Consultancy to develop intervention package for reducing TB stigma in communities with low literacy

KNCV Tuberculosis Foundation

KNCV Tuberculosis Foundation is an international non-profit organization dedicated to the fight against tuberculosis (TB), still the second most deadly infectious disease in the world. KNCV is an international center of expertise for TB control that promotes effective, efficient, innovative and sustainable tuberculosis control strategies in a national and international context.  We are an organization of passionate TB professionals, including doctors, researchers, training experts, nurses and epidemiologists. We aim to stop the spread of the worldwide epidemic of TB and to prevent the further spread of drug-resistant TB. Over the past century we have built up a wealth of knowledge and expertise, initially by successfully controlling TB in the Netherlands. Since the 1970s, we have also shared our knowledge and expertise with the rest of the world. We operate from a central office in The Hague in the Netherlands, a regional office in Central Asia and country offices worldwide. KNCV raises funds from private, institutional, corporate, and government donors.

Purpose of the Assignment

KNCV seeks to contract an individual or organization to produce a multi-level intervention package that is designed to reduce TB stigma in community settings.

Interventions that include a variety of interactive and participatory approaches are sought—  to educate communities with varying levels of literacy on reducing the stigma associated with TB. Successful applications will be those that reflect a socio-ecological theoretical approach –meaning that they include interventions at multiple levels and with multiple target groups influential at the community level (see Figure).

Community level stigma reduction often do require an understanding of underlying community structures and power dynamics. A successful intervention would assist community members in understanding who are the major influencers and power brokers, opinion leaders, positive deviants, and early adopters of new norms and practices within the community. Community-based interventions should not require high levels of literacy or text-based TB knowledge.

Figure: Spaces for Community-level Interventions to Reduce Stigma (Heijnders and Van der Meij):1


Interventions likely to be effective in reducing TB stigma at the community level include:

  1. Interventions for opinion leaders-
    1. Key messages, appropriate non-stigmatizing terminology,
  2. Interventions for youth
    1. Sports, games, theatre
  3. Interventions for journalists and media
    • Training on stigma-free reporting

e.g. fact sheets

    • Bios of prominent people of good reputation who survived TB to show it is curable and that it happens to good people
  1. For the community
    1. Edutainment -Film, music, artwork, sound installations that catalyze feelings of solidarity, empathy, alliance, respect among those without TB.[1]
    2. Structured contact interventions3,4 with TB Ambassadors, TB heroes, (e.g. role models of good character, and demonstrative qualities such as perseverance, resilience, fortitude).

The stigma reduction package may be composed of a complete set of materials, such as:

  1. Videos (testimonials, )
  2. Music, (Songs, sounds, narratives)
  3. Graphic Art (illustrations, comics, photography)
  4. Curricula (facilitator guides, slides, exercises)
  5. Web-based tools (games, self-study, quizzes)

Community Interventions should engage meaningfully with the myths and misconceptions around TB only if these ideas reproduce stigma. We believe that an effective reducing TB stigma at the community level obliges a changing of assumptions about TB. The messages embedded in the intervention package help to convey that TB is (for example):

  • curable with effective therapy5,6
  • No one’s fault—it is a disease of good people exposed to bad air.
  • everyone’s responsibility to prevent and amenable to intervention – air is cleaned by good ventilation[2]


KNCV Tuberculosis Foundation is reaching out to scientists, creative change-makers, community leaders, innovators, and justice-seekers to help create the tools to dismantle TB stigma in people with TB, communities with a high TB burden, institutions where TB stigma thrives, and in structures that support TB stigma.

KNCV seeks to develop a series of new interventions to tackle stigmatizing messages, behaviors, and social structures using a heart+head+hands approach.  We believe that to dismantle TB stigma we need to:

  1. a) CHANGE HEARTS: by growing empathy and solidarity
  2. b) CHANGE MINDS: by shifting cognitive processes and improving knowledge, and
  3. c) ALL HANDS: by engaging all stakeholders in the daily labor of making the world more just and healthy for people with TB.

We seek collaborators who can help us to build impactful intervention packages that can be adapted to different settings.  Our tool box will contain clear evidence-based, multi-level stimuli to shift hearts and minds, policies and practice.

