Transcript ISTC in Indonesia

ISTC
The Indonesian Experience
Erlina Burhan
Indonesian Society of Respirology
ISTC Task Force
Indonesian Medical Association
Contents
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Background
Initiating ISTC
Endorsement
Key events
Roll out of ISTC
Conclusions
Back ground - Present practices &
need for ISTC
• TB care is standardized & implemented in the public
sector mainly through the network of Primary Health
Center’s and some hospitals
• CXR is the commonly used diagnostic tool in hospitals &
private practice
• Sputum smear is very much underutilized in hospitals &
private practice & sputum culture is uncommon
• Many doctors are using other tests (serology test, PCR)
instead of sputum testing
• Treatment regimens vary considerably in private practice
• Hence the need for a tool to bridge the NTP with
Professional societies, Private sector & Hospitals
• The Tool - ISTC
Process of introducing ISTC
• March 2005 : Sensitization of key opinion leader during
JEMM
• July 2005: Introduction of ISTC draft to key opinion
leaders (WHO/ KNCV)
• August 2005: Introduce ISTC to professional
organization
• September 2005: Workshop for professional
organization to develop a plan to endorse, socialize,
disseminate and implement ISTC
• September 2005: appoint ISTC team led by Indonesian
Society of Respirology
• October 2005: Various professional organization
Meetings
• November 2005: First National TB Congress with
presentations on ISTC
• December 2005: Finalizing Work Plan for socialization
• Supported closely by the ATS with several visits from Dr Phil
Hopewell and Ms Fran Du Melle
Process of Endorsement
• January 2006:
– First formal Endorsement Letter from Indonesian Society of
Respirology
– Introducing ISTC to the President of the Indonesian Medical
Association and other Specialist Organizations (organized by
Indonesian Society of Respirology)
• February 2006:
– Follow up meeting
and Discussion with
Indonesian Medical Association
– Indonesian Medical Association
endorse the standards in
February 2006
Launch of ISTC
• World TB Day 2006 : IDI
(Indonesian Medical Association)
formally endorsed the standards &
launched by Minister of Health
Endorsement and Key Events
• ISTC Task force at IMA was
established
• ISTC short version in Bahasa
(incl addendum) Indonesia
was published and
disseminated
• ISTC is included in various
scientific meetings of
professional organization
Roll Out ISTC
With support from NTP, WHO, and KNCV;
• Indonesian Society of Respirology has
implemented:
– Two days Workshops in 13 provinces in
coordination with local chapters of
professional societies & Provincial/District
health authorities
– ISTC Short version were delivered to all
participants
– All the topics were delivered as a CD and
handout to participants
• Indonesian Medical Association
– Develop National Task Force
– Socialization and establishment of Provincial
TF in 12 provinces to ensure sustainability &
local ownership
– Development guideline for implementation
TB in Private Practitioner
– Piloting TB in PP through certification and
accreditation scheme
TOPICS
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Why & What of ISTC
Epidemiology of TB
Standard diagnosis
Standard treatment
Standard Public Health Responsibility
MDR TB
TB-HIV
The Role of Chest X Ray
Group work & discussions
The Role of Professional
Organizations
• Socialization and dissemination
• Having ISTC as a topic in their annual meetings,
scientific sessions and seminars
• Meetings to socialize and dissemination the
standards ( Hands on )
• ISTC articles in Journals
Conclusions
• Involvement of key professional opinion leaders/champions,
right from introduction is important for buy in, acceptance &
endorsement
• Professional society members
relate more easily to ISTC than
NTP guidelines since it is
evidence based & more clinical
oriented
• ISTC can act as the bridge
between the NTP, Professional
societies & Private sector
• NTP’s can outsource the
socialization & roll out of
ISTC to Professional
organizations
• A Hospital assessment study done on DOTS practices in 2007/8 in
Public & Private hospitals acts as baseline data to evaluate the impact
of ISTC in future.