1
HEALTH SERVICES DELIVERY
1.4
DISEASE CONTROL PROGRAMME
1.4.2.a
Communicable Diseases Control:
Respiratory Diseases Control (ARI & TB) (as of March 2008)
A Focal Point
B Implementing Agencies
C Target Areas & Beneficiaries
DDG/PHS I
Director/NPTCCD, MoH,
Provincial Directors of Health Sevices
Chest Hospital/ welisara , District Chest Clinics, Patients
With respiratory diseases and community
Project Summary:
This project aims at reducing the morbidity and mortality from Tuberculosis and other
communicable and non-communicable respiratory diseases and minimizing the disability
caused by them by strengthening the most national programme. The following activities are
implemented.
 Enhance case detection of TB by
- establishing microscopy centers in all the Out Patient Departments of Teaching
Hospitals,
Provincial Hospitals& Base hospitals and in all District & Peripheral
hospitals
- establishing sputum collection centers in all other primary care health institutions
- active screening of high risk groups
- enhancing X-ray facilities.
 Expansion of DOTS to increase the cure rate of TB.
 Enhance indoor care services of good quality for TB and non TB respiratory patients.
 Enhance diagnostic facilities so that the early and accurate diagnosis of respiratory diseases
is possible to start therapeutic measures early.
 Measures to diagnose occupational lung diseases early and to reduce the incidence.
 Enhance the human resource in number and improve their knowledge and skills so that the
service delivery by them would increase patient satisfaction.
 Enhance the human resource in number and improve their knowledge and skills so that the
service delivered by them would increase the patient satisfaction.
1.
Justification:
Tuberculosis (TB) is a global emergency. The incidence of TB has been increasing over the last 4
years. TB mostly affects the 15-54 age group. This being the productive age group affects the
economy of the country. The spread of Human Immuno-deficiency virus (HIV) and the emergence of
multi drug resistance made the control of TB even more urgent. To achieve the targets set, it is
necessary to strengthen the national programme for TB control. Respiratory diseases other than TB
needs focus attention. Disability caused by asthma affects the economy of the country. Urbanisation
and industrialization increase the incidence of environmental and occupational lung diseases.
Increasing the facilities for early detection and proper management of respiratory diseases would
reduce the disease burden.
2.
Important Assumptions/Risks/Conditions:



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3.
The existing health care system in the country will remain the same.
PDHSS and DPDHSS will extend their corporation.
The risk of Chest Physicians leaving the national programme for TB control and chest
diseases and join the curative services exists.
Preventive and curative services should be integrated at all levels of health care
services.
Project Objective:
Objective
To reduce the mortality and
morbidity from TB and other
communicable and
non-communicable respiratory
diseases and to minimize the
disability caused by the same by
strengthening the national
programme.
4.
Indicators
 TB Case detection rate
Sputum conversion rate
 TB Cure rate
 Disease specific
mortality rate DOTS
coverage
Means of Verification
 Administration report of
NPTCCD
 District TB register
 Central TB register
Notification register
 IMMR
Project Output/Product:
Outputs
More cases of TB detected so
that they can be cured and the
sources of infection in the
community is reduced
DOTS expanded to all the
districts and the cure rate is
increased
Indicators
 Case detection rate
 Cure rate
 Disease specific death
rate
 The population
coverage of DOTS
 Cure rate
Means of Verification
 District TB register
 Central TB register
 Notification register
Incidence of MDRTB is
reduced
Indoor care of good quality
provided to patients with TB
and non-TB respiratory
diseases when needed
 Sputum conversion rate
 District TB register
 Population- Bed Ratio
 Average daily inpatient
census of the TB wards.
 Average daily inpatient
census in respiratory units
 Inpatient bed
occupancy rates
 Cure rate
 Monthly hospital bulletin
 IMMR
 Cure rate at the district
level
 District TB register
Laboratory facilities enhanced
at the central level keeping
with the international standards
Laboratory facilities
established at the provincial
level
 Administration Report of
the NPTCCD
 District TB register
Outputs
Accurate and early diagnosis of
the respiratory diseases is made
enabling to start therapeutic
measures before the disease
state is advanced
Disease burden and the
disability, and mortality from
asthma and other respiratory
diseases are reduced
Indicators
 Disease specific
mortality rate
 School attendance in
children
 Number of days of
restricted activity
 Disease specific
mortality rate
Occupational lung diseases are  Incidence of
detected early and measures are occupational lung diseases
taken to reduce the incidence
Adequate number of staff
 Population per
placed and trained to do the
qualified doctor
specific job and developed
 Population pr health
worker
 Population per
qualified nurse
5.
