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Engaging All Care Providers in S.E Asia Region Approach to Health Systems Strengthening

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Engaging All Care Providers in S.E Asia Region Approach to Health Systems Strengthening Jan Voskens. IUATLD Paris, 31 October 2006 Summary Why is engaging all care ... – PowerPoint PPT presentation

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Title: Engaging All Care Providers in S.E Asia Region Approach to Health Systems Strengthening


1
Engaging All Care Providers in S.E Asia
Region Approach to Health Systems Strengthening
  • Jan Voskens.
  • IUATLD Paris, 31 October 2006

2
Summary
  • Why is engaging all care providers a component
    of the Stop TB Strategy?
  • PPM status, results and evidence of success
  • Tools and guidelines to address barriers for
    scale up
  • Lessons for health systems strengthening
  • Plans and Next steps

3
Treatment seeking behavior TB patients (Prevalence
survey 2004)
4
Private and Public Partners
  • Hospitals China, Indonesia
  • Private Practitioners India, Indonesia,
    Bangladesh, Philippines, Myanmar etc
  • Medical colleges India, Indonesia
  • NGO facilities and Community Based Organizations
  • Corporate sector (workplaces) all countries
  • Public sector providers other then MoH other
    Ministries, prisons Health Insurance facilities
    etc. (India, Indonesia, Bangladesh, Philippines)

5
Task Mix (generic)
Source draft GUIDE ON ENGAGING DIVERSE HEALTH
CARE PROVIDERS IN TB CONTROL, StopTB
6
Components of Stop TB Strategy PPP Focus
7
HBCs with PPM DOTS initiatives, 2006
High burden countries without PPM pilots
High burden countries with PPM initiatives
High burden countries scaling up PPM
8
PPM Situation in Member Countries in SEAR
National policy and guidelines in place, scaling up India, Indonesia, Myanmar, Nepal
National policy in place, Widespread involvement of NGOs pilots involving PPs Bangladesh
Formative stage Sri Lanka, Thailand, Timor-Leste
No anti-TB drugs in private sector Bhutan, Maldives
No private health care DRR Korea
9
Public health impact of PPM
  • Improves quality of care success rate above the
    target of 85 (vs. lt50 in non-DOTS)
  • Increases case detection 10-50 increase !
  • Reaches the poor
  • Bangalore study 50 of patients were from the
    lowest socioeconomic strata (of 3 SES groups)
  • Myanmar study 67 of patients treated by private
    GPs were from the two lowest socioeconomic groups
    (of 5 )
  • Financial protection 50-100 US reduction for
    patients in India (compared to private non-DOTS)
  • (over 30 evaluated initiatives in more than 20
    countries)

10
(No Transcript)
11
Is PPM cost effective?
  • Cost effectiveness of PPM has clearly been
    demonstrated in studies from India, Philippines
    and South Africa .
  • PPM-DOTS can be affordable and cost-effective
    compared to treatment provided through NTP
  • similar or lower cost per patient treated
  • similar or better cost-effectiveness

12
Funding sources
  • Government / Ministries
  • GFATM
  • Fidelis
  • TB CAP
  • Bilateral donors (USAID CIDA, etc)
  • National and international NGOs
  • Corporate sector

13
Challenges
  • Building trust
  • Combining approaches Public Health
    Clinical
  • Scaling up successful pilots
  • Investments in HRD
  • All hands on deck !!
  • expanding Quality DOTS in other sectors
  • to curb MDR

14
Different views perspectives
Public Health workers
Clinicians In Private sector
15
Barriers to PPP expansion identified in 3rd
Subgroup Meeting 2005
  • Lack of commitment of NTP and MoH
  • Limited capacity of NTP (staff numbers, time,
    motivation, skills)
  • Lack of tools
  • Guidelines
  • Training materials and tools
  • Advocacy tools
  • Limited technical support (regional, global)

16
Tools and guidelines
  • responding
  • to the barriers identified

17
1. PPM guidelines and documents
  • Technical Application
  • Tuberculosis Control Assistance Program
  • (TB CAP)
  • RFA Solicitation Number M-OAA-GH-HSR-05-1015
  • Submitted To
  • United States Agency for International
    Development
  • Ronald Reagan Building, 7.09-064
  • 1300 Pennsylvania Avenue, N.W.
  • Washington, D.C. 20523
  • Submitted By
  • KNVC Tuberculosis Foundation
  • Riouwstraat 7, The Hague
  • Documents from WHO PPM projects
  • and PPP Subgroup reports

18
Lessons for Health System Strengthening (1)
  • Generic constraints in health systems
  • HR crisis how to involve human resources
    available in other sectors?
  • Weak governance / stewardship of MoH, especially
    vis-à-vis private sector providers
  • Many providers alienated from public health
    programmes and disease surveillance
  • Patients waste large part of their limited
    resources (out-of-pocket) on poor quality health
    care

19
Lessons for Health System Strengthening (2)
  • PPM experiences provide valuable lessons for
    HIV, malaria other programs
  • Building capacity in public sector to engage
    other care providers (private-, hospitals,
    prisons, army etc.)
  • Practical approaches to map out and work with
    other providers,
  • Management framework to involve other sectors
    (steps)
  • Proper compensation / incentive schemes for
    various providers, etc

20
Lessons for Health System Strengthening (3)
  • Sensitisation of private and other providers to
    take on public health tasks including
    surveillance (standardised recording and
    reporting)
  • Improved linking and referral systems
  • Standardised quality care services at low cost
    across the health system

21
Plans next steps
22
Planned activities to assist scaling up of
PPM(1)
  • Technical assistance for PPM Country planning
  • Development of generic PPM strategies
    operational guidelines
  • (based on Stop TB Strategy, Global and Regional
    plans, "PPM Guidance Document", ISTC, the
    "Planning and budgeting tool", situational
    analysis tool, etc
  • Development of national PPM strategies and
    guidelines,
  • PPM planning workshops in regions
  • Advocacy for PPM to catalyze wider implementation

23
Planned activities to assist scaling up of
PPM(2)
  • HRD
  • More staff needed (focal points/ external TA)
  • Regional training for focal points and national
    PPM consultants
  • PPM consultant course April 2007, Sondalo
    (11-18)
  • Training of NTP staff on interacting with
    partners at operational level

24
Planned activities to assist scaling up of
PPM(3)
  • International Standard for TB Care (ISTC)
  • Dissemination of ISTC
  • Inclusion of ISTC in pre- and in-service training
  • Developing implementation guide for ISTC

25
Planned activities to assist scaling up of PPM
(4)
  • 4. Hospital linkage, public-public mix
  • Postgraduate course on hospital-linkage, (IUATLD
    06)
  • Development of operational guidelines for
    hospital-linkage, including workshop in Asia 2007

26
Planned activities to assist scaling up of PPM
(5)
  • 5. Monitoring and Evaluation
  • Include assessment of PPM in every program review
  • Encourage use of PPM indicators
  • OR on selected issues (e.g. cost-effectiveness,
    TB-HIV, DOTS plus etc)
  • Document new and on-going PPM initiatives

27
Thank you for your kind attention
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