community based dot(s) kong kimsan md, puhp jica tb control project, cambodia 11 th -july-02
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Community Based DOT(S)
Kong Kimsan MD, PUHPJICA TB Control Project, Cambodia
11th-July-02
Outline of Presentation
• Summary of workshop on 21st June 2002
• Feed back from NGOs• Experiences from community
survey
Summary of workshop on 21st June 2002(1)
• Who are eligible patients?What criteria for DOT in community?- Handicapped- Child- Very distant- AIDS Home Care client
Summary of workshop on 21st June 2002(2)
• Who can be DOT watcher?1. DOT watcher should be:
- Members of health center committee- Community leaders- Village Health Volunteers- NGO workers/volunteers- Local health professionals - School teachers
2. What kind of training should be provided?
Summary of workshop on 21st June 2002(3)
• Supervision:1. Who can supervise (DOT watcher
& TB patient)?- OD TB supervisor- TB Unit staff- Trained health center staff- Trained NGO health professional
2. How often?- Weekly?, Bi-weekly? ……………
Summary of workshop on 21st June 2002(4)
• Drug management and supply:1. Drug collection: Who?
- DOT watcher- TB patient- Others
2. Who should keep TB drugs of the patient?- DOT watcher- or TB Patient
Summary of workshop on 21st June 2002(5)
• Record?1. TB Register: HC2. Treatment Card: Should be kept in HC or TB Unit3. Who record ()?
DOT watcher?, Patient? or How often?4. Additional: Should have Special Card DOT
watcher
Summary of workshop on 21st June 2002(6)
• How often do TB patient see health worker (HC)?
1. Every week?2. Every 2 weeks?3. Or only 3 times in treatment? Month2,
Month5 and Month8.4. Others?
Summary of workshop on 21st June 2002(7)
1. How to follow up the patient?2. Patient should come to see health worker?
- Weekly? Every 2 weeks? Monthly?2. Home visit by HC/OD? 3. How often?
Summary of workshop on 21st June 2002(8)
• Detection:How to detect patient?
- Symptomatic detection- Sputum collection- Sputum sending - Diagnosis or only screening: Smear+ & Smear-
Summary of workshop on 21st June 2002(9)
• Support DOT in Community1. Who?
- HC staff- DOT watcher- Patient
2. Activities:- Training- Transportation- Incentive ….
Feed back from NGOs (1)
1. RHAC: 2. Eligible patients: + Family Size, Distance3. DOT watcher: + Job description, DOT
watcher should be responsible TB drug collection.
4. Supervision: NGOs worker can be Community DOT(S) Supervisor or DOT watcher.
Feed back from NGOs (2)
• JOCS: 1. Community Participation:
- TB patient detected in community is few- Needed much flexible for guideline- DOT watcher: Ex-TB patient
2. Per diem: If people understand, they will not ask money (DOT watcher)
Feed back from NGOs (3)
1. MSF (Sothnikum): 2. Eligible patients: Many people in village (Very
remote area) cannot come to HC every day, especially women with young children (cost & time).
3. DOT watcher: - Relative of patient, Responsible member of the community, The feedback Committee members. - A small incentive should be paid to DOT watcher by CENAT (Except relative of patient).
Experience from community survey (1)
• Prevalence survey: 1. Clusters:- Chrava Village (Kratie): - Morn Village (Kamport)- Steung Trang (Kampong Cham)2. Who can be DOT watcher?- Family members of the TB patient - Neighbors- Village leaders/feedback committee member- Village Health Volunteers
Experience from community survey (2)
• Note Book Distribution: 1. Where? Primary School in:- Kg Tralach OD (Kg. Chhnang) - Sothnikum OD (Siem Reap)- Thmorkol OD ( Battambang)2. Who can be DOT watcher?- Village leaders/feedback committee member - School teacher- Family members of the TB patient - Village Health Volunteers
Experiences from community survey (3)
• Review of DOTS in HC (Kampong Tralach OD): 1. Svay Chuk2. Svay3. Long Vek4. Kg. Tralach Leu
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