Forging Partnerships 

to Eliminate 

Tuberculosis: 

A Guide and Toolkit
 

2007
 

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention 

Division for Tuberculosis Elimination 
 

 Forging Partnerships 

to Eliminate 

Tuberculosis: 	 	 	 A	Guide	and	Toolkit 

	 	 	 2007 

Centers	for	Disease	Control	and	Prevention	
 

National	Center	for	HIV/AIDS,	Viral	Hepatitis,	STD,	and	TB	Prevention
 

Division	of	Tuberculosis	Elimination
 
Ordering Information 

Copies	of	the	Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit,	are	available	 

from	the	Division	of	Tuberculosis	Elimination’s	online	ordering	system	at	www.cdc.gov/tb.	 

The	publication	number	is	00-6552. 

	 

This document is also accessible via the Internet at www.cdc.gov/tb. 
Acknowledgements
 

Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit	was	prepared	by	the	 

Division	of	Tuberculosis	Elimination,	Communications,	Education,	and	Behavioral	 

Studies	Branch	of	the	Centers	for	Disease	Control	and	Prevention	(CDC).	Scott	McCoy,	 

Maria	Fraire,	and	Wanda	Walton	in	the	CDC’s	Division	of	Tuberculosis	Elimination	 

directed	the	project,	providing	invaluable	leadership	and	contributions.	Special	thanks	to	 

Constella	Health	Sciences,	Inc.	for	overseeing	the	project	and	to	project	manager	Patricia	 

A.	President	and	primary	consultant	Janine	Pryor.	 

We	gratefully	acknowledge	the	following	people	who	provided	invaluable	guidance	in	 

shaping	this	publication:	 

Sandra	Barnett 

Garfield	County	Public	Health	 

Glenwood	Springs,	Colorado 

Rajita	Bhavaraju	 

New	Jersey	Medical	School	 

National	Tuberculosis	Center	 

Rachel	Blair 

Hawaii	State	Department	of	Health 

Paul	T.	Britton 

Indiana	Department	of	Health 

Jeffrey	B.	Caballero 

Association	of	Asian	Pacific		 

Community	Health	Organizations	 

Cynthia	Glocker	Crick 

National	Center	for	HIV,	STD,	 

	 and	TB	Prevention 

CDC 

Francesca	Gany 

Center	for	Immigrant	Health 

NYU	School	of	Medicine 

Vipra	Ghimire	 

Virginia	Department	of	Health 

Lisa	George 

Metropolitan	Health	Department	 

Nashville,	TN	 

Fernando	Gonzalez 

Texas	Department	of	Health 

Mary	Anette	Grayer 

Detroit	Health	Department	 

Detroit,	Michigan 

Genevieve	Greeley 

New	Mexico	Department	of	Health 

Kathleen	Hursen	 

Massachusetts	Department	of	Public	Health 

Melissa	Hopkins 

Consultant,	Commonwealth	of	Kentucky	 

Olga	Joglar		 

Puerto	Rico	Department	of	Health	 

Harriet	Kay 

DeKalb	County	Board	of	Health 

Decatur,	Georgia 

Laurel	Little 

Garfield	County	Public	Health	 

Rifle,	Colorado 

iii 
John	Lozier	 

National	Health	Care	 

	 for	the	Homeless	Council 

Allan	Lynch 

Iowa	Department	of	Public	Health 

Vernon	A.	Maas 

Health	Resources	and		 

	 Services	Administration 

Ellen	J.	Mangione 

Colorado	Department	of	Public	Health		 

	 and	Environment 

Jose	Montero 

New	Hampshire	Department	of	Health		 

	 and	Human	Services 

Roger	Murray 

Nebraska	Department	of	Health		 

	 and	Human	Services 

Mindee	Reece 

Kansas	Department	of	Health		 

	 and	Environment 

Kristen	Rounds 

South	Dakota	 

Department	of	Health 

Dan	Ruggiero 

Division	of	Tuberculosis	Elimination 

CDC 

Alok	Sarwal 

Colorado	Asian	Tuberculosis		 

	 Elimination	Project 

Barbara	Schultz 

Colorado	Department	of	Public	Health		 

	 and	Environment 

Eric	A.	F.	Simoes 

Children’s	Hospital	and	University	 

	 of	Colorado	Health	Sciences	Center	 

Gary	Simpson 

New	Mexico	Department	of	Health 

Van	Simsiman 

Filipino-American	Community	 

	 of	Colorado	 

Sacsy	Sukcharoun 

American	Lung	Association	of	 

	 San	Diego	and	Imperial	County	 

Savitri	J.	Tsering 

Wisconsin	Department	of	Health		 

	 and	Family	Services 

P.K.Vedanthan	 

University	of	Colorado	Health		 

	 Sciences	Center 

Charles	Wallace 

Texas	Department	of	Health 

Maureen	Wilce	 

Division	of	Tuberculosis	Elimination	CDC 

Barbara	Weber	 

Community	Health	Services	 

Bloomington,	Indiana	 

Gloria	Williams 

Filipino-American	Community	 

		 of	Colorado	 

iv 
DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service 

	 Centers for Disease Control 

and Prevention 

Atlanta, GA 30333 

Dear	Colleague: 

