WILLIAM GARAY LOPEZ, MD

Transcription

1 IMPROVING CASE FINDING ACTIVITIES THROUGH EFFECTIVE LABORATORY MANAGEMENT AND HEALTH EDUCATION IN THE NATIONAL TUBERCULOSIS PROGRAM OF PERU WILLIAM GARAY LOPEZ, MD

2 REPUBLIC OF PERÚ Tumbes Piura Amazona s La Libertad San Martín Loreto Área: 1 285,216 km 2 Population: ,774 Anual Growth Rate: 1,7% Population of Lima and Callao: 8,7 millions (32.3% to total of population and 46% to urban population) Callao Ancash Estratificación según población t otal por departa mentos Huánuco Cerro de Pasco Lima Ica Junín Lambayeque Cajamarca Huancavelica Ayacuch o Ucayali Apurimac Cusco Arequipa Madre de Dios Moquegu a Puno Lima Piura La Libertad Cajamarca Puno Junin Cusco Lambayeque Ancash Arequipa Loreto Huanuco Callao San Martin Ica Ayacucho Apurimac Ucayali Huancavelica Amazonas Tacna Pasco Tumbes Moquegua Madre De Dios Percentage Tacna P75 P50 P25

3 BACKGROUND INFORMATION Basic health services are partially management to the local health direction, except to private health services. Lima, The Capital City has the most number of private physicians, clinics and hospitals (specialty and tertiary, both public and private) Implementation of the DOTS Strategy: 100% TB, all forms is the 25th leading cause of morbidity and 11th leading cause of mortality (2004) In 2004 the case detection rate was 65% and the cure rate was 89,6% 77% of Tuberculosis patients are productive population.

4 TB SYMPTOMATICS DETECTED SREx Bk Diag. Total % Number SREx ,4 % % Number Bk Source: DGSP-Operational Reports of SSNPyCTB

5 LABORATORY NETWORK: ORGANIZATION BY LEVELS LNRM LRR : 23 NATIONAL HEALTH INSTITUTE National Laboratory of Reference of Micobacterias (LNRM) REGIONAL REFERENCE LABORATORY LNI : 42 NATIONAL HOSPITALS LABORATORY LOCAL LABORATORY: 1289 LOCAL LABORATORY 5300 URM Sample Collect Unit (URM)

6 STAKEHOLDERS ANALYSIS BENEFICIARIES POTENTIAL OPPONENTS IMPLEMENTING AGENCIES DECISION MAKERS FUNDING AGENCIES Patients Pharmaceut ical Industry Regional Government Ministry of Health Government of Peru Family and community Pacients Organizati on Provincial Government People Health Direction Regional Governme nt Health workers Private practitioner Districtal Government Local Government Global Fund Health Centres Private clinics Health Centres NGOs National Tuberculosis Program Patient's Organization NGOs Supplies providers

7 High Morbidity and mortality rates from TB CORE PROBLEM Low case detection rate Low number of case finding Lack of knowledge about TB of the community Weak monitoring and evaluation of NTP Poor quality of Laboratories HW has low knowledge on NTP Inadequate health education of the community Insufficient trained health staff to conduct monitoring Limited monitoring and supervision Different level in M and S among coordinat ors Poor condition of Laboratories facilities There is no ACS Plan that is being implemented Community not receive Health education by HWs Low budget for Monitoring and Supervision Lab Health Workers are not trained No update on NTP provided to profession als Low budget to monitoring and supervision Multifun ction of supervis ors Insuffici ent Laborat ory supplies Poor maintena nce of microscop es Lack of budget for training programs Lack of IEC material s No regular HE conducted by H facilities PROBLEM ANALYSIS

8 Low Morbidity and mortality rates from TB High case detection rate Number of case finding increased Good knowledge about TB of the community Monitoring and evaluation permanent of NTP Quality of Laboratories improved Conditions of Laboratory facilities improved HWs has knowledge on NTP Adequate health education of the community ACS Plan is being implemente d Health education was provided by the HWs Sufficient trained health staff to conduct monitoring Adequate monitoring and supervision Low budget for Monitoring and Supervision Coordinato rs With good of knowledge about M and S Lab Health Workers were trained Updates on NTP given to professional s Low budget to monitoring and supervision Multifun ction of supervis ors Laborato ry supplies were sufficien t provided Maintenan ce of microscop es was improved Budget for training programs provided IEC materials were sufficient provided HE were conducted by H facilities OBJECTIVE ANALYSIS

9 CASE FINDING AND HE APPROACH P-P Low Morbidity and mortality rates from TB High case detection rate O-G HE AND M AND E APPROAC H Number of case finding increased Good knowledge about TB of the community Monitoring and Evaluation permanent of NTP O-P Quality of Laboratories improved Conditions of Laboratory facilities improved knowledge about TB by HWs is improved knowledge about TB by community is improved ACS Plan is being implemente d Health education was provided by the HWs Sufficient trained health staff to conduct monitoring Adequate monitoring and supervision Low budget for Monitoring and Supervision Coordinato rs With good of knowledge about M and S Lab Health Workers were trained Updates on NTP given to professional s Low budget to monitoring and supervision Multifun ction of supervis ors Laborato ry supplies were sufficien t provided Maintenan ce of microscop es was improved Budget for training programs provided IEC materials were sufficient provided HE were conducted by H facilities OBJECTIVE ANALYSIS

