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THAILAND

THAILAND. TB case notification rate by province, 2003. 1 to 15. Distribution of new smear-positive cases ( RATE / 100,000 POP . ). 16 to 30. 31 to 45. 46 to 60. 61 to 75. 76 +. Introduction.

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THAILAND

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  1. THAILAND TB case notification rate by province, 2003 1 to 15 Distribution of new smear-positive cases ( RATE / 100,000 POP . ) 16 to 30 31 to 45 46 to 60 61 to 75 76 +

  2. Introduction • Thailand is of 22 countries (high burden countries) which are home to 80% of the people in the world who are infected with TB • Thailand ranks 17th among the 22 HBCs • Low cure rates (17-68%) • Patient compliance is the most serious problem • in TB control

  3. Background • 1996 introduction of DOTS strategy in 8 pilot districts • 4-7 years later covered all districts in each region/province • Training and Supervision as a core active for improving • Cohort report as a tool for NTP monitoring and evaluation • Cohort data report flow from DTC-PTC-RTC-NTC

  4. Goals • To achieve 100% DOTS coverage with sustained quality • To achieve 70% case detection (PTB+>63/100,000) • To achieve 85% success rate • To reduce defaulted rate to less than 5% • To reduce MDR-TB to less than 2%

  5. MOPH DDC (TB cluster) Provincial Health Office District Hospital 12 Regional /DPC (SALT cluster) PCU

  6. Political commitment has not been successfully communicated to the peripheral levels • Decreased managerial capacity in the context • Weakened financial basis of the NTP • Decreased performance of the NTP • Insufficient preparation for decentralized drug procurement

  7. Supervision The NTP has formulated a supervision plan covering all levels of the program as follows:

  8. The NTP should develop a standard mechanism for supervision and collaborative meetings. • All health facilities should develop their own plans for supervision and meetings in accordance with NTP guidelines. • The NTP should develop a training course focusing specifically on supervision skills.

  9. Recording and Reporting • The analysis of reports by program managers at the regional level is uneven. The content and depth of analysis of the reports shown to reviewers varied by region. • Significant delays in forwarding and compiling reports were observed. Only 11 of 75 provinces had submitted reports. • There are two parallel systems of reporting TB cases. One is for disease surveillance through Form 506 to the Bureau of Epidemiology, the other is for the NTP trimester report through form TB07, sent to the TB cluster.

  10. 4 Competences • Urban TB Control (9 sub-contracts) • Prison TB Control (3 sub-contracts) • HIV-TB Integrated Program (16 sub-contracts) • Crossborder TB Control (3 sub-contracts)

  11. GFATM Consolidated project activities • Expand DOTS services and case detection • Community outreach, education, and case detection • Surveillance and monitoring and evaluation • Capacity building, training • Network of laboratory and QA/QC system • Integrated care with regular health system and HIV-TB services

  12. The Result of Evaluation

  13. Objectives: • Strengthen TB-program management at all levels • Capacity building, training of NTP human resources and improve quality of NTP • Improve TB-information systems • Expansion of TB program, TB/HIV program and increase collaboration of partnerships including private sectors • To promote public awareness and TB education in general and marginalized populations, including people living with TB/HIV

  14. THAILAND IMPLEMENTING THE STOP TB STRATEGY

  15. DOTS Expansion Achievements • 100 % DOTS coverage among health facilities under MOPH • Established DOTS strategy to cover all 138 prisons nationwide • Developed a comprehensive HR-development plan • Introduced TB education in nursing school

  16. DOTS Expansion Challenges • Increasing laboratory-capacity for EQA by using Lot Quality Assured Sampling, and improving supervision, monitoring and evaluation activities • Strengthen laboratory capacity for sputum culture at intermediate laboratory level • Implementing DOTS in mega city • Include a TB/DOTS chapter in all medical training curricula

  17. DOTS Expansion Planned Activities • Strengthen DOTS through improved supervision, monitoring and evaluation • Finalize and implement HR development information system

  18. TB/HIV, MDR-TB and Other Challenges Achievements • Established national TB/HIV coordinating board • Developed practice guidelines for collaborative TB/HIV activities and MDR-TB • Trained health-care workers in collaborative TB/HIV activities • Conducted third DRS • Strengthened supervision, monitoring and evaluation in TB control in mobile and cross-border populations and poor urban areas

  19. TB/HIV, MDR-TB and Other Challenges Challenges • Establishing mechanisms for NAP and NTP collaboration • Developing TB/HIV training materials and curriculum • Strengthening laboratory capacity in regional TB laboratories

  20. TB/HIV, MDR-TB and Other Challenges Planned Activities • Expand collaborative TB/HIV strategies to all administrative levels countrywide • Develop further collaboration with NGOs working with migrants, mobile and cross-border populations, and the poor • Pilot testing of practical guidelines for MDR-TB • Upgrade regional TB laboratories to reference laboratories

  21. Strengthening Health Systems Achievements • Developed collaboration between NTP and general hospitals and prison health services and conducted training for TB staff

  22. Strengthening Health Systems Challenges • Restructuring of health system, including the integration of tasks and rotation of staff • Increasing numbers of illegal migrants and mobile and cross-border populations ineligible for universal health coverage • Decentralization of budget-allocation systems • Improving computer-based recording and reporting system

  23. Strengthening Health Systems Planned Activities • Scale up collaborative activities with general public hospitals, prisons and military services • Development a list of standard indicators for TB management at all health facilities under MOPH

  24. Involving All Care Providers Achievements • Strengthened supervision, monitoring and evaluation of DOTS services in prisons

  25. Involving All Care Providers Challenges • Involving private practitioners and corporate health services in TB diagnosis and treatment

  26. Involving All Care Providers Planned Activities • Collaborate with academic institutions to introduce TB curriculum to nursing, medical and public-health schools

  27. Community TB Care and Advocacy, Communication & Social Mobilization Achievements • Secured funding for communityinvolvement in TB from government and GFATM • Appointed village health volunteers (VHVs) as community DOT-observers in pilot areas

  28. Community TB Care and Advocacy, Communication & Social Mobilization Challenges • Develop a national ACSM plan and technical capacity for ACSM at all levels

  29. Community TB Care and Advocacy, Communication & Social Mobilization Planned Activities • Scale up involvement of VHVs

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