HELLO MY FRIENDHOW ARE YOU TODAY?
Maarten Bosman
• Birth cohort 1946• Married, two sons (men!! 34 and 27)• “Tropical Doctor” in Tanzania 74-77• Khmer refugees ICRC 1980• “Family Doctor” in Netherlands 80-84• TB manager NTP in Kenya 84-89• TB consultant KNCV 89-98
• Stop TB initiative in WHO Geneva 99-2000
• Back in KNCV 2001
• MO stop TB for Vietnam, Lao and Cambodia since September 2002 in Hanoi
• October 2006 retired from WHO; independent TB consultant since
Interests/Experiences
Health Sector Reform
TB control in Nomads
Urban TB control
TB/HIV
Consultancies
• Bangladesh, Cambodia, China, Lao, Thailand, Vietnam
• Ethiopia, Ghana, Kenya, Mali, Mozambique, Tanzania, The Gambia, Somalia, Zambia
• Serbia
TB control: The Planning Cycle
Planning and Managing TB control
Objectives of the module• Knowledge acquired:
Basic principles of TB control (DOTS)
Planning and management of TB control• Skills acquired:
Assessment of quality of TB services
Reporting of findings and providing recommendations
The Stop TB Strategy of WHO
1. Pursue high-quality Dots expansion and enhancement
2. Address TB/HIV, MDR-TB and other challenges
3. Contribute to health system strengthening
4. Engage all care providers
5. Empower people with TB, and communities
6. Enable and promote research
Study Approach
Program Cycle Management• Problem or Situational Analysis• Planning and implementation of interventions• Quality assurance and performance audit by
supervision• Monitoring through HMIS• Analyzing and evaluation of results
Overall objective of TB control
Reduce transmission of TB in the community and in this way reduce the prevalence of M.tuberculosis
infected persons in the community
Purpose of TB control
To remove sources of infection of M.tuberculosis
from the community by early identification and cure of
infectious cases of TB
Strategy
• Political Commitment to control TB
• Laboratory network for direct microscopy
• Short-course chemotherapy and DOT
• Guaranteed supply of anti-TB drugs
• HMIS for monitoring and evaluation
TB Control Process
• (Self) referral of suspects
• Identification of suspects
• Examination of suspects
• Diagnosis of cases
• Registration for Treatment
• Providing and supervising treatment
• Case-holding
• Evaluating results
Functions NTP
• Conditions for different steps of the process meet defined standards
• Assure quality of interventions
• Secure necessary equipment, means and funds
• Monitor the process and evaluate outcome
• Plan and manage the process
Planning and managing the process
Levels
• The Community
• The District Health System
• The Intermediate Level
• The National Level
• Global? Sub-regional?
Training Methodology
• Interactive, problem solving oriented discussions
• Practical exercises in working groups
• Field visits
• Group presentations
AsiamAsiam181181,035 sq km,035 sq km
425 x 425 km425 x 425 km
MakaldiamMakaldiam
ChanigoliaChanigolia
14 million people in 200814 million people in 2008
Demography
Population 200814 millionAnnual Growth 2%Urban 20%Life expectancy 57yrInfant mortality 68Under 5 malnutrition36%
EconomyEconomy
GDP 8 billion US$GDP 8 billion US$
Agriculture 30%Agriculture 30%
Industry 26%Industry 26%
Services 44%Services 44%
Export 3.7 billion US$Export 3.7 billion US$
Import 4.7 billion US$Import 4.7 billion US$
Debt 3.5 billion US$Debt 3.5 billion US$
Is ASIAM a paradise?Is ASIAM a paradise?
Depends who you are:Depends who you are:
35% of people below poverty line35% of people below poverty line
High prevalence of High prevalence of
AIDSAIDS
TuberculosisTuberculosis
MalariaMalaria
High child mortalityHigh child mortality
ASIAM
A Case Study• Review of TB control in Asiam
1992, 1996 and 2002• Asiam R7 and R10 proposals to GFATM• Asiam data sets I, II and III• Set of exercises• Group work and presentations
Group 1
NGHIA HUYNH
KHANH PHAM
XINXU LI
KHAMLA CHOUMLIVONG
RACHEL SISMAR
MARIAH PRESTON
Group 2
HARDEW KAUR
NGOC DIEP BUI
THI MINH NGOC NGUYEN
KHAMLUB SENBOUNSOU
EDWIN HENRY DAIWO
KHIN ZAW
Group 3
OYUNTUYA TUMENBAYAR
PWINT HAYMAR NAING
NANG SARM PHONG
TRISASI LESTARI
THI THANH VAN NGUYEN
NICHOLAS GOHINO BUWAO
Group 4
ANH BINH LUONG
YULING ZHAO
FRANK UNDERWOOD
MA CECILIA VAGAY
MARK DUPI
SAORITH SENG