Tuberculosis	(TB)	is	one	of	the	leading	causes	of	death	from	infectious	disease	 

worldwide.	An	estimated	2	billion	persons	—	one	third	of	the	world’s	population	—	are	 

infected	with	the	bacteria	that	cause	TB.	Each	year,	approximately	9	million	persons	 

become	ill	from	TB;	of	these,	almost	2	million	die. 

Yet,	many	people	in	the	United	States	think	that	TB	is	a	disease	of	the	past	—an	illness	 

that	no	longer	threatens	us	today.	One	reason	for	this	belief	is	that,	in	the	United	States,	 

we	are	at	an	all-time	low	in	the	number	of	new	persons	diagnosed	with	active	TB	disease.	 

However,	the	rate	of	decline	has	slowed	in	the	past	two	years,	and	inequities	persist	 

in	racial,	ethnic,	and	foreign-born	groups.	Will	this	success	make	us	vulnerable	to	the	 

neglect	that	has	historically	come	with	declining	numbers	of	persons	suffering	with	TB,	 

or	will	it	provide	us	with	the	opportunity	to	accomplish	our	goal,	the	elimination	of	TB	 

in	this	country?	 

Now	is	the	time	to	take	decisive	actions,	beyond	our	current	efforts,	that	will	ensure	that	 

we	reach	this	attainable	goal.	Building	and	strengthening	partnerships	is	one	of	those	 

decisive	actions.	This	country’s	unprecedented	progress	in	controlling	TB	in	recent	years	 

will	not	be	sustainable	without	strengthened	collaborations	with	local,	state,	national,	 

and	international	partners	from	all	sectors	of	our	society.	This	kind	of	partnership	action	 

must	be	taken	in	order	to	reach	those	at	highest	risk	for	TB,	and	to	identify	innovative	 

strategies	to	collaborate	with	them	to	improve	testing	and	treatment	among	high-risk	 

populations. 

There	is	a	great	deal	of	work	that	remains	to	be	done: 

•	 Despite	the	decreased	case	rate	among	foreign-born	persons,	more	than	half	of	the	 

TB	cases	in	the	United	States	in	2005	occurred	in	this	population,	and	the	case	rate	 

was	almost	nine	times	greater	in	this	population	than	among	U.S.-born	persons.	 

•	 For	substance	abusers,	the	homeless,	and	others	at	risk	who	are	often	hard	to	reach,	 

community-based	organizations,	neighborhood	health	centers,	and	private	providers	 

need	to	be	enlisted	to	help	identify	undetected	TB	cases	and	latent	TB	infection	as	 

well	as	encourage	treatment.	 

•	 TB	rates	among	people	born	in	the	United	States	differ	remarkably	by	race.	In	2005,	 

rates	among	non-Hispanic	blacks	remained	more	than	eight	times	higher	than	rates	 

v 
among	non-Hispanic	whites.	Non-Hispanic	blacks	and	foreign-born	individuals	 

accounted	for	three-fourths	of	TB	cases	in	2005.	Narrowing	this	gap	in	TB	rates	is	a	 

critical	factor	in	achieving	TB	elimination.	 

•	 Low-incidence	areas	in	the	United	States	need	continued	support	to	ensure	that	they	 

maintain	the	capacity	and	expertise	to	respond	to	TB	outbreaks	when	they	occur. 

The	Centers	for	Disease	Control	and	Prevention	(CDC)	and	the	Advisory	Council	for	 

the	Elimination	of	Tuberculosis	(ACET),	an	external	advisory	group	to	the	Secretary	 

of	Health	and	Human	Services	and	the	Director	of	the	CDC,	have	long	recognized	the	 

moral	obligation	as	well	as	the	public	health	benefit	of	eliminating	TB	in	this	country.	 

Supported	by	the	conclusions	in	the	Institute	of	Medicine	(IOM)	report	Ending Neglect: 

The Elimination of Tuberculosis in the United States,	ACET	and	CDC	believe	eliminating	 

TB	in	the	United	States	is	a	realistic	goal	and	have	a	plan	by	which	to	do	so.	Both	groups	 

are	committed	to	this	goal	and	recognize	that	success	will	require	collaborating	with	 

others.	 

