PPMNSA

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PPM-NSA

• Yemen
• PPM planning and budgeting workshop
• Cairo 25-28 Feb 2007

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Introduction

• General Information
• Administrative divisions22 governorates
• 333 Districts
• Population 19.7 millions
• Population growth rate3.45
• Infant mortality rate 61.5 deaths/1,000 live
  births (main causes malnutrition, Malaria)
• Life expectancy at birth 61.75 years male
  59.89 years female
• People living with HIV/AIDS12,000 (est.)
• GDP - per capita - 820
• Population below poverty line45.2

Yemen
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Tuberculosis Epidemiology

• Incidence All form 17,130 cases (87/100,00
  popu.) New smve 7,680 (39/100,000 popu.)
• Prevalence 30,299 cases (151/100,000 popu.)
• Death about 2,500 annually
• DOTS coverage 98
• DOTS case detection rate 42 (2005)
• Female/Male ratio 1 1.4
• DOTS Treatment Success 87 ( 2006 cohort)
• Rate of MDR among new cases 3.1
• TB-HIV co-infection lt1

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TB Case detection by type in absolute number is
in decreasing trend.
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Treatment success rate since 1995 (Dots Cases)
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Highest case detection observed between age
group 15-34 age group
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Composition of Non-NTP structure

• Public other than NTP Medical service of
  Ministry of Interior, Medical service of Ministry
  of defence, Medical teaching institutes
• Semi governmental Al-Thawra Hosp, Al-Kuwait
  Hospital
• Private for profit Total of 92 hospitals, 336
  polyclinics, 534 physicians clinics, 709
  specialty clinics, 744 laboratories, and 1,601
  pharmacies and 1077 PHC operating in the private
  sector in Yemen.
• Private non-for profit Yemeni Womens
  Association, Yemeni Youth Association and Yemeni
  Red Crescent play important roles in health care
  delivery. INGO- Charitable Society for Social
  Welfare (CSSW).

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PPM rationale

• NTP DOTS coverage is close to 100 however the
  CDR is only 42.
• Only 31.6 of TB symptomatic use public
  facilities
• Dense network of private sector- The country has
  altogether 3496 physicians out of them 974 are
  specialists. 336 policlinic, 534 Physicians
  clinic and 709 specialist clinics.
• Doctors who work in the public usually also work
  in the private sectors simultaneously.

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PPM objectives

• The over all objective of the PPM initiative is
  to involve all health care providers in
  delivering effective TB services to reach all
  segments of the population .
• Improve access, equity and quality of TB care
  inline with the International Standards for TB
  Care (ISTC).
• Increasing TB case notification and reduce
  financial burden on TB patients.

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Utilization of health services

• private health expenditure of total health
  expenditure 73 (Public Expenditure Review,
  Health Sector Republic of Yemen, 1999-2003)
• Utilization rate by sector

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Factors influencing health provider choices

• Distance In Yemen 50 patients were living
  within ½ an hour of health facility another 50
  need one hour or more.
• Confidence in getting cured
• Advice by ex-cured patients or relatives In
  Yemen over 65 patients are motivated by other
  cured patients or relatives)
• Free service

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NTP preparedness

• Focal point / NTP team for PPM
• Yemen is in initial phase of initiating
  systematic PPM in the country. The NTP recognized
  the importance of PPM. The focal person for PPM
  will be identified soon.
• Budget head for PPM? How much?
• Under GFATM 4th round a budget has been
  foreseen for PPM. New financial support will be
  sort from other donors for scale up PPM in the
  country.
• PPM part of strategy / operational plan?
• Guidelines for operational plan has been
  proposed in NSA.

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Main constraints for NTP to expand PPM

• Identification and training of NTP focal person
• Establishing PPM consultative committee from
  major stakeholders
• Identification and Training of PPM focal person
  at governorate level
• Additional financial support to strengthen
  existing and proposed PPM initiatives.

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Experiences from existing PPM initiatives

• In Yemen the PPM initiative was limited mainly
  to non-NTP public sectors-Prisons, Army hospital,
  Medical teaching institutes except one NGO -
  Charitable Society for Social Welfare.
• - Main learning is that collaboration is
  possible but need to establish a regular system
  of feed back and monitoring.

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Lessons Learned

• Mutual respect and trust
• Commitment to follow NTP guidelines
• Greater coverage, quality and access
• Joint monitoring and supervision is possible and
  essential
• PMPs capacity to manage TB cases
• Quality assurance of laboratory services of
  partners
• Commitment of NTP/NGOs/Partners to scale up PPP
  activities

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Preparedness of non-NTP providers

• The private sector although works for profit-
  but willing to collaborate with the NTP. Several
  private clinics are under taking public health
  task vaccination, free of cost with the support
  of EPI programme of the country. The private
  clinics visited showed very positive view to take
  same type of initiative for TB control programme
  as well.

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Regulatory environment

• In Yemen, Regulatory agencies exist for medical
  services, medical education and diagnostic
  laboratories and drug monitoring department.
• No regulation exists for notification of TB
  cases diagnosed or treated outside NTP
  facilities.
• Anti-TB drugs are available in the open market
  and sold with or without prescription.

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Tentative task mix table

• Main provider groups and their contribution

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Further steps has been taken toward cooperation
between NTCP and PPM.

• NTCP has taken the involvement of PPM into
  consideration since latest nineteenths and has
  executed several activities toward this goal
• Conducting one day orientation on TB control for
  PPM in Sanaa city 1999.
• Conducted study on (The impact of orientation and
  training of private practitioners on the
  notification of tuberculosis patients to the
  national tuberculosis control programme in
  Sanaa, Republic of Yemen) (2002 emro TDR small
  grant scheme)
• The NTCP has included budget for the PPM
  involvement activities in its 5 years proposal
  for the Global fund grant.

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Recent Progress toward PPM involvementin TB
control

• According to the recommendation of WHO expert
  (Dr. Abdulhamid last December 2006)
• 1- The NTCP has appointed health officer as focal
  point for PPM at central level
• 2- A Ministerial decree has been issued to form A
  committee to implement the partnership and
  cooperation between NTCP and PPM from the
  following
• -US of MOHP for PHC
• - GD of DC Surveillance
• - NTCP Manager
• - GD of Privet sector in MOHP
• PPM health officer
• - Representative of Privet sector
• - representative of Islah charity
• - representative from Al Saleh association
• - representative from Military medical
  services sector.
• The duty of the committee is to planning,
  coordinate, Monitor and evaluate the cooperation
  of involvement of PPM in TB control.

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Recent Progress toward PPM involvementin TB
control

• 3-NTCP has held a one day workshop for the PPM
  in Sana'a and Aden city to discuss the future
  plan of the cooperation with PPM, representatives
  from all stockholders) was invited to the
  workshop (privet, NGOs, Universities, Militry
  sector, prison etc..)
• 4- NTCP has executed training for PPM in 3 major
  cities in Yemen (Sana,a Hodeidah, and Aden city
  by financial support from GF and WHO.( by this
  training 20 privet facilities and one NGOs was
  involved in 2007)

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Thank You for your Kind attention