Meeting of the National Managers of TB Control National Programmes in the Eastern Mediterranean Regi

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Meeting of the National Managers of TB
ControlNational Programmes in the Eastern
Mediterranean Region

• Damascus
• Syrian Arab Republic
• 15 17 September, 2002
• TB Control In
• AFGHANISTAN
• Dr Khaled Siddiq, NTP manager

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Afghanistan according to defined regions
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• Background
• The country just started recovering from 23 yrs
  war, during which NTP was dismantled
• TB widely recognized as public health priority
• New cases (all types) estimated at 70,000/year
• TB-related deaths 23,000/year
• 65-70 of all cases notified in women

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• Case-finding
• Cases reported in 2001
• New cases S 4639 (46.7)
• S- 2739 (27.6)
• E/P 2552 (25.7)
• Relapses 209 (2 of the total)
• TOTAL N. OF TB PATIENTS 10139

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Treatment outcome Cohort analysis of S
patients enrolled in the year 2000
Cured 77 Treatment completed 9 Died
4 Failure 3 Defaulted 5 Transferred
out 2 Total patients evaluated 2615 Success
rate 85.5
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• Challenges
• Public administration (incl. health system) under
  reconstruction while still facing political
  instability
• Low general health service coverage (35)
• DOTS coverage around 15 (61/350 districts
  covered)
• Large, unregulated private sector TB medicines
  available in private pharmacies (often low,
  non-NTP standard)
• Several NGOs provide health care in rural areas
  coordination issue
• Till recently, NTP main focus on Kabul Central
  Region
• High number of displaced people (IDP,returnees)
  with TB

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• Progress
• National Coordination Meeting (Kabul, April 2002)
  endorsed DOTS as the strategy to control TB
  countrywide
• National Workshop on Communicable Disease Control
  (Kabul, July 14-16, 2002) produced consensus
  statements on key issues concerning DOTS
  expansion
• First Inter-Agency Coordination Committee meeting
  (Kabul, July 17, 2002) created a permanent forum
  for all stakeholders in TB control in Afghanistan
  (MoPH, NGOs, donors, UN, private sector,
  academics)
• National workshop on Strategic Planning (Kabul,
  Aug. 6-8, 2002) produced regional and national
  plans budget 2002-2005
• Field trip to Northern regions (Aug. 17-23, 2002)
  helped translate strategy into action plan at
  regional level
• Regional action plans being currently developed
  countrywide

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Strategic Plan for DOTS expansion

• Drawn by national and regional staff of MoPH, WHO
  and NGOs, with technical support from WHO-HQs
• Based on four basic indicators
• n. of district covered by DOTS
• n. of patients detected and put on DOTS
• n. of laboratories diagnosing TB
• n. of health facilities offering DOTS
• and their likely projection in the next 3 years
• Agreement on costing of activities reached
  through discussion. Some loose assumption needed.
• A tool for budgeting and financial gaps
  identification
• It provides guidance for planning at local level

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DOTS Expansion Plan main budget items

• Total cost US 12,581,302
• Most important cost components
• Anti-TB medicines 42.4
• Laboratory supplies 11.1
• Training 7.5
• Food support (staff patients) 20.1
• Supervision 7.0
• Funds secured so far US 2.1 M from CIDA
  (through WHO)
• US .85 M from Italy (through WHO)
• US ??? M from Japan
• US ??? M from ?????
• Financial gap to be filled ?????

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• Plans
• Application to GFATM in September 2002, aimed
  mainly at
• strengthening NTP at all levels (central,
  regional and provincial)
• Expansion in the number of health facilities (88
  ? 141) offering DOTS in 2002
• Procurement of goods for DOTS expansion
• (gt0.5 M US TB drugs, office equipment for NTP,
  teaching aid, and vehicles, to reach Kabul
  within Sep. 2002)
• Promotion of new approaches to DOTS
• (training of Community Health Workers on DOTS
  included in the strategic plan integration with
  other programmes and services, esp. malaria
  control and epidemic prone diseases)

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Summary

• TB is an acknowledged public health priority
• Reconstruction of NTP still in its initial stages
• Lack of trained human resources a major
  constraint
• Financial requirement 2002-2005 12.5 M US gap
  9 M US (GFATM?)
• Next steps strengthening NTP Central Unit and
  regional level
• intensive training programme at regional level
• distribution of TB drugs (improved logistics)
• expansion of DOTS to public sector health
  facilities
• community mobilization (CB-DOTS)
• workshop on TB among mobile populations
• mobilization of the private sector