1 / 18

Key issues in DOTS implementation

Key issues in DOTS implementation. Dr Saidi M. Egwaga. TB in the world 2002. People infected  2 billion New TB cases 8.6million New ss+ TB cases 3.8million Prevalence HIV in new adult cases 12% Prevalence MDR in new cases 3.2% Deaths from TB (inc HIV) 1.8m.

bechtel
Download Presentation

Key issues in DOTS implementation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Key issues in DOTS implementation Dr Saidi M. Egwaga

  2. TB in the world 2002 • People infected 2 billion • New TB cases 8.6million • New ss+ TB cases 3.8million • Prevalence HIV in new adult cases 12% • Prevalence MDR in new cases 3.2% • Deaths from TB (inc HIV) 1.8m

  3. Global targets for TB controlMILLENNIUM DEVELOPMENT GOALS • WHA by 2005: 70% case detection, 85% cure DOTS beyond public health services • MDGs by 2015: Halve prevalence and deaths HIV/AIDS, drug resistance, migration

  4. Progress towards Global TB Control targets • Case Detection Rate 36% (target 70%) • Cure Rate 83% (target 85%)

  5. High treatment success in DOTS areas 100 DOTS smear+ target 85% 90 non DOTS smear+ 80 70 60 Treatment success (%) 50 40 30 20 10 0 1995 1996 1997 1998 1999 2000 2001

  6. What countries have achieved in 2002 Outstanding progress in some countries: • Increase case detection and cure: India, Indonesia, Myanmar, Pakistan, Cambodia, Viet Nam • Increase case detection but low cure: South Africa • Some progress: Mozambique, Afghanistan, Philippines

  7. Financial resources • New sources available GFATM 189 million to TB and TB/HIV control for 2 years FIDELIS (CIDA) WB,TBCTA, etc. • Gap to be addressed 200 million per year in countries 20 million per year for technical assistance

  8. Major challenges • Health workforce crisis • High turn-over • Need for updated training and retraining (pre-service and in-service) • Retention • Brain-drain • Deployment • HIV epidemic • HRD is absent in MoH strategic planning

  9. Major challenges • Access to health services • Poor health care infrastructure • Weak laboratory networks • Health systems reform • Little involvement of some PHC providers in TB control • No link with other public health care providers (e.g. hospitals, prisons, etc) • Inadequate involvement of private sector • Inadequate cultural sensitivity

  10. Major challenges • Insufficient political commitment • Shortages of staff at different levels in some NTPs • Inadequate funding for training and supervision, monitoring and evaluation • No budget line for TB drugs in most countries

  11. Major challenges • TB / HIV epidemic in some countries • Overloaded health care services • Stigma • High death rates among TB patients • Competition for scarce resources • Collaboration between NTPs and NACPs

  12. Country experience in addressing challenges • Training needs assessments (Indonesia) • Collaboration with training institutions (Tanzania) • Community involvement (Uganda) • Involvement of private sector (India, Philippines) and NGOs (Bangladesh)

  13. Country experience in addressing challenges • Link with hospitals (Indonesia, India, China) • National Programme evaluation (China) • Rapid DOTS expansion (India) • Collaboration between NTPs and NACPs (Kenya, Tanzania, Brazil) • COMBI (Kenya, Bangladesh, India)

  14. Total patients placed on treatment and population covered under DOTS each quarter, India (1994-2003) 238,204

  15. STOP TB Partnership • Very good positive spirit of the DEWG • Stop TB is working in countries • Progress in some countries despite difficulties • Countries gaining momentum and some very close to targets

  16. HOWEVER... • No time for complacency • 2004 is the year of accelerating actions in TB control

  17. Ultimate Goal: a generation of children free from tuberculosis

More Related