Progress and plans for
PPM in the
South-East Asia Region
Fifth PPM Subgroup Meeting
3 - 5 June, Cairo
TB incidence rates per capita
per 100 000 population
TB in SE Asia
5 m prevalent cases
3 m new cases and
500 000 deaths/ yr
< 10
10 to 24
25 to 49
50 to 99
100 to 299
300 or more
No Estimate
~150,000 new MDR-TB cases/yr
~ 2.5 - 3 million TB-HIV co-infected
Countries with GF support
for PPM
All countries in the Region with the exception of
Myanmar and DPR Korea benefit from support
from the Global Fund for expanding private and
public partnerships
Regional Progress
• Bangladesh: >90% of TB services through NGOs; Prisons, medical
colleges, railways, garment industries being involved
• India: 262 medical colleges; >17695 PPs; >2946 NGOs; > 150
corporate houses; tea estates, railways, employees state insurance
hospitals, Ministries of Shipping, Mines, Petroleum and Oil, Indian
Medical Association; District TB Societies
• Indonesia: All lung clinics and 37% of large hospitals; 7 medical
schools; Ministry of Defence, Police and Prisons Dept
• Myanmar: Private providers; Railways; Ministries of Defence,
Religious affairs; Labour, Education and Home Affairs
• Nepal: Private providers; teaching hospitals, communities through
village and district DOTS committees
• Thailand: NHSO, Ministry of Labour; prisons systems; private
hospitals association; community based organizations, local and
international NGOs; Thai business coalition
Successful approaches
Some examples
• Intensified training of private and public hospital and laboratory
staff in Indonesia
• Introduction of coordination meetings between community
health facilities and hospitals: Yogyakarta, Indonesia; between
partners: Myanmar
• Franchising, allowing for ensuring of quality throughout network:
PSI Sun Quality Health Network
• Inclusion of private laboratories in diagnostic network & QA
systems in, India; SQH and accredited labs in Myanmar
• Establishing of referral networks and better follow up of
transfers eg., in Padang, Indonesia, between lung clinic and
puskesmas; provision of a list of DOTS centres for referral to
teaching institutes in India
• Endorsement of the International Standards of TB Care by
professional bodies-- Medical associations in India, Indonesia
Regional Priorities: 2008-2009
• Catalyze wider implementation (India, Indonesia, Myanmar, Nepal)
Document on-going initiatives, disseminate best practice examples for wider
use
• More actively engage with professional associations, teaching
universities for dissemination of the ISTC, and use of recommended
guidelines
• Ensure coordination mechanisms/forums for information exchange at
all levels in countries
• Expand collaboration with industry, corporate sector (not much
progress here– may be an area for the PPM sub-group to focus on)
• Help in developing clear strategies and operational guidelines based
on lessons learnt (Bangladesh, Sri Lanka, Thailand) sectors not yet involved
• Support pilots in (Bangladesh, Thailand)
• Organize a regional training for national consultants/focal points on
strengthening public-private partnerships (long-standing dream!)
PPM activities in priority countries
Priority
countries
National Situation PPM focal
assessment
person
conducted
appointed
PPM Operational
guidelines developed
Bangladesh
Yes, included in the Yes, focal point
5-year NTP plan
exists at NTP,
(2006-2011)
Min of H&FW
PPM is mainstreamed
into the technical and
operational guidelines of
the programme. PPM
guideline is also
available as schemes for
collaboration.
India
Yes, included in the Yes, focal point
5-year NTP plan
exists at Central
(2006-2011)
TB Division, Min
of H&FW
PPM mainstreamed into
technical and operational
guidelines of the
programme. Separate
guidelines also available
as schemes for
collaboration.
PPM activities in priority countries
Priority
countries
National Situation PPM focal
assessment
person
conducted
appointed
PPM Operational
guidelines developed
Indonesia
Yes-2003 and
during the
subsequent
external MMs, in
2005 and 2007
Yes
Yes
Myanmar
Yes – during the
joint MMs in 2004
and 2007
Yes
Yes – under revision
Thailand
No
No
No
Progress: Bangladesh
Provider
group
Involvement
Contribution
Professional
associations
No
There are schemes to involve these associations for
ACSM activities
Corporate
Sector
Yes.
