Action PlanAction PlanPrepared by :Prepared by :

Ismat Ara KhusheedIsmat Ara Khusheed

Deputy Director,PTP SindhDeputy Director,PTP Sindh At JAPAN 2006At JAPAN 2006

SINDHSINDH

100% DOTS Coverage since November 2003

GENERAL FEATURESGENERAL FEATURES Name; city district Government ,KarachiName; city district Government ,KarachiArea ;3527sq.kmArea ;3527sq.kmPopulation Density;2795 per sq kmPopulation Density;2795 per sq kmAverage housr hold size ; 7Average housr hold size ; 7Literacy rate ;60%Literacy rate ;60%Nos of town ;18Nos of town ;18Nos of diagnostic centre ;55Nos of diagnostic centre ;55Nos of treatment centres ;111Nos of treatment centres ;111Average public transport fare ;Rs.10 one wayAverage public transport fare ;Rs.10 one wayAverage time travel ;45 minutes one way by public Average time travel ;45 minutes one way by public

transport.transport.Large no of migrants who have flocked to karachi in Large no of migrants who have flocked to karachi in

search of opportunities.search of opportunities.

Back GroundBack Ground Karachi is the largest city of Pakistan and the capital of Karachi is the largest city of Pakistan and the capital of

its southern province of Pakistan karachi is divided in to its southern province of Pakistan karachi is divided in to 18 towns every town is supervised by town health 18 towns every town is supervised by town health officer.officer.

Mega city is administered by city district Govt. Of Mega city is administered by city district Govt. Of karachi (CDGK).which has an elected city council each karachi (CDGK).which has an elected city council each town has its own council and Nazim.town has its own council and Nazim.

Mega city like karachi pose a great challenge to Mega city like karachi pose a great challenge to community –based urban DOT strategy the public community –based urban DOT strategy the public sector cannot achieve the target of detecting all new TB sector cannot achieve the target of detecting all new TB cases hence PTP is in need of building partnership to cases hence PTP is in need of building partnership to bridge the gaps between public and private sectors bridge the gaps between public and private sectors prevailing in the urban DOTS.prevailing in the urban DOTS.

OrganogramOrganogram

Secretary Health

DG Health

Director TB Control Program

Deputy Director Hyderabad

Deputy Director Karachi

Deputy Director Sukkur

Deputy Director Larkana

Technical Support from NTP

4 NPOs and 1 Sociologist

DEFAULT RATEDEFAULT RATE

14%16% 15%

17%

13% 14% 14%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

Q1, 03 Q2, 03 Q3, 03 Q4, 03 Q1, 04 Q2,2004

Q3,2004

%

OUT COMEOUT COME

Dots coverage 2003 100%Dots coverage 2003 100%

New case detection sspos 52%New case detection sspos 52%

Case detection of all type 63%Case detection of all type 63%

Smear conversion 82%Smear conversion 82%

Success rate 86%Success rate 86%

Default rate 14%Default rate 14%

BeneficiariesBeneficiaries ImplementingImplementing

Agencies.Agencies.

Decision Decision makers.makers.

Funding Funding agenciesagencies

PotentialPotential

Opponents.Opponents.

PatientPatient EDOEDO

THOTHO

BHU. RHCBHU. RHC

Teaching Teaching HospitalHospital

Ministry ofMinistry of

HealthHealth

National National tuberculosistuberculosis

MohMoh

PtpPtp

GFATMGFATM

GeneralGeneral

practionerpractioner

CommunityCommunity

peoplepeople

Partner agenciesPartner agencies

FIEDELISFIEDELIS

CIDACIDA

WHOWHO

NationalNational

TuberculosisTuberculosis

programprogram

CIDACIDA

WHOWHO

FIEDELISFIEDELIS

PrivatePrivate

HospitalHospital

quakquak

EDO.EDO. NGONGO

TB AssociationTB Association

GfatmGfatm

Provisional Provisional

TubrtculosisTubrtculosis

programprogram

QuackQuack

hakeemshakeems

Traditional Traditional healershealers

Stakeholders AnalysisStakeholders Analysis

High defaulter rate

Poor compliance to Treatment of TB

patients

Weak linkage bet. Diagnostic

& treatment centers For case-holding activities

Il-Legal migrant of TBPt at karachi city

No proper home address

Difficulties to tress them

Poor co- ordinationAmong facilities

Pt develop drug resistantProblem Analysis

Poor compliance to Treatment of TB patients

Side EffectsLack of knowledge

Of TB patient

IN Sufficient Health education

HW has lack of knowledge

Very busy

Stop taking medicine

Lack of training

No funds

Too many responsibilities

Go to the alternative treatment

Problem Analysis

Poor capacity of health workers

Low defaulter rate

good compliance to Treatment of TB

patients

Good linkageSystem bet. Diagnostic

& treatment centersFor case-holding activities

Less migrant of TBPt at karachi city

permanent home address

Easy to trace them

Good co- ordinationAmong facilities

Pt not develop drug resistantObjective Analysis

Good compliance to Treatment of TB patients

Side Effects decreasedSufficient knowledge

Of TB patient

Sufficient Health education

HW has enough knowledge

HW have time

Continue taking medicine

Adequate training

Funds are available

Adequate responsibilities

Objective Analysis

Stop alternative treatment

improved capacity Of health workers

Sufficient Sufficient

HE to PT.HE to PT.

