TUBERCULOSIS CONTROL PRIVATEPUBLIC MIX IN LEBANON

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TUBERCULOSIS CONTROLPRIVATE-PUBLIC MIXIN LEBANON

• BY
• DOCTOR MTANIOS SAADE
• NTP MANAGER-LEBANON
• OMAN 12-14 JUNE 2005

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BACKGROUND

• LEBANON LOCATED IN THE EASTERN COAST OF THE
  MEDITERRANEAN SEA
• 10452 KM SQUARE - 4 MILLION INHHABITANTS
• POPULATION GROWTH RATE 1.64
• 28 OF THE POPULATION UNDER 15 YEARS
• HEALTH CARE SYSTEM
• - MAINLY PRIVATE SECTOR WITH 140 HOSPITALS ,
  6000 CLINICS ,700 DISPENSARIES, 160 LABS WITH
  MICROSCOPES .
• - IN PARALLEL , THERE IS A PUBLIC SECTOR AND A
  SEMI GOVERMENTAL SECTOR
• 20 SEMI GOVERNMENTAL HOSPITALS (MOH)
• 3 GENERAL HOSPITALS(MOH) AND 63 DISPENSARIES
• 1 MILITARY HOSPITAL
• 13156 DOCTORS ,MAJORITY PRIVATE(90)
• THE STAFF EMPLOYED IN THE PUBLIC SECTOR MAY
  PRACTICE PRIVATELY(LEGAL OR ILLEGAL)

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TB SITUATION IN LEBANON

• 8 TB PUBLIC CONTROL CENTERS , 2 AT THE CENTRAL
  LEVEL IN BEIRUT,6 AT THE PROVINCIAL LEVEL
• TB AND DOTS STRATEGY
• THE STRUCURE OF TB SERVICES IS BASED ON TWO
  LEVELS
• - CENTRAL LEVEL INCLUDES NATIONAL
  COMMITTEE,CENTRAL COMMITTEE AND SCIENTIFIC
  COMMITTEE
• -PROVINCIAL AND PERIPHERAL LEVEL WITH 6 TB
  CONTROL CENTERS RESPONSIBLE FOR
  PREVENTION,DIAGNOSIS, TREATMENT, RECORDING
  REPORTING AND SUPERVISION OF DOTS STRATEGY .
• - EPIDEMIOLOGY OF TUBERCULOSIS
• ESTIMATED INCIDENCE 11 PER 100000 INHABITANTS
• THE INCIDENCE RATE DECREASED FROM 25 IN
  1993 (993CASES) TO 10 PER 100000 IN 2004(393
  CASES)
• THE IMPACT OF HIV IS NEGLIGIBLE
  (SEROPREVALENCE 0.2PER 1000 POP
• PRIMARY TB MDR IS 0.66
• - FIRST LAUNCH OF DOTS END OF 1998
• DOTS ALL OVER JUNE 2000
• 92 SUCCESS RATE 74 DETECTION RATE
• LAUNCH OF DOTS PLUS 20 MAY 2005

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PUBLIC HEALTH SECTORIN LEBANON

• A GOVERMENTAL SECTOR
• INCLUDING GROUPS OF PROVIDERS
• COMPRISES REGULATIONS AND RULES
• ALLOWING THE ORGANIZATION OF DIFFERENT
  MEDICAL ACTS IN THE FIELD OF PREVENTION,DIAGNOSIS
  ANDTREATMENT
• MAIN PROVIDER MINISTRY OF PUBLIC HEALTH(NTP)
• OTHERS
• - MINISTRY OF DEFENSE(ARMY)
• -MINSTRY OF INTERIOR(INTERIOR SECURITY
  FORCES,GENERAL SURETY,MUNICIPALITIES)
• -MINISTRY OF LABOR(SOCIAL SECURITY,COOP,CASINO,PO
  RT)
• -MINISTRY OF HYDROELECTRIC RESOURCES
• -MINISTRY OF EDUCATION(MEDICAL SCHOOL AND
  UNIVERSITIES)
• - MINISTRY OF JUSTICE (PRISONERS)

