Quantitative research – to provide • Number of publications resources
more rigorous and scientific indicators produced and distributed.
41
• Number of supporting community • Increase case detection rate.
resources – signage, audio-visuals,
merchandise and other community It should be noted that the M&E Framework is
resources produced and disseminated. a continuous process which operates at every
stage of the Strategic ACSM Planning Cycle.
• Number of main media resources – radio,
However, post-intervention survey data
television, news print and outdoor
media - public service announcements should be collected following completion of
produced and disseminated. each campaign phase to provide campaign
intelligence and set strategic direction for
• Number of media advocacy events and
future ACSM phases, themes and approaches.
articles generated on Radio, TV and in
newspapers. Specific performance indicators and measures
for the surveys could include the following:
Additionally, more important impact and
outcome indicators should also be examined
• Campaign Prompted and unprompted
recall - of community based and IPC
which differ from clinical outcome and approaches, Community dialogue - social
impact indicators for treatment outcomes. networks, community advocates, peers,
Impact indicators for ACSM could include the etc. Community Events – community
following: theatre, music and dance, workshops.
Community media- outdoor signage
9.1.3 Impact Indicators – billboards, wall branding, transport
signage publications materials and
• Awareness - Increase in general awareness merchandise - Performance measure -
of TB and TB as a priority health issue. Campaign impact evaluation.
• Knowledge - Increase in knowledge of
• Message Assimilation - reach and
TB symptoms, TB diagnosis, referral, frequency of activities and main media
treatment, case detection and cure. materials, to desired target groups -
• Attitudes – toward TB Stigma, attitudes Performance measure – community
toward NTP and DOTS health services, feedback and media confirmation
attitudes toward treatment adherence. schedule.
• Perceptions - Increase in personal risk • Message Salience - Target group
perceptions toward TB. Perceptions understanding, acceptance and
of free quality treatment, Increase in ownership of campaign messages,
response and self-efficacy perceptions - Performance measure - Campaign
– the TB messages make sense and I feel impact evaluation.
confident to be able to act on them.
• KAP - recall of campaign call to action and
• Behaviour - Increase in behavioural key messages. Changes in knowledge,
intentions toward early case detection, attitudes, risk and self-efficacy
early screening, patient referral, treatment perceptions, behavioural intentions,
adherence, utilization of public sector and behaviours - Performance measure

services and advocacy in favour of all of -Campaign impact evaluation.
the above.
• Social Acceptability - Stakeholder and
community acceptability of campaigns
9.1.4 Outcome Indicators - Performance measure - stakeholder
feedback via consultation process and
• Increase in TB ACSM organizational
participatory research.
capacity and sustained programming.
• Decrease in TB stigma and risk
9.2 Action Research:
behaviours.
• Decrease in TB morbidity and mortality. Every activity or event should be evaluated in
order to re-plan for the next steps basing on
• Decrease in health care costs.
the experience of success/failure. A tool called
42
After Action Review "AAR" will be used for this for improvements to future activities.
purpose.
Because AAR participants actively discover
An After-Action Review (AAR) is a professional what happened and why, they can learn and
discussion of an event, that focuses on remember more than they would from a

performance standards and enables critique or more formal evaluation. A critique
development professionals and colleagues only gives one viewpoint and frequently
with similar or shared interests to discover provides little opportunity for discussion of
for themselves what happened, why it events by participants. Other observations
happened, and how to sustain strengths and and comments may not be encouraged. The
improve on weaknesses. The AAR tool affords climate of a critique, focusing on what is wrong,
leaders, staff, and partners an opportunity to often prevents candid discussion and stifles
gain maximum benefit from every program, opportunities for learning and team building..
activity, or task.
TYPES OF AARs
It provides: All AARs follow the same general format, involve
• Candid insights into specific strengths and the exchange of ideas and observations, and
focus on improving training proficiency. AAR
weaknesses from various perspectives
• Feedback and insight critical to improved organizers can decide whether the review will
be formal or informal. See
performance
• Details often lacking in evaluation reports Formal AARs require more resources and
alone. involve more detailed planning, coordination,
• Good basis for a document for detailed logistical support, supplies, and time for
description of the year activities through facilitation and report preparation. A facilitator
compiling the AARs at the end of each guides the review discussion, and notes are
year recorded on flip charts with the help of a
The AAR is the basis for learning from our dedicated scribe. The meeting should follow
successes and failures. A good manager an agenda, using the four guiding questions to
or leader does not learn in a vacuum: the set up the “meat” of the discussion. Following
people involved in an activity—those closest the AAR session itself, a formal report is
to it—are the ones best poised to identify presented. Recommendations and actionable
the learning it offers. No one, regardless of items are later brought to the attention of
how skilled or experienced they are, will see Agency management.
as much as those who actually carry out the Informal AARs are usually conducted on-site
events, program, or activity. The AAR is the immediately following an event, activity, or
keystone of the process of learning from program. They require a different level of
successes and failures.
preparation, planning, time to be carried