Good Linkage Good Linkage system system approachapproach

Economic Economic development development approachapproach

H.E AND economic H.E AND economic development approach.development approach.

Costs BenefitCosts Benefit 55 44 33 44

SustainabilitySustainability 33 33 33 55

FeasibilityFeasibility 44 44 22 55

Available Available resources.resources.

44 33 33 33

1616 1414 1111 1717

Project SelectionProject Selection

Project selectionProject selection Provisional tuberculosis programme Provisional tuberculosis programme

should emphasize on effective case should emphasize on effective case holding mechanism through health holding mechanism through health education and capacity building of health education and capacity building of health workers.workers.

PDMPDM Project NameProject Name:: effective case holding mechanism effective case holding mechanism

through healtteducation and referral syatem.through healtteducation and referral syatem.

Target area:Target area: slums of six towns of Karachi city.slums of six towns of Karachi city.

Target group:Target group: The target population in slums and The target population in slums and katchi abadies of six towns ,of karachi iskatchi abadies of six towns ,of karachi is approximately 3 millionapproximately 3 million

Duration;Duration; 1-7-2006 TO 31-6-20091-7-2006 TO 31-6-2009 Date;Date; 23-2-2006. 23-2-2006.

Narrative Narrative SummarySummary

O. V. IndicatorsO. V. Indicators Means of Means of VariationVariation

Important Important AssumptionsAssumptions

Overall Goal:Overall Goal:To reduce the To reduce the mortality and mortality and morbidity due to morbidity due to tuberculosis in tuberculosis in Karachi.Karachi.

The mortality The mortality and morbidity is and morbidity is reduced by 10% reduced by 10% by 2009 in 6 by 2009 in 6 towns in Karachi.towns in Karachi.

Health management Health management and information and information system. system.

Sindh health Sindh health department department continues to continues to include PTP as one include PTP as one of the priority of the priority programmes.programmes.

Project purposeProject purpose;;

To reduce the To reduce the default rate in default rate in

KarachiKarachi. .

The default rate The default rate has reduced by has reduced by half by the year half by the year 2009. 2009.

Quarterly reports,Quarterly reports,

Annual reports.Annual reports. The population in The population in the slum areas in 6 the slum areas in 6 towns in Karachi towns in Karachi do not increase do not increase drastically.drastically.

OUTPUTS.OUTPUTS.

1. Sufficient H.E is 1. Sufficient H.E is provided to TB provided to TB patients and patients and community.community.

1- TB patient s 1- TB patient s knowledge on TB knowledge on TB is increased by is increased by 30% by the year 30% by the year 2007.2007.

-Project survey.-Project survey.

-Project records on -Project records on trainings conducted.trainings conducted.

-Monthly reports,-Monthly reports,

Minutes of meeting.Minutes of meeting.

TB register. TB register.

The TB situation of The TB situation of migrant population migrant population do not become do not become worsen.worsen.

2. Capacity of 2. Capacity of health workers is health workers is improved through improved through training.training.

3- Good linkage 3- Good linkage between between diagnostic & diagnostic & treatment centers treatment centers established for established for effective case effective case holding activities. holding activities.

2-. 50% of LHW 2-. 50% of LHW have completed have completed TB training by TB training by 2007.2007.

3- Number of 3- Number of diagnostic centers diagnostic centers that have monthly that have monthly meeting with meeting with treatment centers treatment centers increase by 80% increase by 80% in 2008.in 2008.

4- Number of 4- Number of properly transfer properly transfer out cases out cases increase by 50% increase by 50%

in 2008.in 2008.

ACTIVITIES:ACTIVITIES:

1-1Conduct base-line 1-1Conduct base-line survey to identify causes of survey to identify causes of defaulter cases. defaulter cases.

1-2. Interview & 1-2. Interview & questionnaire to TB patients questionnaire to TB patients & families to identify their & families to identify their knowledge on TB.knowledge on TB.

1-3Conduct advocacy 1-3Conduct advocacy meetings with stakeholders.meetings with stakeholders.

1-4. IEC materials 1-4. IEC materials developed & distributed.developed & distributed.

2- Develop supervisory 2- Develop supervisory guidelines.guidelines.

2-3 Conduct workshop with 2-3 Conduct workshop with HWs.HWs.

2-4 Conduct one day 2-4 Conduct one day seminar every month.seminar every month.

2-5 Trainings conducted.2-5 Trainings conducted.

3- Directory furnished.3- Directory furnished.

3-1 Monthly meeting with 3-1 Monthly meeting with

DC & TC.DC & TC.

InputsInputs

Personnel:Personnel: long term expert, long term expert, project leader, project co-project leader, project co-ordinator.ordinator.

Short term experts as Short term experts as required.required.

Equipment:Equipment: vehicle, vehicle, maintenance parts, POL maintenance parts, POL and spare parts.and spare parts.

Training material and IEC Training material and IEC materials.materials.

Funding of workshops and Funding of workshops and meetings.meetings.

Training facilityTraining facility

Local cost.Local cost.

Facilities like DHDCofficeFacilities like DHDCoffice

Trained workers continue to Trained workers continue to work for their facilities.work for their facilities.

Pre-conditionsPre-conditions

The NTP and CIDA support The NTP and CIDA support the project. the project.

Thank youThank you