Three corporate sector health care units are involved
Hospitals
Yes
DOTS Corners functional at 24 medical colleges by end
2007
Informal
providers
Yes. Very good
involvement
(Shasthyo Sebikas, Village doctors: Contribution is in
terms of referral of TB suspects for diagnosis and acting
as DOT-providers
Private
laboratories
No
There are schemes for involvement of private labs as
designated microscopy centres for the programme
NGOs and
private
practitioners
Yes
29 NGOs involved as partner of NTP by the end of 2007
and private practitioners are being oriented and involved
Bangladesh
Plans for PPM 2008-2009
• Actively engage professional bodies,
BMA,BPMPA, specialists using the International
Standards for TB Care
• Enhance coordination and collaboration
between different Ministries
• Expand collaboration with industry, corporate
sector and pharmacy holders through respective
association
• Development and distribution of advocacy
materials to private providers
Progress: India
Provider group
Involvement
Contribution (Measured in terms of numbers of
patients only in 14 sentinel sites)
Professional
associations
Yes. Involvement of a
few associations
Establishment of the
Indian Medical
Professional Association
Coalition against TB
(IMPACT) in 2007.
GFATM supported project being implemented by
the Indian Medical Assoc (IMA) since 2007.
Endorsement of ISTC by members of the IMPACT
in their personal capacity: March 2008
(endorsement by member associations in process)
Joint consensus statement on pediatric TB by IAP
in place and used
Corporate
Sector
Yes.
About 150 corporate sector health units involved
Hospitals
Very good involvement
Over 262 medical colleges involved by end of 2007
Informal
providers
Yes.
Referral of suspects for diagnosis; act as DOT
providers
Private
laboratories
Yes.
Schemes for involvement of private labs as
designated microscopy centres for the programme
NGOs and
private
practitioners
Yes
2946 NGOs and 17695 private practitioners
involved by end of 2007
Intensified urban PPM districts; India (14): Summary of contribution by different
health sectors – 3rd qtr 2006 to 2nd qtr 2007)
India
Plans for PPM 2008-2009
• Revise PPM guidelines for NGOs and
private practitioners
• Work with the IMA to increase the number
of private practitioners collaborating with
national programme
• Develop guidelines for further involvement
of the Employee State Insurance and
Railways health facilities in TB control
Progress: Indonesia
Provider group
Involvement
Contribution
Professional associations
Yes
Endorsement & roll out of ISTC
Corporate Sector
Yes
Guidelines on TB in work place
introduced on a pilot basis
Hospitals
Yes
Hospital assessment done in 117
hospitals. HDL guidelines developed.
TO placed in large hospitals
Informal providers
Limited to pilot studies
under FIDELIS etc
Pilot studies done on involvement of
PP in Bali & Yogja
Private laboratories
Limited to pilot studies
Same as above
Prison medical services
Yes
MOU signed between Min of Justice
& MOH. Guidelines developed.
Training started for 30 prisons
Progress: Indonesia
Achievements
A hospital assessment study on the implementation of DOTS strategy conducted
Guidelines on Hospital DOTS Linkage (HDL) developed and 15 Technical and Surveillance Officers for
HDL have been placed in 12 clusters of districts
Integration of DOTS into medical school curriculum implemented
ISTC translated and adapted into Bahasa (Indonesian language), officially endorsed and rolled out to
the professional organizations
Ministerial decree issued to support DOTS implementation under different Directorate Generals
Directive letter from DG Medical Care on DOTS implementation in hospital issued
Guidelines on TB in workplace, prison and army developed, and activities initiated
CEA study initiated on PPM approaches
Constraints
Varying degree of commitment and
quality of services in DOTS implementation
Plans for 2008-2009
Dissemination of HDL guidelines/ training
Strengthening linkages and surveillance in HDL
Further expansion of HDL to other public and private hospitals,
Institutionalizing of ISTC, incl. certification/accreditation
Hospital assessment study in outer Java
Progress: Myanmar
– National PPM DOTS Sub group established
– PPM capacity at WHO strengthened
(international MO + national consultant)
– PPM capacity at MMA strengthened
(national PPM team + 2 Divisional Coordinators
and part-time Township Coordinators/ full time
social outreach workers in all townships)
Achievements: PPM DOTS Sub group in
Myanmar
• Standardized Training Manual PPM DOTS
• 3Diseases Orientation
Package for GPs
•Implementation Guide on
PPM DOTS (draft)
• Strategy Paper on PPM
DOTS in Myanmar (draft)
Progress: Myanmar
Provider group
Involvement
Contribution
Professional
associations
Yes
1.
