Regional Advocacy, Communication and Regional Advocacy, Communication and Social Mobilization Planning Workshop for Social Mobilization Planning Workshop for

Tuberculosis ControlTuberculosis Control

Amman, Jordan 13-17 April 2008Amman, Jordan 13-17 April 2008

Regional Advocacy, Communication and Social Regional Advocacy, Communication and Social Mobilization Planning Workshop for Tuberculosis Mobilization Planning Workshop for Tuberculosis

ControlControl

Amman, Jordan 13-17 April 2008Amman, Jordan 13-17 April 2008

•Population: Population: 5.6 million

•Surface area: 89,000 Sq.Km

•Middle income country: 1,208 JD (1,700 US $)

•Demographic transition: life expectancy: 71.5 years

• Epidemiologic transition:

- Infant Mortality rate: 22/1000

live births

-Decrease in communicable diseases, including TB.

Increase in chronic diseases, including chronic respiratory diseases (CRD).

Syria

Saudi Arabia

Iraq

Various Health system in Various Health system in Jordan (1999 – 2003)Jordan (1999 – 2003)

Country Health Data

2001

2002

2003

Number of Hospitals 91 95 97

Hospital Beds 8982 9383 9743

Ministry of Health 3357 3462 3587

Royal Medical Services 1760 1791 1801

JordanJordan UniversityUniversity Hospital Hospital 517 531 540

King Abdullah University Hospital - 197 283

Private Sector 3348 3402 3532

Health Centers of MOH

Type of Center 2001 2001 2002 2002 20032003

Comprehensive Health Centers 47 53 52

Primary Health Centers 338 336 340

Peripheral Health Centers 258 258 259

Maternity and Child Health Care Centers 351 351 353

Chest Diseases Centers 11 11 12

Dental Clinic 240 247 250

TB control in JordanTB control in Jordan Low TB burden: in 2007: Low TB burden: in 2007:

* 333 TB cases (all types) (in addition to 150 cases* 333 TB cases (all types) (in addition to 150 casesAmong foreigners transferred out) Among foreigners transferred out) * Incidence (all TB types): 6 / 100,000 population * Incidence (all TB types): 6 / 100,000 population * SS+ incidence: 1.8/100,000 population* SS+ incidence: 1.8/100,000 population * ARI : 0.04% * ARI : 0.04%

TB incidence decreasing: 13/100 000 in 1992 TB incidence decreasing: 13/100 000 in 1992 6 in 20076 in 2007

100% population DOTS coverage (1998)100% population DOTS coverage (1998) Case Detection Rate: 63% (2005)Case Detection Rate: 63% (2005) Success Rate: 87% (2006)Success Rate: 87% (2006) Prevalence of MDR :5% (2006)Prevalence of MDR :5% (2006)

structure of TB control structure of TB control programme in Jordan programme in Jordan

Structure of the Structure of the Tuberculosis Control in Tuberculosis Control in

JordanJordanThe National TB (NTP) in Jordan is a The National TB (NTP) in Jordan is a vertical Programme vertical Programme

At the Central level the Chest Disease At the Central level the Chest Disease Division (in Amman City), responsible for Division (in Amman City), responsible for Tuberculosis control program Tuberculosis control program throughout the country including throughout the country including supplying medicines. The main role is supplying medicines. The main role is planning, coordination and supervision planning, coordination and supervision of the control activities.of the control activities.

At the peripheral level, there are 12 At the peripheral level, there are 12 chest centers covering the whole chest centers covering the whole countrycountry. .

The National TB (NTP) in Jordan is a The National TB (NTP) in Jordan is a vertical Programme vertical Programme

At the Central level the Chest Disease At the Central level the Chest Disease Division (in Amman City), responsible for Division (in Amman City), responsible for Tuberculosis control program Tuberculosis control program throughout the country including throughout the country including supplying medicines. The main role is supplying medicines. The main role is planning, coordination and supervision planning, coordination and supervision of the control activities.of the control activities.

At the peripheral level, there are 12 At the peripheral level, there are 12 chest centers covering the whole chest centers covering the whole countrycountry. .

Distribution of Diagnostic TB Distribution of Diagnostic TB Centers in JordanCenters in Jordan

GoalGoal Reduce mortality and morbidity and Reduce mortality and morbidity and

transmission of tuberculosis, while transmission of tuberculosis, while preventing drug resistance, until preventing drug resistance, until tuberculosis no longer poses a threat to tuberculosis no longer poses a threat to public health, and achieve the public health, and achieve the Millennium Development Goals (Goal 6, Millennium Development Goals (Goal 6, Target 8) by 2015Target 8) by 2015

OBJECTIVESOBJECTIVES

Improve TB care for vulnerable Improve TB care for vulnerable populations in Jordan (Refugees, poor, populations in Jordan (Refugees, poor, mobile) .mobile) .

