PPMNSA Pakistan

1
PPM-NSAPakistan

• PPM planning and budgeting workshop
• Cairo 25-28 Feb 2007

2
Introduction Pakistan
NA Pop 1M DC 11
FATA Pop 3.7M DC 28

• Country map and information

AJK Pop 3.7M DC 67
NWFP Pop 21.2M DC 181
Punjab Pop 87.4M DC 435
Balochistan Pop 7.8M DC 80
Sindh Pop 36.3M DC 205
3
TB Epidemiology

• M/F ratio 49
• Age trend 15-24 years - highest in numbers

4
Composition of Non-NTP structure
5
PPM rationale and tentative PPM objectives

• 100 NTP DOTS coverage CDR still 50.
• PPM projects elsewhere15 - 50 increase in CDR
• Sizeable non-NTP sector, with high potential
  role.
• Patients preferences non-NTP options.
• New Stop TB Strategy enhanced scope of work.
• PPP aims to
• Enhance DOTS coverage and quality
• Face new challenges (MDR, TB-HIV, Hospitals)

6
Utilization of health services
7
NTP preparedness-1

• National strategic framework for PPP development
  a part of National strategic plan (2005 - 10)
• PPM model and guidelines development exercise
  TAMA
• PPM implementation incorporated in public budget
• Coverage Nationwide
• Allocation USD 8 M
• Approach District-led partnership development
• Strengthening nationwide EQA to support Public
  and Private sector providers.
• DOTS implementation in Public sector
  satisfactory results

8
NTP preparedness-2

• Multiple small-scale PPM implementation
  initiatives launched
• Greenstar - franchising (GFATM)
• PATA and AKHSP - network strengthening (GFATM)
• MC and ASD - public sector strengthening through
  PPM (FIDELIS/EC)
• TAF - ACSM in 20 districts (GFATM)
• USAID supported PPM Initiative
• NTP to scale-up the PPM implementation develop
  operational guidelines and materials

9
Preparedness of non-NTP providers

• Pakistan Chest Society and Paediatric Society
  involved
• Pakistan Medical Association and Family Physician
  Association contacted
• ISTC endorsement process not yet started
• Encouraging small-scale PPM experiences in TB
  control, FP, awareness raising, vulnerable
  populations.
• Intervention with private hospitals development
  and implementation in selected districts of
  Punjab.

10
Regulatory environment

• Anti-TB drugs easily purchased from the market.
• TB notification not mandatory.
• Almost no regulations (implemented) on
  establishment of private practice
• Enforcement of the existing regulations very
  weak.
• Way Forward
• Short-term basis Peer-regulation (e.g. through
  PMA)
• Long-term basis Participate in developing
  regulations and enforcement arrangements

11
Tentative task mix table

• Main provider groups and their contribution