We	hope	this	document,	Forging Partnerships to Eliminate Tuberculosis: A Guide and 

Toolkit,	will	foster	the	kinds	of	collaborations	needed	to	make	TB	elimination	a	reality. 

	 Sincerely, 

	
 

	 	 	 	 Kenneth	G.	Castro,	M.D. 

	 Assistant	Surgeon	General 

	 Director 

	 Division	of	Tuberculosis	Elimination 

	 National	Center	for	HIV/AIDS,	Viral	Hepatitis,	STD,		 

	 	 and	TB	Prevention 

vi 
Table of Contents
 

1. About the Guide and Toolkit.................................................................................1
 

What’s	Inside	the	Guide	..................................................................................... 1
 

Making	the	Guide	and	Toolkit	Work	for	You	..................................................... 2
 

2. What Your Colleagues Say about TB Partnerships.................................................5
 

TB	Partnership	Benefits	..................................................................................... 5
 

Things	to	Keep	in	Mind	..................................................................................... 6
 

Relationship	Building:	Lessons	Learned	............................................................. 6
 

3. What Successful Health-Related Community Partnerships 


Have in Common..................................................................................................9
 

Use	a	Mutual	Selection	Process	when	Recruiting	Partners	.................................. 9
 

Encourage	Size	and	Value	Diversity	.................................................................. 10
 

Recruit	Partners	Who	Are	Leaders	within	Stakeholder	Populations	.................. 10
 

Understand	and	Address	Motivational	Issues	of	Potential	Partners	................... 11
 

Establish	Ground	Rules	(Codes	of	Conduct)	.................................................... 12
 

Embrace	a	Common	Vision	............................................................................. 12
 

Develop	Commitment	through	Leadership	...................................................... 13
 

Committed Core Leadership	........................................................................... 13
 

Organizational Driver .................................................................................. 14
 

Leadership Delegation ................................................................................... 14
 

Create	Decisionmaking	Protocols	..................................................................... 14
 

Social Control	............................................................................................... 15
 

Project Selection ............................................................................................ 15
 

Credible Commitment	................................................................................... 15
 

Building Ownership	...................................................................................... 16
 

Anticipate	and	Manage	Conflict	....................................................................... 16
 

Conclusion	....................................................................................................... 17
 

4. How Well Do You Know Your Environment? ......................................................19
 

Demographic	Information	on	Your	Program	Area	............................................ 19
 

Epidemiological	Profile	of	Your	Program	Area	.................................................. 19
 

Information	on	Your	Program	Area’s	At-Risk	Populations................................. 22
 

Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit vii 
General Background Information....................................................................22
 

Information Specific to Your Program Area ......................................................23
 

Understanding	Primary	Care	Providers	in	Your	Program	Area	...........................25
 

Comparing	Your	Data	to	Your	Area’s	TB	Program	.............................................26
 

Identifying	and	Understanding	Additional	Stakeholders	....................................27
 

Related	Resources	..............................................................................................28
 

Cultural and Linguistic Competence Tools and Resources ..................................28
 

TB Program Assessment and Training Resources ...............................................29
 

Additional Publications..................................................................................30
 

5. Determining Your Purpose and Choosing Partners.............................................. 31
 

Your	Partnership’s	Overall	Purpose	....................................................................31
 

Types	of	Partnerships	You	Will	Use	...................................................................31
 

Level	of	Support	for	Partnering	within	Your	Agency	..........................................34
 

Tips and Strategies .........................................................................................34
 

Things to Keep in Mind	
..................................................................................34
 

Resources	You	Can	Dedicate	to	Your	Partnering	Efforts	....................................34
 

Tips and Strategies .........................................................................................34
 

Characteristics	of	Effective	Partners	...................................................................35
 

What Is a Good Partner? ................................................................................35
 

Things to Keep in Mind	
..................................................................................36
 

Recruitment	of	Effective	Partners	......................................................................36
 

Things to Keep in Mind	
..................................................................................37
 

Related	Resources	..............................................................................................38
 

6. Creating a Sense of Ownership............................................................................ 41
 

Step	1:	Create	Your	Partnership’s	Culture	..........................................................41
 

Research Suggests ............................................................................................41
 

Tips and Strategies .........................................................................................42
 

Step	2:	Consistently	Share	Information	.............................................................42
 

Research Suggests ............................................................................................42
 

Tips and Strategies .........................................................................................43
 

