PPM (PPA) and ISTC in Mexico
PPA Objectives
NTP
 Reinforce DOTS strategy
through interinstitutional
coordination for TB prevention
and care
 Guaranted quality attention to
all TB patients based on ISTC
and official Norm
 Involvement to public and
private health institutions to
CENAVECE
Programas
Preventivos
meet MDG according to the
TB Global Plan and STOP-TB
strategy
 Increase Respiratory
simptomatics
 Improve quality diagnosis
 Strengthening case reference





Increase case notification
Increase cure rate
Avoid MDR and XDR
Direct observe treatment
Decrease direct and undirect
cost for patients and institutions
 Decrease:


TB Incidence, prevalence and
mortality
“Yo puedo detener la Tuberculosis… Tú también puedes”
PPA Background, Mexico

Governments by themselves can not solve TB
problem

Mexico has TB Official Norm from 1993, updated
each 5 years and shows guidelines to be
respected legally
CENAVECE
Programas
Preventivos

Mexico was considered a pilot country to
implement the ISTC and implement them.
“Yo puedo detener la Tuberculosis… Tú también puedes”
PPA Background, Mexico

August – November, 2006:
National meetings with health public and private institutions to
introduce the PPA objectives and action lines
Activities:

Review of current status about the care services on TB

Overseeing the degree of involvement with the NTP and the
private sector, laboratories, medicine and nurse schools,
CENAVECE
pharmaceutical industry and NGOs
Programas
Preventivos

Draft of validated National Standards for TB Care based on
the ISTC and National TB Official Norm
“Yo puedo detener la Tuberculosis… Tú también puedes”
Current status identified

Lack of operational research on the attention,
treatment outcomes and cost of services for TB
patients .

Weak linkage between official and private services.

Lack of an effective reporting system from private
health services.
CENAVECE
Programas
Preventivos

Lack of agreements between private and public
health services with government
“Yo puedo detener la Tuberculosis… Tú también puedes”
Different activities per health provider, Mexico
Public
NGO
Private
hospital
Reference
✓
✓
✓
✓
✓
✓
Microscopy
✓
X
✓
X
✓
X
Diagnosis
✓
X
✓
✓
X
X
Treatment
✓
X
✓/X
✓
X
X
Treatment
supervision
✓
X
✓/X
X
X
✓
Notification
✓
X
✓/X
X
X
X
Activity
Private
Private
Phisician
Lab.
Nophisicia
n
CENAVECE
Programas
Preventivos
“Yo puedo detener la Tuberculosis… Tú también puedes”
Estimated costs by private TB services
Cost for the
patient USD
Payment to
PhD
Mínimum
Maximum
Average
560
1,200
1,000
Laboratory and
XRay and other
services
800
1,500
1,200
Medications
720
890
800
Hospitalized in
complicate
patient
CENAVECE
Programas
Preventivos
Others
Total
Remarks
agreements
agreements
agreements
agreements
5,900
17,800
15,000
660
2,000
1,300
Indirect spent
19,300
Only for patients
with income
8,640
23,390
“Yo puedo detener la Tuberculosis… Tú también puedes”
Opportunities in PPA, Mexico (1)

There is political will from the government and
interest from public-private institutions.

Great possibility to improve activities from national
level to the local level.

There are best practices on vinculation in some
States in Mexico.
CENAVECE
Programas
Preventivos

Opportunity to foster a formal training programme in
order to validate private Phisicians
“Yo puedo detener la Tuberculosis… Tú también puedes”
Oportunidades
en APP,(2)
México
Opportunities
in PPA, Mexico

Strong linkage between public and private
organizations to benefit the NTP.

Agreements with:

National schools of medicine and nursing associations

National pharmacies association (ANAFARMEX)

National private hospitals association

National University (UNAM)
CENAVECE

2 chains of national private laboratories (el Chopo, Olarte and Akle)
Programas
Preventivos

Validation of processes by InDRE
“Yo puedo detener la Tuberculosis… Tú también puedes”
Opportunities in PPA, Mexico (2)

Include traditional
medicine (indigenous)
CENAVECE
Programas
Preventivos
“Yo puedo detener la Tuberculosis… Tú también puedes”
Achievements

1st Mexican Standars for Tuberculosis Care, validated by
Ministry of Health

Instrument of verification about the grade of involvement
of public-private health providers
CENAVECE
Programas
Preventivos

Distribution of chart of rights and responsabilities of the
TB patients (Mexican version).
“Yo puedo detener la Tuberculosis… Tú también puedes”
Next steps


To introduce the “Mexican standards for
Tuberculosis care” to ALL Ministries of health in the
country.
Implementation in States with high TB burden
(Guerrero, Chiapas, Baja California, Estado de México,
Distrito Federal, Nuevo León, Jalisco y Chihuahua).

Development of a National Standars pocket guide

Engagement of societies of expert specialist.

To start validation of technical capacity in public and
private laboratories by InDRE
CENAVECE
Programas
Preventivos
“Yo puedo detener la Tuberculosis… Tú también puedes”
PPA Action Plan
PPA implementation phases in
Mexico
1. To refrend standars
November 2006- August 2007
2. Analyze of current status with publicprivate providers
3. Human and funding resourses
Jun - September2007
5. Implementation and apply tool of
verification ( pilot areas)
5.1 Planning
5.2 Communication
5.3 Election of organizations and focal
CENAVECE
Programas
points (specialists)
Preventivos
5.4 Implementation.
7. Expansion.
November 2006-Marzo de 2007
November 2006-Jun 2007
4. Development of operational
6. Monitoring and Evaluation
Dates-Places
October 2008-D.F. Mexico state, Baja
California, Guerrero, Chiapas,
Jalisco y Chihuahua.
2009-2010 expansion to all country
annual
2011-2012
“Yo puedo detener la Tuberculosis… Tú también puedes”
Time line
2nd Visit
1st visit
Workshop
November the
14th, 2006
Monoitoring and evaluation by TB-CAP/ USAID
Improve statal specialists in TB
attention
2006
2007
2008
2009-2010
Mexican Standars for Tuberculosis Care (MSTC)
Patients chart
CENAVECE
Implementation and scaling up of PPA by MSTC
Programas
Preventivos
Index to measure the
degree of involvement
of public-private health
providers
“Yo puedo detener la Tuberculosis… Tú también puedes”
Gracias
Dr. Martín Castellanos Joya
Encargado del Programa Nacional
para la Prevención y Control de la
Tuberculosis
t 2614-6436, f 2614-6433
martinjoya@yahoo.com.mx
http://cenave.gob.mx/tuberculosis/
CENAVECE
Programas
Preventivos
Unión Internacional
Contra la Tuberculosis
y Enfermedades
Respiratorias
“Yo puedo detener la Tuberculosis… Tú también puedes”
Recomendations (1)

Formalize the Public-Private Aliance (APP) trough
agreements in the STOP-TB Committee México, to
assure sustainability of this iniciative to benefict
NTP.

To develop an easy tool to measure the
colavorative garde in TB attention (diagnosis and
treatment.

To analyze,document and expand APP activities on
CENAVECE
Programas
Preventivos
order that improve TB control
“Yo puedo detener la Tuberculosis… Tú también puedes”
Recomendations (2)

Build capacity in public and private services by
allied specialist

To develop a wallet guide of the Mexican
standars for TB care.

Expand APP plan to all country.
CENAVECE
Programas
Preventivos
“Yo puedo detener la Tuberculosis… Tú también puedes”