viet nam stop-tb partnership · vstp meeting: april 2010, followed by regular quarterly meetings...
TRANSCRIPT
Viet Nam STOP-TB Partnership:
Building a Sustainable Response
Nguyen Dinh Huong1, Dinh Ngoc Sy2 Nguyen Viet Nhung2, Nguyen Ngoc Minh2
Bruce Struminger3, Cornelia Hennig4
November 15, 2012 Kuala Lumpur, Malaysia
1. Chair of VSTP 3. Former Co-Chair VSTP 2. Vietnam NTP 4. Co Chair VSTP
Vietnam STOP-TB Partnership: Outline
1. Country background information 2. TB epidemiology 3. Challenges 4. National partnership introduction 5. Partnership principal activities 6. Conclusion
1. Country Background Information
• Area: 330.957 km2 • Distance: >3.200km, borders with
China, Laos & Cambodia • Population: 89 million (2011)
• Rural: 59,952 million (68,25%) • Urban: 27,888 million (31,75%) • Average density: 265/km2
• Administration • Provinces: 63 • Districts: 698 • Communes: 11,121
• LLMI country since 2010: $1,411 GDP per capita (2011)
2. TB epidemiology in Viet Nam
• Ranks 12th among 22 TB high burden countries.
• Ranks 14th among 27 countries with high burden of MDR-TB.
• TB prevalence in Viet Nam remains high. National prevalence survey (VINCOTB-06) showed that the previous estimation was underestimated by 60%.
A significant number (~40%) of tuberculosis cases remain undiagnosed or unreported.
40% ? Too difficult, …
TB epidemiology in Viet Nam 2006 ( WHO Report - 2008)
Incidence all cases /100.000 173
Incidence new AFB (+) /100.000 77 114 (Prevalence new AFB (+) -VINCOTB-06)
Prevalence all cases/100,000 225
Prevalence AFB (+) /100.000 90 145 VINCOTB-06
TB mortality /100.000 23
Of new TB cases, % HIV (+) 5.0%
Of new TB cases, % MDR-TB 2.7%
Of previous treated TB, % MDR-TB 19%
TB case notification
200 000
400 000
600 000
800 000
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
# su
spec
ts/s
s+ c
ases
0
10
20%
posit
ivity
# suspects# ss+ TB cases%positivity
Notification trend 2000-10, Viet Nam
Number of suspect screened 2000-09, Viet Nam
NTP End term Evaluation 2007-2011.
3. TB Response Challenges: human and financial resource, programmatic
• Human resources – Stigma, low financial compensation, and perceived risk
affect recruitment; lack of sufficient staff results in over-work; in combination these result in high staff turn-over
– Need for training on new approaches and techniques
• Financial resources – GVN budget: grossly insufficient, barely covering DOTS – Heavy dependence on external funding for PMDT, TB/HIV,
PPM, ACSM, high risk groups in context of rapidly decreasing funding
– New diagnostic tools: promising but expensive
Funding levels & gaps, 2013-15 (1)
Financial Need (USD) 2013 2,014 2,015 Total
Objective 1: High quality DOTS 48,557,537 54,067,373 49,350,967 151,975,876
Objective 2: TB/HIV, MDR-TB, Closed settings 6,449,221 7,254,870 8,267,339 21,971,429
Objective 3: HSS 3,445,845 4,310,847 4,487,344 12,244,036
Objective 4: PPM 2,814,085 2,164,900 2,154,153 7,133,138
Objective 5: ACSM 4927475 4934582 4633739 14,495,796
Objective 6: Surveillance and research 393,000 1,577,764 435,000 2,405,764
Total (in US$s) 66,587,162 74,310,335 69,328,542 210,226,039
Funding levels & gaps, 2013-15 (2)
Financial Gap (USD) 2013 2014 2015 Total
Funding needs 2011-2015 66,587,162 74,310,335 69,328,542 210,226,039
Estimated fund
Central Gov’t budget 5,500,000 6,000,000 6,500,000 18,000,000
Provincial Gov Fund 4,741,607 5,435,115 6,152,621 16,329,343
Global Fund 10,503,688 10,616,383 11,495,842 32,615,913
TB CARE I (PEPFAR) 3,900,171 3,900,171 3,900,171 9,600,342
EXPAND TB In-kind n/a n/a
CDC (PEPFAR) 293,000 293,000 293,000 879,000
Total in US $s 24,938,466 26,244,669 28,341,634 79,524,769
Funding Gap, US $s 41,648,696 48,065,666 40,986,908 130,701,270
Programmatic challenges
Challenge Intervention Ss(-) & EPTB increase HIV/TB Relapse/failure/default cases & reTx after default increase
DOT / PMDT
High CNR + poor Tx outcomes in congregate settings
TB control in congregate settings
High Tx success rate, but high prevalence rate and ~40% incident cases untreated each year
+ PPM
Very low CNR among children less than 14 years Childhood TB control
Strengthening of recording/reporting
Programmatic challenges
Challenges Response Reduced international financial support Advocacy Cross-cutting issues of MDRTB, TB/HIV, PPM, closed settings … requires broad engagement of non-NTP partners
Partnership
Diagnostic delay for susceptible and resistant TB, suboptimal treatment adherence
New diagnostic tools, decentralization, shorter regimen, addl community engagement
Access barriers in mountainous areas ACF, ACSM, community DOT
SLD management Drug supply & Forcasting
Shortage of HR More incentives ($, training)
Accessibiltity (Patient charge) + Health insurance
4. VSTP Establishment & Sustainability
