Malnutrition and precarious living conditions are social determinants that are risk factors for tuberculosis (TB). While the National TB Control Programme (NTP) of Benin is a well-functioning control programme, TB incidence isn’t decreasing.
“How can we control TB, when patients who have finished their treatment return to the same environment where they are exposed to the same risk factors that contributed to the development of their TB episode in the first place?” says Professor Dissou Affolabi, head of Benin's National TB Control Programme. “It is time to handle the problem differently".
The NTP of Benin, in collaboration with TDR, is thus leading a research project to explore strategies where the social and environmental circumstances of the patient – not just medical treatment – are prioritized. This research project, dubbed ETAP (Empower TB Patients Against Poverty), is in line with one of the pillars of WHO’s End TB Strategy that promotes a patient-centred care approach.
The project consists of two phases: phase 1, conducted in 2018–2019, aimed at measuring patients’ poverty level as well as understanding the multiple dimensions of deprivation including stigma and social exclusion. In phase 2, the assessment made in phase 1 will help define what strategies (including social innovations) can be implemented and rigorously evaluated to address the social, human and financial vulnerability of TB patients while ensuring their physical recovery from the disease.
At the end of phase 1, a two-day workshop was convened by the NTP of Benin in collaboration with TDR and SIHI, the Social Innovation in Health Initiative, which involved former TB patients, representatives from various ministries (Health, Agriculture, Sports, Social Affairs and microfinances), NGOs, researchers, local social innovators and entrepreneurs. This workshop was facilitated by the NGO MAD (Make A Difference), to help participants tap into their creativity to identify innovative ways of social recovery through multisectoral engagement.
Priorities identified during the workshop:
- Addressing the social stigma and lack of self-reliance
- Achieving food/nutritional security
- Creating or linking to jobs that will empower people while improving healthcare and restoring social networks in innovative ways
- Piloting activities that can ensure self-sustainability of the patients and their households
- Continuing to apply research in NTP activities to maintain their credibility and relevance.
Key insight: People own what they create
People need to solve their own problems and propose solutions, supported by know-how from local and external sources when appropriate. We therefore need to create an environment to encourage, develop and catalyse the self-mobilizing and entrepreneurial capacity of TB patients based on self-determination. The NTP of Benin is committed to nurturing such an environment, in line with the patient-centred care approach promoted by the End TB Strategy.
Next steps
- A working group (WG) will be created with selected key workshop participants representing diverse sectors, who will co-create a model based on outcomes from the workshop that respond to the vision, ambitions, objectives and priorities identified.
- The outputs from the workshop may well result in the NTP becoming the first social innovation lab in Benin and an example for other countries in West Africa to adapt the approach to their local contexts. Research will be integrated to inform the development, acceptance, impact and testing of key social innovation initiatives, which would then be adapted and scaled for other locations throughout the country and region.
For more information, contact Dr Beatrice Halpaap and Dr Corinne Merle.