Applicants are strongly encouraged to leverage ideas that have worked in reducing other kinds of stigma. In this case, applicants should be able to adapt those existing interventions to address TB and KNCV will provide support on how best to do that, if appropriate.

Leveraging the science of stigma reduction, we seek social and scientifically informed approaches that can be readily adapted and deployed in countries such as: Afghanistan, Bangladesh, Botswana, Cambodia, Democratic Republic of Congo, Ethiopia, Georgia, India, Indonesia, Kyrgyzstan, Malawi, Mozambique, Myanmar, Namibia, Nigeria, Philippines, Romania, Tajikistan, Tanzania, Ukraine, Uzbekistan, Vietnam, Zambia, or Zimbabwe.

Passive learning (e.g. listening, watching) should be limited in favor of more active forms of behavior and attitude change (e.g. doing, discovering, problem solving). The over-use of power point is discouraged.

The package described in the application must reflect a specific behavioral change theory or theory-driven community mobilization approach. We are looking for an individual or organization that understands how to connect behavioral theory to an overall intervention design which leads to outcomes that are measurable and effective in the reduction of TB stigma.


  1. Applicants should build their package around a clear theoretically -informed, evidence-based framework that specifies which domains of stigma are being addressed and what is the hypothesized mechanism of stigma reduction for each module. The intervention package must be informed by both theory and practice of TB stigma reduction. Authors should provide citations to any studies supporting the theories underlying the intervention and reasons why it is expected to be effective in reducing stigma.
  2. Applicants should include a prominent role for persons with TB or persons with a history of TB as technical partners in the development of the interventions to ensure the quality and relevance of the interventions.
  3. All intervention packages should include a module specific to the stigmatization of people with multi-drug resistant TB (MDR-TB). Stigma toward people with MDR/XDR TB are likely fostered and sustained by distinct sets of underlying factors.
  4. The intervention package will eventually include an appropriate monitoring & evaluation envelope- (i.e. with measures and stigma scales that map to the specific stigma domains in the intervention). The M&E content will be developed by KNCV in collaboration with authors and is not required as part of the application or the full package.
  5. If interventions need to follow a specific sequence – these implementation guidelines should be specifically explained. The authors should indicate the minimum dosage of the intervention expected to be required to detect any noticeable changes in the expected outcomes and the preferred manner of implementation. Optional or advanced modules of the intervention should be specifically defined.
  6. All TB stigma reduction interventions must be gender-aware and informed by region-specific literature on TB and gender.
  7. In many communities TB stigma may be temporized or potentialized by other powerful stigmas.1,2 So addressing TB stigma, even successfully, will not reduce the suffering of people with TB very much. Applicants should therefore indicate how this intervention could be combined with other anti-stigma efforts.


The materials developed under this contract would be co-owned and co-branded (by the author and KNCV TB Foundation). KNCV would reserve the right to make modifications to the work such as translation, copy editing, and combination with other content. End-users would also be encouraged to tailor to the interventions to the needs of their setting. If the applicants consider aspects of the intervention package to be original works of art ( i.e. not modifiable), this should  be clearly specified.


The proposed budget should not exceed $15,000. Budgets should include the time needed to craft the package by an expert or very small team. Successful applications will likely be those that have already developed similar materials in the past, which need only modify existing materials.

Additional Information

This RFA does not require the applicant to provide graphic design competency as this will be provided. An Instructional Designer and Social Scientist will be available to contribute to ensure the logical coherence between the behavioral theory employed, the interventions developed, the materials developed, and the measurement metrics used (M&E).


8 September Annotated outline off the full intervention package (scope of work)
22 September Rough draft of half of the intervention package
6 October Full draft of the intervention package
13 October Technical review feedback from KNCV
27 October Revised draft of the intervention package
3 November Final draft of the intervention package to copy editors and lay out


The final published version of the TB Stigma reduction Tool Box will be presented by the authors in The Hague December 13-14th, 2017. Travel expenses for 1 author will be paid by KNCV TB Foundation.

Please note the deadline for submission of the final materials is: November 3rd , 2017

Application Instructions

Interested applicants should supply:

  • A complete application form (three to ten-page) including:
    1. Conceptual framework (Figure 1)
    2. Matrix of Intervention Modalities and Aims (Figure 2)
    3. Matrix of Intervention Delivery mechanisms (Figure 3)
    4. Budget proposal
  • 1 or 2 page track record of the individual or organization in related efforts
  • CVs of the main content developer(s) – highlighting track record in TB and stigma reduction.

