1 / 18

Assessing DOTS Expansion Limits in Health Systems: Strengthening Strategies

This assessment focuses on evaluating the expansion of DOTS through existing health systems, addressing limitations, enhancing contributions to system strengthening, and promoting complementarity. It delves into system aspects, infrastructure, human resources, training, funding, and more, presenting case studies from Ethiopia, Vietnam, Kenya, Nigeria, Pakistan, and discussing decentralization issues and financial challenges.

carmont
Download Presentation

Assessing DOTS Expansion Limits in Health Systems: Strengthening Strategies

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. Health system assessments Has DOTS expansion reached its limits through existing health systems? Christy Hanson WHO Geneva

  2. Health system assessments Aims: • Enhance DOTS expansion efforts by tapping into underutilized strengths of the existing health system • Recognizing and addressing limitations of the health system in supporting DOTS expansion • Enhancing the contribution of DOTS expansion to the aims of health systems strengthening • Promote complementarity Application: • Planning within NTP • Global lessons learned • Partners Forum

  3. System aspects explored • Infrastructure • Coverage of health facilities by type / capacity • Public and private sectors • Human resources • Distribution • Activities by cadre • Training • Monitoring mechanisms • Supplies / logistics • Funding • Planning

  4. Measuring DOTS coverage

  5. Ethiopia DOTS coverage within limited PHC • 45% of rural population within walking distance from PHC facility • 85% of pop. lives in rural • Wide regional variance in facilities per population • 33% have access to safe water • 45% live on <US$1 / day • 30% of existing facilities implementing DOTS

  6. Vietnam DOTS Coverage within strong PHC • 11% of population in areas with limited geographical access to PHC • North / south variance: human resources • Hospital use: • 36% of users from highest income quintile • 8% from lowest income quintile

  7. Kenya Where patients go vs. Where the system provides DOTS

  8. Private sector • Overall: limited awareness of the role or magnitude of private sector, limited engagement in TB control • Ethiopia:limited but exists, pharmacies, hospitals • Kenya: almost equal use of public and private providers as entry point • Pakistan: 40% of health care provided by private sector • 79% of TB patients seek care initially in private sector • Vietnam: 60% of outpatient visits with private clinics

  9. Kenya Human resources 300 trained clinical officers unemployed

  10. Ethiopia Human resources: distribution

  11. Nigeria Human resources: distribution

  12. Human Resources: Training • Vietnam: systematic training for TB • 10,000 general health workers / year • Training not integrated in other general health training • No examples of TB integrated within pre-service training • No examples of NTP involvement in general PHC in-service training • Kenya: TB training of clinical officers stopped • Nigeria: States responsible for training own staff in PHC • NTP supports state training of 60 workers / year • Pakistan: training lady health workers for TB • Ethiopia: New cadre of health workers to be trained / deployed at most decentralized level (PHC)

  13. Vietnam Human resources involved in TB control Total: 15,772 staff involved in TB control

  14. Decentralization issues • Increased decision-making and budget authority at decentralized levels • Variable levels of political commitment to TB • Variable resources to invest in TB • Shifting of resources (human, financial) • Ethiopia: process • Nigeria: release of funds, planning • Vietnam: poor provinces, less to invest in health • Pakistan:

  15. High costs for patients • Nigeria: 70% of health expenditures private, mostly out-of-pocket • Kenya: cost-recovery in 68% of public facilities • Vietnam: 80% of health expenditures - direct household spending • Per capita household spending US$20 • Documented wealth inequalities in utilization of services: Kenya, Vietnam

  16. TB compared to other disease control programmes • Coverage • Kenya: immunization services in 80% of public facilities, reproductive health in 75% of facilities • TB control in 30% of public facilities • Ethiopia: leprosy has broader coverage than TB • Drug supplies: TB supplies generally more stable than other essential drugs

  17. Summary • Has DOTS Expansion reached its limits through existing health systems? • Strengths • Integrated lab networks • Stable drug supplies • Challenges • Political commitment at decentralized levels • Utilizing and building capacity of PHC • Recognizing types of facilities and workers, tailoring NTP • Engaging private sector and pharmacies • Training • Limited coverage of PHC in some countries

  18. Discussion • Any messages that would be useful to bring to Partners Forum?

More Related