Feedback compares the actual output of out, facilitation, and reporting. Frequently,
a process with the intended outcome. By an informal AAR is carried out by those
focusing on the desired outcome and by responsible for the activity, and if necessary,
describing specific observations, teams the discussion leader or facilitator can either
can identify strengths and weaknesses and be identified beforehand or chosen by the
together decide how to improve performance. team itself. As with a formal AAR, the standard
This shared learning improves team proficiency format and questions guide the discussion.
and promotes bonding, collegiality, and group Team or project leaders may use informal AARs
cohesion. as on-the-spot coaching tools while reviewing
Though not a cure-all for all issues or overall group or individual performance. For
problems, the AAR provides a starting point example, the team could quickly
43
• Evaluate performance against a desired
standard or established performance
objective
• Identify strengths and weaknesses
• Decide how to improve performance
In addition, informal AARs provide instant

feedback: ideas and solutions can be
immediately put to use, and the team can learn
from them for future or similar application.
Providing direct feedback, just in time, is a key
strength of the informal AAR.
The date and time of the AAR should be

identified as part of the planning schedule
for the event. It is imperative that the AAR be
considered as an integral part of the entire
planning process. The AAR process has four
steps:
• Step 1. Planning the AAR
• Step 2. Preparing for the AAR
• Step 3. Conducting the AAR
• Step 4. Following up (using the AAR
results)
Refer to USAID technical guidance for

more details about AAR process
At the following website
http://pdf.usaid.gov/pdf_docs/PNADF360.pdf
44
10. ACSM STRATEGY PRIORITIES
The success of the ACSM strategy over the transportation of sputum (provision of
term of the project; 20092014- will depend cups at sub-Centre level)
largely on the establishment of an effective • Conduct advocacy through local leaders
system to manage the many technical and and community groups to make a
coordination aspects of the strategy rollout. community commitment to TB referral.
If effective management and coordinating
mechanisms are not in place, a number of
• Include targets presentation on meeting
agendas for risk areas.
competing forces may surface to undermine
the strategy and the potential effectiveness of
• Develop possible promotional posters
and other incentives for front-line
interventions. Broad representation and best fieldworker such as prizes for the
practice in ACSM program management will collection of sputum to meet targets.
ensure the optimum delivery of the strategy.
Priority 2 - ACSM Program Management
The establishment of a participatory system
10.1 ACSM Year One Priorities - of ACSM program management is critical to
20092010- the long-term success of the program. Once
Key Focal Areas to be addressed: an effective management structure is in place
• Engaging new partners and functions effectively at a State level, the
• Strategic Approaches structure can be replicated at District and
• Targeted Interventions eventually, sub-District level. This will require
• Intensified Training and Supervision organizational development to integrate the
range of ACSM and IEC personnel currently
• Incentives for Performance
operating within RNTCP, Health and Social
Priority 1 - Adopt Targeted interventions Welfare Departments.
– 8020/ rule – 80% of ACSM efforts diverted
Recommendations
to 20% of the worst performing Governorates
and other risk areas. • Establish an ACSM Technical sub-
Committee with representation from
Recommendations staff with core competencies in Capacity
ACSM STRATEGY PRIORITIES
• Recruit new NGOs and other program Building and Institutional Strengthening,
Community Advocacy and Events, Mass
partners to expand reach of ACSM efforts.
Media Production and Distribution and
• Using IPC approaches and a range of
Monitoring and Evaluation.
incentives focus on population and OPD
based targets. • Conduct quarterly meetings or as required
in line with the 4 stage strategic ACSM
• Utilize authoritative reinforcement of
planning cycle and to establish a cohesive
NTP policy at state level.
and integrated management structure to
• Consider the possibility of incentive based coordinate program activities.
returns for front-line workers for sputum
collection and successful case detection. • Notify Governorate ACSM or other
relevant staff for their attendance to the
• Support fieldwork staff in collection and National ACSM planning workshop.
45
• Complete and endorse the ACSM segmentation, behavioural objectives,
Strategy 20092014- by October 2009 development of interventions, selection
and conduct the first integrated ACSM of channels for delivery and performance
planning workshop by November 2008. monitoring.
Provide Technical Assistance for the
planning process.
• Conduct ACSM training of trainers (ToT)
to leverage activities.
• Utilize the 4 stage strategic approach for
Priority 4 - IEC Materials Production and
future ACSM campaign planning in the
lead-up to World TB Day 2009. Logistics
The complete range of TB IEC resources is in
Priority 3 - Training and Supervision need of rationalization and the development
A potential shortcoming of the NTP currently of a core range of TB IEC materials is warranted.
is the poor capacity and for effective patient The international Patient Charter may assist
education through IPC approaches as a result in clarifying patient/provider responsibilities
of health worker competing priorities and to assist in creating a customer focus culture.
little sustained commitment to refresher An adequate supply of IEC materials is also
training. More concentrated training needs desperately required to support front-line field
to be conducted with a greater component of workers in education through IPC approaches
ACSM being included within clinical training and boost the profile of the NTP around the
programs at all levels. The supervisory role also country.
needs to be stepped up immediately in those
Governorates where performance targets have Recommendations
not been met. Training to build capacity with • Rationalise a core set of IEC materials for
ACSM and HEO staff must also be conducted TB control.
to expand the reach and effectiveness of the • Produce Patient Charter – Distribute
current program. broadly and include charter principals in
training activities.
Recommendations
• Develop effective NTP Brand and slogan
• Incorporate ACSM component within to support specific campaign themes
training modules for MOs, and other and apply uniformly to all IEC materials
health service providers to instill a and programs.
culture of ‘client focus’ enhanced service
delivery and effective TB inter-personal
• Establish Communication Resource
Information System (CRIS) - for effective
communication. and continuous IEC materials distribution.
• Support field-staff LHWs and HEOs with
Priority 5 - Establish Monitoring, Evaluation
greater ACSM training opportunities
and incentives and provide an enhanced and Research Framework
component of TB ACSM within other M&E has been identified as a gap in the ACSM
health priority training. program evolution which is currently being
ACSM STRATEGY PRIORITIES
• Conduct a media training workshop at addressed and scaled-up.

