Simms, Alison

Arts & Sciences



Mozambique - Evaluation of a community participatory program for TB case detection and treatment support

The Vurhonga Community-based DOTS Project is a USAID-funded project to the NGO World Relief (HQ in Baltimore) for using volunteer women to visit all households, detect persons with symptoms suggestive of TB, support them in seeking screening at the nearest health facility, and, if they are found to have TB, support them throughout the treatment process. The project makes use of World Relief's pioneering Care Group model in which 10 volunteer women meet as a group with a facilitator every 2-4 weeks and then visit the 10 households for which they are responsible. The goal of the project is to increase case detection and completion of treatment. The project is being carried out in 8 districts in southern Mozambique (Gaza Province), with a combined population of approximately 300,000 people.

Global Health Mentor: Jonathan E. Golub, PhD

            I was privileged to travel to Mozambique for my global field placement with World Relief, a Christian NGO.  I worked on the evaluation of the success of World Relief's community participatory program for TB case detection and treatment support. The work enhanced my STATA skills and abilities to collaborate with colleagues in the United States and Mozambique.  Our participation came at the conclusion of the program, allowing us the gratification of seeing that the program was positive and resulted in notably increased early TB knowledge and treatment.

            The main reason for the program’s success was its volunteer staff.  The volunteers educated the local population about TB and then followed them from infection detection through treatment.  The volunteers cared sincerely for those whom they served as well as their communities. These relationships will enhance the sustainability of the project results because, even after the program concludes, the patients will continue to receive encouragement to visit clinics for treatment. 

             It was the formation of my own relationships while in Chokwe which made my service and education all the more enjoyable.  I am grateful to have had a host, Dr. Pieter, who gladly stayed up late into the evenings to talk with us about Mozambique culture.  Dr. Pieter even explained the many local projects of World Relief and invited us to accompany him long distances to experience those projects.  We were able to see the beautiful community gardens that World Relief helps to oversee. We also saw the water pumps which World Relief had helped communities to install and maintain, supplying clean water to villages.

We also visited the clinics where the patients in the TB program went for treatment.  These visits helped me more thoroughly understand how difficult it is for people living any distance from Chokwe to receive TB treatment.  Often the clinics’ lab technicians are not available to test whether a patient’s TB sputum was positive, resulting in patients being unable to receive treatment.  Patients typically have to walk an hour or more to reach a clinic and, upon arrival, the clinic often sends them home because of insufficient personnel to test them. World Relief has plans to address the clinics’ frequent lack of technicians by establishing regular pickups of sputum samples from clinics for testing at Carmelo, a large hospital in Chokwe, which has a machine that can rapidly get TB results.  This system with allow patients to receive treatment at a quicker rate.

            My service at Chokwe also helped me to further appreciate the complexities of implementing public health programs.  The interaction of culture, government and economy determines whether a public health program will be effective.  My public health education prior to Chokwe helped me to understand that this is true in Baltimore, and I saw it more clearly as an observer outside of my own culture, government and economy.   In the US, for example, women tend to still be relatively more un-empowered than men.  However, in the population I worked with, the culture, government and economy empowered women far less than in the US.  The women around Chokwe are vitally important and must be empowered because they almost exclusively take care of the children along with managing the home and crops -- this makes them the ultimate enablers of public health results.  

I realized that one will never truly understand the complexities of successfully implementing a public health program unless they participate in and understand the interaction of culture, government and the economy and work closely with the people to help empower those whom the program is supposed to benefit. 


Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...

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