Please use the template provided to submit your application.

KNCV TB Stigma Reduction Application Template Final Draft

Reducing TB stigma among health care workers- Sample_Application


Proposals will be evaluated by a multidisciplinary team. Proposals will be rated according to:

  • The track record of the applicant.
  • The coherence of the link between the theory, tools, and specific outcomes
  • The transformative potential of the package
  • The balance between affective, cognitive, and active change efforts.
  • The likelihood that the applicant can complete the work in the short time period.

Proposals that are impactful and comprehensive in scope will be preferred over proposals that privilege feasibility, incremental improvement, or traditional chalk+talk methods.


  1. Bond V, Nyblade L. Supportive Social Context and Intentions for Civic and Political Participation: An Application of the Theory of Planned Behaviour. J Community Appl Soc Psychol. 2006;61:452–61.
  2. Bond V, Nyblade L. The Importance of Addressing the Unfolding TB-HIV Stigma in High HIV Prevalence Settings. J Community Appl Soc Psychol [Internet]. 2006;16(January):452–461. Available from:


  1. Heijnders M, Van Der Meij S. The fight against stigma: an overview of stigma-reduction strategies and interventions. Psychol Health Med [Internet]. 2006;11:353–63. Available from:
  2. Baral SC, Karki DK, Newell JN, Smith I, Rieder H, Rouillon A, et al. Causes of stigma and discrimination associated with tuberculosis in Nepal: a qualitative study. BMC Public Health. 2007;7:211.
  3. Lusli M, Peters RMH, Zweekhorst MBM, Van Brakel WH, Seda FSSE, Bunders JFG, et al. Lay and peer counsellors to reduce leprosy-related stigma–lessons learnt in Cirebon, Indonesia. Lepr Rev [Internet]. 2015;86:37–53. Available from:
  4. Peters RMH, Dadun, Zweekhorst MBM, Bunders JFG, Irwanto, van Brakel WH. A Cluster-Randomized Controlled Intervention Study to Assess the Effect of a Contact Intervention in Reducing Leprosy-Related Stigma in Indonesia. Vol. 9, PLoS Neglected Tropical Diseases. 2015.
  5. Rood E, Mergenthaler C, Bakker M, Redwood L, Mitchell E. Who would keep TB a family secret? Using 15 DHS surveys to study individual correlates of TB courtesy stigma and health seeking behavior. Int J TB Lung Dis.
  6. Nina Sommerland, Edwin Wouters, Ellen M.H. Mitchell, Millicent Ngicho, Lisa Redwood, Caroline Masquillier, Rosa van Hoorn, Susan van den Hof AVR. Interventions to Reduce Tuberculosis Stigma – A Systematic Review. IJTLD.
  7. Link BG, Phelan JC. Conceptualizing Stigma. Annu Rev Sociol. 2001;27:363–85.
  8. Pescosolido BA, Martin JK, Lang A, Olafsdottir S, Kumar A, Hessini L, et al. Stigma and its public health implications. Soc Sci Med. 2006;367:1–28.
  9. Thomas BE, Shanmugam P, Malaisamy M, Ovung S, Suresh C, Subbaraman R, et al. Psycho-Socio-Economic Issues Challenging Multidrug Resistant Tuberculosis Patients: A Systematic Review. PLoS One [Internet]. 2016;11:e0147397. Available from:
  10. Bond V, Nyblade L. The Importance of Addressing the Unfolding TB-HIV Stigma in High HIV Prevalence Settings. J Community Appl Soc Psychol [Internet]. 2006;16:452–461. Available from:
  11. Balogun M, Sekoni A, Meloni ST, Odukoya O, Onajole A, Longe-Peters O, et al. Trained community volunteers improve tuberculosis knowledge and attitudes among adults in a periurban community in southwest Nigeria. Am J Trop Med Hyg. 2015;92:625–32.

[1] Art should take special care to avoid evoking pity, pathos, or patronizing attitudes toward people with TB. Making people with TB into victims is disempowering.

[2] Communications should be careful not to over-emphasize the air-borne nature of TB, as evidence suggests that this tends to increase fear and social distancing (stigma). 5,12