Report of group work: Group 1
Fifth meeting of the Subgroup on PPM for TB care and control
EMRO, Cairo, Egypt, 3-5 June 2008

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RV Asokan
Mysoun Al Hasen
Karin Bergstrom
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Erlina Burhan
Mirtha Del Granado
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Mao Tan Eang
Fran Du Melle
Philip Hopewell
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Ghada Muhgazi
Benjamin Nwobi
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Julia Seyer
Andrew Suleh

1.
Key recommendations to NTPs on
 how to engage PAs (PMA) for TB care
NTPs should sensitize the PAs on TB care. The goal is to involve the PAs as partners focusing on the ISTC (Stop Tb Strategy). NTPs should initially conduct a National Situation Analysis
(on the role of private sector in TB care and identify the roles to performed by PAs).
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The PAs should be involved in policy formulation, preparation and dissemination of national guidelines.

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NTPs should support CMES, trainings, journals, workshops, research etc to involve members of PAs in TB care.
Global TB partners and the governments should assist NTPs technically and financially for PA activities.
Capacity building of NTPs to facilitate these activities has to be undertaken
Certification of trained PAs, accreditation of institutions and access to forum for the members should be facilitated.

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PPM subgroup should have adequate representation from PAs.
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It should provide guidance and technical assistance to NTPs to engage PAs.
Create a forum where PAs can interact and exchange experiences and ideas.
PPM subgroup should develop tools for M&E and indicators for involvement of PAs.

3.
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Facilitate information flow from private sector either through NTPs or Pas.
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Periodic NSAs should be carried out.

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Agenda item: developing national coalitions of PAs
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Agenda item: Role of the
International PAs

• Abu –Saad Refaat
• Al Domainy Khadija
• Awe A
• Chakaya Jeremiah
• Chin Daniel
• Farghally Ayman
• Kilicaslan Zeki
• Uplekar Mukund
• Wang Lixia
• Wei Xiaolin
• Zignol Matteo
• Jan Voskens Facilitator

1. Issues and Challenges of involving
Hospital in TB control
2. Comments on the HDL guidelines: terminology; content; presentation
3. Comments on the incorporation of issues such as TB/HIV; MDR TB and
Infection control in HDL document.
4. Recommendation on next steps for HDL guidelines

Issues and challenges of involving
Hospitals in TB control
Financial Issues
1. Hospitals not eager to loose their patients by referring to the NTBP and thus loose income
2. Elaborate on Compensation mechanism.
1. Incentives to Hospitals.
2. Dilemma of Free drugs or affordable drugs
3. Insurance

1. Specify the target audience for the document.
? NTBP ; ?Hospital Director; Decision is to focuss on both.
2. The Document to be made simple; more bullets, shorter sections, concise and easy to read. remove duplications;
3. Contents to include short sections on Infection
Control, TB/HIV and MDR
4. The document be linked with the document on
‘‘ engaging all health care provider’’. Should it be an annex of that document ?

1. To put the new comments together for final draft.
2. Final draft forwarded to wider audience.
Including end users; hospitals , NTP for comments.
3.
Printing of final document; distribution on web and hard copies along with document on engaging all health care providers.

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Facilitator: Shaloo Puri Kamble

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 Clarification of concepts and definitions
 Sharing of country experiences
 Process of engaging the corporate sector- concrete steps for NTP
 Contribution and advantages of engaging the corporate sector
 The significance of an interface in facilitating NTP – business sector collaboration
 Importance of advocacy for NTP-business sector collaboration
 The role of community and trade unions in bottom-up facilitation of NTP-business sector collaboration
 Need to build evidence base on initiatives engaging the corporate sector
 Need for practical guidance and tools for NTP to engage the corporate sector
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Linking with existing mechanisms and platforms….DONT REINVENT THE WHEEL !

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• First get internal buy-in and then external buy-in
• Prioritize and engage potential and existing stakeholders (NGOs, business associations, FAIR
TRADE organizations, etc.) to act as intermediaries
(NTP overstretched!)
• Need assessment and mapping of industries/companies to prioritize sectors, groups or regions for initial engagement
• Assist PPM subgroup in documenting successful initiatives in country
• Develop guidance or framework for involvement of corporate sector

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• Design appropriate messages for reaching out to the corporate sector
• Disseminate corporate self assessment tool to companies through interfaces as part of a mapping and information collection exercise
• Promote of inclusion of TB services in health insurance packages
• Design, implement and enforce regulations for TB control (?)

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• Document existing corporate sector initiatives and build evidence base
• Measure advantages or benefits of corporate sector engagement in TB control which will help in designing messages to convince NTP staff and companies to get involved
• Facilitate dissemination and follow up of self assessment tool as part of a global mapping exercise and also building evidence base
• Identify and draw lessons from other disease programmes which are engaging the corporate sector and/or piggy back on existing mechanisms (for example:HIV in the workplace programmes)

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• Coordinate with ILO and other agencies/partners working in this area
(collaborative working group)
• Work with ILO to exert their influence with trade unions to initiate workplace programmes
• Collaborate with ACSM working group to jointly work on engaging the private sector and to push bottom up facilitation of NTP-business sector collaboration (PCTC)
• Organize missions for NTP staff to visit successful initiatives

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• Document, develop tools and guidance in tandem with GHI and GBC
• Support GHI and GBC in conducting national/regional sensitization workshops for business managers, etc.…..provide technical assistance
• Work together on putting TB control on the World
Economic Forum and GBC global meeting agendas

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 Collaborate with global accreditation agencies (ISO) to insert TB control as one of the essential criteria for certification
 Stigma and discrimination- addressing this
 Including corporate initiatives in Global
Fund Dual track financing applications
 Putting TB on the agenda of local economic development agendas

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Group 5
Wilfred Nkhoma
Aziz Mohamed Abdel
PK Mitra
Eva Nathanson
Ohkado Akihiro
Seita Akihiro
Cheri Vincent
Sara Massaut
Vishnu Kamineni

Good discussion but not enough information to address the issues and expected outcomes.
– Incomplete list of planned TA at country level
(only 4 partners: JATA, WEF, The Union and
LHL)
– Missing partners: ATS, WHO and KNCV etc.

