NTP Managers Meeting 2002

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NTP Managers Meeting 2002

• Damascus, Syrian Arab Republic
• 15 17 September 2002

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EMRO Stop TB Team
3
We finished the first round

• Good DOTS expansion
• 18 countries with DOTS ALL OVER
• Yemen Sudan gt 90, Somalia gt 70
• 80 treatment success rate
• Good innovative
• Private public mix, partnership
• 414,992 patients under DOTS (9802)
• Saved 250,000 lives 1 million family members

However. (or And.)
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We have a 2nd round problem
DOTS Case Detection Rate
Global Target
Regional trend
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Pakistan Afghanistan

• 55 of EMR burden
• Low DOTS coverage
• PAK 24
• AFG 15(end 2001)
• Low case detection
• PAK 3
• AFG 9(2000)

Others
PAK43
AFG12
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Due to the 2 high burden countries?
DOTS Case Detection Rate
Global Target
Regional trend
Pakistani trend
Afghanistan
7
How about other countries?
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Notifications of TB cases from other health care
providers in EMR
9
How about other countries?
DOTS Case Detection Rate
Other countries trend
Regional trend
Pakistani trend
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Low DOTS Case Detection Rate in EMR (in
comparison with global average)
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EMR starting pointAgenda of the meeting 2002

• Issue
• Improve case detection rate while maintaining
  high treatment success rate
• Main agenda in the Meeting 2002Case detection
  rate

Notified cases
Estimated cases
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EMR Starting Point

• Improve Notifications
• Improve quality case management
• Improve comprehensiveness health sector
  involvement
• DOTS expansion in Afghanistan, Pakistan etc.
• Revisit Estimates
• Revisit estimates

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Improve Notifications

• Quality case management
• Laboratory network
• TB surveillance
• High risk group management
• Adult lung health initiative
• Comprehensiveness intersectoral collab.
• Private public mix, other health sectors
• Operational research

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Improve quality 1

• Laboratory network
• Regional SNRL development
• Quality assurance system
• Lab training course
• Drug resistance surveys

Improve N Quality
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Improve quality 2

• TB surveillance
• Improved use of quarterly reports
• High intermediate burden countries
• District based, computerized system at central
  level
• Nominal (individual) TB surveillance
• Low intermediate burden countries
• Present in Qatar Syria, Pilot in Egypt Iran
• Computerized, nominal system

Improve N Quality
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Discrepancies from DOTS FAX
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Improve quality 3

• High risk group management
• Contact management system
• Strategy management package development
• Specific guidelines, recording reporting forms
  including those for preventive treatment
• Adult lung health initiative
• Pilot operation is ongoing in Morocco

Improve N Quality
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Improve comprehensiveness

• Intersectoral collaboration
• Private public mix
• Protocols implementation
• Medical schools
• Collaboration guidelines published
• Operational research
• 7-country study on delay analysis (02)
• Workshop with IUATLD/USAID (Oct 02)

Improve N Comprehensiveness
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DOTS Expansion

• National capacity development
• National commitment
• Multi-year strategic plan
• National partnership
• IACC / CCM
• Multi Bi support
• International initiatives
• GDF, GFATM, etc

Improve N DOTS expansion
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Pakistan DOTS expansion

• Start showing changes
• Competent NTP strong political leader
• Increased GOP budget
• IACC strategic plan
• More partners
• WB, DFID, JICA, USAID..
• Continued expansion is challenge

Improve N DOTS expansion
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Afghanistan DOTS expansion

• 23-year wars just finished
• Very weak health services
• DOTS is just at start
• 1 MO NPOs
• IACC in July 2002
• Strategic plan underway
• CIDA support (2.1 M)
• JICA, Italy
• DOTS expansion in health reconstruction is
  challenge

Improve N DOTS expansion
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Main funding partners in EMR
Red support through WHOBlack
bilateralUnderlined under negotiationAGFUND
DRS support (0.1M total) Including donation in
kind
CIDA (2M)NOR (0.7M) ITALY (0.8M)JICA (1M)
AGFUND
USAID (2M)Dutch, AGFUND
USAID (2M)WB, DFID (0.2M)JICA (1M)GTZ(?),GDF,
GRLA, AGFUND
LHL/NOR (1M)IDB (2,7M), GDF
JICA (0.9M)GDF, AGFUND
NOR (0.8M)WHO
Norway (0.4M)GDF, WHO
FrenchGDFAGFUND
Improve N DOTS expansion
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Revisit estimates

• Hot countries
• Egypt, Iran, Iraq, Jordan, Syria, Sudan
• Improve N (notifications)
• Epidemiological surveys, studies etc.
• PPD survey in Oman, Sudan (2003)
• Disease prevalence survey (?)
• Epidemiological studies

Revisit E Estimation
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DRS and DOTS PLUS

• Drug resistant survey / surveillance
• Egypt has started
• 9 countries will start
• LEB, JOR, SYR, YEM, (SUD), 4 GCC
• AGFUND support (0.1M) to DJI, EGY, PAK, SYR, YEM
• Chronic case management
• Introduce chronic case register in all countries
• Introduce DOTS Plus to selected countries
• Adopt specific guidelines, recording reporting
  system

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NTP Managers Meeting 2002
Case detection rate in EMR

• PLANS TO
• Improve notifications
• Quality
• Lab, surveillance, HRG
• Comprehensiveness
• PPM, Other ministries
• DOTS expansion
• Pakistan, Afghanistan
• Review estimates
• DOTS Plus, Partnership

Global target
EMR trend