PPM DOTS Subgroup of DEWGLinking all health care providers to

National TB Programmes

PPM DOTS Subgroup Secretariat

DEWG, 27 October 2004, Paris

2003-2004 progress

• 2nd PPM DOTS Subgroup Meeting, SEARO, New Delhi, Feb. 2004

• Report on cost-effectiveness of PPM published

• "What makes PPM work?" Cross-site analysis published

• Intensified support to Countries

• Country missions to, Bangladesh, China, India, Kenya, Myanmar,

• PPM surveillance system being piloted in 12 of 14 cities scalingup PPM DOTS in India

• Facilitation of PPM project documentation

• Draft PPM DOTS guidelines under preparation

2003-2004 progress

NTPs alone may not make it: The example of Mumbai

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A True Public-Private Mix can help make it: The example of Mumbai

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TB hosp DOTNGOsMed colleges DOTMumbai PPMumbai RNTCP

40% increase by PPM providers

Source: RNTCP, Mumbai, India

PPM now implies: linking all public and all private health care providers to National TB Programmes in order to foster universal standards of care and

secure equity in access across the whole health care system

PPM DOTS progress in countries

22 High TB burden countries

High burden countriesHigh burden countries

HBCs perceiving need for involving private sector, September 2004

High burden countriesHigh burden countries

HBCsHBCs perceiving need to work with private sectorperceiving need to work with private sector

HBCs with PPM DOTS initiatives, September 2004

High burden countries with PPM initiativesHigh burden countries with PPM initiativesHigh burden countries without PPM pilotsHigh burden countries without PPM pilots

Prisons

Hospitals

High burden countries scaling up PPM High burden countries scaling up PPM

Growing evidence base

>40 PPM projects started >20,000 patients evaluated

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1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

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Evaluated PPMprojects

Journal articles onevaluated PPMprojects

Treatment success New sputum smear positive cases

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Baseline private sector treatment success

Upfront paym

ent

Impact on case notification (new sputum smear positive cases)

PPM Site

Baseline Rate

Increase

Evaluation Approach

Hyderabad 50/100,000 23% Compared to neighbouring TU Delhi 60/100,000 36% Change controlled Kannur 25/100,000 15% Change in same TU Lalitpur 54/100,000 61% Change in same area HCMC 100/100,000 18% Change controlled Punalur 25/100,000 50% Change in same TU Thane 50/100,000 14% Change in same TU

Cost-effectiveness of PPM DOTS

218

144118

338

143

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Delhi PPM-DOTS

Delhi privatesector non-

DOTS

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Figure: Cost-effectiveness of alternative strategies in Delhi and Hyderabad, societal perspective, i.e. costs include costs to public sector, private providers and patients/attendants †Error bars show 5th and 95th centiles in uncertainty analysis

Source: Katherine Floyd, STB

Equity and financial protection

• Economic analysis shows that patient costs reduced by >60% in Delhi and Hyderabad PPM compared to private non-PPM DOTS

• Preliminary data show high proportion of patients in PPM projects being poor (Symposium on PPM and MDGs 1st Nov)

Sustainability

• Hyderabad: since 1995

• Damian Foundation Bangladesh: since 1997

• Nepal: since 1998

• Several projects in India and Philippines running for 3-5 years

Way forward for the PPM DOTS Subgroup

• Complete PPM DOTS Guidelines

• Decentralise and strengthen technical capacity for PPM DOTS

• Continue mainstreaming PPM DOTS into DOTS expansion

• Disseminate and emphasize the international standard of tuberculosis care

Way forward, cont.• Facilitate resource mobilisation, e.g. strengthen PPM

component in GFATM proposals

• Explore PPM DOTS+ and PPM for TB/HIV

• Documentation and guidelines for different PPM strategies: Medical colleges, NGOs, individual PPs, Social Franchising

• Operational research on PPM and poverty related MDGs (equity in access, diagnostic delay, financial burden for patients)

It doesn't matter if a cat is black or white, so long as it

catches mice.

Deng Xiao Ping

On liberalisation of Communist Party rules, Time, January 6, 1986. Source: ”Political Quotations”, ed. Daniel B. Baker (1990)