Corporate Sector
Yes
(Railways, Labour)
Hospitals
Yes
4 Tertiary Specialist Hospitals Pilot
Project, Yangon Division
Informal providers
Yes
Private laboratories
Yes
Through PSI social franchising scheme
and through MMA
Other provider
groups
Yes
Ministry of Defence, Religious affairs,
Education and Home affairs
Myanmar Medical Association( MMA
)526 General Practitioners involved
in 23 townships)- Contributed
20.27% of sputum smear positive
cases to National Tuberculosis
Programme
Myanmar
Plans for PPM 2008-2009
Public Private Mix DOTS
1.
Finalize Implementation Guide on PPM DOTS and Strategy paper on PPM DOTS in
Myanmar
2.
Sustain in implementing townships and scale up public private mix DOTS project
•
Myanmar Medical Association( MMA ) 600 General Practitioners involved in 26
townships
•
to include private and charity hospitals, religious hospitals
•
Population Services International (PSI) –to scale up number of Sun Quality Health Care
Doctors
•
CARE Myanmar to sustain in 10 townships
•
IOM to sustain 6 townships
•
JICA under the Major infectious diseases control project, to scale up to 6 townships
•
Myanmar Red Cross Society and Myanmar Maternal and Child Welfare Association
members act as DOT Providers
Public Public Mix DOTS
•
To consolidate the public public mix demonstration projects in 4 tertiary specialist Hospitals
•
Develop Interim Guidelines on Public Public Mix DOTS
•
End 2008: joint workshop on TB control between NTP and Prison Department
ISTC
•
Workshop with leading medical specialists on Adapting ISTC to Myanmar context, July 2008
•
Conduct similar workshop for GP branch of the Myanmar Medical Association
•
Implement and roll out the ISTC stepwise approach
Progress: Thailand
 MOU with National Health Security Office
 MOU with Ministry of Labour to implement TB control in the
workplace
 MOU with MSF for TB treatment and care among migrants
 Coordination with Department of Corrections to continue
TB control in prisons
 Collaboration with US. CDC for TB surveillance and
research
 Engagement of Private Hospital Association to provide TB
care according to ISTC
 ISTC translated into Thai and endorsed by NTP
 Involvement of NGOs (World Vision, American Refugee
Committee, Thailand Bossiness Coalition of AIDS) to
control TB in vulnerable population
Progress: Thailand
Provider group
Involvement
Contribution
Professional
associations
No
TB control in the workplace
Corporate Sector
Yes
Hospitals
Yes
Informal providers
No
Private laboratories
No
Other groups
Yes
About 60 Private hospitals implementing TB
activities with TB recording and reporting
system
TB control activities with R&R system in 144
prisons
Thailand
Plans for PPM 2008-2009
–
–
–
–
Establishment of working group to develop a plan,
oversee the implementation and coordinate
mechanisms at all levels of the programme
Officially appointment of a focal person for PPM
National situational analysis of PPM
Continuation for PPM collaborative activities with:
•
•
•
•
•
Private Hospitals
Factories
Prisons
NGOs
Health insurance organization
Tuberculosis prevalence rates in SEAR countries
1990
2006
1,200
TB prevalence per 100,000 population
1,100
1,000
900
800
789
700
625
621
568
600
500
438
431
391
400
411
340
299
300
253
244
244
180
200
197
169
147
108
96
100
54
80
0
Timor-Leste
Bangladesh
Nepal
India
Indonesia
Source : WHO, Global Tuberculosis Control Report 2008
DPR Korea
Myanmar
Bhutan
Thailand
Maldives
Sri Lanka