Progress and plans on PPM in TB Control in South-East Asia Region Dr Md Khurshid Alam Hyder Regional Adviser-TB WHO/SEARO
3 million new cases 500 000 TB deaths every year, but relatively low MDR-TB and HIV prevalence in most parts of the Region mean that cost-effective interventions today, will go a long way in the future
The Stop TB Strategy and Regional Strategic Plan, 2006-2015 Sustaining and enhancing DOTS to reach all TB patients, improve case detection and treatment success Establishing interventions to address TB/HIV and MDR-TB Forging partnerships, including with communities, to ensure equitable access to international standards of TB care for all Contributing to strengthening health systems
Private and Public Partners Bangladesh: >90% of TB services through NGOs; Prisons, medical colleges, railways, garment industries being involved Bhutan: private pharmacy retailers, traditional practitioners India: 282 medical colleges; >10,000 PPs; >2000 NGOs; > 150 corporate houses; tea estates, railways, employees state insurance hospitals, Ministries of Shipping, Mines, Petroleum and Oil, Indian Medical Association; District TB Societies; Rotary International Indonesia: All lung clinics and hospitals; >30% of large hospitals; 7 medical schools; Ministry of Defence Myanmar: Private providers; MMA; Railways; Ministries of Defence, Religious affairs; Labour, Education and Home Affairs to be involved Nepal: Private providers; teaching hospitals, communities through village and district DOTS committees; nursing homes, I/NGO, CBO, pharmacies, volunteers, factories, slum areas, prisons Sri Lanka: NGOs; Medical Practitioners Association; private specialists Thailand: Bangkok metropolitan administration (NHSO), prisons systems, community based organizations, local and international NGOs, Thai business coalition Timor Leste: NGOs, Church health network
Factors that have contributed to success Strong public sector commitment, initiative: (India, Myanmar, Indonesia) Interest on part of many providers NGOs: BRAC, Damien (Bangladesh) Caritas (Timor-Leste) Corporate sector: (Bangladesh, India) Use of existing resources, external support GF in most countries; UAB in Indonesia, PSI in Myanmar, Nuffield in Bangladesh, Nepal Provision of guidelines, necessary additional inputs by NTPs (intensified training, drugs, assistance with reporting, patient retrieval) Allowing flexibility, while ensuring adherence to technical guidelines (India, through various schemes)
Factors that have contributed to success Continuous dialogue (through professional forums, national and regional/district level meetings Use of interfaces: Medical association( Delhi); not-for profit hospital (Hyderabad) ; Regional task forces (Medical colleges, India) for coordination, consensus Recognition of private sector contribution (Mahavir, Hyderabad, India) Documentation, dissemination of information on successes: Yogyakarta, Indonesia, Mahavir, India, Increase in client base due to visibility provided by DOTS: e.g., Hyderabad, India; SQH, Myanmar
Factors that have contributed to success Intensified training of private and public hospital and laboratory staff in Indonesia; pre-service training in medical schools: India 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 Kannur, 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
Impact on case finding Partner Site Increment in case notifications NGOs Bangladesh ~30-35% Private Hospitals, Private practitioners Hyderabad, India 23% Lalithpur, Nepal 21% Delhi, India 29% N. Sumatra, Yogyakarta and Palembang, Indonesia 24% Taunggyi, Myanmar 10% Medical Schools India 10-20% Industry, workplaces EPZs, Bangladesh Increments in case finding among young women up to 20% Tea Estates, India ~24%
Regional Priorities 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 application 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 Organize a regional training for national consultants/focal points on strengthening public-private partnerships (long-standing dream!)
Q: How can we further enhance engagement of the private sector to further increase access to quality services?
Conclusions-SEA Regional Workshop on PPM (19-23 September 2011) Insufficient commitment and priority to PPM; Only a small proportion of PPs are involved; Involvement of nonqualified PPs is minimal; Many health NGOs are not engaged in TB care; Suboptimal involvement of large hospitals (public/private/corporate/academic); Weak documentation and reporting of PPM contributions; Regulatory approaches for rational practices and drug use are nonexistent in most member states; Implementation of national plans for PPM is inadequate.
Recommendations-SEA Regional Workshop on PPM (19-23 September 2011) Create a Regional Advisory Group to expedite and monitor PPM scale-up; Prioritize PPM in the agenda of the TWG & programme managers meetings; Programme manager to raise the priority for PPM & mobilize human & financial resources through GFATM, TBREACH etc; Utilize intermediary organizations and innovative approaches to enhance the involvement of PPs; Promote ISTC/patient charter by the member states and WHO; Develop specific mechanisms to target non-qualified providers/pharmacies; Map NGOs working for health and encourage those not involved to work for TB;
Recommendations-SEA Regional Workshop on PPM (19-23 September 2011) Cont. Develop country specific schemes for involving large hospitals in consultation with the higher authorities responsible for hospitals, specifically addressing internal coordination and external networking; Insist on proper documentation of the contribution of PPM and reporting the same at the national & global levels; Understand and initiate country specific needs & mechanisms to implement regulatory approaches including mandatory case notification, accreditation & rational drug use; Ensure proper implementation & monitoring of the national PPM scale-up plan.
Thank You