tb-prisons-kimerling2 by xiaohuicaicai

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									Gaining and Maintaining
Political Commitment




           Michael E. Kimerling MD, MPH
          University of Alabama at Birmingham
                   Gorgas TB Initiative
     5 Components of DOTS Programs
1.    Political commitment to sustained TB control activities to be
      present at all levels: local, regional, national

2.    Case detection by sputum smear microscopy for symptomatic
      patients, who are most likely to transmit disease

3.    Standardized treatment regimen for all sputum smear positive
      cases, with directly observed therapy (DOT) to achieve high
      cure rates and avoid drug resistant TB

4.    A regular, uninterrupted supply of all essential anti-TB drugs

5.    A standardized recording and reporting system that allows
      assessment of treatment results for each patient and of the
      TB control program's overall performance
    Global                                    Main Actor in NTP


PAHO Region


    National


Region Health
    Area

    District
The mission of all levels is to ensure every TB patient access to effective diagnosis,
treatment, and cure. TB patient is a central actor of the National TB Program.
Government commitment to sustained TB
control has the following components:


Policy formulation;

Support with financial resources;

Support with human resources; and

Administrative support necessary to ensure that TB
control is an essential part of health services.

                             Strategy to control TB in the WHO European
                             region, Copenhagen, Denmark, 2000
                           Dr. Indira Aimagambetova, USAID/CAR
Components of health policy

                    Context




                         Actors

 Соntent                                                   Process
            Gill Walt. Health Policy. An Introduction to
            Process and Power. London, 2000
       Process of TB Policy Formulation

     Problem                                          Implementation
     TB epidemics                                          NTP
                                         Evaluation




                                      What to do?
                                      DOTS strategy
Gill Walt. Health Policy. An Introduction to
Process and Power. London, 2000
 Human Resources
                 Identification of needs



 On-job                               Theoretical and
training                                 practical
                   Management
                                         training



Monitoring and
  evaluation                      Distribution of
                                 human resources
Issue of credibility
 For staff: are you coming back?
    Early engagement in process
 For prisoners: What do they get?
 Show a plan early: Feasible in a given context
 Take action: Move beyond words only
    Need some resources
 Show results: Data for informed discussion
 Commitment to continuous dialogue: Purpose of
  continued improvement and problem-solving
Commitment in Honduras
 Administrative support:
  To initiate TB control prison program, and active
  participation in evaluations
    MOH, MOS
 Policy formulation:
  Developed through joint prison-civil workshops
  (bottom → up approach)
 Human resource development:
  Tied to DOTS expansion, integrated into PHC
    Includes high-level policymakers
Commitment in Honduras
 Financial support: initially generated at the prison
  level (directors) and through staff initiatives with
  local support (church, community, other)
    But need funding allocations from local, regional
     and national levels
    Prison TB Control must be identified as a
     funding priority based on national objectives
NTP (Civil) and Prison Health Staff (MOS) Workshop:
Presentation Workshop: Beginning to plan together
(Tegucigalpa, Honduras May 2001)
Collaboration
between the civil
and penal sectors
established for
the benefit of
staff, inmates and
their families
Who is a Respiratory Symptomatic? How do we
select them?
                            RESPIRATORY
                            SYMPTOMATIC
                                 INMATES
     INMATES
                              3. Visits to clinic
 1. Entry Screening*          by sick inmates*
                                                        INMATE FAMILIES
 2. Mass Screening                (passive)
                          4. Contact investigation
                                                        Contact investigation
    (both active)       in patient dormitories/cells*
                                   (active)

 Normally done once    Can be done multiple times




          *All RS identified are entered into a Cough Registry
In Honduran prisons, we now have
operations

   …but we need political commitment to keep
      it going and to improve the services
    provided… issue of continued credibility
Whose responsibility? “Not mine!”

      Joint prison-civil?
      Larger community?
      Church?
      Health Staff?
      Somebody else?
How do you start the process?

              First step?
             Second step?

            Must be practical

								
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