Things to Keep in Mind	
..................................................................................43
 

viii Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit 
Step	3:	Create	a	Common	Vision	......................................................................46
 

Research Suggests ............................................................................................46
 

Tips and Strategies .........................................................................................47
 

The	Vision:	A	Guide	for	Effective	Action	..........................................................48
 

Things to Keep in Mind..................................................................................49
 

Related	Resources	..............................................................................................49
 

7. Making Progress and Making Decisions: Structure and 


Decisionmaking Issues......................................................................................... 51
 

Partnership	Structure:	An	Overview	..................................................................51
 

Research Suggests.................................................................................................51
 

Things to Keep in Mind..................................................................................52
 

Creating	Partnership	Structures	That	Fit	Your	Needs	.........................................52
 

Creating	Decisionmaking	Processes	that	Fit	Your	Needs	....................................53
 

A Step-by-Step Approach for Collaborative Decisionmaking ..............................54
 

Anticipating	and	Managing	Differences	............................................................55
 

Tips and Strategies .........................................................................................57
 

Related	Resources	..............................................................................................59
 

8. Sustaining Longer-Term Partnerships.................................................................. 61
 

Recognize	and	Reward	Partners	.........................................................................61
 

Things to Keep in Mind..................................................................................62
 

Combine	Planning	with	Action	....................................................................62
 

Things to Keep in Mind..................................................................................62
 

Create	a	Learning	Partnership	...........................................................................63
 

Related	Resources	..............................................................................................63
 

9. Sharing the Message: Working with the Media and TB Stakeholders................... 65
 

Common	Formats	for	Accessing	the	Media	.......................................................66
 

Meetings with Editorial Boards.......................................................................66
 

Press Briefings ................................................................................................67
 

Press Conferences ............................................................................................67
 

Media Advisories............................................................................................68
 

Press Releases..................................................................................................68
 

Public Service Announcements (PSA) ..............................................................68
 

Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit ix 
Feature Stories................................................................................................69
 

Op-Ed Pieces .................................................................................................69
 

Letters to the Editor........................................................................................69
 

Public Access TV Stations................................................................................70
 

Media Interviews (Television, Radio, and Print Media)....................................70
 

Checklist	for	Conducting	a	Press	Conference	....................................................70
 

Articulate a Compelling Reason for the Press Conference ...................................70
 

Identify, Recruit, and Prepare Press Conference Speakers ...................................70
 

Assemble the Necessary Materials.....................................................................71
 

Ensure Journalists Attend................................................................................71
 

Follow Up and Follow Through ......................................................................72
 

Social	Marketing	with	TB	Stakeholders	.............................................................72
 

Related	Resources	..............................................................................................73
 

10. Preparing Your Partnership to Communicate During a TB Outbreak................. 75
 

Communication	Planning	for	TB	Outbreaks	....................................................75
 

The	Pre-Event	Phase	.........................................................................................75
 

Conducting a TB Outbreak Communication Needs Assessment .........................76
 

Developing a TB Outbreak Communication Plan............................................77
 

Determine the Resources Needed to Carry Out the Plan ....................................80
 

Preparing the Partnership to Carry Out the Plan..............................................81
 

The	Event	Phase	................................................................................................82
 

The	Post-Event	Phase	........................................................................................82
 

Related	Resources	..............................................................................................84
 

Risk Communication Websites.........................................................................84
 

Risk Communication Training........................................................................84
 

11. Evaluating and Measuring Success....................................................................... 85
 

The	CDC’s	Recommended	Evaluation	Framework	...........................................85
 

What is the CDC Framework for Program Evaluation? ....................................86
 

A	Collaborative	Approach	to	Evaluation............................................................88
 

Things	to	Keep	in	Mind	....................................................................................89
 

Related	Resources	..............................................................................................89
 

x Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit 
12. Selling Your Success to Others: Getting Support ................................................. 91
 

Obtaining	Resources	.........................................................................................91
 

Preparation	........................................................................................................91
 

Finding	Funders	................................................................................................91
 

Government Funds.........................................................................................92
 

Foundations...................................................................................................93
 

Company Sponsored Foundations and Corporate Giving...................................94
 

Things to Keep in Mind..................................................................................95
 

Gaining	Support	for	Public	Policy	Initiatives	.....................................................95
 

Things to Keep in Mind..................................................................................94
 

Related	Resources	..............................................................................................96
 

13. Glossary .............................................................................................................. 97
 

14. Reference List.................................................................................................... 103
 

15. Key CDC Resources.......................................................................................... 105
 

16. Toolkit .............................................................................................................. 109
 

Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit xi