Priority programmes and rural retention the example of TB. Karin Bergstrom Stop TB Department WHO, Geneva

Transcription

1 Priority programmes and rural retention the example of TB Karin Bergstrom Stop TB Department WHO, Geneva

2 In this presentation I will briefly: review the TB situation in the world discuss "evidence" on TB control and health workforce retention poor TB control intimately linked to workforce issues in general and rural retention in particular

3 Global TB Control Targets 2015: Goal 6: Combat HIV/AIDS, malaria and other diseases Target 8: to have halted by 2015 and begun to reverse the incidence Indicator 23: incidence, prevalence and deaths associated with TB Indicator 24: proportion of TB cases detected and cured under DOTS By 2005: detect at least 70% of new sputum smear positive TB cases and cure at least 85% of those 2015: 50% reduction in TB prevalence and deaths by : elimination (<1 case per million population)

4 Latest Global TB Estimates Estimated number of cases Estimated number of deaths All forms of TB Greatest number of cases in Asia; greatest rates per capita in Africa Multidrug-resistant TB (MDR-TB) 9.27 million (139 per 100,000) ~ 500, million (25 per 100,000) ~150,000 Extensively drug-resistant TB (XDR-TB) ~50,000 ~30,000 HIV-associated TB 1.37 million (15%) 456,000 23% HIV/AIDS

5 The STOP TB Strategy Pursue high-quality DOTS expansion and enhancement a. Secure political commitment, with adequate and sustained financing b. Ensure early case detection, and diagnosis through quality-assured bacteriology c. Provide standardised treatment with supervision, and patient support d. Ensure effective drug supply and management e. Monitor and evaluate performance and impact 2. Address TB-HIV, MDR-TB, and the needs of poor and vulnerable populations a. Scale up collaborative TB/HIV activities b. Scale-up prevention and management of multidrug-resistant TB (MDR-TB) c. Address the needs of TB contacts, and poor and vulnerable populations 3. Contribute to health system strengthening based on primary health care a. Help improve health policies, human resources development, financing, supplies, service delivery and information b. Strengthen infection control in health services, other congregate settings and households c. Upgrade laboratory networks, and implement the Practical Approach to Lung Health (PAL) d. Adapt approaches from other fields and sectors, and foster action on the social determinants of health 4. Engage all care providers a. Involve all public, voluntary, corporate and private providers through Public-Private Mix (PPM) approaches b. Promote use of the International Standards for Tuberculosis Care (ISTC) 5. Empower people with TB, and communities through partnership a. Pursue advocacy, communication and social mobilization b. Foster community participation in TB care, prevention and health promotion c. Promote use of the Patients' Charter for Tuberculosis Care 6. Enable and promote research a. Conduct programme-based operational research, and introduce new tools into practice b. Advocate for and participate in research to develop new diagnostics, drugs and vaccines 2006/rev. 2009

6 The health workforce crisis the problem TB control services are provided within the framework of national health systems and the dire shortage of health workers in many places is among the most significant constraints to achieving all health-related MDGs WHO estimates that 57 countries are facing a critical shortage of health service providers and 15 of those countries are TB HBC Expansion of TB control has reached a critical level, and the HRD needs are exceeding central and peripheral level capacity to ensure service quality, expand services and add new interventions such as the management of M/XDR-TB NTP managers have identified inadequate human resources as the most important constraint for reaching TB control targets (programme reviews; SEARO TB-HSS workshop August 08). Most HRD issues have been disregarded by policy makers, TB programme managers, and planners. Donors, technical and other partners to NTPs have put the emphasis on the organization of training courses for DOTS and on the numbers of trained staff to the detriment of the quality of training and the formulation of coherent comprehensive HRD strategies to address retention and performance The triple threat posed by the HIV/AIDS epidemic to the health workforce by the risk of infection, disease and death to health service providers; the increased workload and demands on already overstretched health systems; and the stigmatization of health care related occupations, have had a devastating effect on the availability of health workers. This in turn severely affects the implementation of TB control services.

7 TB-training status: MD at HC LEGEND : % TRAINED < 50% 50 80% % > 100%

8 TB training status paramedic at HC LEGEND : % TRAINED < 50% 50 80% % > 100%

9 TB training status lab. technician at HC LEGEND : % TRAINED < 50% 50 80% % > 100%

10 SUCCESS RATE BY PROVINCE, Target SR 85 % INDONESIA West Sumatera West Nusa Tenggara West Kalimantan West Java South Sumatera South Sulawesi South Kalimantan South East Sulawesi Riau Papua North Sumatera North Sumatera North Maluku Nad Maluku Lampung Jambi Gorontalo East Nusa Tenggara East Kalimantan East Java Dki Diy Central Sulawesi Central Kalimantan Central Java Bengkulu Banten Bali Babel % 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

11 Addressing the health workforce crisis Countries should develop strategic and operational plans for health workforce development to both strengthen basic TB control and scale up management of M/XDR-TB. Plans need to go beyond traditional training activities and address staffing, motivation, retention and support systems issues. Plans should address the three core challenges in HRD: improving recruitment; helping the existing workforce to perform better (including quality training), and slowing the rate at which health workers leave the health workforce NTPs need to collaborate and coordinate with other health programmes and departments responsible for overall health workforce development, to ensure that health workforce needs for TB control are included in overall health workforce development.

12 The Beijing call for action..recognizes that there are..too few trained and motivated health care providers to offer proper treatment and support for patients..commit to ensuring sufficiently trained and motivated staff are available to implement both TB and M/XDR-TB diagnosis, treatment and care, as part of overall health workforce development efforts

13 Thank you for your attention