EMR TB Strategic Plan Workshop Going Over the Magic Mountain TB control in the next 10 years

1
EMR TB Strategic Plan WorkshopGoing Over the
Magic MountainTB control in the next 10 years

• Stop TB
• WHO EMRO

2
Year 2005 climbing station

• 10 years after DOTS introduction
• DOTS Basic package for TB Control
• Proper diagnosis, treatment, monitoring,
  logistics and political will for TB control
• Amid the progress to the global targets
• Detect 70 of existing cases, and successfully
  treat 85 of them
• 10 years to Millennium Development Goals
• Have halted by 2015 and begun to reverse the
  incidence of TB (MDG Target 8 of Goal 6)

3
TB control climbing path
4
Stages of TB control and expected trend of case
notifications
Stage III a. Reduce burden(Halve prevalence
deaths)
Stage I. Expand services (100 DOTS, 85 TSR)
Stage II. Improve service quality(85 TSR 70
CDR)
Stage III .b Reduce burden(Halve incidence)
DOTS Case notification rate
5
Situation of TB control in EMR

• DOTS expansion is almost done (Stage I)
• 100 coverage in 19 countries
• gt80 regional population covered
• Still expansion in Afghanistan, Somalia and
  south-Sudan (complex emergency)
• Majority are in Stage II (improve quality)
• 84 treatment success (regional average)
• 28 case detection (regional average)

6
Situation of TB control in EMR
7
Year 2005 progress in climbing

• Base camp is established
• Good DOTS in MOH services
• 100 in Pakistan (May 05)
• 81 treatment success
• But, the path is muddy
• Very low case detection
• We need to pave the path
• Look into DOTS component
• DOTS in complex emergency
• We need to widen the path
• Address new challenge
• Different sectors, HIV, Chronic TB, respiratory
  care, community etc
• Revise the height estimate

Trend in case detection in EMR (1999-2003)
Global target
Other 20 countries combined
AFG PAK combined
8
Why we have to pave the path?
Public health facilities involved in DOTS Karachi
Sindh Province TB Control Programme, Feb 2005
9
Why we have to pave the path?
Laboratory QA possible?
Good reporting possible?
Drug management possible?
10
Why we have to pave the path?
With ENRS, Yes Good reporting is possible!
11
Why we need to widen the path?
Non-public health facilities involved in DOTS
Karachi
Sindh Province TB Control Programme, Feb 2005
12
Why we need to widen the path?
PR 30 per SM
PR 10 per SM
Free SM
PR Pakistani Rupee US 1 PR 59SM Smear
examination
Sm
Joint Pakistan TB Review Feb 05
13
Why we need to widen the path?
Basiran, 35F married, mother of twoTB treatment
last 3 yearsSpent almost US 600 .Husband sold
all his live-stocksand bankrupt (catastrophic
expenditure)
14
Why we need to widen the path?
TB campaign
15
Why we need to revise the height?
16
How we will proceed?

• Vision
• Achieve 70/85 by 200X (Stage II outcome target)
  MDG by 2015 (Stage III reduction targets)
• Strategy
• DOTS.2 (New Stop TB Strategy)
• Expanded, comprehensive strategy to provide
  universal standard of TB care for all those
  suffering
• Enhancement of DOTS activities
• Embracement of new approaches tools

17
DOTS.2 (New Stop TB Strategy) - I

• Enhancement of DOTS
• Enhancement of key component of DOTS
• Laboratory network
• Surveillance including ENRS
• Drug management
• Supervision
• Expansion of DOTS in complex emergency
• Afghanistan, Somalia, Sudan etc
• Human resource development

18
DOTS.2 (New Stop TB Strategy) - II

• Embracement of new approaches tools 1
• Expanded partnership
• National Regional Stop TB Partnerships
• Advocacy, Communication Social mobilization
• Community-Based Initiative (BDN)
• Health sector involvement
• Public-public-private DOTS
• Comprehensive care for vulnerable populations
• HIV/TB
• Care for chronic / MDR TB (DOTS Plus)
• Comprehensive approach in respiratory care (PAL)

19
DOTS.2 (New Stop TB Strategy) - III

• Embracement of new approaches tools 2
• Preventive methods
• Preventive chemotherapy for latent infection
• Vaccination (BCG)
• Infection control
• Epidemiological review of TB burden
• Epidemiological surveys
• Drug resistance survey/surveillance
• HIV seroprevalence survey
• Research Development
• Operational research
• New tool development

20
Steps to move with DOTS.2

• 10-year national regional strategic plans
• Directions, activities cost to achieve MDGs
• Formulation of DOTS.2 concept
• Revision of National TB guidelines for MDGs
• National regional stop TB partnerships
• Partnerships to achieve the MDGs

21
Inter-country workshop

• 10-year national regional strategic plans
• Strategic directions to achieve MDGs
• DOTS.2 (New Stop TB Strategy)
• How to enhance DOTS embrace new approaches
• Indicators to monitor and predict
• Case detection treatment outcome
• Epidemiological impact (inc. prev. mort)
• Costing exercise
• Total cost to achieve the MDGs

22
Inter-country workshop

• Hit four birds with one stone!
• Formulate National strategic plans
• Directions, activities, cost and impact
• Formulate regional strategic plan outlines
• Contribute to Global Plan.2 to Stop TB
• Contribute to MDG exercise at all levels
• The real bird to hit is the money
• Regional national partnerships to fill the gap!
• And Going over the Magic Mountain

23
Going Over the Magic Mountain