• Current information provided by only 4 partners
• Countries receiving TA: India, Philippines,
Pakistan, Yemen,Cambodia, Bangladesh,
Zambia, S. Africa, China, Namibia
• TB Team is current coordinating mechanism
– List of consultants (32) but are they experts and/or active?
– Activities planned—only 3 TA planned specifically for
PPM, are there more? (not including GF and reviews)

• Information provided to group does not allow accurate identification of gaps
• Group discussions reveal gaps in the AFRO region:
– Francophone—language issues
• Is TA being provided at all?
• Non-HBC not seen as priority at the global level
• Eastern Europe
– What is happening and is there a need?

• TA is often partner driven
• Lack of communication and coordination with NTP
• Existing capacity at NTP to identify, coordinate and monitor TA —not optimally utilized
• PPM TA needs to be based on and in alignment w/National Strategic Plan

• Improved systematic documentation of TA (TB
TEAM) —regular updating of planned missions
– Including partner contributions
• Address non-HBC needs – generic and PPM specific
• Mapping/categorization of countries based on
PPM needs (low/middle income, insurance etc.)
• Translate critical guidelines in major operating languages —e.g. Francophone countries
• Improved coordination with NTP to avoid duplication —based on perceived needs of NTP

• Increase use of TB TEAM
• Include HSS consultants in PPM missions
• Common definition of PPM as supporting component to Stop TB Strategy
• Avoid fragmented approaches to PPM
(TB/HIV, MDR and IC)

• Dr Hassan Sadiq
• Dr. Martin Gninafon
• Dr. Hee Jin Kim
• Dr. Mtanios Saade
• Dr. Alfonso Tenorio
• Dr. Shafiullah
Talukder
• Dr. Felix Salaniponi
• Dr. Jaime Lagahid
• Dr. Aayid Munim
• Dr. Salah-Eddine
Ottmani
• Guy Stallworthy

Proposed Global Indicators of PPM Contribution to
TB Control
• Number and % of private facilities actively involved in:
– Referring suspects
– Diagnosing TB cases
– Managing TB patients
• Number and % of notified cases diagnosed by the private sector
• Number and % of notified cases managed in private sector

• Estimate the total number of private providers
• Introduce/revise recording and reporting tools to identify role of private providers
– Design revised tools
– Train staff
– Test new tools
– Revise new tools
– Introduce new tools nationwide

Advocacy for PPM Monitoring at National
Level
To private sector
• Regular consultations (with professional associations, private providers, etc) to understand importance of monitoring within context of ISTC
To Ministry of Health
• Explain benefits to TB control from increased resources dedicated to monitoring contribution of private sector
Both
• Ensure ownership by reviewing monitoring data in PPM coordination/management committees that involve both public and private sector representation

Assessing PPM Contribution to MDR-TB
• No, % of private and public non-NTP providers involved in MDR diagnosis and treatment according to international
(WHO, Union) standards
• No, % of DST conducted by private and public non-NTP labs
• No, % of 2 nd line treatments managed by private and public non-NTP providers

• Private sector participation in TB/HIV coordinating body
• #, % of private TB diagnostic centres that offer VCT
• #, % of TB cases diagnosed in private sector who receive VCT
• #, % of people testing positive for HIV in private sector who are screened for TB

HAI El Tilib
SA Hamid
B Kaboru
BA Kumar
F Ledoux
R Malmborg
I Nyasulu
C Gordon
K Inaba
S Baghdadi
L Velebit
MoH, Sudan
Damien Foundation, Bangladesh
WHO HQ
Community Health Nurse, India
TB/HIV advocate, Cameroon
LHL, Norway
WHO Malawi
World Care Council Facilitator
WHO South Sudan
WHO EMRO
WHO HQ

Issues of patient and community empowerment to be addressed are part of, yet beyond the scope of the work of the PPM Subgroup…
• Low CDR = TB commonly not perceived as
Health priority and/or is highly stigmatized
• Sensitization of the general population
• Patient and community empowerment

• To NTPs, @ national/subnational level: Ensure patient representation and participation in the national PPM coordinating body (and subnational levels where activities are present)
• To PPM Subgroup: Ensure that ISTC and PCTC are promoted and used hand in hand
– in documents, trainings (e.g. Sondalo), international meetings
– All references to ISTC should be
ISTC/PCTC

• Handbook for the implementation of ISTC has already been prepared.
• Why wasn't the same done for PCTC????
– PPM Subgroup to commit to developing a handbook for the implementation of PCTC as well
• WHO HQ, WHO Regional Offices, and Stop TB
Partners to more actively promote the adoption of PCTC as part of national guidelines at country-level

WHO to:
• a) more pro actively facilitate capacity building of patient and community groups ie. TA for Global Fund dual track proposals
• b) to facilitate translation of PCTC in all
UN languages.

• Previously initiated MoU (inclusion of the
Charter in the TB drug kits) WCC and
GDF to be followed up at DEWG (core immediately