Panos Institute, London

This 24-page report outlines why communication should be placed centrally on the tuberculosis (TB) agenda, and offers a number of strategies for doing so. It is intended for policy-makers, programmers, and health communicators seeking to understand contemporary communication opportunities and challenges associated with addressing this disease.

The authors begin by providing some data to indicate where we are, globally, with regard to meeting TB targets. To meet these targets, they suggest, advocacy, social mobilisation, and programme communication are crucial in terms of ensuring greater public engagement, political commitment, and real improvements in case detection and cure. Among the TB-related communication challenges they outline:

• Increasing case detection through public engagement, moving beyond mere
  awareness-raising
• Closing the time gap between the onset of TB symptoms and the seeking of treatment
• Involving national and international partners and linking with broader health and development campaigns and movements
• Supporting the involvement of activists and TB patients in defining strategies for controlling TB and reducing stigma associated with the disease
• Supporting civil society in monitoring government responses to TB
• Embracing large numbers of private healthcare providers within a comprehensive TB response
• Addressing the issue of TB/HIV co-infection, and capitalising on successful
  HIV/AIDS communication interventions
• Engaging in mobilisation and advocacy for the strengthening of health systems/health infrastructures

Various communication strategies have been developed around the world to meet these challenges - e.g., some focus on the politics of communication, whereas others aim to raise awareness on relatively simple issues. "Each has its own value", the authors note, and so present "a bewildering choice to busy TB programme managers at the country level." To this end, they call for an effort to collate and simplify TB communication tools, such as through the creation of an accessible and practical toolkit which offers comprehensive, practical communications guidance to national TB responses.

Also explored here is the need to increase communications capacity; existing communications staff could benefit from training, the authors urge, and more staff could be recruited to offer communications advice to national TB responses. Perhaps such training efforts could focus on what is described here as "the very first step in strengthening political and social commitment to fighting TB": building a critical mass of people who understand TB as a critical issue of relevance to the general population. In this regard, TB communication must go beyond the usual flurry of media and communication activities around World TB Day, the authors argue.

Specific suggestions offered here include engaging the media and celebrities in efforts to draw out the relationships between this public health issue and other elements of social and economic life - building awareness while also promoting active engagement and local ownership of the TB issue and solutions. Community members such as teenage peer educators can get involved in using music and DJ-ing to get their health message across to young people. As illustrated by this example, it might be fruitful to explore a range of approaches for more creative use of the media, and of various information and communication technologies (ICTs). The key strategies of building TB patient-activist groups and establishing linkages with people living with HIV/AIDS (PLWHA) networks are also discussed here.

To further examine such models for involvement in national TB responses - that is, those which include affected communities and local and international non-governmental organisations (NGOs) - fora could be organised to enable meaningful stakeholder engagement. Along these lines, partnership is advanced as a notable strategy in developing a communication-centred response to TB. For instance, "The Stop TB Partnership needs to urgently review its national partnerships
development process and ensure that NGOs and civil society groups, especially
those specialising in grassroots-level advocacy and activism, can be mobilised
around the TB issue....Beyond those partnerships with civil society and other organisations, a significant new challenge relates to embracing the private health sector." The key here is crafting methods for exchanging information and connecting that "are attractive
to users, tailored to different contexts, and complementary to other national
information and data collection efforts. These must be rigorously tested."

The authors also call for increased efforts to monitor the effectiveness of TB communication. Certainly, setting specific and measurable goals for achieving a critical level of TB awareness is important, but the authors call for a broadening of the range of monitoring and evaluation (M&E) methods to include measuring the impact of advocacy, social mobilisation and communication interventions.

Click here to access a related peer-reviewed summary on the Health e Communication website, and to participate in peer review.