progress and plans for ppm in the south-east asia region
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Progress and plans for PPM in the South-East Asia Region. Fifth PPM Subgroup Meeting 3 - 5 June, Cairo. per 100 000 population. < 10. 10 to 24. 25 to 49. 50 to 99. 100 to 299. 300 or more. No Estimate. TB incidence rates per capita. TB in SE Asia 5 m prevalent cases - PowerPoint PPT PresentationTRANSCRIPT
Progress and plans for PPM in the
South-East Asia Region
Fifth PPM Subgroup Meeting
3 - 5 June, Cairo
TB incidence rates per capita
25 to 49
50 to 99
100 to 299
< 10
10 to 24
300 or more
No Estimate
per 100 000 population
TB in SE Asia 5 m prevalent cases3 m new cases and 500 000 deaths/ yr
~150,000 new MDR-TB cases/yr
~ 2.5 - 3 million TB-HIV co-infected
Countries with GF support for PPM
All countries in the Region with the exception of Myanmar and DPR Korea benefit from support from the Global Fund for expanding private and public partnerships
Regional Progress
• Bangladesh: >90% of TB services through NGOs; Prisons, medical colleges, railways, garment industries being involved
• India: 262 medical colleges; >17695 PPs; >2946 NGOs; > 150 corporate houses; tea estates, railways, employees state insurance hospitals, Ministries of Shipping, Mines, Petroleum and Oil, Indian Medical Association; District TB Societies
• Indonesia: All lung clinics and 37% of large hospitals; 7 medical schools; Ministry of Defence, Police and Prisons Dept
• Myanmar: Private providers; Railways; Ministries of Defence, Religious affairs; Labour, Education and Home Affairs
• Nepal: Private providers; teaching hospitals, communities through village and district DOTS committees
• Thailand: NHSO, Ministry of Labour; prisons systems; private hospitals association; community based organizations, local and international NGOs; Thai business coalition
Successful approachesSome examples
• Intensified training of private and public hospital and laboratory staff in Indonesia
• Introduction of coordination meetings between community health facilities and hospitals: Yogyakarta, Indonesia; between partners: Myanmar
• Franchising, allowing for ensuring of quality throughout network: PSI Sun Quality Health Network
• Inclusion of private laboratories in diagnostic network & QA systems in, India; SQH and accredited labs in Myanmar
• Establishing of referral networks and better follow up of transfers eg., in Padang, Indonesia, between lung clinic and puskesmas; provision of a list of DOTS centres for referral to teaching institutes in India
• Endorsement of the International Standards of TB Care by professional bodies-- Medical associations in India, Indonesia
Regional Priorities: 2008-2009• Catalyze wider implementation (India, Indonesia, Myanmar, Nepal)
Document on-going initiatives, disseminate best practice examples for wider use
• More actively engage with professional associations, teaching universities for dissemination of the ISTC, and use of recommended guidelines
• Ensure coordination mechanisms/forums for information exchange at all levels in countries
• Expand collaboration with industry, corporate sector (not much progress here– may be an area for the PPM sub-group to focus on)
• Help in developing clear strategies and operational guidelines based on lessons learnt (Bangladesh, Sri Lanka, Thailand) sectors not yet involved
• Support pilots in (Bangladesh, Thailand)
• Organize a regional training for national consultants/focal points on strengthening public-private partnerships (long-standing dream!)
PPM activities in priority countries
Priority countries
National Situation assessment conducted
PPM focal person appointed
PPM Operational guidelines developed
Bangladesh Yes, included in the 5-year NTP plan (2006-2011)
Yes, focal point exists at NTP, Min of H&FW
PPM is mainstreamed into the technical and operational guidelines of the programme. PPM guideline is also available as schemes for collaboration.
India Yes, included in the 5-year NTP plan (2006-2011)
Yes, focal point exists at Central TB Division, Min of H&FW
PPM mainstreamed into technical and operational guidelines of the programme. Separate guidelines also available as schemes for collaboration.
