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					NTP Managers Meeting 2002

  Damascus, Syrian Arab Republic
     15 – 17 September 2002
EMRO Stop TB Team
    We finished the first round
• Good DOTS expansion
  – 18 countries with DOTS ALL OVER
  – Yemen & Sudan > 90%, Somalia > 70%
  – 80% treatment success rate
• Good innovative
  – Private public mix, partnership
• 414,992 patients under DOTS („98–„02)
  – Saved 250,000 lives &1 million family members
   However…. (or And….)
         We have a                           “2nd   round” problem
                                       DOTS Case Detection Rate          Global Target
                           70%
DOTS case detection rate




                           60%

                           50%
                           40%                                        Regional trend

                           30%
                           20%

                           10%
                           0%
                                 '98   '99   '00    '01   '02   '03      '04    '05
       Pakistan & Afghanistan
• 55% of EMR burden    TB incidence in EMR
• Low DOTS coverage
  – PAK 24%
  – AFG 15%
    (end 2001)         Others         PAK
                                      43%
• Low case detection
  – PAK 3%
                                AFG
  – AFG 9%                      12%
    (2000)
Due to the 2 high burden countries?
                                        DOTS Case Detection Rate            Global Target
                            70%
 DOTS case detection rate




                            60%

                            50%
                            40%                                          Regional trend

                            30%
                            20%
                                        Afghanistan                     Pakistani trend
                            10%
                            0%
                                  '98   '99    '00    '01   '02   '03       '04    '05
                             How about other countries?
Treatment success rate




                                                                       BAH         OMAN
                              PAL   SOM          SYR     EGY    JOR                         LEB    UAE
             85
                                                                             TUN                  MOR
                                          IRAQ            YEM   IRAN                                     QAT
       1999 (%)




                                                   SAA                                     SUD
                                                                                                         LYB




                 0
                         0                                                            70
                                          DOTS case detection rate 2000 (%)
   Notifications of TB cases from
 other health care providers in EMR
Health              Notification-related activities by country
care
provider   Fully        Refer         Notify       No             No TB
           notify      cases to      in pilot     notify          related
                       Program        areas                      activities
Min. of      9            2              1          2                1
Interior   60%           13%            7%         13%              7%
Min. of      3            4              3          4                2
Defense    19%           25%           19%         25%             13%
Private      0            4              1          7               0%
sector      0%           33%            8%         58%
                            How about other countries?
                                       DOTS Case Detection Rate
                           70%
                                                               Other countries’ trend
DOTS case detection rate




                           60%

                           50%
                           40%                                           Regional trend

                           30%
                           20%
                                                                         Pakistani trend
                           10%
                           0%
                                 '98   '99   '00   '01   '02       '03      '04     '05
Low DOTS Case Detection Rate in EMR
  (in comparison with global average)
30%
                                                      27%

25%                 23%
                                         21%
20%
       16%
15%


10%
             1999                              2000

                          EMR   Global
           EMR starting point
           Agenda of the meeting 2002
• Issue:
  – Improve case detection rate while
    maintaining high treatment success rate
• Main agenda in the Meeting 2002

  Case detection rate = Notified cases
                        Estimated cases
         EMR Starting Point
• Improve “Notifications”
  – Improve quality: case management
  – Improve comprehensiveness: health sector
    involvement
  – DOTS expansion in Afghanistan, Pakistan etc.
• Revisit “Estimates”
  – Revisit estimates
           Improve Notifications
• Quality: case management
  –   Laboratory network
  –   TB surveillance
  –   High risk group management
  –   Adult lung health initiative
• Comprehensiveness: intersectoral collab.
  – Private public mix, other health sectors
  – Operational research
                        Improve quality – 1
       • Laboratory network
             –   Regional SNRL development
             –   Quality assurance system
             –   Lab training course
             –   Drug resistance surveys




Improve “N” – Quality
                        Improve quality – 2
       • TB surveillance
             – Improved use of quarterly reports
                   • High & intermediate burden countries
                   • District based, computerized system at central level
             – Nominal (individual) TB surveillance
                   • Low & intermediate burden countries
                   • Present in Qatar & Syria, Pilot in Egypt & Iran
                   • Computerized, nominal system


Improve “N” – Quality
Discrepancies from DOTS FAX
           Notified     Sputum     Treatment
                      conversion    outcome
                       evaluated   evaluated

