Progress and plans for PPM in the South-East Asia Region

1. Progress and plans for PPM in the South-East Asia Region Fifth PPM Subgroup Meeting 3 - 5 June, Cairo

2. per 100 000 population < 10 10 to 24 25 to 49 50 to 99 100 to 299 300 or more No Estimate TB incidence rates per capita TB in SE Asia 5 m prevalent cases 3 m new cases and 500 000 deaths/ yr ~150,000 new MDR-TB cases/yr ~ 2.5 - 3 million TB-HIV co-infected

3. Countries with GF support for PPM All countries in the Region with the exception of Myanmar and DPR Korea benefit from support from the Global Fund for expanding private and public partnerships

4. Regional Progress • Bangladesh: >90% of TB services through NGOs; Prisons, medical colleges, railways, garment industries being involved • India: 262 medical colleges; >17695 PPs; >2946 NGOs; > 150 corporate houses; tea estates, railways, employees state insurance hospitals, Ministries of Shipping, Mines, Petroleum and Oil, Indian Medical Association; District TB Societies • Indonesia: All lung clinics and 37% of large hospitals; 7 medical schools; Ministry of Defence, Police and Prisons Dept • Myanmar: Private providers; Railways; Ministries of Defence, Religious affairs; Labour, Education and Home Affairs • Nepal: Private providers; teaching hospitals, communities through village and district DOTS committees • Thailand: NHSO, Ministry of Labour; prisons systems; private hospitals association; community based organizations, local and international NGOs; Thai business coalition

5. Successful approachesSome examples • Intensified training of private and public hospital and laboratory staff in Indonesia • Introduction of coordination meetings between community health facilities and hospitals: Yogyakarta, Indonesia; between partners: Myanmar • Franchising, allowing for ensuring of quality throughout network: PSI Sun Quality Health Network • Inclusion of private laboratories in diagnostic network & QA systems in, India; SQH and accredited labs in Myanmar • Establishing of referral networks and better follow up of transfers eg., in Padang, Indonesia, between lung clinic and puskesmas; provision of a list of DOTS centres for referral to teaching institutes in India • Endorsement of the International Standards of TB Care by professional bodies-- Medical associations in India, Indonesia

6. Regional Priorities: 2008-2009 • Catalyze wider implementation (India, Indonesia, Myanmar, Nepal) Document on-going initiatives, disseminate best practice examples for wider use • More actively engage with professional associations, teaching universities for dissemination of the ISTC, and use of recommended guidelines • Ensure coordination mechanisms/forums for information exchange at all levels in countries • Expand collaboration with industry, corporate sector (not much progress here– may be an area for the PPM sub-group to focus on) • Help in developing clear strategies and operational guidelines based on lessons learnt (Bangladesh, Sri Lanka, Thailand) sectors not yet involved • Support pilots in (Bangladesh, Thailand) • Organize a regional training for national consultants/focal points on strengthening public-private partnerships (long-standing dream!)

7. PPM activities in priority countries

8. PPM activities in priority countries

9. Progress: Bangladesh

10. Bangladesh Plans for PPM 2008-2009 • Actively engage professional bodies, BMA,BPMPA, specialists using the International Standards for TB Care • Enhance coordination and collaboration between different Ministries • Expand collaboration with industry, corporate sector and pharmacy holders through respective association • Development and distribution of advocacy materials to private providers

11. Progress: India

12. Intensified urban PPM districts; India (14): Summary of contribution by different health sectors – 3rd qtr 2006 to 2nd qtr 2007)

13. India Plans for PPM 2008-2009 • Revise PPM guidelines for NGOs and private practitioners • Work with the IMA to increase the number of private practitioners collaborating with national programme • Develop guidelines for further involvement of the Employee State Insurance and Railways health facilities in TB control

14. Progress: Indonesia

15. Progress: Indonesia PPM • Achievements • A hospital assessment study on the implementation of DOTS strategy conducted • Guidelines on Hospital DOTS Linkage (HDL) developed and 15 Technical and Surveillance Officers for HDL have been placed in 12 clusters of districts • Integration of DOTS into medical school curriculum implemented • ISTC translated and adapted into Bahasa (Indonesian language), officially endorsed and rolled out to the professional organizations • Ministerial decree issued to support DOTS implementation under different Directorate Generals • Directive letter from DG Medical Care on DOTS implementation in hospital issued • Guidelines on TB in workplace, prison and army developed, and activities initiated • CEA study initiated on PPM approaches • Constraints • Varying degree of commitment and qualityof services in DOTS implementation • Plans for 2008-2009 • Dissemination of HDL guidelines/ training • Strengthening linkages and surveillance in HDL • Further expansion of HDL to other public and private hospitals, • Institutionalizing of ISTC, incl. certification/accreditation • Hospital assessment study in outer Java

16. Progress: Myanmar • National PPM DOTS Sub group established • PPM capacity at WHO strengthened (international MO + national consultant) • PPM capacity at MMA strengthened (national PPM team + 2 Divisional Coordinators and part-time Township Coordinators/ full time social outreach workers in all townships)

17. Achievements: PPM DOTS Sub group in Myanmar • Standardized Training Manual PPM DOTS • 3Diseases Orientation • Package for GPs • Implementation Guide on • PPM DOTS (draft) • Strategy Paper on PPM • DOTS in Myanmar (draft)

18. Progress: Myanmar

19. Myanmar Plans for PPM 2008-2009 Public Private Mix DOTS • Finalize Implementation Guide on PPM DOTS and Strategy paper on PPM DOTS in Myanmar • Sustain in implementing townships and scale up public private mix DOTS project • Myanmar Medical Association( MMA ) 600 General Practitioners involved in 26 townships • to include private and charity hospitals, religious hospitals • Population Services International (PSI) –to scale up number of Sun Quality Health Care Doctors • CARE Myanmar to sustain in 10 townships • IOM to sustain 6 townships • JICA under the Major infectious diseases control project, to scale up to 6 townships • Myanmar Red Cross Society and Myanmar Maternal and Child Welfare Association members act as DOT Providers Public Public Mix DOTS • To consolidate the public public mix demonstration projects in 4 tertiary specialist Hospitals • Develop Interim Guidelines on Public Public Mix DOTS • End 2008: joint workshop on TB control between NTP and Prison Department ISTC • Workshop with leading medical specialists on Adapting ISTC to Myanmar context, July 2008 • Conduct similar workshop for GP branch of the Myanmar Medical Association • Implement and roll out the ISTC stepwise approach

20. Progress: Thailand • MOU with National Health Security Office • MOU with Ministry of Labour to implement TB control in the workplace • MOU with MSF for TB treatment and care among migrants • Coordination with Department of Corrections to continue TB control in prisons • Collaboration with US. CDC for TB surveillance and research • Engagement of Private Hospital Association to provide TB care according to ISTC • ISTC translated into Thai and endorsed by NTP • Involvement of NGOs (World Vision, American Refugee Committee, Thailand Bossiness Coalition of AIDS) to control TB in vulnerable population

21. Progress: Thailand

22. Thailand Plans for PPM 2008-2009 • Establishment of working group to develop a plan, oversee the implementation and coordinate mechanisms at all levels of the programme • Officially appointment of a focal person for PPM • National situational analysis of PPM • Continuation for PPM collaborative activities with: • Private Hospitals • Factories • Prisons • NGOs • Health insurance organization