Improve tuberculosis care for people Improve tuberculosis care for people suffering from multi-drug resistant suffering from multi-drug resistant tuberculosis and TB/HIV in Jordantuberculosis and TB/HIV in Jordan

Improve general tuberculosis care Improve general tuberculosis care

Trends over time of the incidence Trends over time of the incidence of TB in Jordan (per 100,000 pop. of TB in Jordan (per 100,000 pop.

per year) per year)

1412.8

28.9

21

25

23.2

21.1

16

1413

6

5.3

6.4

6

18.9

6.2

27.8

14.8

19.2

11.510 10.5

6

6.4 5.8

1211

98.3

7.8

0

5

10

15

20

25

30

35

Year

Incid

enceR

ate

/100,0

00 p

op

Trends over time of the Trends over time of the number of new TB cases in number of new TB cases in

JordanJordan

0

50

100

150

200

250

300

350

400

2002 2004 2006 Year

Num

ber

TB

Cas

es

Pulmonary TB

Extra-pulmonaryTB

SS+ Pulmonary

Total TB

CHALLENGESCHALLENGES Low Detection Rate: TB case Low Detection Rate: TB case

detection for new sputum smear detection for new sputum smear positive pulmonary TB cases in 2005 positive pulmonary TB cases in 2005 was 63% (target of 70%);was 63% (target of 70%);

MDR TB is increasing among MDR TB is increasing among Jordanians (2% in 2004 , 5% in Jordanians (2% in 2004 , 5% in 2006) 2006)

ACSM ACTIVITIESACSM ACTIVITIES

JOR506 G02-T/NTP-MOH

COMPONENT 1: PURSUING, OPTIMIZING AND SUSTAINING QUALITY DOTS

N.Activity Indic

atorBudget

(in USD)Funding

source

1.1 POLITICAL COMMITMENT WITH INCREASED AND SUSTAINED FINANCING:

NTP will initiate one meeting per year headed by the Ministry of Health and members of a higher policy forum or a National board, to plan and monitor activities of the NTP and to strengthen commitment and financial sustainability

One meeting is held yearly

WHOMOH

NTP will play a key role in activating CCM to assess needs and requirements and to review and revise action plans for TB control in Jordan.

Regular meetings every three months

GFATM

At Governorate levels, TB coordinators will reactivate M&E committees

M&E Committees meet biannually

WHOMOH

COMPONENT III: ENGAGE ALL CARE PROVIDERS

N. Activity Indicator Funding source

3.1 PUBLIC-PUBLIC, AND PUBLIC-PRIVATE (PPM) APPROACHES:

Setting up a database for all stakeholders and focal persons

in all areas entitled to control and manage TB cases.

Database Established

GFATM

Forming a steering committee to plan and implement PPM

strategy and to build commitment.

Steering Committee

Formulated

GFATM

Developing the PPM Strategy PPM strategy Developed and

printed

GFATM

Train all TB care providers in all Train all TB care providers in all areas responsible on TB case areas responsible on TB case management.. management..

No.of TB care providers trainedNo.of TB care providers trained

N. Activity Indicator

3.1.5 Supervisory visits to all TB control clinics No. of Visits Conducted

3.1.6 Ensuring supply of anti-TB drugs to clinics dealing with TB cases.

All clinics dealing with TB cases provided with anti-TB drugs

3.1.7 Printing all guidelines and revised R&R formats needed for the TB-Care provider to

ensure adherence to guidelines.

Guideline and revised R&R

format developed and printed

3.1.8 Increase awareness of medical Schools’ staff and nursing schools’ staff about TB problem through training.

No. of medical Schools’ staff and

nursing schools’ staff trained

COMPONENT III: ENGAGE ALL CARE PROVIDERS

N. Activity Indicator

3.1.3.1.99

Increase awareness of medical Increase awareness of medical Schools’ students and nursing Schools’ students and nursing schools’ students about TB schools’ students about TB problem through trainingproblem through training

No. of medical No. of medical Schools’ Schools’ students and students and nursing nursing schools’ schools’ students students trainedtrained

COMPONENT III: ENGAGE ALL CARE PROVIDERS

INTERNATIONAL INTERNATIONAL STANDARDS FOR TB CARE STANDARDS FOR TB CARE

(ISTC(ISTC) ) To translate and disseminate ISTC among

syndicate of physicians, private sector directorate, not for profit hospital and

policlinics, and NGOs.

ISTC translated,

printed and distributed

Organize lectures and congress for all stakeholders about the international standards for TB care.

No. of stakeholder

attended lectures

Measuring the impact of adherence to the standards on quality of care and patient

satisfaction.