Djibouti        206         206          324
Egypt          1020         947          671
Iran           1152        1105        1151
Somalia        1142         928        1126
Sudan          2069        1637        3173
Tunisia         167         235          232
UNRWA          1123        1123        1079
                        Improve quality – 3
       • High risk group management
             – Contact management system
                   • Strategy & management package development
                   • Specific guidelines, recording & reporting forms
                     including those for preventive treatment
       • Adult lung health initiative
             – Pilot operation is ongoing in Morocco



Improve “N” – Quality
              Improve comprehensiveness
       • Intersectoral collaboration
             – Private public mix
                  • Protocols implementation
             – Medical schools
                  • Collaboration guidelines: published
       • Operational research
             – 7-country study on “delay analysis” (02)
             – Workshop with IUATLD/USAID (Oct 02)
Improve “N” – Comprehensiveness
                               DOTS Expansion
       •   National capacity development
       •   National commitment
       •   Multi-year strategic plan
       •   National partnership
            – IACC / CCM
            – Multi & Bi support
       • International initiatives
            – GDF, GFATM, etc

Improve “N” – DOTS expansion
                Pakistan: DOTS expansion
                                                               DOTS coverage
       • Start showing changes                                 National TB Budget

       • Competent NTP & strong                        50                           250
         political leader




                                                                                          GOP budget (Rp M)
                                                       40                           200
       • Increased GOP budget



                                        DOTS cov (%)
                                                       30                           150
       • IACC & strategic plan
       • More partners                                 20                           100
            – WB, DFID, JICA, USAID..
                                                       10                           50
       • Continued expansion is
                                                        0                           0
         challenge
                                                            *99/00 *00/01 *01/02



Improve “N” – DOTS expansion
            Afghanistan: DOTS expansion
  • 23-year wars just finished              Age/sex distribution of S+ cases

  • Very weak health services         600
  • DOTS is just at start             500
        –   1 MO + NPOs               400
        –   IACC in July 2002         300
        –   Strategic plan underway   200
        –   CIDA support (2.1 M)      100
        –   JICA, Italy                 0
  • DOTS expansion in health                  0-   15- 25- 35- 45- 55- 65+
    reconstruction is challenge                         Male    Female


Improve “N” – DOTS expansion
   Main funding partners in EMR
    Red: support through WHO
    Black: bilateral                                                CIDA (2M)
    Underlined: under negotiation
                                                                    NOR (0.7M)*
    AGFUND: DRS support (0.1M total)
    *: Including donation in kind                                   ITALY (0.8M)
                                                                    JICA (1M)
                                               AGFUND
                               USAID (2M)
                               Dutch, AGFUND

                                                                             USAID (2M)
                                                                             WB,
                                                                             DFID (0.2M)
                                                                             JICA (1M)
                                                                             GTZ(?),GDF,
             LHL/NOR (1M)                                                    GRLA,
             IDB (2,7M), GDF                                                 AGFUND
                                                           JICA (0.9M)
                                                           GDF, AGFUND
                 NOR (0.8M)*
                 WHO
                                                        Norway (0.4M)*
                                       French           GDF, WHO
                                       GDF
                                       AGFUND
Improve “N” – DOTS expansion
                           Revisit estimates
        • “Hot” countries
              – Egypt, Iran, Iraq, Jordan, Syria, Sudan
        • Improve “N” (notifications)
        • Epidemiological surveys, studies etc.
              – PPD survey in Oman, Sudan (2003)
              – Disease prevalence survey (?)
              – Epidemiological studies


Revisit “E” – Estimation
         DRS and DOTS PLUS
• Drug resistant survey / surveillance
   – Egypt has started
   – 9 countries will start
      • LEB, JOR, SYR, YEM, (SUD), 4 GCC
   – AGFUND support (0.1M) to DJI, EGY, PAK, SYR, YEM
• Chronic case management
   – Introduce chronic case register in all countries
   – Introduce DOTS Plus to selected countries
   – Adopt specific guidelines, recording & reporting system
    NTP Managers Meeting 2002
PLANS TO                           Case detection rate in EMR
                                                         Global target
• Improve notifications          70%

   – Quality                     60%
      • Lab, surveillance, HRG   50%
   – Comprehensiveness           40%
      • PPM, Other ministries    30%
                                                      EMR trend
   – DOTS expansion              20%
      • Pakistan, Afghanistan
                                 10%
• Review estimates               0%
• DOTS Plus, Partnership               '99 '00 '01 '02 '03 '04 '05

				
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posted:11/4/2011
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