Gaining and Maintaining Political Commitment

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Gaining and MaintainingPolitical Commitment
Michael E. Kimerling MD, MPH University of
Alabama at Birmingham Gorgas TB Initiative
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5 Components of DOTS Programs

• Political commitment to sustained TB control
  activities to be present at all levels local,
  regional, national
• Case detection by sputum smear microscopy for
  symptomatic patients, who are most likely to
  transmit disease
• Standardized treatment regimen for all sputum
  smear positive cases, with directly observed
  therapy (DOT) to achieve high cure rates and
  avoid drug resistant TB
• A regular, uninterrupted supply of all essential
  anti-TB drugs
• A standardized recording and reporting system
  that allows assessment of treatment results for
  each patient and of the TB control program's
  overall performance

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Main Actor in NTP
Global
PAHO Region
National
Region Health Area
District
The mission of all levels is to ensure every TB
patient access to effective diagnosis, treatment,
and cure. TB patient is a central actor of the
National TB Program.
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• Government commitment to sustained TB control
  has the following components
• Policy formulation
• Support with financial resources
• Support with human resources and
• Administrative support necessary to ensure that
  TB control is an essential part of health
  services.
• Strategy to control TB in the WHO European
  region, Copenhagen, Denmark, 2000

Dr. Indira Aimagambetova, USAID/CAR
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Components of health policy
Context
Actors
Process
??ntent
Gill Walt. Health Policy. An Introduction to
Process and Power. London, 2000
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Process of TB Policy Formulation
Problem TB epidemics
Implementation NTP
Evaluation
What to do? DOTS strategy
Gill Walt. Health Policy. An Introduction to
Process and Power. London, 2000
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Human Resources
Identification of needs
On-job training
Theoretical and practical training
Management
Monitoring and evaluation
Distribution of human resources
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Issue of credibility

• For staff are you coming back?
• Early engagement in process
• For prisoners What do they get?
• Show a plan early Feasible in a given context
• Take action Move beyond words only
• Need some resources
• Show results Data for informed discussion
• Commitment to continuous dialogue Purpose of
  continued improvement and problem-solving

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Commitment in Honduras

• Administrative support To initiate TB control
  prison program, and active participation in
  evaluations
• MOH, MOS
• Policy formulation Developed through joint
  prison-civil workshops (bottom ? up approach)
• Human resource development Tied to DOTS
  expansion, integrated into PHC
• Includes high-level policymakers

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Commitment in Honduras

• Financial support initially generated at the
  prison level (directors) and through staff
  initiatives with local support (church,
  community, other)
• But need funding allocations from local, regional
  and national levels
• Prison TB Control must be identified as a funding
  priority based on national objectives

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NTP (Civil) and Prison Health Staff (MOS)
Workshop Presentation Workshop Beginning to
plan together (Tegucigalpa, Honduras May 2001)
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Collaboration between the civil and penal sectors
established for the benefit of staff, inmates and
their families
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Who is a Respiratory Symptomatic? How do we
select them?
All RS identified are entered into a Cough
Registry
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In Honduran prisons, we now have operations

• but we need political commitment to keep it
  going and to improve the services provided issue
  of continued credibility

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Whose responsibility? Not mine!

• Joint prison-civil?
• Larger community?
• Church?
• Health Staff?
• Somebody else?

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How do you start the process?

• First step?
• Second step?
• Must be practical