PPM activities in priority countries
Priority countries
National Situation assessment conducted
PPM focal person appointed
PPM Operational guidelines developed
Indonesia Yes-2003 and during the subsequent external MMs, in 2005 and 2007
Yes Yes
Myanmar Yes – during the joint MMs in 2004 and 2007
Yes Yes – under revision
Thailand No No No
Progress: BangladeshProvider group
Involvement Contribution
Professional associations
No There are schemes to involve these associations for ACSM activities
Corporate Sector
Yes. Three corporate sector health care units are involved
Hospitals Yes DOTS Corners functional at 24 medical colleges by end 2007
Informal providers
Yes. Very good involvement
(Shasthyo Sebikas, Village doctors: Contribution is in terms of referral of TB suspects for diagnosis and acting as DOT-providers
Private laboratories
No There are schemes for involvement of private labs as designated microscopy centres for the programme
NGOs and private practitioners
Yes 29 NGOs involved as partner of NTP by the end of 2007 and private practitioners are being oriented and involved
Bangladesh Plans for PPM 2008-2009
• Actively engage professional bodies, BMA,BPMPA, specialists using the International Standards for TB Care
• Enhance coordination and collaboration between different Ministries
• Expand collaboration with industry, corporate sector and pharmacy holders through respective association
• Development and distribution of advocacy materials to private providers
Progress: India
Provider group Involvement Contribution (Measured in terms of numbers of patients only in 14 sentinel sites)
Professional associations
Yes. Involvement of a few associations Establishment of the Indian Medical Professional Association Coalition against TB (IMPACT) in 2007.
GFATM supported project being implemented by the Indian Medical Assoc (IMA) since 2007.
Endorsement of ISTC by members of the IMPACT in their personal capacity: March 2008 (endorsement by member associations in process)
Joint consensus statement on pediatric TB by IAP in place and used
Corporate Sector
Yes. About 150 corporate sector health units involved
Hospitals Very good involvement Over 262 medical colleges involved by end of 2007
Informal providers
Yes. Referral of suspects for diagnosis; act as DOT providers
Private laboratories
Yes. Schemes for involvement of private labs as designated microscopy centres for the programme
NGOs and private practitioners
Yes 2946 NGOs and 17695 private practitioners involved by end of 2007
Intensified urban PPM districts; India (14): Summary of contribution by different health sectors – 3rd qtr 2006 to 2nd qtr 2007)
India Plans for PPM 2008-2009
• Revise PPM guidelines for NGOs and private practitioners
• Work with the IMA to increase the number of private practitioners collaborating with national programme
• Develop guidelines for further involvement of the Employee State Insurance and Railways health facilities in TB control
Progress: Indonesia
Provider group Involvement Contribution
Professional associations Yes Endorsement & roll out of ISTC
Corporate Sector Yes Guidelines on TB in work place introduced on a pilot basis
Hospitals Yes Hospital assessment done in 117 hospitals. HDL guidelines developed. TO placed in large hospitals
Informal providers Limited to pilot studies under FIDELIS etc
Pilot studies done on involvement of PP in Bali & Yogja
Private laboratories Limited to pilot studies Same as above
Prison medical services Yes MOU signed between Min of Justice & MOH. Guidelines developed. Training started for 30 prisons
Achievements A hospital assessment study on the implementation of DOTS strategy conducted Guidelines on Hospital DOTS Linkage (HDL) developed and 15 Technical and Surveillance Officers
for HDL have been placed in 12 clusters of districts Integration of DOTS into medical school curriculum implemented ISTC translated and adapted into Bahasa (Indonesian language), officially endorsed and rolled out to
the professional organizations Ministerial decree issued to support DOTS implementation under different Directorate Generals Directive letter from DG Medical Care on DOTS implementation in hospital issued Guidelines on TB in workplace, prison and army developed, and activities initiated CEA study initiated on PPM approaches
Constraints Varying degree of commitment and
quality of services in DOTS implementation
