Progress and plans for
PPM in the
WHO Region of the
Americas
Fifth PPM Subgroup Meeting
3 - 5 June, Cairo
Regional PPM Progress
Regional PPM Progress
Strategic Lines of the Regional
TB Plan for the Americas
1. Strengthening and/or expansion of quality DOTS
2. Implementation and/or strengthening of the TB/HIV
collaborative activities, MDR-TB prevention and
control and strategies for unattended populations
3. Contribution to health system strengthening
4. Involvement of all health providers
5. Empowerment of affected populations and their
communities, and implementation of ACSM
strategies
6. Operational, clinical and epidemiological research
Regional PPM Progress
The TB control is integrated in PHC by the MoH.
% of the population with access to health care according to
provider - PPM countries 2007
PROVIDER CATEGORY
MoH
DOR
%
BOL ELS BRA MEX ECU
%
%
%
%
%
60
30
40
80
42
28
Public Insurance
7
25
20
6
57
21
Private Insurance
20
14
3
Total Pub sect + Insurance
87
100
99
For-profit or non profit
Private Services
55
60
12
5
Without coverage
13
33
35
TOTAL
100
100
100
Salud en las Americas, OPS/OMS 2007
49
26
100
1
27
100
100
PPM activities in priority countries
Priority countries
National Situation
assessment
conducted
PPM focal person
appointed
DOR
Pilot area
Yes
BOL
Pilot area
Yes
BRA
Pilot area
Yes
ELS
Non
Yes
MEX
Pilot area
Yes
ECU
Yes
Yes
PPM Operational
guidelines
developed
Regional PPM Progress
Results from PPM surveys in Latin America
Regional PPM Progress
Results from PPM surveys in Latin America
Provider
BOL
BRA
. % TB % TB
dx
Ttx
Public
93.2
Private
4.5
94.4
3.3
%
TB
dx
ELS
%
TB
Ttx
%
TB
Ttx
Ref. %
TB
dx
86.8 98.9 97.8 100
100
87.7 87.7 76.7
13.2
0
12.3 12.3 23.3
1.1
Ref. %
TB
dx
DOR
2.2
0
%
TB
Ttx
Regional PPM Progress
ACTIVITIES 2006-2007
Number
Of countries
PPM in the national action plan
10
Carried out the PPM survey protocol* (In pilot
areas)
6
Carried out the PPM survey protocol (Whole
country)
1
Map Providers (In a pilot area)
6
Map Providers (Whole country)
1
Assess NTP capacity for PPM
6
Selection of providers (Prioritization)
6
Defining the “task mix”
2
ISTC Endorsement by the MOH*
2
* In process (MEX, ELS and URU)
Regional PPM Progress
• To date, most of the NTPs have carried out alliances
with other suppliers specially with the public sector
not previously involved (hospitals, public insurance,
prisons, military and police health services and
others).
• Other initiatives have been carried out with the
universities and professional societies and to a lesser
extent with NGOs and for-profit private sector.
• The NTPs’ experience engaging private pharmacies
and traditional medicine is scarce.
Regional PPM Progress
PPM
PPM
PPM
PPM
PPM
Countries with PPM initiatives in place
PPM
MEX
ELS
DOR
BOL
BRA
ECU
PPM
PPM
Countries planned to initiate PPM
COL
GUA
PAR
URU
PPM contribution to TB control in
El Salvador
El Salvador
TB case notification all forms - 1990-2006
4500
STOP TB strateg y
80
4000
(Including PPM)
70
3500
60
3000
50
End of civ il war
(1981-1992)
2000
1500
1000
500
0
DOTS Implementation
2500
Cases
40
30
20
Rate
10
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Cases
2367
2304
2495
3347
3901
2422
1686
1662
1700
1623
1485
1458
1550
1383
1407
1794
1644
Rate
45.7
43
46.3
62
70
43
29
28.1
28
27
24
23
24
21
20.8
26.1
23.5
**
Rate per 100,000 hab.
*
1997 a 2005 Datos MSPAS/ISSS
0
Regional PPM Progress
Mexico
•
National meeting to present the PPM objectives and action lines
•
Verification of degree of involvement of the NTP and the private sector
•
Validation of evaluation form for each state involved
•
Draft of validated National Standards of Care based on the ISTC and
national TB norms
•
Agreements with the industry and federal laboratory
•
Agreements with schools of medicine and nursing
•
Agreements with national pharmacies association
•
Agreements with national private hospital association
•
Nine states (25%) already with PPM activities
Regional PPM Progress
Brazil
• Agreement between the Ministry of Health and
the Business and Industrial sector (SESI) for the diagnosis and
treatment of TB in patients found in the work force of the sector.
• Notification and reference of all TB cases within the health system
(SUS) with guarantee of diagnosis and TB drugs financed by the
MoH.
• National Brazilian consensus for TB management with wide
involvement of Pneumology Society, TB Research network and
schools of medicine.
• Ministerial resolution endorsing a TB control plan for prisons,
indigenous population and TB/HIV.
Brazil
Provider group
Involvement
Professional
associations
Yes
Corporate Sector
Yes
Hospitals
Yes
Informal providers
NO
Private laboratories
Yes
Prison
Yes
Industrial Sector
Yes
Contribution
Constraints and challenges for
PPM implementation in the Americas
• Weakness of the NTP leadership in some
countries
• Limited experience in coordination, integration
and alliances with other actors
• Public and private insurance security focused on
curative care
• Segmented and disorganized private sector with
limited interest.
• Scarce knowledge of the role and coverage of
the private sector, including private pharmacies.
• Scarce knowledge of the participation of
tradicional medicine
Opportunities for PPM implementation
in The Americas
• PPM included in the Regional TB plan and several
country plans, some with specific budgets and
indicators.
• PPM activities supported by the GFATM
• Existence of technical and financial support from
partners
• Free TB drugs available
• Some positive pilot experiences in countries and
expansion already underway
• ISTC available and Regional implementation
guidelines developed
• National Stop TB partnerships already organized in 4
countries: Brazil, Honduras, Mexico and Peru
Regional Priorities
2008-2009
• Expand the PPM initiative at country level in BOL,ECU, DOR, BRA,
MEX.
• Carry out the PPM surveys in four countries (COL, PAR, GUAT,
URU) and implement the PPM initiative
• Promote the adoption of the ISTC and the Patient chart  improve
the quality on DOTS among all health providers.
• Disseminate the implementation guidelines for the ISTC
The adoption of the ISTC is recognized as a great opportunity to
reach the objectives of TB control in the Region.
Regional Priorities
2008-2009
• Strengthen advocacy efforts to include PPM
activities in all TB country plans and Global Fund
projects
• Conduct PPM consultant training workshops at
Regional level
• Continue and strengthen technical support to
countries for PPM planning and implementation
including effective engagement of private
laboratories and involvement of informal health
care providers and pharmacies.
The Americas involving all health
providers in TB Control
THANK YOU !