Impact measurement Strategic implications in EMR

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Impact measurement Strategic implications in EMR

• How accurate our estimates are?
• Tools for impact measurement
• Surveillance
• Disease prevalence survey
• Infection prevalence survey (PPD survey)
• Vital statistics, OR and others
• Country characteristics
• Countries that achieved 70/85 (JOR, LEB, OMA,
  TUN MOR)
• GCC countries (BAH, KUW, QAT, SAA, UAE)
• High incidence countries (AFG, DJI, PAK, SOM,
  SUD)
• Intermediate incidence countries (stagnant or
  declining notifications) (EGY, IRA, IRQ, SYR,
  YEM)
• Specific situations (LIY, PAL)

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Trends in case notification ratesCountries that
achieved the 05 targets
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Countries that achieved 70/85(JOR, LEB, OMA,
TUN,.. MOR)

• Situations issues
• This group has a good surveillance system. They
  have engaged almost all care providers.
• ?Case notifications could be close to estimates
• Differences in CDR in SS and All
• LEB JOR CDR ss 79 77, while CDR all 107
  132, respectively. Why?
• Strategic directions
• Surveillance
• Further strengthen surveillance with e-system
• Analysis of data at sub-national level
• Ensure notifications from all health care
  providers
• ? Case notifications estimates
• Strengthen vital statistics for TB specific
  mortality (MDG)
• Disease / prevalence surveys no need

4
Trends in case notification ratesGCC Countries
(BAH, KUW, QAT, SAA, UAE)
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GCC Countries (BAH, KUW, QAT, SAA, UAE)

• Situations issues
• Low CDR BAH 11, KUW 62, QAT 44, SAA 40, UAE
  18
• Presence of large number of non-national
  populations
• Incomplete expansion of high-quality DOTS (UAE
  and ?)
• Strategic directions
• Strengthen surveillance with e-system
• Nationality
• All health care providers
• Analyze notifications among non-nationals
• Disease prevalence survey Not relevant
• Infection prevalence survey?
• Strengthen vital statistics for TB mortality
• Expand high quality DOTS PPM UAE, SAA

6
Trends in case notification ratesHigh incidence
countries (AFG, DJI, PAK, SOM, SUD)
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High incidence countries(AFG, DJI, PAK, SOM, SUD)

• Situations
• Low CDR AFG 22, DJI 42, PAK 37, SUD 35
• Increasing notifications CDR in Afghanistan
  Pakistan
• Decline in notifications and CDR in Djibouti (and
  Sudan)
• Tuberculin survey completed in Somalia, ongoing
  in Sudan
• Strategic directions
• Expand high-quality DOTS
• Need for extensive PPM, contact management.
• Surveillance
• expand high-quality surveillance
• Disease prevalence survey
• Possible in PAK, DJI, and AFG (subject to
  security)
• Relatively small sample size AFG 16,200 PAK
  30,500 DJI 10,800 and available funds vs.
  logistics arrangement
• Infection prevalence survey (tuberculin)
• done in Somalia, process in Sudan

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Trends in case notification ratesIntermediate
incidence countries (EGY, IRA, IRQ, SYR, YEM)
Stagnation or declining notifications
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Countries with intermediate incidence(EGY, IRA,
IRQ, SYR, YEM)

• Situation
• Stagnant or declining notifications
• Low CDR EGY 59, IRA 56, IRQ 18, SYR 41, YEM
  39
• Real challenge in EMR ? case of Yemen, Syria and
  more
• Strategic directions
• Expand case finding yield
• PPM, PAL, suspect management, contact management
• Surveillance
• High quality surveillance with e-system
• Detailed analysis at sub-national level (Indian
  study Chris)
• Disease prevalence survey
• Possible but large sample size (300-500K) ? large
  or
• Infection prevalence survey Yemen in 06/07
• Others vital statistics

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Impact Measurement Countries with special
situations- Libya and Palestine
-CDRgt100 and poor process indicators
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Special situation LIY PAL

• Libya
• 168 CDR in 2005 while 31 defaulter rate
• Need for full implementation of DOTS Stop TB
  strategy (Samihas mission, 2006)
• Impact measurement tools
• Surveillance ? needs urgent strengthening
• Disease prevalence survey possible
• Infection prevalence survey ???
• Palestine
• 6 CDR in 2005 under complex emergency
• Very limited surveillance activities almost zero
  in West Bank
• Need for full implementation of DOTS Stop TB
  Strategy (according to the security)
• Seita, Khaled, Nadia are ready to go