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PRIVATE HEALTH SECTOR

• SECTOR COMPRISING ALL PROVIDERS WHO EXIST OUTSIDE
  THE PUBLIC SECTOR.
• INCLUDES PRIVATE MEDICAL INSURANCE, LARGE AND
  SMALL COMMERCIAL COMPANIES WITH A GROUP OF
  PROFESSIONALS DOCTORS,NATIONAL AND INTERNATIONAL
  ORGANIZATIONS, INDIVIDUAL PROVIDERS
• HOSPITALS,NURSING AND MATERNITY
  HOMES,CLINICS,PARAMEDICAL WORKERS,DIAGNOSTIC
  FACILITIES(LAB-RADIO), PRIVATE PHARMACIES,
  PRIVATE MEDICAL SCHOOLS AND UNIVERSITIES

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PUBLIC -PUBLIC MIX

• INTRA SECTORIAL COLLABORATION BETWEEN THE NTP AND
  THE OTHER PUBLIC HEALTH FACILITIES
• -PRISONERS(2 SURVEYS) , GOOD COLLABORATION,
  QUARTERLY NOTIFICATION AND FOLLOW UP, ANNUAL
  EVALUATION ,DRUGS GIVEN BY NTP
• - ALL PUBLIC TB PATIENTS(CIVIL AND MILITARY)
  ARE TREATED AND MONITORED BY THE NTP
• - ACTS AND FACILITIES ARE FREE OF CHARGE FOR
  ALL TB PATIENTS ESPECIALLY DELIVER OF TB DRUGS
  AND SMEAR EXAMINATIONS
• - HOSPITALIZATION IS FREE OF CHARGE FOR TB
  PATIENTS( N NN) WHO NEED TO BE CLOSELY FOLLOWED

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PUBLIC PRIVATE MIX(1) MEDICAL AND SCIENTIFIC
ACTIVITIES

• THE INVOLVEMENT OF THE PRIVATE SECTOR IN TB
  CONTROL IS EVIDENT ON DIFFERENT LEVELS
• 1- THE NATIONAL TB COMMITTEE COMPRISES THE
  GENERAL DIRECTOR OF THE MOH, THE DIRECTOR OF
  PREVENTIVE MED , THE CHIEF OF THE CENTRAL LAB
  AND THE NTP MANAGER IN ADDITION TO THE FOLLOWING
  REPRESENTATIVES WHO,UNICEF,SANATORIUM , ARMY,
  INTERIOR SECURITY FORCES , UNIVERSITIES AND
  PULMONARY SOCIETY
• 2-THE SCIENTIFIC COMMITTEE INCLUDES NTP MANAGER
  , PULMONARY PROFESSORS OF MEDICAL UNIVERSITIES
  AND ONE DOCTOR FROM THE SANATORIUM
• 3- THE PROTOCOL OF TB CONTROL PREPARED BY
  THE SCIENTIFIC COMMITTEE
• 4- TASK FORCE IN THE MEDICAL UNIVERSITIES
• CHEST DISEASE INFECTIOUS DISEASE LABORATORY
  -UNIFICATION OF TB CURRICULA

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PUBLIC-PRIVATE MIX(2)

• 2 BOOKLETS PREPARED BY THE SCIENTIFIC COMMITTEE
• ONE FOR DOCTORS
• THE OTHER FOR HEALTH WORKERS
• - DISTRIBUTION TO ALL LEBANESE DOCTORS
  THROUGH THE LOP(LEBANESE ORGANIZATION OF
  PHYSICIANS) AND DURING SEMINARS AND MEETINGS
• - DISTRIBUTION TO HEALTH WORKERS , ESPECIALLY
  DURING TRAINING FOR THE DOTS STRATEGY
• INTRODUCING IN THE COLLOQUIUM 4 OBLIGATORY
  QUESTIONS ON TB CONTROL THAT WILL BE ASKED TO
  YOUNG GRADUATES (STARTING 2004)
• CONTINUAL EDUCATION(FOR GP)
• ONE SHORT FILM MOVIE PREPARED BY NTP AND
  DISTIBUTED TO PRIVATE AND PUBLIC PHYSICIANS