Measurements tools settled

COMPONENT IV: EMPOWER PEOPLE COMPONENT IV: EMPOWER PEOPLE WITH TB, AND COMMUNITIESWITH TB, AND COMMUNITIES

Activity Indicator

NTP social Workers organize focus group discussion with patients on patients’ charter

Established or not

Orientation meetings with all policy makers Proportion. of attendance

Establish a support Group for TB patients and their families in collaboration with Jordanian Anti TB

Association (JATA)

Support Group Established

Conducting KAP studies KAP study conducted

TOT for health care providers No. of care providers trained

Conducting a campaign No. of governorate involved

No. of seminars conducted

COMPONENT IV: EMPOWER PEOPLE COMPONENT IV: EMPOWER PEOPLE WITH TB, AND COMMUNITIESWITH TB, AND COMMUNITIES

Production of health education materials (TV spots, Radio broadcasting, booklets, posters, etc…) For

different target groups.

No. of materials developed by type.

No. of sites of distribution.

School student awareness raising activities No. of schools conducted

awareness raising activities

Celebrating the World TB day No. of sectors involved

Creating and updating a website of NTP Jordan Website created and updated

Community participation in TB Community participation in TB Care:Care:

Setting up a complete database about national and international NGOs.

Database is Done

Orientation meeting with all NGOs focal persons to increase awareness about TB problem and to build

commitment

No of meetings conducted

Integrating international NGOs in fund raising and sharing in TB control through materials, conferences

and research.

No of conferences shared by NGOs,

No of Materials

Orientation meeting with community leaders to participate in TB fight

No. of meetings conducted

Empower community volunteers to support TB patients No of Volunteers supporting NTP

Integrating the women lead NGOS to support the NTP. No.. of women lead NGOs involved n

NTP activities

PATIENTS’ CHARTER FOR TUBERCULOSIS CARE:PATIENTS’ CHARTER FOR TUBERCULOSIS CARE:

Forming a task force to set up a national document for TB patients’ rights.

Task force formulated

Setting and printing a poster and booklets for TB rights

Posters and booklets printed

Disseminating the poster and booklets to all chest facilities, all partners and

private clinics.

Posters and booklets disseminated

ENABLE AND PROMOTE RESEARCHENABLE AND PROMOTE RESEARCH

Activity Indicator

NTP in collaboration with WHO and other partners identify the main research areas for next five year

Conducting two studies per year Number of studies

accomplished

Monitoring and Evaluation Monitoring and Evaluation (M&E) activities(M&E) activities

Key Indicators Baseline

Establishment of M&E task force within the National TB program

 

Training and refresher training workshops for 45 social workers and home visitors related to TB

 

 

Upgrading of Surveillance and strengthening Upgrading of Surveillance and strengthening M&E systemM&E system

Key Indicators Baseline

Training for Governorate TB coordinators on surveillance including data verification and quality in terms of completeness, accuracy and timeliness through electronic templates in 3 days duration workshops for 40 staff.

 

NTP will supply the TB management units (TBMU) with computers and printers resources and other equipments (CDs, flash memories …..etc needed for ENRS implementation based on needs

 

ACSM Contribution to National TB ACSM Contribution to National TB ControlControl

National Objectives Related Interventions

1- Improve TB care for vulnerable populations in Jordan

Empower community volunteers to support TB Patients through establishment of volunteer network between the NTP and all NGOs nationwide.

Orientation meetings (1 every quarter) with Concerned NGOs focal persons, influential leaders to increase awareness about TB problem and to build commitment

Outreach educational sessions to increase awareness about TB

Production of health education materials (Broadcasting, booklets, posters, etc…) For different target groups.

Educational sessions conducted toincrease awareness on TB among students schools

ACSM Contribution to National TB ACSM Contribution to National TB ControlControl

National Objectives Related Interventions

1- Improve TB care for vulnerable populations in Jordan

Conducting KAP studies to to Assess the knowledge, Assess the knowledge, attitude and perception attitude and perception of the population of the population regarding TB;regarding TB;

ACSM Contribution to National ACSM Contribution to National TBTB

ControlControl2- Improve

tuberculosiscare for peoplesuffering from multi-drug resistant tuberculosis and TB/HIV in Jordan

Developing and printingTB/HIV guideline

ACSM Contribution to National ACSM Contribution to National TBTB

ControlControl3- Improve

general tuberculosis care

NTP will play a key role in activating TBcoordinators to assess needs requirementsand to review action plans for TB and toreactivate M&E strategy (meeting onquarterly basis).

Training and refresher training workshopsfor 45 social workers and home visitorsrelated to TB

Translate and disseminate InternationalStandards for Tuberculosis Care (ISTC)among syndicate of physicians, privatesector, not for profit hospital and policlinics,and NGOs.

NTP social Workers organize 8 focus groupdiscussion with patients on patients’ charter

ACSM Contribution to National ACSM Contribution to National TBTB

ControlControl3- Improve

general tuberculosis care

Conducting a study on Case finding among tuberculosis suspects and barriers interfering with their timely healthcare in mid and northern Jordan

Support and collaboration of governorate health authorities

Community

compliance

Support of other

concerned departments & sectors

CONCLUSIONSCONCLUSIONS

Highest level of

political support

Successful TB Elimination

Reaching Global Target

Support of concerned

international organization

Thank youThank you