Plans for 2008-2009 Dissemination of HDL guidelines/ training Strengthening linkages and surveillance in HDL Further expansion of HDL to other public and private hospitals, Institutionalizing of ISTC, incl. certification/accreditationHospital assessment study in outer Java
Progress: Indonesia
Progress: Myanmar
– National PPM DOTS Sub group established– PPM capacity at WHO strengthened
(international MO + national consultant)– PPM capacity at MMA strengthened
(national PPM team + 2 Divisional Coordinators and part-time Township Coordinators/ full time social outreach workers in all townships)
Achievements: PPM DOTS Sub group in Myanmar
• Standardized Training Manual PPM DOTS
• 3Diseases Orientation Package for GPs
•Implementation Guide on PPM DOTS (draft)
• Strategy Paper on PPM DOTS in Myanmar (draft)
Progress: MyanmarProvider group Involvement Contribution
Professional associations
Yes 1. Myanmar Medical Association( MMA )526 General Practitioners involved in 23 townships)- Contributed 20.27% of sputum smear positive cases to National Tuberculosis Programme
Corporate Sector Yes (Railways, Labour)
Hospitals Yes 4 Tertiary Specialist Hospitals Pilot Project, Yangon Division
Informal providers Yes
Private laboratories Yes Through PSI social franchising scheme and through MMA
Other provider groups
Yes Ministry of Defence, Religious affairs, Education and Home affairs
Myanmar Plans for PPM 2008-2009
Public Private Mix DOTS1. Finalize Implementation Guide on PPM DOTS and Strategy paper on PPM DOTS in
Myanmar2. Sustain in implementing townships and scale up public private mix DOTS project
• Myanmar Medical Association( MMA ) 600 General Practitioners involved in 26 townships
• to include private and charity hospitals, religious hospitals• Population Services International (PSI) –to scale up number of Sun Quality Health Care
Doctors• CARE Myanmar to sustain in 10 townships• IOM to sustain 6 townships• JICA under the Major infectious diseases control project, to scale up to 6 townships• Myanmar Red Cross Society and Myanmar Maternal and Child Welfare Association
members act as DOT ProvidersPublic Public Mix DOTS• To consolidate the public public mix demonstration projects in 4 tertiary specialist Hospitals• Develop Interim Guidelines on Public Public Mix DOTS• End 2008: joint workshop on TB control between NTP and Prison Department
ISTC• Workshop with leading medical specialists on Adapting ISTC to Myanmar context, July 2008 • Conduct similar workshop for GP branch of the Myanmar Medical Association• Implement and roll out the ISTC stepwise approach
Progress: Thailand
MOU with National Health Security Office MOU with Ministry of Labour to implement TB control in the
workplace MOU with MSF for TB treatment and care among migrants Coordination with Department of Corrections to continue
TB control in prisons Collaboration with US. CDC for TB surveillance and
research Engagement of Private Hospital Association to provide TB
care according to ISTC ISTC translated into Thai and endorsed by NTP Involvement of NGOs (World Vision, American Refugee
Committee, Thailand Bossiness Coalition of AIDS) to control TB in vulnerable population
Progress: ThailandProvider group Involvement Contribution
Professional associations
No
-
Corporate Sector Yes
TB control in the workplace
Hospitals Yes About 60 Private hospitals implementing TB activities with TB recording and reporting system
Informal providers No
Private laboratories No
Other groups Yes TB control activities with R&R system in 144 prisons
Thailand Plans for PPM 2008-2009
– Establishment of working group to develop a plan, oversee the implementation and coordinate mechanisms at all levels of the programme
– Officially appointment of a focal person for PPM– National situational analysis of PPM– Continuation for PPM collaborative activities with:
• Private Hospitals• Factories• Prisons• NGOs• Health insurance organization
621 625
568
438 431 411
244
340
147108
180 169
253299
244
789
391
8096
197
54
0
100
200
300
400
500
600
700
800
900
1,000
1,100
1,200
Timor-Leste Bangladesh Nepal India Indonesia DPR Korea Myanmar Bhutan Thailand Maldives Sri Lanka
TB
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ce
pe
r 1
00
,00
0 p
op
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n1990 2006
Tuberculosis prevalence rates in SEAR countries
Source : WHO, Global Tuberculosis Control Report 2008