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Example 1: Advocating for High-Tuberculosis Burden Countries under the ASCM Framework

Adapted from: Deane, J., and Parks, W. Advocacy, Communication and Social Mobilization to Fight TB: a 10-Year Framework for Action / ASCM Subgroup at Country Level. World Health Organization and Stop TB Partnership. Geneva: WHO Press, 2006.

Every person with the airborne infectious disease tuberculosis infects, on average, 10 to 15 people every year (WHO). Currently, one third of the world’s population, or two billion people, are infected with TB-causing microbes (WHO). It is a disease of poverty, greatly affects those living with HIV/AIDS, and has caused several African countries to declare it a regional emergency. Nelson Mandela warned, “We cannot fight AIDS unless we do much more to fight TB” (WHO). TB has killed more women than all other causes of maternal mortality combined (Stop TB, Module 4). The treatment for TB is a long course of antibiotics and many fail to take the complete course giving the microbes a chance to thrive and become resistant to first-line treatments.

Global targets to control tuberculosis were developed by The Global Plan to Stop TB, 2006-2015. To help meet the strategic directions of this plan, the Advocacy, Communication and Social Mobilization to Fight TB (ASCM) was established as a working group of the Stop TB Partnership. The goal of the ASCM Working Group (ASCM WG) is to support The Global Plan to Stop TB by mobilizing “political, social and financial resources; to sustain and expand the global movement to eliminate TB; and to foster the development of more effective ACSM programming at country level in support of TB Control” (ASCM 7). ASCM also supports the Millennium Development Goal of halting and beginning “to reverse the incidence of TB by 2015 and to have reduced TB prevalence rates by 50% compared with the year 1990” (ASCM 12).

The ASCM WG works to address four key challenges: case detection and treatment adherence, combating stigma and discrimination, empowering people affected by TB, and mobilizing political commitment and resources for TB (ASCM 12). The ASCM WG has embraced four key terms in their efforts: communication, advocacy, social mobilization, and capacity building. Advocacy, communication, and social mobilization are seen as integral and valued efforts in TB strategies. Communication involves all channels of information in mass media, community media, and interpersonal interaction.ASCM views that for communication practitioners to be effective, “communication should be understood as a two-way process, with ‘participation’ and ‘dialogue’” (ASCM 15). Communication targeted at health workers, employers, families and communities can help reduce TB-related stigma, which is a major barrier for people to seek diagnosis and treatment.

 Advocacy in the ASCM definition “denotes activities designed to place TB control high on the political and development agenda, foster political will, increase financial and other resources on a sustainable basis, and hold authorities accountable to ensure that pledges are fulfilled” (ASCM 16). Advocacy involves policy advocacy aimed at influencing senior politicians, program advocacy aimed at convincing opinion leaders at the local and community levels, and media advocacy to generate government and donor support. “In the global context, advocacy for TB control is to be understood as a broad set of coordinated interventions”, while in “country contexts, advocacy efforts broadly seek to ensure that national governments remain strongly committed to implementation of national TB control/elimination policies” (ASCM 16). The latter may focus on press conferences, meetings between stakeholders, and letter-writing. ASCM emphasizes capacity building in their advocacy efforts because it helps to make the program efforts sustainable. ASCM has numerous models and tools for doing advocacy work with matching indicators. They include the promotion of TB champions within and outside government, the establishment of national partnerships, TB patient activism, use of media, and World TB day promotional materials. Anticipated outcomes of timely and sustained advocacy efforts include 1) governments make TB a high priority and provide quality services, 2) effective monitoring, 3) an increase in the number of TB-free communities, and 4) governments, communities, and households integrate appropriate health values and practices into their culture (ASCM 50).  Funding of such advocacy efforts was determined through in-country consultations, an analysis of proposals submitted to The Global Fund for AIDS, TB, and Malaria, and “extensive experience in other health issues suggesting that an overall 5-15% of total TB control program efforts should be allocated to country-level ACSM activities” (ACSM 84).

ASCM encourages matching tools and problems because “advocacy sets up the enabling environment, but by itself might not change behavior” and it recognizes that campaigns could have unintended consequences or “build the wrong behavior” (Stop TB, Module 5). Advocacy may not necessarily change behavior but it can raise awareness, influence policy, and set the public agenda.  It is recommended to consider specific community opinion leaders who make health decisions because “people make many behavioral choices to comply within their communities and social networks” (Stop TB, Module 5).

Peru and Mexico have seen positive results of ACSM in TB control efforts. In Peru and Mexico, TB was approached as originating in a social, economic and cultural context. In Mexico, appropriate community and local mass media supported communication mechanisms (ACSM 19). Peru used patient-centered mobilization and empowered patients in creating “citizenship awareness of the complexity of TB,” and “brought in the commitment of new actors” (ACSM 20). In both countries, advocacy and community mobilization efforts have been sustained over many years.


"2007 Tuberculosis Facts." World Health Organization and Stop TB Partnership. 13 Nov. 2007 

Deane, J., and Parks, W. Advocacy, Communication and Social Mobilization to Fight TB: a 10-Year Framework for Action / ASCM Subgroup At Country Level. World Health Organization and Stop TB Partnership. Geneva: WHO Press, 2006.

"Introduction to Advocacy Communication and Social Mobilization Workshop." Module 4 and 5. Stop TB Partnership. Sept. 2005. 15 Nov. 2007