Download - TB PUBLIC-PRIVATE MIX DOTS

TB PUBLIC-PRIVATE MIX DOTS

Dr. Team Bakkhim Deputy Director

CENAT

Intercontinental Hotel7th November, 2012

NATIONAL FORUM ON PUBLIC-PRIVATE PARTNERSHIP IN HEALTH

OUTLINE

Background of TB PPM-DOTS TB PPM-DOTS : Design and implementation Lessons learnt from the success Recommendations

TB PUBLIC-PRIVATE MIX DOTSDr. Team Bakkhim, Deputy Director, CENAT 1 of 16

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 )


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


Clients suspected TB

Private Clinic / cabinet Private Pharmacy / depot Private Lab.

Public Hospital / Health Center Diagnosis, Treatment

Recording & Reporting

PHASE I REFERRAL STRATEGY

=

Referral System


GOAL FOR TB PPM-DOTS

To test and scale–up 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


SPECIFIC TB PPM-DOTS OBJECTIVES

Reduce diagnostic delay for people with suspected TB, increase case detection, and decrease the opportunity for multi-drug resistance

Strengthen 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 ACTIVITIES Develop TB PPM-DOTS strategy Identify and engage private sector partners (Pharmacists

Association of Cambodia (PAC) and Cambodian Medical Association (CMA))

Review and revise national recording and reporting forms Develop standardized referral tools Develop IEC and training curriculums Develop Memorandum of Understanding agreements Organize a sensitization workshop for public and private-public

providers and sign MoU agreements Build capacity for national, PHD, and OD TB staff on PPM and

supervision of private sector Train private providers and DOTS health center staff Conduct quarterly Public-Private Partner meetings Conduct monthly supportive supervision and data collection


PPM IMPACT INDICATORS

Number of private providers involved in PPMD. Number of TB suspects referred from the pharmacy to

the DOTS health center Number of TB suspects presenting at DOTS health

center with referral from private providers Number of TB cases identified among TB suspects

referred from private providers.


Julian Hansen

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

ACHIEVEMENT


0200400600800

10001200140016001800

2005 2006 2007 2008 2009 2010 2011

DistrictPrivate

Year 2005 2006 2007 2008 2009 2010 2011District 3 15 37 37 37 37 37Private* 287 755 1362 1690 1735 1735 1547

ACHIEVEMENT : PRIVATE PROVIDERS INVOLVED IN TB PPM-DOTS

* Pharmacy, Cabinet/clinic, Laboratory, other


0100020003000400050006000700080009000

10000

2005 2007 2009 2011

ReferredReceived TB cases

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 3415

ACHIEVEMENT : REFERRED, RECEIVED AND TB CASES

76%

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-TB


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,…)


Julian Hansen

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)


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)


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 )


THANK YOU!