10 CRITERIA CASE FINDING ACTIVITIES APPROACH PROJECT SELECTION HEALTH EDUCATIO N APPROACH MONITORI NG AND EVALUATI ON APPROACH COMBINED CASE FINDING ACTIVITIES AND HEALTH EDUCATIO N APPROACH COMBINED HEALTH EDUCATIO N AND MONITORI NG AND EVALUATI ON APPROACH COST BENEFIT FEASIBILIT Y SOCIAL RISK AVAILABLE RESOURCE S TOTAL

11 PROJECT NAME: Improving case finding through effective Laboratory management and health education in the National Tuberculosis Program of Peru DURATION: April April 2009 TARGET AREA: Peru country TARGET GROUP: Health workers and community. DATE: February 12, 2006

12 PROJECT DESIGN MATRIX Narrative Summary Objectively Verifiable Indicators Means of Verification Important Assumptions Overall Goal: To achieved a case detection of 90% or more The case detection rate will increased by 40% in 2009 Annual Reports Cohort Analysis Health Indicators The new government will permit to continue the project. Project Purpose: 1. Case finding are improved. 2. Good knowledge about TB by health workers and community. 1.The number of TB cases detected increased by 20% in The number of major errors are reduced by Laboratory reduced by 50% in The number of health workers with knowledge about TB increased by 30% in The number of community with knowledgeable about TB increased in 20% in Annual Reports KAP Survey about knowledge in health workers and community National Institute for Health continue to support the NTP Trained health workers will remain working with the health directions.

13 Outputs: Quality of Laboratories improved. Health Workers increased knowledge on NTP Knowledge about TB for the Community is improved. 1.The number of Laboratories with good equipment and supplies increase by 40% in The number of Health workers with high knowledge about NTP increase by 50% in The number of community with high health education about TB increase by 30% in Annual Report of National Institute of Health KAP Survey about knowledge in health workers and community National Institute for Health continue to support the NTP Assigned budget for KAP Survey

14 Activities: 1.Conditions of Laboratory facilities improved. 2.Laboratory supplies were sufficient provided. 3.Maintenance of microscopes was improved. 4.Med Tech and laboratory technicians were trained. 5.Budget for training programs provided. 6.Updates on NTP given to Professionals (P,N,M) 7.ACS Plan is being implemented. 8.IEC materials were sufficiently provided. 9.Health education were conducted by H facilities. 10.Health education was provided by the HWs. Inputs: NTP Staff. Funds Facilitators. Surveyors. NTP Coordinators. Printer materials. Meeting places. Training materials. Preconditions: Acceptance of the project by the authorities of Ministry of Health. Acceptance of the project by the authorities of Regional Directions of Health. Allowance of budget for proposal. Good attitude of Regional Coordinators. Active participation of Stakeholders. Active participation of Community leaders.

15 Inputs NTP Staff Funds Facilitators Surveyors. NTP Coordinators. Printer materials. Meeting places. Activities Conditions of Laboratory facilities improved. Laboratory supplies were sufficient provided. Maintenance of microscopes was improved. Health worked were trained in TB. Med Tech and laboratory technicians were trained. Budget for training programs provided. Updates on NTP given to Professionals (P,N,M) ACS Plan is being implemented. IEC materials were sufficiently provided. Health education were conducted by H facilities. Health education was provided by the HWs. Training materials.

16 ACTIVITIES 1.GOOD CONDITION OF LABORATORIES 1.1. Hold meeting for Laboratory Technicians to do situational analysis. 2. CONTINUOUS TRAINING OF HEALTH WORKERS 2.1. Get meeting with Regional Directors for increase budget for training Initial survey about KAS of TBC in Health workers and community Training about TB for Health Workers Refresh Training to Laboratory Health Workers Invite a professional manteinance companies to do manteinance (fixying,cleaning,etc) Supply of laboratory materials each quarter Maintenance of microscopes Acquisitions of new microscopes for replace old of them.

17 ACTIVITIES 3. IMPLEMENTATION OF ACS PLAN 3.1. Activities about ACS Plan Submit of summary report about ACS Plan to stakeholders Presentation to ACS Plan to authorities Approbation of ACS Plan to authorities Meeting with stake holders about ACS Plan Meeting with community leaders about ACS Plan Workshop with coordinators about ACS Plan Training to coordinators in ACS Activities of the ACS Plan Preparation of IEC materials Distribution of IEC materials Local theathers,festivals Rally Interchange experiences Monitoring meetings of ACS Evaluation meetings of ACS. IT S POSSIBLE?

18 YES!!! IT S POSSIBLE FOR THEM!!

19 SACCSAYHUAMAN MACHU PICCHU AREQUIPA THANKS FOR YOUR ATTENTION AND WELCOME TO PERU!!