 School attendance register
 Attendance registers at
working places
 Analysis of leave registers
 IMMR
 Director /Information
Related Projects:
Project No.
1.1.4
1.3.4
1.3.5
6.
Means of Verification
 Mortality data from the
RGO’ office
 Annual health bulletin
Project Title
World Bank Project
GFATM
Strengthening of Laboratory and Diagnostic Services
Total Quality Control/Management of Hospital Services
Total Quality Control/ Management of Promotive & Preventive services
Relevant Agencies to be Coordinated:
MoH, BES, Provincial Health Ministry, Private hospitals, Independent Medical Practitioners’
association, College of General Practitioners and Sri Lanka Medical Association
7.
Monitoring & Evaluation:
1. Who?
2. When?
D/ NPTCCD, DPDHS, Central MoH, Provincial MoH
Baseline, Mid – term,
End, One year after completion
3. What actions to be taken based on results of monitoring & evaluation?
Enhance supervision, Development of guidelines on the use of the facility,
Internal circulars
8.
1
2
3
4
Activities:
Activities
Expected Results
Establishment of microscopy
centres at every hospital according
to the national norm
Establish sputum collection centres
in the peripheral health facilities
Increased case detection
Active screening of high risk
groups (contacts, diabetics, HIV
patients and institutionalised
people)
Provide X-ray facilities at each
District Chest Clinic (including
mobile x rays)
5
Develop a mechanism to
incorporate the private and the
Aurvedhic sector in DOTS
implementation
6
Formulate guidelines in DOTS
implementation
Develop a mechanism to involve
NGOs in defaulter tracing
7
Number of sputum
samples tested per
month
Increased case detection Number of sputum
samples collected
and transported per
month
Increased case detection Percentage of cases
Transmission interrupted detected by active
screening out of all
sputum positive cases
Increased case detection Percentage of TB
Diagnosis of sputum
patients diagnosed by
smear negative patients
X-ray only in each
and patients with
chest clinic
non-TB respiratory
% of non-TB resp.
diseases
diseases diagnosed
monthly.
Increase in cure rate
Number of General
DOTS center made more practitioners as
accessible to the patient treatment observers
Defaulter rate reduced
in each district
No. of Sputum smear
positive PTB cases
treated at each
private hospital
Increased cure rate
Guidelines prepared
Defaulter rate reduced
Reduced incidence of
MDRTB
8
Establishment of rehabilitation
center for drug addicts and
alcoholics
Reduced defaulter rate
Reduced incidence of
MDRTB
9
Establishment of TB wards in each
District
Indoor facilities of good
quality for needed TB
patients
Indoor facilities of good
quality for patients with
respiratory disease
Reduction of deaths
10 Establishment of a respiratory unit
with high dependency care unit in
each district
Process Indicators
Number of defaulters
traced by the
involvement of
NGOs in each district
monthly
Number of drug
addicts/alcoholics
treated in
rehabilitation centers
each year
Bed occupancy rate
every month
Bed occupancy rate
in Respiratory units
Disease specific
11 Establishment of a high
dependency care unit in each OPD,
DH and Peripheral Hospital.
12 Establishment of a well equipped
Central Reference Laboratory at
Welisara
from respiratory
diseases
Reduction of asthma
deaths
Facilities for advanced
investigations
established
13 Establishment of a CT scan unit at
Chest Hospital, Welisara
Accurate and early
diagnosis of respiratory
diseases and to start the
specific therapeutic
intervention before the
disease is advanced
14 Establishment of Bronchoscopy
Accurate early diagnosis
units in each Province
of respiratory diseases
15 Provision of inhaled drugs to all the Reduction of
hospitals and chest clinics for
uncontrolled asthma
management of asthma
16 Prevention among workers of
disability and disease arising out of
environmental factors, processes
and materials used
17 Establishment of a national training
institute for TB control
Decreased incidence of
occupational lung
diseases
Well trained staff
death rate calculated
monthly
Disease specific
death rate calculated
monthly
Investigation rates
Decreasing disease
specific death rate
Decreasing disease
specific death rate
Increasing school
attendance
Improvement in
attendance at work
place
Increased
productivity
Guidelines produced
Training curricula
prepared
Training material
produced