ATTAINMENT OF GLOBALLY ACCEPTABLE CURE RATE THROUGH QUALITY DOTS SERVICES IN SELECTED AREAS OF THE NATIONAL CAPITAL REGION (2006-2009) - PowerPoint PPT Presentation

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ATTAINMENT OF GLOBALLY ACCEPTABLE CURE RATE THROUGH QUALITY DOTS SERVICES IN SELECTED AREAS OF THE NATIONAL CAPITAL REGION (2006-2009)

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Title: ATTAINMENT OF GLOBALLY ACCEPTABLE CURE RATE THROUGH QUALITY DOTS SERVICES IN SELECTED AREAS OF THE NATIONAL CAPITAL REGION (2006-2009)


1
ATTAINMENT OF GLOBALLY ACCEPTABLE CURE RATE
THROUGH QUALITY DOTS SERVICES IN SELECTED AREAS
OF THE NATIONAL CAPITAL REGION(2006-2009)
  • Amelia C. Medina, MD, MPH
  • Head, Infectious Disease Prevention and Control
    Cluster
  • Center for Health Development-Metro Manila

2
The Philippines ......
  • Total Population 84,241,341 (2005)
  • Land area 300,000
    sq. kms.
  • Regions 17
  • Provinces 79
  • Cities 115
  • Municipalities 1,495

3
National Capital Region (Metro Manila)
  • Population 10,485,356
  • (2005)
  • Land Area 636 sq. kms.
  • Urban Poor Pop. 39.9
  • Pop. Density 16,486/sq.km.
  • Annual Growth Rate 1.06
  • Literacy Rate 94
  • Cities 14
  • Municipalities 3
  • Barangays 1,697

4
TB and NTP..
  • The Philippines is 9th among the 22 HBCs
  • 3rd in the Western Pacific Region
  • 6th leading cause of morbidity and 5th leading
    cause of mortality
  • Region wide implementation of DOTS in 2000
  • DOTS reporting centers
  • 433 health centers
  • 4 CHD-MM retained hospitals
  • 18 PPMD Units
  • 29 QA Centers
  • 14 TB Diagnostic Committees
  • 128 Microscopy Centers

5
Case Detection Rate, 2000-2004
6
Treatment Outcome 2003, New Smear () Cases
7
Cure Rate by City / Municipality, 2003
8
Cure Rate vs. Completion Rate, 2000-2003
9
Stakeholders Analysis
Beneficiaries Implementing Agencies Decision Makers Partner Agencies Funding Agencies Potential Opponents
TB cases Health Workers Community City Health Offices Health Centers Microscopy Centers Local Government Units City Health Offices Health Centers PPMD Units CHD-MM Retained Hospitals Selected DOH Hospitals NGOs Mass Media Faith-based Organizations Local Coalitions Local Govern-ment Units Center for Health Devt-Metro Manila Infectious Disease Office-DOH JICA LEAD for Health Project-MSH WHO TDFI-GFATM PhilCAT PhilTIPS-USAID CATiMM Local Government Units CHD-MM IDO-DOH GFATM LEAD for Health Project-MSH JICA Private Practition-ers Private Clinics Private Hospitals Govern-ment Hospitals
10
PROBLEM ANALYSIS
Poor socioeconomic condition
Increase morbidity and mortality from TB
Low Cure Rate
Health workers do not Implement NTP Policies and
guidelines
Poor adherence to treatment among TB cases
Monitoring patient response To treatment is
not Strictly followed
Weak monitoring and Evaluation of the program
Poor case holding management
Inadequate health education Provided to patients
Lack of IEC materials and collaterals
Insufficient number of Staff to conduct Health
education
Lack of commitment and Low morale of Health
workers
Health workers lack Knowledge on NTP
Defaulter mechanism Not implemented
Referral system not In place
Limited budget for health Promotion activities
Undermanned health centers
Untrained newly hired personnel
Lack of vehicle and Transportation allowance For
defaulter tracing
Low salaries and benefits
Insufficient budget for training
Non-filling up of vacancies
Exodus of health workers
Low salaries and compensation
11
PROBLEM ANALYSIS
12
OBJECTIVE ANALYSIS
Improved socioeconomic condition
Decrease morbidity and mortality from TB
High Cure Rate
Strict implementation of NTP Policies and
Guidelines by health workers
Good adherence to treatment among TB cases
Monitoring patient response To treatment is
Strictly Followed as scheduled
Effective and Regular monitoring and Evaluation
conducted
Excellent case holding management
Adequate health education Is provided to patients
Adequate IEC materials and collaterals
Sufficient number of trained Staff to
conduct Health education
Committed and highly motivated Health workers
Health workers are Knowledgeable on NTP
Defaulter tracing mechanism Is implemented
Functional Referral system
Provision of budget for health Promotion
activities
Well staffed health centers
Trained newly hired personnel
Vehicle and Transportation allowance For
defaulter tracing provided
High salaries and benefits
Sufficient budget for training
Vacancies filled up
Health workers stick with Their jobs
Health Education Approach
CAPABILITY BUILDING APPROACH
High salaries and compensation
13
OBJECTIVE ANALYSIS
Quality Assurance Approach
Monitoring and Evaluation Approach
QUALITY SERVICE APPROACH
14
PROJECT NAME ATTAINMENT OF GLOBALLY ACCEPTABLE
CURE RATE THROUGH QUALITY DOTS SERVICES IN
SELECTED AREAS OF THE NATIONAL CAPITAL REGION
  • TARGET GROUPS Health Workers
  • TARGET AREAS Cities of Valenzuela,
    Marikina, Muntinlupa and Las
    Pinas
  • DURATION Three (3) Years
  • SCHEDULE July, 2006 July, 2009