National level (in the lead-up to World
TB Day campaign) and involve and Recommendations
Governorate media representatives in • Establish technical sub-Committee for
ACSM trainings. Research and liaise with market research
partners to develop formative, evaluative,
• Identify training needs for ACSM staff
impact and outcome research methods
operating within NGOs, NTP, Health and
Social Welfare departments and provide and tools.
training support to ensure coordinated, • Conduct a follow-up KAP survey after
integrated, Governorate and District level the Phase 1 campaign to identify TB
ACSM priorities and planning approaches knowledge, attitudes, practices and beliefs
- problem identification, audience (KAP) and related performance indicators.
46
11. DOCUMENTATION & DISSEMINATION
By documenting and sharing ACSM lessons,

The NTP and partners can review experiences
and provide strategic input for future activities.
12. CONCLUSION
ACSM challenges, activities and lessons
may be similar or different across countries It is hoped that the key elements,
within the different regions. Sharing ideas guiding principles and illustrative
between countries therefore enables “cross activities outlined in this TB ACSM
pollination” of experiences and prevents strategy for Egypt will provide a model
“reinventing the wheel”. Sharing results may from which to build technical and
also prompt partners to reciprocate with organizational
similar experiences, lessons they have learnt, capacity, participation, ownership and
new ideas or potential resources. involvement can be built by all program
Compiling the After –Action Reviews 'AARs" partners. If implemented, faithfully, it is
will give us a detailed document about anticipated that this larger scale, more
the ACSM activities throughout the whole integrated, multi-level program roll-
year. This Document will be printed out and out will be able to achieve measurable
disseminated to our stakeholders. behavioral impact and sustainable
social change needed to eradicate TB
Dissemination of our experiences will be in Egypt in years to come.
through the following methods:
• World Wide Web’s programme web sites,
• Written reports, articles and other
ACSM updates can be shared through
community newsletters, newspaper or
journal articles and presentations at
community or national level meetings. DOCUMENTATION & DISSEMINATION
• Compact Disks (CDs)
• Media Conferences
47

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Egypt National TB Control Program