Country Progress Report (Papua New Guinea)

1
Country Progress Report(Papua New Guinea)

• The ninth Technical Advisory Group and National
  TB Programme Managers meeting for TB control in
  the Western Pacific Region
• Manila, Philippines
• 9 -12 December 2014

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TB Epidemiology
3
TB epidemiology
4
TB Epidemiology

• High transmission of TB in communities as a high
  proportion of SS patients are among the young
  economically productive age group 15-35 years
  old, mainly among females
• High transmission of TB within households 28 of
  TB cases are children, 2013
• TB in urban areas 70 of cases during last 5
  years ( settlements, overcrowding, culture of
  extended families)
• TB in mainly in Southern region NCD is the most
  important TB hotspot reports 5 x national
  average notification, 25 caseload, only 5
  population
• TB/HIV half of provinces have high TB/HIV burden
• Estimated MDR TB rate, 2013- New
  4.5
• -Retreatment 24

5
Major successes

• Steady increase of case notifications
• Procurement of all medicines from GDF , no stock
  outs
• TB patients receiving HIV tests have increased
  from 13 in 2011 to 24 in 2013.
• DRS is going to finalise by the end of 2014.

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Major Successes, 2014

• 1. NSP 2015-2020

• 6. Inter-ministerial Task Force since Nov 2014

1. TB CN , 2015-2017, was approved by GF, 21 Million
   USD
2. External review of TB program, Feb 2014
3. TB CN for NCD, 10 million AusD, DFAT
4. M/XDR TB Emergency Response Team since August
   2014

• 7. Campaign by PM, Oct and Nov, 2014

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Major challenges

• Health System related factors
• Lack of manpower at all levels , HR crisis
  (quantity)
• Poor managerial capacities at all levels 
• Poorly supervised staff resulting in low staff
  morale (unprofessional behavior, low motivation,
  and absenteeism)
• You can have the best strategy and the best
  building in the world, but if you dont have
  hearts and minds of the people who work with you,
  none of it comes to life. Renee West
• Poor capacities in strategic planning, budgeting
  and monitoring, and program evaluation
• Poor maintenance of infrastructure ( run down
  facilities with obsolete equipment)
• Limited ownership at provincial, district, health
  facility, and community levels
• Poor coordination and communication between
  different levels of government because of
  fragmentation of organizational and
  administrative health structures

8
Major challenges

• TB program specific factors
• TB patients present late for diagnosis resulting
  to on-going transmission in the community
• Clinicians over reliance on x rays and clinical
  assessment of TB and lack of labs resulting in
  low bacteriological confirmation of TB ( high
  rate of sputum not done)
• Limited supervised treatment, most patients self
  administer
• High defaults with limited retrieval actions
• Limited supervision and constructive feedback at
  all levels
• High child TB, BCG uptake low lt60 BCG
  stock-outs
• Slow uptake of TB/HIV collaborative activities in
  most provinces
• Weak involvement of provincial offices in the
  implementation of drug resistant TB, poor
  monitoring and supervision of DR TB,
  infrastructure inadequate for DR TB management/
  infection control issues

9
National TB Strategy/Policies

• Timeframe2015-2020, aligned with WHO End TB
  strategy and National Health Sector Plan
• NSP prioritized 30 BMUs ( 10 of BMUs) in 14
  provinces
• 75 defaulters ( all cases)
• 65 smear not done
• 53 of national TB burden
• GF support needed for 28 BMUs (12 provinces)
• Two BMUs to be supported by DFAT and MSF

10
National TB Strategy ( targets and budget)
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Reach the unreached

• Intensive case finding among child contacts of
  bact pos. patients and PLWH
• Contact investigation not working fully, info
  not available.
• TB-HIV In practice is happening, but data not
  collected by HIV program.
• Child-TB serious issue special intervention in
  GF CN

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Laboratory

• LED microscopes No roll out
• Xpert 17 in country (National 1, Regional 4,
  Provincial 12 and District 0 (See map)
• Quality Assurance
• Participation per quarter between 19.5 and
  35.6 of microscopy sites
• s Laboratory Information Management System
• Manual entry
• TA partners
• WHO, QMRL, DFAT and World Vision

13
GeneXpert Locations in PNG
Current
Proposed
Partners/PHO/Private
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Surveillance

• Quality of TB reports
• Provincial teams (informally designated TB
  TB/Leprosy Officer, M and E officer and Health
  Information officer) were trained on data quality
  assessment that includes availability,
  completeness, consistency, accuracy and
  timeliness
• New Case Definition roll out
• Forms for drug sensitive TB will be revised to
  align with the WHO new case definitions
• MDRTB Guidelines revision initial meeting was
  conducted in October. This is still on-going.

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Surveillance

• Data Analysis and utilization
• National Level Quarterly reports are circulated
  by NTP Manager also used to identify and
  prioritize facilities to focus on.
• Provincial Level some provinces analyse their
  data for management meetings and provincial
  reviews.

16
PMDT

• Treatment success rate 14, 2011
• Special case Daru ( dilapidated hospital, high
  transmission of DR-TB in the community (half of
  MDR TB cases are new) and hospital (4 staff
  sick with M/XDR TB) , no doctors, high level of
  outrage)
• Barriers HS barriers ( no HCWs ), lack of PC3
  lab, high costs of culture and DST, high initial
  LTFU rate
• Action plans
• Completion of DRS
• M/XDR TB emergency Response team
• DFAT NCD project
• Implementation of PMDT activities in TB NSP (
  partially financially supported by GF)
• Continuous advocacy

17
MDR/XDR-TB Emergency Response

• Established in August 2014
• Five (5) meetings conducted
• One meeting conducted by Health Minister
  governors of Western, Gulf NCD to gain
  political interest.
• Budget needed PGK8M (K2M for Prime Ministers
  Media Campaign K6 to Gulf, NCD Western)
• Partners presence
• Highlights of provincial responses
• Action plans submitted
• Intensive LTFU tracing ( decreased from 36 to
  14, NCD)
• Argument manpower support
• Treatment supporters
• Additional hospital staff

18
Bold policies and supportive systems

• In 2014, the GoPNG began to implement its major
  health financing reform which provides universal
  coverage through its Free Primary Health Care
  and Subsidised Specialist Services Policy.
• Health facilities will no longer charge user fees
  as they used to whenever operating funds could
  not support their service delivery levels .
• The policy was put into effect on the 24th of
  February 2014 and is targeted at poverty
  reduction and addressing the inequities in health
  care access.

19
Drug Regulation - Progress since the last meeting

• Medicines and Cosmetic Act 1999 and Regulation
  2001 is under review and the first national
  consultation workshop was held in Sep 2014
• Provincial Pharmaceutical Inspectors Training
  held in Sep 2014
• National Strategic Plan on Strengthening
  Medicines Regulatory Framework was developed in
  Nov 2014
• QC testing of TB drugs at TGA Australia
• Global Fund Concept Note for HSS has been
  endorsed in Nov 2014. The grant will be used to
  strengthen product registration, setting up a QC
  lab, compliance and inspection
• 2-week training on Logistics Management
  Information System in Nov 2014

20
Patient centred care involvement of patients and
civil society

• Community mobilization activities development of
  CBOs based on NSP
• Involvement of patient groups in TB control
  were involved in NSP and CN development, members
  of of TB WG
• Forms of social support to TB patients
  transportation costs and food are included in TB
  GF CN and NCD DFAT project