PPMDOTS in Cambodia Working with Private Pharmacies DOTS Expansion WG Meeting Paris 15th October 200

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PPM-DOTS in Cambodia Working with Private
PharmaciesDOTS Expansion WG MeetingParis 15th
October 2008Dr. Mao Tan EangDirector National
Center for TB and Leprosy Control (CENAT) MoH,
Cambodia

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Presentation Outline

• Background
• Rationale for PPM-DOTS
• Goal and Objectives for PPM
• Main Strategies for PPM-DOTS with Private Sector
• Achievement (up to June 2008)
• Key activities with Pharmacies
• Future plan
• PPM-DOTS partners

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I. Background

• In 2005 the National Tuberculosis Program (NTP)
  began to engage private providers in TB control.
• The NTP with support from their partners
  developed the Public-Private Mix (PPM) strategy
  (phase I Phase II) and PPM-DOTS in prisons and
  Factories .
• PPM-DOTS in prisons and Factories still at pilot
  phase.
• During Phase I, with USAID funds and JICA, NTP
  and partners designed and implemented a referral
  network between private health providers and
  pharmacies where symptomatic individuals seek
  care and public sector DOTS facilities in pilot
  provinces.

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II. Rationale

• Cambodia is among the 22 TB high burden countries
  
• Approximately two-thirds of all Cambodians are
  infected with TB, and around 13,000 Cambodians
  die annually from the disease
• NTP focus on reducing morbidity and death rates
  due to tuberculosis, a key strategy for improving
  the overall health of the population
• To align with the WHO Global strategy for TB
  control
• The private sector is accessible with two thirds
  of Cambodians seeking care outside the public
  sector for their first visit with TB symptoms

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III. Goal and Objectives for PPM

• Goal
• To test-out and scaleup a public-private mixed
  DOTS partnership
• model that aims to strengthen both, the public
  and private sectors in TB
• case management and increase case detection
• Objectives
• Reduce diagnostic delay for people with suspected
  TB, increase case detection, and decrease the
  opportunity for multi-drug resistant
• Strengthen public-private linkages partnerships
  in TB case management and control through a
  referral system to public DOTS services
• Improve access to quality DOTS services for
  people seeking care at the private sector
  providers by implementing DOTS services in
  private clinics and hospitals qualified by NTP
  (Phase II)

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IV. Main Strategies for PPM-DOTS with Private
Sector

• PPM-DOTS Phase I
• Private sector only responsible for referring TB
• suspects to public sector
• PPM-DOTS Phase II
• Private sector (excluding pharmacy and lab) can
• diagnose and treat TB patients ( not yet
  implemented)

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V. Achievements (3 years up to June 2008)

• Service coverage
• - PPM-DOTS available in 11 provinces and 38
  Operational Districts (OD)
  (total
  provinces 24, total OD77 in the country)
• - Private Clinics 488
• - Private Pharmacies 896
• Service provision

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(No Transcript)
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Phase I Strategy
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VI. PPM-DOTS with Pharmacies

• 1. Key activities
• Develop PPM strategy
• Identify and engage private sector partner
  (Pharmacists Association of Cambodia PAC)
• Review and revise national recording and
  reporting forms
• Develop standardized referral tools
• Develop IEC and training curriculums
• Develop Memorandum of Understanding agreements

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• Organize a sensitization workshop for public and
  private-public providers and sign MoU agreements
• Train Province and District TB supervisors to
  deliver pharmacy staff training
• Build capacity for national, Province and
  District TB staff on PPM and supervision of
  private sector
• Train pharmacy and DOTS health center staff
• Conduct quarterly Public-Private Partner meetings
  
• Facilitate pharmacy staff field visits to DOTS
  services
• Conduct monthly supportive supervision and data
  collection

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2. Main indicators

• Number of TB suspects referred from the pharmacy
  to the DOTS health center
• Number of TB suspects presenting at DOTS health
  center with referral from pharmacy
• Number of All types of TB identified among TB
  suspects referred from pharmacies
• Number of smear positive TB cases identified
  among TB suspects referred from pharmacies

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• 3. TB PPM sites (Private Pharmacies)

2005-2008 11 provinces 38 ODs 476
Health centers 30 Referral hospitals 896
pharmacies
Kandal
Phnom Penh
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4. Strengths

• Strong support from Pharmacist Association
  (attending meeting/WS and ME etc )
• Referrals from pharmacies in PPM areas are
  yielding high percentages of smear-positive TB
  cases out of those being evaluated, so that there
  is a clear benefit to involving pharmacies in TB
  case detection
• During this period 9,447 referrals were made of
  which 4,509 attended DOTS services and 844 were
  diagnosed to have TB.
• This result suggests that the pharmacies are an
  excellent location to identify undiagnosed cases.

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5. Weaknesses

• Overall, the proportion of TB suspects referred
  from the private pharmacies and the actual number
  who received follow-up at the public TB-DOTS
  facilities remains at around 50
• Based on the project follow-up results, there are
  some contributing factors to the lack of
  followup such as inadequate communication and
  recording system.
• Some private pharmacy staff do not provide clear
  information to the TB suspects in order for them
  to choose the most convenient location of DOTS
  facility.
• Limited incentives to both service providers
• linkage with other NGO network in and outside the
  PPM target areas is still limited

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VII. Conclusion Future Plan

• PPM-DOTS has contribution to overall TB case
  detection-contribution goes beyond concrete
  number of TB cases identified
• Evaluation after 3 year implementation
• Introduction of PPM-DOTS phase II (from 2009)
• Resource mobilization for maintaining and scaling
  up activities (GFATM,USAID)
• Involve more professional associations
• Expand DOTS in prison and factories

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VIII. Major Partners for PPM-DOTS

• USAID
• PATH ( with Pharmacies)
• JICA
• URC
• RHAC
• CATA
• GFATM (from 2009)

• Ministry of national Defense
• Ministry of Interior
• Ministry of Labor
• Pharmacist Association of Cambodia
• Medical Association of Cambodia
• Cambodia Medical Council

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• Comments/Questions
• mao_at_online.com.kh

Thank You