TB PUBLIC-PRIVATE MIX DOTS

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TB PUBLIC-PRIVATE MIX DOTS. Dr. Team Bakkhim Deputy Director CENAT. NATIONAL FORUM ON PUBLIC-PRIVATE PARTNERSHIP IN HEALTH. Intercontinental Hotel 7 th November, 2012. OUTLINE. Background of TB PPM-DOTS TB PPM-DOTS : Design and implementation Lessons learnt from the success - PowerPoint PPT Presentation

Transcript of TB PUBLIC-PRIVATE MIX DOTS

Public Private Mix: DOTS

TB PUBLIC-PRIVATE MIX DOTS

Dr. Team Bakkhim Deputy DirectorCENATIntercontinental Hotel7th November, 2012NATIONAL FORUM ON PUBLIC-PRIVATE PARTNERSHIP IN HEALTHOUTLINEBackground of TB PPM-DOTSTB PPM-DOTS : Design and implementation Lessons learnt from the successRecommendations

TB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT

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BACKGROUND OF THE PROJECT (1)Cambodia is ranked 21 among the 22 TB high burden countries Approximately two-thirds of all Cambodians are infected with TB, and around 13,000 Cambodians die annually from the disease National Tuberculosis Program (NTP) focus on reducing morbidity and death rates due to tuberculosis is a key strategy for improving the overall health of the population The private sector is accessible, with two thirds of Cambodians seeking care outside the public sector for their first visit with TB symptoms To align with the WHO Global strategy for TB control (Stop TB Strategy 2006 : engage all care providers )

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BACKGROUND OF THE PROJECT (2)In 2004 the NTP began to engage private providers in TB control.The NTP, with support from their partners, developed the Public-Private Mix (PPM) strategy and it was approved by the Ministry of Health. During Phase I, with USAID/JICA funds, the NTP and partners designed, implemented, and evaluated a referral network in the private sector where symptomatic individuals seek care and public sector DOTS facilities in pilot provinces TB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT

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Clients suspected TBPrivate Clinic / cabinet Private Pharmacy / depotPrivate Lab.Public Hospital / Health CenterDiagnosis, TreatmentRecording & ReportingPHASE I REFERRAL STRATEGY =Referral SystemTB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT

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GOAL FOR TB PPM-DOTSTo test and scaleup a public-private mixed DOTS partnership model that aims to strengthen both the public and private sectors in TB case management and increase case detection TB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT

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SPECIFIC TB PPM-DOTS OBJECTIVESReduce diagnostic delay for people with suspected TB, increase case detection, and decrease the opportunity for multi-drug resistanceStrengthen public-private linkages & partnerships in TB case management and control through a referral system to public DOTS services (Phase I)Improve access to quality DOTS services for people seeking care at the private sector providers by implementing DOTS services in private clinics and hospitals qualified by NTP (Phase II)

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Specific PPM objectivesReduce diagnostic delay for people with suspected TB, increase case detection, and decrease the opportunity for multi-drug resistantStrengthen public-private linkages & partnerships in TB case management and control through a referral system to public DOTS services (Phase I)Improve access to quality DOTS services for people seeking care at the private sector providers by implementing DOTS services in private clinics and hospitals qualified by NTP (Phase II)

KEY ACTIVITIESDevelop TB PPM-DOTS strategyIdentify and engage private sector partners (Pharmacists Association of Cambodia (PAC) and Cambodian Medical Association (CMA))Review and revise national recording and reporting formsDevelop standardized referral toolsDevelop IEC and training curriculumsDevelop Memorandum of Understanding agreements Organize a sensitization workshop for public and private-public providers and sign MoU agreementsBuild capacity for national, PHD, and OD TB staff on PPM and supervision of private sectorTrain private providers and DOTS health center staffConduct quarterly Public-Private Partner meetings Conduct monthly supportive supervision and data collection

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PPM IMPACT INDICATORSNumber of private providers involved in PPMD. Number of TB suspects referred from the pharmacy to the DOTS health centerNumber of TB suspects presenting at DOTS health center with referral from private providersNumber of TB cases identified among TB suspects referred from private providers.

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What does this abbreviation stand for? Please provide whole words.

- 2005 : Piloting in : - 3 ODs (2 provinces) (JICA,USAID/PATH, URC)

- 2008 up to now : scaling up : - 37 ODs (10 provinces) (USAID/PATH/TBCARE I /FHI 360/ RHAC, RACHA)TB PPM sites ACHIEVEMENTTB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT

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Year 2005 2006 2007 2008 2009 2010 2011District 3 15 37 37 37 37 37Private* 287 755 1362 1690 1735 1735 1547ACHIEVEMENT : PRIVATE PROVIDERS INVOLVED IN TB PPM-DOTS* Pharmacy, Cabinet/clinic, Laboratory, otherTB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT

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Year 2005 2006 2007 2008 2009 2010 2011 Total Referred 314 1989 5562 4212 9781 7612 5024 34494 Received 242 1154 2763 1882 5540 4280 2920 18781(54%) TB cases 46 224 533 301 769 851 691 3415ACHIEVEMENT : REFERRED, RECEIVED AND TB CASES76%58%50%45%57%57%58%There is clear benefit to involving private providers to identify undiagnosed TB cases, to stop selling Anti-TB drugs and prevent MDR-TBTB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT

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LESSONS LEARNT(1)Factors for success: Strong support from MoH officials and key stakeholders (USAID, JICA)Leadership from NTP at all levels (Central, Provincial, OD)Clear task division (MoU)Commitment from all partners (PATH, JICA, URC, RACHA, RHAC, CATA)Strong support from professional societies in Cambodia (CMA, PAC)High commitment/motivation of private providers at all levels (Pharmacist, cabinet/clinic,)TB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT

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Need to highlight: How did PPP enhance the success of this intervention? What difficulties were faced in using a PPP approach? Geographic application :Usefulness of PPM-DOTS in less-populated geographic areas (rural) : Solution applying difficulties (thinly populated, transportation, time, money) Recommendations : should be integrated with other projects

Partnerships :Need participation of all private providers Recommendation : Link with other organizations/institutions (Cambodia Medical Council Committee, Cambodia Pharmacist Council Committee, Cambodia nurse/midwife association) LESSONS LEARNT(2)TB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT

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Supportive supervision:Supervision : to ensure that they maintain a high commitment to their efforts to achieve the TB PPM-DOTS goals. Recommendations : need regular conscientious supervision of PHD/OD Regular meetings :The meetings between the key players are critical factor in the program success and serve several vital functions (opportunity to learn best and receive feedback and new health information) LESSONS LEARNT(3)TB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT

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for instance Incentives:Private providers, especially pharmacists in Cambodia participate and support public health programs for reason of merit-offering, professional development and social status.Recommendations : offering a cash incentive to key players would not threaten program sustainability. LESSONS LEARNT(4 )TB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT

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for instance THANK YOU!TB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT

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