Initial concept and reason for formation: 2008, realization that an effective national TB response required significantly increased engagement and coordination of all stakeholders in TB control, including GVN and non-GVN partner organizations and the community at large Practical goal to significantly increase case finding and develop and ensure a sustainable TB response that is more patient-centred, community-based, engages the private sector, and includes PAL
First formal VSTP meeting: April 2010, followed by regular quarterly meetings Strong support from MOH and local partners, now over 39
VSTP establishment (cont’d)
Host organization and legal status: Vietnam Association Against TB and Lung Diseases - VATL
Unique strength: mass organizations with high potential for ACSM at the community and household levels and political leverage at the national, provincial, local levels
Women’s Union, Farmers’ Union, Youth Union, Red Cross, Veteran AssociationH
VSTP’s Partners
Partners # members National Lung Hospital / NTP
WHO – Vietnam Office
Women’s Union ~ 14 million
Farmers’ Union > 10 million
Red Cross > 10 million
Youth Union > 6 million
Veteran’s Association > 3.5 million Other NGO/CBO/Academic and bilateral/multilateral organizations: Vietnam Association Against Tuberculosis and Lung Diseases, CDC, USAID, KNCV, MCNV, PATH, URC, FHI, PSI, University of California San Francisco, Woolcock Medical Research Institute
Other VN government organizations: Ministry of Health, Ministry of Public Security, Ministry of Labour-Invalids and Social Affairs, Ministry of Education and Training, Viet Nam Administration of HIV/AIDS Control, National Institute for Hygiene and Epidemiology
Private sector: Ha Noi Association of Private Medical Practitioners, Hai Duong Association of Private Practitioners, Hung Thinh Pharmaceutical and Medical J.S. Company, METRO Cash & Carry Company
5. VSTP Primary Activities
Advisory role to NTP on technical and policy issues for TB control in Vietnam
Information sharing and improved coordination and collaboration
Support to NTP in developing and implementing solutions for challenges Initial priority focus to develop ACSM and PPM advisory networks among VSTP partners Financial and technical resource mobilization from local and international organizations Quarterly full partnership meetings, TWG meetings, ad hoc one-on-one meetings
VSTP Activities-highlights
GR R9 proposal development NTP 2007-2011 mid-term & end-term evaluations GR R9 Phase 2 proposal development National Strategic Plan for Tb control 2011-15 National Strategy for Tb control to 2020, vision 2030
VSTP Activities-highlights
Partners 2012 TB Month Activities
National Lung Hospital National Tuberculosis Control Program
•Mass media campaign on national and local television channels and newspapers
• 2 documentary films on NTP achievements from 2007-2011 and Contribution of the Royal Netherlands for TB control in Vietnam
• Photo and publication exhibition • In collaboration with Post and Telecommunication
Corporation: issuance of stamp set "For a Vietnam Free of Tuberculosis"
World Health Organization – Vietnam Office
• Journalist competition with more than 100 entries on TB control. Award ceremony is scheduled to take place in May, with free TB consultation and a performance show
•Media photo contest on TB control
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VSTP Activities-highlights
Partners 2012 TB Month Activities
Women’s Union
• Performance Festival for all levels of NTP and mass organizations. Final event held March 23, 2012 with participation of ~200 staff from Lung and TB hospitals, Farmers' Union and Women's Union
Youth Union • TV talk show with 70 outstanding youth delegates from 10 provinces and cities
Red Cross
• Meeting for community health with participation of Deputy Prime Minister, MOH leaders and ~5000 individuals
• Blood donation campaign for TB patients • Live broadcast TV program on national television • Gift packages for 50 low-income TB patients
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5. Conclusion
1) The Vietnam National STOP-TB partnership is a critical element in the strategy to achieve maximally effective TB control in Vietnam and offers a catalytic mechanism for achieving TB control 2) How to build STOP-TB partnership? The NTP remains CORE; importance of creating an environment of inclusion (active solicitation of input from all members, as a group and as individuals), transparency, mutual benefits, and responsibilities 3) How to make it sustainable and effective? Advocacy, ACSM, as the primary mission, mechanism offering an environment and opportunity for partners to share experience, knowledge, ideas, finances, and sweat equity 4) The VSTP is a young partnership that has matured rapidly, but remains in a process of evolution -PPM and ACSM TWGs already active, other TWGs in process of formation -VSTP continues to expand with new partners while keeping old partners engaged
On behalf of the Viet Nam National STOP-TB Partnership: