Public Private Mix sub group meeting 23 October, 2011 Scale up PPM in Myanmar

Transcription

1 Public Private Mix sub group meeting 23 October, 2011 Scale up PPM in Myanmar Dr. Thandar Lwin Programme Manager National TB Programme, Myanmar

2 Myanmar INDIA KACHIN BANGLA DESH CHIN RAKHINE SAGAING MAGWE MANDALAY BAGO SHAN KAYAH AYARWADDY YANGON KAYIN MON CHINA LAOS THAILAND Area - 676,578 sq.km Regions/States - 14 Districts - 67 Townships Sub Townships - 60 Wards - 2,781 Village tracts - 13,714 Villages - 64,910 Population - 57 millions TANINTHARYI Urban - 30% Rural - 70%

3 Magnitude of TB in Myanmar A major public health problem Estimated incidence all forms (2010) Estimated prevalence of TB (2010) Estimated TB mortality (2010) 384/100,000 pop. 525/100,000 pop. 49/100,000 pop. (Global TB control: a short update to the 2010 report, WHO, Geneva. 2011) MDR-TB among new TB patients 4.2% ( ) HIV prevalence among new TB patients 10.4 % (2010, in 20 sentinel sites)

4 Achievement of NTP in 2010 Total TB patients notified = 137,403 (CNR = 279/100,000 pop.) Total smear positive TB patients notified = 48,783 (CNR = 99/100,000 pop.) New smear positive TB patients notified = 42,318 (CNR = 86/100,000 pop.) CR = 77%, TSR = 85%

5 Prevalence of TB among aged 15 years and above ( ) Smear Positive Case Bacteriologically confirm Case >15 Yrs No. /100,000 95% CI No. /100,000 95% CI All Participants ( ) ( ) Strata Region ( ) ( ) State ( ) ( ) Urban/ Rural Urban ( ) ( ) Rural ( ) All Age S(+) prevalence 172/100,000 Bac(+) prevalence 434+/100,000

6 Background for PPM Political commitment - policy on Private- Public Mixed DOT was adopted in Operational guideline on Public Private Mix was developed by NTP together with PSI, MMA, JICA and WHO and published in Public-Private Mix-DOTS: PSI and MMA are coordinating with NTP. Lab. using by PPs are under EQA (358 public labs + 62 private labs) Public-Public Mix-DOTS : 4 Public Hospitals started in 2007 Other health related department: Ministry of Labors, Ministry of Home Affairs, Ministry of Defence, Ministry of Railway Involvement of INGOs 11 JATA, UNION, WVI, Pact, AHRN, IOM, Merlin, Malteser, MSF-H, MSF-Switz, MDM Local NGOs MWAF, MMCWA, MMA, MRCS, MHAA

7 Current approaches 1. Advocacy meeting and Training on TB control 2. Drugs and lab. Supplies distribution from NTP 3. Endorsement and Dissemination of International Standards for Tuberculosis Care (ISTC) among Myanmar National Health Professional Associations 4. Offer of incentives to engage care providers - NTP - No incentive. - PSI - To providers, incentives at regular intervals (transportation, nutrition, money) - MMA in kind to PPs, enablers and incentives to patients 5. Supervision, M&E 6. TB screening at work place in collaboration with Occupational Health 7. OR for involving pharmacies and informal health care providers.

8 Public Private Mix in Myanmar In Public-Public Mix currently there are two main non-ntp care providers in Myanmar (1) PSI (2) MMA In collaboration with private parishioners, there are currently three schemes available for engagement of private parishioners in TB control: Scheme 1-Health Education and proper referral of TB suspects Scheme II- Health Education, referral and act as a DOT provider Scheme III referral, diagnosis and treatment provision to run an affiliated DOT clinic

9 PPM with PSI Population Service International (PSI) started the collaboration with NTP in March PSI organizes the PPs and running the Sun Quality Clinics as DOT units. PSI is implementing Scheme 3. In PSI contributed 12.1% of new smear positive pulmonary TB patients notified to NTP and achieved Treatment Success Rate - 85%.

10 PSI--Area coverage of PPM-DOTS network Year No. of Providers No. of State/Region No. of Township up to July new providers in 23 new townships in

11 PSI-- Expansion of sputum microscopy centers Year No. of Private Lab No. of NTP Lab Total up to July

12 PSI contribution on all type s of B cpatients notified to NTP in project area ( ) 15% 11% 12% 13% 15% % 11% PSI NTP

13 PSI contribution on new smear (+) TB patients notified to NTP in project area ( ) 14% 14% 16% 19% % 13% 15% PSI NTP

14 PPM with MMA Myanmar Medical Association (MMA) started in 2005 MMA use three schemes: In 2010, 70 townships have been covered and 914 PPs are implementing Scheme 1, 118 PPs are implementing Scheme 3. In 2011, MMA is planning to implement in 101 townships.

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16 MMA (Scheme I) contribution on new smear (+) TB patients notified to NTP in the project area ( ) % % % % 8108 NTP MMA S

17 MMA (Scheme 1) contribution on total smear (+) TB patients notified to NTP in the project area ( ) % % % % 9608 NTP MMA S

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19 MMA (Scheme III) contribution on new smear( +) TB patients notified to NTP in project area ( ) (16%) (16%) MMA S III NTP

20 17.8% 17.5%

21 (16%)

22 Proportion all forms of TB patients contributed by NTP and other reporting units (2010) PSI, 12.1% MMA, 1.6% MDM, 0.2% AHRN (Shan North), 0.2% MSF-H, 2.1% Hospital, 3.0% NTP, 80.8% 22

23 Treatment outcomes of PSI-PPM DOTS ( )

24 Treatment outcome of new smear positive TB pateints % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% NTP PSI AZG MMA Transferred out Defaulted FaiIure Died TSR Cured

25 Treatment outcome of new smear positive TB pateints % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% NTP PSI AZG MMA Transferred out Defaulted FaiIure Died TSR Cured

26 Treatment outcome of new smear positive TB pateints % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% NTP PSI AZG MMA Transferred out Defaulted FaiIure Died TSR Cured

27 Treatment outcome of new smear positive TB pateints % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% NTP PSI AZG MMA Transferred out Defaulted FaiIure Died TSR Cured

28 Treatment outcome of new smear positive TB pateints % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% NTP PSI AZG MMA Transferred out Defaulted FaiIure Died TSR Cured

29 Public-Public Mix DOTS Public-Public Mix (between NTP and public hospitals) 9 general hospitals - 2 TB hospitals - Specialist hospitals especially treating HIV patients - 1 Military hospital - Workers hospital (TB) - Central jail, Mandalay

30 No of NS(+) TB cases Hospital Contribution in NTP of NS(+) TB cases % % 1.3% 1.6% 1.5% % % NTP total cases Hospital total cases Years

31 No of All S(+) TB cases Hospital Contribution in NTP of All S(+) TB cases % % % % 1.7% 1.9% 1.9% Years NTP total cases Hospital total cases

32 No of All type TB cases Hospital Contribution in NTP of All type TB cases % % 2.9% % 3.1% % % Years NTP total cases Hospital total cases

33 Engage all care providers National Workshop on ISTC (March 4-5, 2009) Dissemination Workshop on ISTC (August 31, 2009) Introduction to Regional level Hospitals : 13 / 17

34 Major barriers to scaling up engagement Weakness in coordination between Practitioners Conceptual changes among private doctors Limitation in resources Operational barriers at all levels transportation, health seeking behavior of patients, patient support, etc. Requirement of ACSM strategy

35 Planned actions to scale up / strengthen engagement 1. NTP - To scale up of PPM hospitals up to 21 hospitals by To disseminate ISTC up to district / township level - To involve informal health care providers and drug sellers in TB control - PAL to do situation analysis and resources mobilization 2. PSI - To expand 100 SQH clinics, 500 SPH workers, townships annually to achieve 15% of national case detection by To involve informal health care providers and drug sellers - To initiate TB/HIV prevention and control activities - Financial/ logistic support to MDR cases in close collaboration with NTP

36 Planned actions to scale up / strengthen engagement 1. MMA-TB - Further scale-up of Scheme III, - To establish more Private Labs and sputum collection centers - To engage all care providers - To intensify community based TB care activities - To strengthen infection control and TB-HIV prevention and control activities - To involve informal health care providers : Pharmacists, Traditional medicine practitioners

37 Thank you