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PUBLIC-PRIVATE MIX(3)DIAGNOSIS AND TREATMENT

• CLOSE COOPERATION IN TERM OF
• 1- DIAGNOSIS MAJORITY OF TB PATIENTS ARE
  DIAGNOSED IN THE PRIVATE SECTOR
• YEAR 2000 2001 2002 2003
  2004
• PRV 90 86.5 80.7
  78.6 70.8
• PUB 10 13.5 19.3
  21.4 29.2
• 2- SMEAR CONTROL IN THE PUBLIC SECTOR TO ALL
  PULMONARY TB CASES DIAGNOSED IN THE PRIVATE
  SECTOR
• 3- TREATMENT ALL TB PATIENTS ARE TREATED
  UNDER THE SUPERVISION OF THE NTP
• -FOR INN PATIENTS SANATORIUM(PRIVATE) ,
  FOLLOWS THE TECHNICAL DIRECTIVES OF THE NTP , THE
  NTP MANAGER IS RESPONSIBLE FOR MONITORING AND
  SUPERVISION
• FREE DRUGS FROM THE NTP
• HOSPITALIZATION IF NEEDED, FREE OF CHARGE
  FOR NATIONAL AND NON NATIONAL TB PATIENTS
• - FOR OUT PATIENTS DOTS FOR SMEAR
  POSITIVE TB PATIENTS , UNDER THE SUPERVISION OF
  TB CENTERS , IN COLLABORATION WITH PRIVATE AND
  PUBLIC HEALTH WORKERS
• - PREVENTIVE TREATMENT

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PUBLIC-PRIVATE MIX(4)MEETINGS CONFERENCES

• PERIODICAL MEETING BETWEEN THE NTP MANAGER AND
  THE REPRESENTATIVES OF THE TB SUB COMMITTEE(3 TO
  4 TIMES PER YEAR) SECTION OF LEB PULM SOC
• MONTHLY MEETING(NTP MANAGER) WITH SANATORIUM
  PHYSICIANS
• ANNUAL CEREMONIAL MEETING WITH THE LEBANESE
  PULMONARY SOCIETY
• ANNUAL MEETING ON THE PROVINCIAL LEVEL WITH
  DOCTORS(GP, PED,CHEST ) AND HEALTH WORKERS
• (ANNUAL MEETING ON THE CENTRAL LEVEL WITH CHIEFS
  OF TB CENTERS , PUBLIC-PUBLIC)

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PUBLIC-PRIVATE MIX(5) RESEARCHES SURVEYS

• OPERATIONAL RESEARCHES
• 1- MDR WITH AMERICAN UNIVERSITY
• (2002-2004)
• 2- MOLECULAR BIOLOGY TB STUDY WITH LEBANESE
  UNIVERSITY (2004 -2005)
• 3- TB-HIV WITH AMERICAN UNIVERSITY (2005-2006)
• NEW TB CONTROL BOOKLET (2005) FOR PHYSICIANS
• SURVEY(QUESTIONNAIRE) WITH
• CHEST DISEASES INFECTIOUS DISEASES
  PEDIATRICS - FAMILY MEDICINE AND GP(2005)

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CONCLUSION AND RECOMMENDATIONS

• CONTINUE AND MAINTAIN GOOD RELATIONSHIPS AND
  COORDINATIONS WITH ALL PHYSICIANS(ESPECIALLY
  PULMONARY AND INFECTIOUS) AND MEDICAL SCHOOLS
• MORE COLLABORATION WITH AIDS PROGRAM
• CONTINUE FREE DRUGS DELIVERY AND FREE
  HOSPITALIZATION
• CONTINUE REGIONAL MEETINGS (MORE CONFERENCES)
• PREPARE TO NEW MEETING WITH PEDIATRICS, FAMILY
  MEDICINE AND GENERAL PRACTITIONNERS WHO ARE
  INVOLVED IN THE DIAGNOSIS OF TB PATIENTS
• GO TO A LEBANESE TB WEBSITE
• OPERATIONAL RESEARCH GENOTYPE MYCOBACT. TUB.
• PUBLIC AWARENESS (MEDIA) 24 MARCH 2005 - 2006
• FOCUS THIS YEAR ON THE DOTS PLUS STRATEGY

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THANK YOU