Engaging other care providers in TB control

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Engaging other care providers in TB control

• Tested models and evidence derived from EMRO
  small grants scheme studies

Meeting of the National Tuberculosis Control
Programme Managers Cairo, Egypt, 4-6 September,
2006 Dr Amal Bassili Focal point, EMRO/TDR small
grants scheme for operational research in
tropical and other communicable diseases WHO/EMRO
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PPM Model 1 Referral or Treatment with
notification Urban Rawlpindi, Pakistan
(2003-2004)

• Training of private practitioners by NTP
• Availing diagnostic facilities for the private
  practitioners patients in the TB Centre in
  Rawalpindi
• Providing the private practitioners with anti-TB
  drugs, sputum cups and recording and reporting
  tools

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Process indicators improved practice
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Process indicators
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Outcome indicators
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Engaging care providers in TB control, Syria,
2004-05
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Underreporting rate among health care providers
7.3 Notified cases 3221/3438
(93.7) Underreported cases6.3
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Sanaa, Yemen Sharkia, Egypt, 2003-2004

• Intervention to increase notification of
  patients by private practitioners in Sana'a,
  Yemen, Sharkya, Egypt during 2003-2004.
• 3 days training vs one day orientation during
  which baseline information was collected and they
  were given referral forms.
• All patients referred/notified from PMPs during
  the last 2 quarters of 2004 were registered.

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Outcome indicators
case notification
CDR
Target
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PPM Model 2 Referral only Kabul, Afghanistan
(2004-2005)

• Collecting baseline information about the extent
  of adherence private practitioners to the NTP
  guidelines using self-administered questionnaires
• The health seeking behaviour of patients was
  studied using quantitative and qualitative tools
• Training of private practitioners and
  distribution of referral sheets
• The private practitioners were requested to refer
  their patients to the two diagnostic centers in
  Kabul for diagnosis and treatment

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Health seeking behavior of patients
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Process indicators

• Case management in the private sector
• No DOTS in the private sector
• 95 of private laboratory cannot perform sputum
  smear microscopy
• Expensive anti TB drugs of doubtful quality were
  prescribed
• The majority stopped treatment within 2-3 months
  due to the high cost of drugs or after initial
  improvement, others were administered drugs for
  more than the recommended duration
• Patients were unaware about the availability of
  free services in the public sector
• The majority sought care at the public sector
  when they were informed about the availability of
  free services
• Satisfaction with care in NTP facilities
• Patients expressed their satisfaction with care
  and quality of the drugs

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Outcome indicator
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PPM Model 3 Treatment with notificationLahej,
Yemen, 2002-2003

• training health care workers in the private
  sector,
• providing them with free sputum microscopy and
  free drugs,
• health education in both sectors and
• tight supervision of the NTP on the private
  sector.

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Outcome indicator
Lahej, Yemen
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PP Model Involving medical colleges in DOTS
implementation in PakistanPakistan Peshawar and
Abbotabad, 2005-2006
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Process indicator-improved practice
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Outcome indicator-increased case detection in the
quarter following the PP
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Conclusions and recommendations

• All tested models proved to be effective in
  increasing case detection. However, each model
  was tailored to the country situation i.e PPM
  should be piloted first before expansion eg
  Sharkia study
• The high acceptability of universities to the PP
  calls for introducing DOTS in medical schools
  curricula and for developing post-graduate
  courses in DOTS
• Future research to determine the extent of
  underreporting in the other sectors as a tool to
  estimate disease incidence

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