introduction thailand one of 22 countries which contain 80% of the estimated tuberculosis (tb) cases...

IntroductionIntroduction

•Thailand one of 22 countries which contain 80% of the estimated tuberculosis (TB) cases in the world.

•Thailand ranks 17th among the 22 high-burden countries (HBCs)

•Low cure rates (17-68%).

•Patient compliance is the most serious problem

in TB-control.

BackgroundBackground

•1996 DOTS strategy was introduced in eight pilot districts

•4-7 years later, DOTS covered all districts in each region/province

•Training and supervision are seen as a core active for improving

•Cohort report is seen as a tool for NTP monitoring and evaluation

•Cohort data report flow from DTC-PTC-RTC-NTC

GoalsGoals

•To achieve 100% DOTS coverage with sustained quality

•To achieve 70% case detection (PTB+>63/100,000)

•To achieve 85% success rate

•To reduce defaulted rate to less than 5%

•To reduce MDR-TB to less than 2%

MOPHMOPH

DDC (TB cluster)DDC (TB cluster)Provincial Health OFProvincial Health OF

District HospitalDistrict Hospital

PCUPCU

12 Regional /DPC12 Regional /DPC

((SALT cluster)SALT cluster)

•Political commitment has not been successfully communicated to the peripheral levels

•Decreased managerial capacity in the context

•Weakened financial basis of the NTP

•Decreased performance of the NTP

•Insufficient preparation for decentralized drug procurement

Staff Place and duration

At least one doctor per hospital

At least one TB clinic staff per hospital

At least one laboratory staff per hospital

At least one DTC per district

At least one health worker per health center

At least one PTC per 500,000 population

At least three RTCs per region

One day at regional level

Two days at regional level

Three days at regional level

Four days at regional level

One day at district or provincial level

Four days at regional level

Four days at central level

SupervisionSupervision

The NTP has formulated a supervision plan covering all levels of the program as follows:

Supervising staffSupervising staff Level Level FrequencyFrequency

TB-Cluster

RTC

PTC

DTC

Health-center staff

Regional level

Provincial and district level

District level

Health-center level

Patients’ home level (when supervised by family members)

Once a year

Trimesterly

Trimesterly

Monthly

Weekly during intensive phase and monthly during continuation phase

• The NTP should develop a standard mechanism for supervision and collaborative meetings.

• All health facilities should develop their own plans for supervision and meetings in accordance with NTP guidelines.

• The NTP should develop a training course focusing specifically on supervision skills.

Recording and ReportingRecording and Reporting

•The analysis of reports by program managers at the regional level is uneven. The content and depth of analysis of the reports shown to reviewers varied by region.

•Significant delays in forwarding and compiling reports were observed. Only 11 of 75 provinces had submitted reports.

•There are two parallel systems of reporting TB cases. One is for disease surveillance through Form 506 to the Bureau of Epidemiology, the other is for the NTP trimester report through form TB07 sent to the TB cluster

Four CompetencesFour Competences

•Urban TB Control (9 Sub-contracts)

•Prison TB Control (3 Sub-contracts)

•HIV-TB integrated program (16 Sub-contracts)

•Cross-border TB control (3 Sub-contracts)

GFATM consolidated project activities GFATM consolidated project activities

•Expand DOTS services and case detection

•Communities and outreach, education and case detection

•Surveillance and monitoring and evaluation

•Capacity building, training

•Network of laboratory and QA/QC system

•Integrated care with regular health systems, and HIV-TB services

The Result of EvaluationThe Result of Evaluation

Areas On TB Control Grade

Urban TB control B1

TB control of the borders A2

TB and HIV/AIDS B2

TB-control in prisons A2

ObjectivesObjectives

•Strengthen TB program-management at all levels

•Capacity-building, training of NTP human resources and improve quality of NTP

•Improve TB-information systems

•Expand TB programs, TB/HIV programs and increase collaboration of partnerships including private sectors

•Promote public awareness and TB education in the general population and marginalized populations, including TB/HIV-infected

THAILANDTHAILANDIMPLEMENTING THE STOP TB STRATEGY IMPLEMENTING THE STOP TB STRATEGY

DOTS ExpansionDOTS Expansion

Achievements

•100 % DOTS coverage among health facilities under MOPH •Established DOTS strategy to cover all 138 prisons nationwide•Developed a comprehensive HR-development plan•Introduced TB education in nursing school


Challenges

•Increasing laboratory capacity for EQA by using Lot Quality Assured Sampling and improving supervision, monitoring, and evaluation activities

•Strengthen laboratory capacity for sputum culture at intermediate laboratory levels

•Implementing DOTS in mega city

•Include a TB/DOTS chapter in all medical training curricula


Planned Activities

•Strengthen DOTS through improved supervision, monitoring and evaluation

•Finalize and implement HR development information system

TB/HIV, MDR-TB and Other ChallengesTB/HIV, MDR-TB and Other Challenges

Achievements

•Established national TB/HIV coordinating board•Developed practice guidelines for collaborative TB/HIV activities and MDR-TB•Trained health-care workers in collaborative TB/HIV activities•Conducted third DRS•Strengthened supervision, monitoring and evaluation in TB-control in mobile and cross-border populations and poor urban areas


Challenges

•Establishing mechanisms for NAP and NTP collaboration •Developing TB/HIV training materials and curriculum•Strengthening laboratory capacity in regional TB laboratories


Planned Activities

•Expand collaborative TB/HIV strategies to all administrative levels countrywide •Develop further collaboration with NGOs working with migrants, mobile, and cross-border populations as well as the poor•Pilot-testing of a practical guideline for MDR-TB•Upgrade regional TB laboratories to reference laboratories

Strengthening Health SystemsStrengthening Health Systems

Achievements

•Developed collaboration between NTP and general hospitals and prison health services and conducted training for TB staff


Challenges

•Restructuring of health system, including the integration of tasks and rotation of staff•Increasing numbers of illegal migrants and mobile and cross-border populations ineligible for universal health coverage •Decentralization of budget-allocation system •Improving computer-based recording and reporting system


Planned Activities

•Scale up collaborative activities with general public hospitals, prisons and military services•Develop a list of standard indicators for TB management at all health facilities under MOPH

Involving All Care ProvidersInvolving All Care Providers

Achievements

•Strengthened supervision, monitoring and evaluation of DOTS services in prisons


Challenges

•Involving private practitioners and corporate health services in TB diagnosis and treatment


Planned Activities

•Collaborate with academic institutions to introduce TB curriculum to nursing, medical, and public-health schools

Community TB Care and Advocacy, Communication & Social Mobilization

Achievements

•Secured funding for community TB involvement from government and GFATM•Appointed village health volunteers (VHVs) as community DOT-observers in pilot areas

Community TB Care and Advocacy, Communication and Social Mobilization

Challenges

•Develop a national ACSM plan and technical capacity for ACSM at all levels

Community TB Care and Advocacy, Communication and Social Mobilization

Planned Activities

•Scale up involvement of VHVs

introduction thailand one of 22 countries which contain 80% of the estimated tuberculosis (tb) cases...

Documents