PPM planning and budgeting workshop

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PPM planning and budgeting workshop
Cairo, Egypt 25-28 February 2007
R. Indongo, NTCP, MOHSS A. Heita, NABCOA
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Introduction

• Population 1.8 million

• Namibian economy depends Mining, agriculture,
  fishery tourism
  
• Classified by World Bank as low middle income
  country.
  
• 2005 GDP estimated at US 6.1 billion with an
  annual growth rate of 3.5.
  
• The per capita GNI estimated at US 2,990.
• Has one of the most unequal income distributions
  in the continent.
  
• GINI coefficient, a measure of economic disparity
  was estimated at 0.6 in 2005

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TB Epidemiology

• Highest TB incidences in the world.
• TB case finding
• 15,771 All types of TB
• 5,356 PTB
• 1.5 increase in the last decade
• CDR Sm Pos. 88 (WHO 2006)
• CNR 784/100000
• HIV 61
• 1.31 MF ratio, 88 of cases in 15-54 age group

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CASE FINDING 2006, NAMIBIA
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Age-Sex distribution, SM cases 2006 Namibia
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Regional distribution of TB , 2006, Namibia
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Treatment results, Namibia, 2005
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NSA Namibia

• Carried out January 29-2 February07
• Involved review of key documents, visits
  interviews with 14 organizations involved in
  private health care

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Health Provider Mix in Namibia

• State ( Public Sector) Health Care System
• Hospitals, Health Centres and Clinics
• A small user fees with an exemption policy
• The Faith Based Health Care System
• This system is part of the state health care
  system
  
• The Private Health Care System
• Hospitals, Medical Polyclinics, Clinics, primary
  health care centres and pharmacies
  
• Traditional Healers appear not to play a major
  role
  

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Health Provider Mix in Namibia

• There are a total of 42 hospitals, including
  private hospitals, 34 health centres and 244
  clinics.
  
• Public health care system including the faith
  based institutions cater for 95 of health care
  provision and private sector for only about 5
  of health care provision (DHS 2000).

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Health Financing in Namibia

• Medical Aid covers 70 of state sector
  employees and about 30 of private sector
  employees
  
• Members of a Medical AID Fund utilize private for
  profit health care providers
  
• Majority of private for profit health care
  providers urban based.
  
• Out of pocket payments for medical services
  estimated to be lower than in most other sub
  Saharan African countries.
  
• State finances most health services especially
  for the poor and low income earners
  
• Out of pocket payments appear to be low around
  5
  

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Summary of current state/non state link in TB care

• Unstructured and not formalized
• Numbers of TB patients moving between two sectors
  unknown
  
• Procedures for working up patients in private
  sector not known and suspected to be at variance
  with national guidelines
  
• Treatment of TB in the private sector also
  suspected to be at variance with national
  guidelines

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Main objectives of PPM in Namibia

• Improve case detection IEC and referral of TB
  suspects
  
• Strengthen case holding (DOT)

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NTCP preparedness for PPM

• NTCP willingness to engage with private sector
• Private sector willingness to engage with the
  NTCP
  
• Availability of individual and corporate partners
  willing and ready to be involved Namibian
  Pharmaceutical Society, NABCOA, Private
  Companies
• The National TB Steering Committee, a multi-
  stakeholder forum available to facilitate
  process
  

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Experiences existing PPM initiatives

• Fishing industry
• Mining sector
• Established private companies eg
• RAMATEX, breweries
• The regular notification of cases by the Roman
  Catholic Hospital in Windhoek etc
  
• Referral by some private health institutions to
  MOHSS registration treatment
  

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Regulatory environment

• Anti-TB Medicines in the private sectors
• No regulations or legal requirements preventing
  private pharmacies from stocking anti-TB
  medicines
  
• Most pharmacies stock small amounts of anti-TB
  medicines including FDCs and single drug
  formulations
  
• Retail pharmacists receive and honor
  prescriptions for anti-TB medicines from private
  practitioners
  
• Notification by private health providers
• Requirement for TB notification understood but
  not adhered to

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Strategic focus PPM for Namibia

• Draw up the strategic vision of PPM focusing on
  sustaining improving CDR, treatment success and
  reducing risk of MDR/XDR TB
  
• Design approaches to enhance engagement of a
  wide array of private sector
  
• Determine additional resources required to mount
  a good PPM initiative
  
• Formation of a national PPM working group

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Strategic focus PPM for Namibia cont

• Define task mix of the various private sector
  providers
  
• Define TB/HIV co-interventions that may be
  included in the PPM approach
  
• Design approaches for M E of the PPM effort
  including development of appropriate ME tools
  
• Define issues that require in depth evaluations
  through research.
  
• Conduct KAP studies, socio-economic profiles of
  TB patients seeking care in the private sector
  etc
  

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THANK YOU