Transcript PPM-DOTS in Cambodia Working with Private Pharmacies DOTS Expansion WG Meeting Paris 15th October 2008 Dr.

PPM-DOTS in Cambodia
Working with Private Pharmacies
DOTS Expansion WG Meeting
Paris 15th October 2008
Dr. Mao Tan Eang
Director
National Center for TB and Leprosy Control (CENAT)
MoH, Cambodia
Presentation Outline
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Background
Rationale for PPM-DOTS
Goal and Objectives for PPM
Main Strategies for PPM-DOTS with Private Sector
Achievement (up to June 2008)
Key activities with Pharmacies
Future plan
PPM-DOTS partners
I. Background
• In 2005 the National Tuberculosis Program (NTP) began
to engage private providers in TB control.
• The NTP with support from their partners developed the
Public-Private Mix (PPM) strategy (phase I & Phase II)
and PPM-DOTS in prisons and Factories .
• PPM-DOTS in prisons and Factories still at pilot phase.
• During Phase I, with USAID funds and JICA, NTP and
partners designed and implemented a referral network
between private health providers and pharmacies where
symptomatic individuals seek care and public sector
DOTS facilities in pilot provinces.
II. Rationale
• Cambodia is among the 22 TB high burden countries
• Approximately two-thirds of all Cambodians are
infected with TB, and around 13,000 Cambodians die
annually from the disease
• NTP focus on reducing morbidity and death rates due
to tuberculosis, a key strategy for improving the overall
health of the population
• To align with the WHO Global strategy for TB control
• The private sector is accessible with two thirds of
Cambodians seeking care outside the public sector for
their first visit with TB symptoms
III. Goal and Objectives for PPM
Goal:
To test-out and scale–up a public-private mixed DOTS partnership
model that aims to strengthen both, the public and private sectors in TB
case management and increase case detection
Objectives:
• Reduce diagnostic delay for people with suspected TB, increase case
detection, and decrease the opportunity for multi-drug resistant
• Strengthen public-private linkages & partnerships in TB case
management and control through a referral system to public DOTS
services
• Improve access to quality DOTS services for people seeking care at
the private sector providers by implementing DOTS services in
private clinics and hospitals qualified by NTP (Phase II)
IV. Main Strategies for PPM-DOTS
with Private Sector
PPM-DOTS Phase I:
Private sector only responsible for referring TB
suspects to public sector
PPM-DOTS Phase II:
Private sector (excluding pharmacy and lab) can
diagnose and treat TB patients ( not yet implemented)
V. Achievements (3 years up to June 2008)
• Service coverage:
- PPM-DOTS available in 11 provinces and 38
Operational Districts (OD)
(total provinces : 24, total OD:77 in the country)
- Private Clinics : 488
- Private Pharmacies : 896 :
• Service provision :
By clinics
By pharmacies Total
TB suspects referred
3130
9447
12577
TB suspects arrived:
2061
4342
6403
574
844
1418
TB cases identified
Number
TB Suspects Referred (by Private Sectors) ,
Received (by Public Sector) and TB Cases Identified
13000
12000
11000
10000
9000
8000
7000
6000
5000
4000
3000
2000
1000
0
TB suspects referred
TB suspects arrived/received
TB cases identified
2005
2006
2007
Year
2008
Total
Phase I Strategy
Public
Hospital
Health Center
Diagnosis, Treatment,
Recording & Reporting
Referral System
Private clinic
Pharmacy
/Depot
Community
Private lab
CHVs
VI. PPM-DOTS with Pharmacies
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1. Key activities
Develop PPM strategy
Identify and engage private sector partner
(Pharmacists Association of Cambodia : PAC)
Review and revise national recording and reporting
forms
Develop standardized referral tools
Develop IEC and training curriculums
Develop Memorandum of Understanding agreements
• Organize a sensitization workshop for public and
private-public providers and sign MoU agreements
• Train Province and District TB supervisors to deliver
pharmacy staff training
• Build capacity for national, Province and District TB
staff on PPM and supervision of private sector
• Train pharmacy and DOTS health center staff
• Conduct quarterly Public-Private Partner meetings
• Facilitate pharmacy staff field visits to DOTS
services
• Conduct monthly supportive supervision and data
collection
2. Main indicators
• Number of TB suspects referred from the
pharmacy to the DOTS health center
• Number of TB suspects presenting at DOTS
health center with referral from pharmacy
• Number of All types of TB identified among TB
suspects referred from pharmacies
• Number of smear positive TB cases identified
among TB suspects referred from pharmacies
3. TB PPM sites (Private Pharmacies)
2005-2008
11 provinces
38 ODs
476 Health centers
30 Referral hospitals
896 pharmacies
Kandal
Phnom Penh
4. Strengths
• Strong support from Pharmacist Association
(attending meeting/WS and M&E etc )
• Referrals from pharmacies in PPM areas are yielding
high percentages of smear-positive TB cases out of
those being evaluated, so that there is a clear benefit to
involving pharmacies in TB case detection
• During this period 9,447 referrals were made of which
4,509 attended DOTS services and 844 were diagnosed
to have TB.
• This result suggests that the pharmacies are an
excellent location to identify undiagnosed cases.
5. Weaknesses
 Overall, the proportion of TB suspects referred from the
private pharmacies and the actual number who received
follow-up at the public TB-DOTS facilities remains at
around 50%
 Based on the project follow-up results, there are some
contributing factors to the lack of follow–up such as
inadequate communication and recording system.
 Some private pharmacy staff do not provide clear
information to the TB suspects in order for them to
choose the most convenient location of DOTS facility.
 Limited incentives to both service providers
 linkage with other NGO network in and outside the PPM
target areas is still limited
VII. Conclusion & Future Plan
• PPM-DOTS has contribution to overall TB case
detection-contribution goes beyond concrete
number of TB cases identified
• Evaluation after 3 year implementation
• Introduction of PPM-DOTS phase II (from 2009)
• Resource mobilization for maintaining and
scaling up activities (GFATM,USAID…)
• Involve more professional associations
• Expand DOTS in prison and factories
VIII. Major Partners for PPM-DOTS
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USAID
PATH ( with Pharmacies)
JICA
URC
RHAC
CATA
• GFATM (from 2009)
• Ministry of national
Defense
• Ministry of Interior
• Ministry of Labor
• Pharmacist Association of
Cambodia
• Medical Association of
Cambodia
• Cambodia Medical
Council
Comments/Questions
[email protected]