PPM (PPA) and ISTC in Mexico

CENAVECEProgramas Preventivos

“Yo puedo detener la Tuberculosis… Tú también puedes”

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 meet MDG according to the TB Global Plan and STOP-TB strategy

Decrease: TB Incidence, prevalence and mortality

PPA Objectives

Increase Respiratory simptomatics

Improve quality diagnosisStrengthening case reference

Increase case notification Increase cure rate Avoid MDR and XDR Direct observe treatment Decrease direct and undirect

cost for patients and institutions



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

Mexico was considered a pilot country to

implement the ISTC and implement them.

PPA Background, Mexico



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, pharmaceutical

industry and NGOs

Draft of validated National Standards for TB Care based on the ISTC

and National TB Official Norm



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.

Lack of agreements between private and public

health services with government



Activity Public NGO

Private hospital

Private Phisician

PrivateLab.

No-phisicia

n

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

Different activities per health provider, Mexico



Estimated costs by private TB services

Cost for the patient USD

Mínimum Maximum Average Remarks

Payment to PhD 560 1,200 1,000agreements

Laboratory and XRay and other services

800 1,500 1,200agreements

Medications 720 890 800 agreements

Hospitalized in complicate patient

5,900 17,800 15,000agreements

Others 660 2,000 1,300 Indirect spent

Total 8,640 23,390 19,300Only for patients with income



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.

Opportunity to foster a formal training programme in

order to validate private Phisicians



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)

2 chains of national private laboratories (el Chopo, Olarte and Akle)

Validation of processes by InDRE

Oportunidades en APP, MéxicoOpportunities in PPA, Mexico (2)



Include traditional medicine (indigenous)

Opportunities in PPA, Mexico (2)



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

Distribution of chart of rights and responsabilities of the

TB patients (Mexican version).



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



PPA Action PlanPPA implementation phases in

MexicoDates-Places

1. To refrend standarsNovember 2006- August 2007

2. Analyze of current status with public-private providers

November 2006-Marzo de 2007

3. Human and funding resourses November 2006-Jun 2007

4. Development of operational Jun - September2007

5. Implementation and apply tool of verification ( pilot areas)5.1 Planning5.2 Communication5.3 Election of organizations and focal points (specialists)5.4 Implementation.

October 2008-D.F. Mexico state, Baja California, Guerrero, Chiapas,

Jalisco y Chihuahua.

2009-2010 expansion to all country

6. Monitoring and Evaluation annual

7. Expansion. 2011-2012



Time line

2006 2007 2008

Workshop November the

14th, 2006

Patients chart

Mexican Standars for Tuberculosis Care (MSTC)

Improve statal specialists in TB attention

Implementation and scaling up of PPA by MSTC

Index to measure the degree of involvement of public-private health

providers

1st visit 2nd Visit

2009-2010

Monoitoring and evaluation by TB-CAP/ USAID



Dr. Martín Castellanos JoyaEncargado del Programa Nacional para la Prevención y Control de la

Tuberculosis

t 2614-6436, f 2614-6433

[email protected]

http://cenave.gob.mx/tuberculosis/

Gracias

Unión InternacionalContra la Tuberculosisy EnfermedadesRespiratorias



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

order that improve TB control



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.

PPM (PPA) and ISTC in Mexico

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