Transcript Overview of the NTP & Key GF Grant Activities

TB service and Health insurance
Extending TB benefit package to help mitigate economic
burden of TB patients, Cambodia contex
TAG-NTP manager Meeting
9-12/ 12/ 2014,WHO,Manila
Dr Mao Tan Eang
Director, National Center for TB and Leprosy Control
(CENAT)
Ministry of Health, Cambodia
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Outline of the Presentation
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Burden of TB in Cambodia
TB Control Infrastructure
NTP achievements
NTP Challenges
TB and health insurance
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1. Burden of TB in Cambodia
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Cambodia,15 Million pop with GDP:<USD 1000 per capita, is still one of the 22
HBC with TB in the world
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Incidence Rate* of all forms of TB for 2012: 411/ 100,000 pop.
(~ 61,000 cases/year )
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*WHO Global TB Report 2013
Prevalence Rate of all forms* of TB for 2012: 764 / 100,000 pop.
*WHO Global TB Report 2013
NTP has achieved the MDG target for this indicator (4 years before schedule)
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Prevalence Rate of Sm+* for > 15 y in 2011: 272/ 100,000 pop.
(*Based on the final result of
Prevalence Survey 2011); -it was 437 /100,000 pop. in 200 2: first Prevalence Survey.
reduction of 38% in 9 years---an average of 4.2 % per year, quoted in WHO 2012 and
UN MDG report 2013 as a best example
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Death rate*: 63/100,000 pop
* WHO Global TB Report 2012
NTP has achieved the MDG target for this indicator (4 years before schedule)
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HIV Sero-prevalence among TB Patients : 2.5% in 1995, 12% in 2003, 10% in
2005, 7.8% in 2007 and 6.3% in 2009
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Estimate of MDR-TB burden in Cambodia (WHO Global TB Report 2012)
– Percentage of TB cases with MDR-TB among new smear positive= 1.4%
– Percentage of TB cases with MDR-TB among re-treatment cases= 10.5%
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2. TB Control Infrastructure
• Central level-CENAT
– Hq for the National TB Program with Technical Bureau (30 staff)
– Referral TB/Chest Hospital* (130 beds)
– National TB Reference Laboratory
• Provincial level (25)
– Provincial TB Supervisors (2 per province)
– Provincial Referral Hospitals with TB services= 24
• Operational District level (82) (OD TB Supervisors)
– Referral Hospitals with TB services : all
– Health Centres with TB services= 1089
– TB Microscopic Centres= 215
– HCs with Community DOTS= 577 ( down from 816 in end 2013)
• Total =1,314 health facilities are providing TB services which
includes the 5 National Hospitals including Referral TB/Chest
Hospital under CENAT, all in Phnom Penh
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3. NTP Achievements
– DOTS started in 1994, until 1998 DOTS services only available at the
hospital level; HC DOTS began in 1999; but massive HC DOTS
expansion started in late 2001 and by end of 2004, all HCs had DOTS
services
– Cases notified increased drastically since the start of HC DOTS
expansion. Currently ,cases notified seems to be peaking for TB all
forms, but declining for sm+ TB cases.
2012
– Smear positive TB cases : 14,838
– All Forms of TB 40,258
2013
– Smear positive TB cases : 14,082
– All Forms of TB 39,055
Cure rate has been maintained over 90% for the last decade
10 years 2004-2013:cases notified under NTP : All forms; 379,819
Sm+ : 178 ,538 --------
prevalence reduced by 4-5% per year
MoH has just received award from USAID: a “Champion in Global fight against TB”
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TB Case Notification, 1982-2013
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TB Incidence-notification gap, Cambodia
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4. Challenges for NTP
• High prevalence,incidence and death rates
• New and more ambitious goals/targets(2014-2020 ,2021-2035) in
line with global strategies (end TB epidemics)
• Case detection gap: missing cases~ 1/3(~20,000 cases undetected)
vs UHC goal
• Resources to maintain and expand existing and new services
• Majority of NTP budget comes from donors/partners( ~75 %)
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5. TB services & Health insurance:
Existing health insurance /social protection
schemes and coverage
Schemes/projects coverage
comments
Health equity fund
(HEF)
58 / 82 districts
MoH & Donors : Social
protection schemes run
by NGO operators for
the poor(40% fund from
government,60% donor)
Community based
health insurance
~3%
For non-poor and
informal sector, run by
NGOs, very small
premium
Private health
insurance (Forte,..)
?
Main clients: NGO/IO
staff,..,run by private
insurance companies
National social security
fund(NSSF)
Most formal private
employees?
Ministry of Labor &
vocational training
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,formal sector employees
TB patient health care & social package
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Diagnosis (sputum examination, X-ray,…)
Anti-biotics before TB diagnosis
Treatment ( anti-TB drugs)
Care for additional/co-morbidity
• Transport to health facilities(
diagnosis,treatment…)
• Nutritional support (patients/relatives)
• ……
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Existing service benefits in public services
Services/benefits NTP
Sputum
examination
(direct,culture,DST)
Health
facility
HEF
X
(Free of
charge
policy)
X:+/-
Antibioticts
Xray
Free
policy+/_
Anti-TB drugs(1st,2nd
Free policy
line)
Transport
X: MDR and
some
children/care
takers
X: for
patients/care
takers with ID
poor only
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NTP
Food for IPD
for TB patient
Health facility
X
(all IPD TB
patients)
Food for
patients and
care takers
funeral
HEF
X
mainly
for IPD
For poorest
patients
For
poorest
patients
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TB services in private sector
• PPM-DOTS cover 27 operational districts
(total ODs=82)
• Private providers just refer TB suspects to
public providers
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Challenges for expanding health insurance
benefits to TB patients
• Knowing the real situation (Who are relevant actors?TB Cost lost along
the acre pathway ,including at private sector ? Benefit package? etc..)
• TB free of charge policy VS HEF(e.g those without ID poor, not all TB
patients have poor ID cards)
• Any possible linkage with private health insurance or
other schemes/projects?
• How to work with the complex interface (integratable /
harmonizable/workable areas) around UHC different
components/angles?
• Who do what and who pay?...etc..
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Some thoughts for managing additional benefits
to help mitigate economic burden of TB patients
• Policy direction on comprehensive package /UHC for TB patients
within overall UHC
• Clear joint inclusive/comprehensive implementation plan linked to
each partner’s overall plan ,e.g 3 year plan
• Clear roles of each stakeholders
• Private sector providers?
• Practical lead/coordinating department/body for coordination,M&E
etc
• Next step: follow up and come up with practical plan
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