PATH Tanzania
TB, TB/HIV Project & IPT in the
Private Health Sector
East African Health Care Federation Conference
Dar Es Salaam: Diamond Jubilee Hall
28th February, 2013
Dr. Zahra H. Mkomwa; Project Director
Presentation Outline:
• Overview of PATH Tanzania TB/HIV
project
• Major activities and achievements
• IPT piloting in the private health sector
• Challenges
• Way forward
• Acknowledgement
Project Overview
•
Started in 2005, USAID/PEPFAR
•
Salaam (Ilala & Kinondoni),
funded
•
•
Coverage: Working in Dar Es
Pwani, Kilimanjaro, Arusha
Signed MoU with MoHSW
Mwanza and Zanzibar (Plan to
Tanzania - Mainland & Zanzibar
expand to Simiyu and Mara)
Work closely with MOHSW
•
Dartmouth, MSH and Initiative
(NACP, NTLP), Regional and
District authorities, APHFTA, IP
(ICAP, AIDS Relief, EGPAF, ITECH) and key collaborators
Sub-partners: UCSF,
Inc.
•
Staffing: > 70 staff (seconded
and central staff)
Major activities
Lab strengthening
 Procured 82 LED Microscope (4
placed at Private facilities)
 2 Gene Xperts operational
 Finalize the national TB lab strategy
TB/HIV
 Supporting 1,042 facilities (197
private health facilities)
 PITC – 95%,
 CPT – 98%
 ART uptake 54%
 IPT (Hindu Mandal & St. Elizabeth)
Pediatric TB
 National guidelines
 Training curriculum
 Trained 273 HCWs
 Continue to scale-up, mentor, and
monitor results
MDR TB
 Develop Guidelines/training material
 Support cohort review panel
 123 patients were initiated treatment
as of Dec 2012
 Developed decentralization plan Shift patients in intensive treatment
phases to districts facilities
Community and private sector
Involvement
Capacity building for HCP (training,
supervision and mentorship
PPP activities
•
Support development of
•Conduct supportive
National guidelines: TB work
supervision and mentorship
place and TB/Diabetes
Type of training
No. HCP trained
3I’s
46
Pediatric TB
49
• Capacity building: Trained 141
LED Microscopy 4
Health care providers in
MDR-TB
3
different focus areas
X-ray
interpretation
TB DOTS
3
Total
141
36
Number of PHFs in PATH
supported regions as of Sept 30,2012
Region
Number of
Public facilities
Arusha
Dar es salaam
168
59
Mwanza
Pwani
Zanzibar
267
133
128
Kilimanjaro
TOTAL
93
845
Number of
Private
facilities
34
34
39
30
18
44
197
Total number
of facilities
202
93
306
163
143*
135*
1,042
Contribution of PHFs on TB
Case Notification April – Sept 2012
Region
Total TB Patients
Contribution from % Contribution of
Private Facilities
Private Facilities
Arusha
1599
587
37%
Dar es salaam
4,633
1,068
23%
Kilimanjaro
1,181
370
31%
Mwanza
3,080
843
27%
Pwani
956
283
32%
Zanzibar
248
24
10%
TOTAL
11,697
3,175
27%
Private sector can contribute and improve TB case notification if well involved !
Isoniazid Preventive Therapy (IPT)
• Tanzania started piloting IPT in 20 sites in 2012
• PATH supports piloting IPT in 2 private hospitals:
oSt. Elizabeth (Arusha)
oShree Hindu Mandal (Dar)
• Started in August 2012: Activities conducted:
oTraining of HCP
odistribution of drugs and data collection tools
oSupportive supervision and mentorship
oThe National Policy Guideline for IPT is used in
both the public and private sectors.
Status of IPT Pilot – Hindu Mandal
Hospital, Dar : 31st Dec 2013
2,500
2,247
2,225
No of Clients
2,000
1,500
1,000
518
281
500
197
0
Enrolled on Care
(CTC)
Screened for TB
Screened for IPT
Eligible for IPT
Started on IPT
Status of IPT Pilot – St. Elizabeth
Hospital, Arusha: 31st December 2013
No of clients
4,768
5,000
4,500
4,000
3,500
3,000
2,384
2,261
2,500
2,000
1,500
862
1,000
500
0
Enrolled on Care
(CTC)
Screened for TB
Eligible for IPT
Started on IPT
Challenges and way forward
SN Challenges
1. Few clients screened for TB
and IPT.
Few IPT-eligible clients
initiated INH
2. Human resource shortage,
capacity, transfers
3. Poor infrastructure for
some PHF: Inadequate
space, equipments
Way forward
Strengthen services through
supervision, mentorship, close
monitoring and motivation of HCPs
Advocate for Government to
second staff to private facilities,
Support training for private HCPs
Advocate for support from
Government, partners/donors) for:
renovations/construction and
supply of equipments
Acknowledgement
USAID
MOHSW Tanzania Mainland
MOH Zanzibar
APHFTA
Shree Hindu Mandal and St. Elizabeth admin and staff
Patients
Regional and District coordinators
Thank you for listening
zmkomwa@path.org
+255 655 371 137