15
Narrative Summary Objectively Verifiable Indicators Means of Verification Important Assumptions
Overall Goal Decrease morbidity and mortality from TB TB morbidity and mortality is reduced by 10 at the end of the project. Health Indices Field Health Services Information System The change in administration will not affect project imple- mentation Comprehensive Unified Policy (CUP) on TB is strictly followed by other GOs, NGOs, POs, etc.
16
Narrative Summary Objectively Verifiable Indicators Means of Verification Important Assumptions
Project Purpose To achieved a cure rate of 85 or more. Increased cure rate by 30 in 2009 Cohort Analysis Private Initiated PPMD Units continuously network and coordinate with their public counterparts
17
Outputs Health workers complied and strictly implemented the NTP policies and guidelines on case holding management. 1.1 By the end of the project, all health workers are trained and accurately and effectively implement the NTP policies and guidelines on case holding mechanism. 1.2 Policies and procedures for detecting defaulters and getting them back to treatment are implemented and monitored for effectiveness in 100 of DOTS centers by 2009 1.3 By 2009, 80 of the DOTS Centers developed and implemented policies and procedures ensuring an effective referral system 1.4 Defaulter and transfer out rates is less than 3 by 2009 Baseline and Endline Survey Results NTP Records and Reports Written policy/ protocols on defaulter tracing Cohort Analysis Referral/Transfer Forms Return Slip from Receiving Units NTP Register Cohort Analysis Trained health workers will remain working with the health offices. Budget will be provided by both the Department of Health and local government units as planned.
18
Outputs 2. Laboratory networks with Quality Assurance System established. 3.1 All sputum follow-up examinations are performed on scheduled dates during the course of treatment. 3.2 External Quality Assessment conducted every quarter by qualified controllers by the end of 2007. 3.3 All microscopy and quality assurance centers have functional microscopes and adequate laboratory supplies. NTP Register Feedback Sheets Follow up Sheets Annual Slide Reading Quality Check and Smear Preparation Quality Check Inventory Reports Stock Cards Patients do not have the difficulty of collecting sputum specimen towards the end of treatment Controllers will not be assigned to other sections of the public health laboratory Trained medical technologists stick on with their jobs

19
Outputs 3. Effective and comprehensive monitoring and evaluation is regularly conducted. 3.1Quarterly monitoring and supervision conducted. 3.2 DOTS centers with improved recording and reporting system increased by 95 at the end of the project. 3.3 Standard monitoring tool developed and used at all levels. Interview of health workers Written reports and recommendations made during supervisory visits. NTP records and reports Filled-up monitoring tools Other funding agencies like Global Fund, JICA and MSH will not require specific monitoring tool for their projects.
20
Outputs 4. DOTS Centers are certified and accredited 90 of DOTS centers are certified and accredited by 2009. List of Certified and Accredited DOTS Centers from NCC-PPMD Certification Standards are sustained by the certified and accredited facilities.
21
ACTIVITIES
  • 1.1 Training Needs Assessment
  • 1.2 Capability Building
  • 1.3 Development and maintenance of a database on
    human resource development
  • 1.4 Workshop on policy formulation
  • 1.5 Formulate and implement a DOTS Centers
    networking and referral system.

22
ACTIVITIES.
  • 2.1 Setting-up of quality assurance centers
  • 2.2 Training of Controllers on External Quality
    Assessment
  • 2.3 Training of untrained Medical Technologists
    on Basic NTP Microscopy
  • 2.4 Training of laboratory technicians on sputum
    smearing and staining procedures
  • 2.5 Inventory and provision of microscopes and
    laboratory supplies
  • 2.6 Provision of recording and reporting forms.

23
ACTIVITIES.
  • 3.1 Development of a monitoring tool
  • 3.2 Development of a Monitoring and Evaluation
    training syllabus
  • 3.3 Training of coordinators and supervisors on
    NTP monitoring and evaluation
  • 3.4 Supervised field practicum on ME
  • 3.5 Quarterly monitoring and supervision
  • 3.6 Quarterly program implementation review
  • 3.7 Year-end evaluation and consultative planning
    workshops

24
ACTIVITIES.
  • 4. DOTS Centers certification and accreditation
  • 4.1 Organize and train TA teams for DOTS
    certification
  • 4.2 Actual provision of technical assistance
    on DOTS Certification and Accreditation
  • 4.3 Conduct assessment and certification of
    DOTS Centers
  • 4.4 Coordinate with PhilHealth for
    accreditation
  • 4.5 Quality check of certified and accredited
    DOTS Center for sustainability

25
ACTIVITIES.
  • 5. Support activities
  • 5.1 Operational research on patients
    delay
  • 5.2 Pilot study of a surveillance system for
    NTP

26
INPUTS
  • Manpower
  • NTP City Medical Coordinator
    Statistician
  • NTP City Nurse Coordinator Physicians
  • Controller
    Nurses
  • HEPO
    Midwives
  • Supervisors at least 3/city
    Medical Technologists
  • Sentrong Sigla Coordinator
    Laboratory Technicians
  • Assessors and Certifiers BHWs
  • TA Team for DOTS Certification and Accreditation
  • Vehicles
  • Transportation Allowances
  • Equipment and Laboratory Supplies
  • Glass slides glass slide boxes
    AFB Staining Kits
  • Sputum cups
    Transport Boxes
  • Immersion oil
    Disinfectants
  • Reporting and Recording Forms
    Alcohol
  • Microscopes
  • Facilities
  • DOTS Centers

Project Cost Php 8,000,000
27
PRECONDITIONS
  • 1. The city government and the city health
    offices will have a full support to the project
  • 2. Clear budget allocation from the national and
    local government

28
THANK YOU!
  • THANK YOU!
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