Amelia C. Medina, MD, MPH Head, Infectious Disease Prevention and Control Cluster

1. ATTAINMENT OF GLOBALLY ACCEPTABLE CURE RATE THROUGH QUALITY DOTS SERVICES IN SELECTED AREAS OF THE NATIONAL CAPITAL REGION(2006-2009) Amelia C. Medina, MD, MPH Head, Infectious Disease Prevention and Control Cluster Center for Health Development-Metro Manila

2. The Philippines ...... Total Population : 84,241,341 (2005) Land area : 300,000 sq. kms. Regions : 17 Provinces : 79 Cities : 115 Municipalities : 1,495

3. National Capital Region (Metro Manila) Population : 10,485,356 (2005) Land Area : 636 sq. kms. Urban Poor Pop. : 39.9% Pop. Density : 16,486/sq.km. Annual Growth Rate : 1.06% Literacy Rate : 94% Cities : 14 Municipalities : 3 Barangays : 1,697

4. TB and NTP….. • The Philippines is 9th among the 22 HBCs • 3rd in the Western Pacific Region • 6th leading cause of morbidity and 5th leading cause of mortality • Region wide implementation of DOTS in 2000 • DOTS reporting centers • 433 health centers • 4 CHD-MM retained hospitals • 18 PPMD Units • 29 QA Centers • 14 TB Diagnostic Committees • 128 Microscopy Centers

5. Case Detection Rate, 2000-2004

6. Treatment Outcome 2003, New Smear (+) Cases

7. Cure Rate by City / Municipality, 2003

8. Cure Rate vs. Completion Rate, 2000-2003

9. Stakeholders Analysis

10. PROBLEM ANALYSIS Poor socioeconomic condition Increase morbidity and mortality from TB Low Cure Rate Health workers do not Implement NTP Policies and guidelines Poor adherence to treatment among TB cases Monitoring patient response To treatment is not Strictly followed Weak monitoring and Evaluation of the program Poor case holding management Inadequate health education Provided to patients Lack of IEC materials and collaterals Insufficient number of Staff to conduct Health education Lack of commitment and Low morale of Health workers Health workers lack Knowledge on NTP Defaulter mechanism Not implemented Referral system not In place Limited budget for health Promotion activities Undermanned health centers Untrained newly hired personnel Lack of vehicle and Transportation allowance For defaulter tracing Low salaries and benefits Insufficient budget for training Non-filling up of vacancies Exodus of health workers Low salaries and compensation

11. PROBLEM ANALYSIS

12. OBJECTIVE ANALYSIS Improved socioeconomic condition Decrease morbidity and mortality from TB High Cure Rate Strict implementation of NTP Policies and Guidelines by health workers Good adherence to treatment among TB cases Monitoring patient response To treatment is Strictly Followed as scheduled Effective and Regular monitoring and Evaluation conducted Excellent case holding management Adequate health education Is provided to patients Adequate IEC materials and collaterals Sufficient number of trained Staff to conduct Health education Committed and highly motivated Health workers Health workers are Knowledgeable on NTP Defaulter tracing mechanism Is implemented Functional Referral system Provision of budget for health Promotion activities Well staffed health centers Trained newly hired personnel Vehicle and Transportation allowance For defaulter tracing provided High salaries and benefits Sufficient budget for training Vacancies filled up Health Education Approach Health workers stick with Their jobs CAPABILITY BUILDING APPROACH High salaries and compensation

13. OBJECTIVE ANALYSIS Quality Assurance Approach Monitoring and Evaluation Approach QUALITY SERVICE APPROACH

14. PROJECT NAME :ATTAINMENT OF GLOBALLY ACCEPTABLE CURE RATE THROUGH QUALITY DOTS SERVICES IN SELECTED AREAS OF THE NATIONAL CAPITAL REGION TARGET GROUPS :Health Workers TARGET AREAS :Cities of Valenzuela, Marikina, Muntinlupa and Las Pinas DURATION :Three (3) Years SCHEDULE :July, 2006 – July, 2009

21. ACTIVITIES: 1.1 Training Needs Assessment 1.2 Capability Building 1.3 Development and maintenance of a database on human resource development 1.4 Workshop on policy formulation 1.5 Formulate and implement a DOTS Centers networking and referral system.

22. ACTIVITIES…. 2.1 Setting-up of quality assurance centers 2.2 Training of Controllers on External Quality Assessment 2.3 Training of untrained Medical Technologists on Basic NTP Microscopy 2.4 Training of laboratory technicians on sputum smearing and staining procedures 2.5 Inventory and provision of microscopes and laboratory supplies 2.6 Provision of recording and reporting forms.

23. ACTIVITIES…. 3.1 Development of a monitoring tool 3.2 Development of a Monitoring and Evaluation training syllabus 3.3 Training of coordinators and supervisors on NTP monitoring and evaluation 3.4 Supervised field practicum on M&E 3.5 Quarterly monitoring and supervision 3.6 Quarterly program implementation review 3.7 Year-end evaluation and consultative planning workshops

24. ACTIVITIES…. 4. DOTS Centers certification and accreditation 4.1 Organize and train TA teams for DOTS certification 4.2 Actual provision of technical assistance on DOTS Certification and Accreditation 4.3 Conduct assessment and certification of DOTS Centers 4.4 Coordinate with PhilHealth for accreditation 4.5 Quality check of certified and accredited DOTS Center for sustainability

25. ACTIVITIES…. 5. Support activities 5.1 Operational research on patient’s delay 5.2 Pilot study of a surveillance system for NTP

26. INPUTS: Manpower: NTP City Medical Coordinator Statistician NTP City Nurse Coordinator Physicians Controller Nurses HEPO Midwives Supervisors – at least 3/city Medical Technologists Sentrong Sigla Coordinator Laboratory Technicians Assessors and Certifiers BHWs TA Team for DOTS Certification and Accreditation Vehicles Transportation Allowances Equipment and Laboratory Supplies Glass slides & glass slide boxesAFB Staining Kits Sputum cups Transport Boxes Immersion oil Disinfectants Reporting and Recording Forms Alcohol Microscopes Facilities DOTS Centers QA Centers Project Cost : Php 8,000,000

27. PRECONDITIONS: 1. The city government and the city health offices will have a full support to the project 2. Clear budget allocation from the national and local government

28. THANK YOU! THANK YOU!