Regional Advocacy, Communication and Social Mobilization Planning Workshop for Tuberculosis Control

Amman, Jordan 13-17 April 2008

Regional Advocacy, Communication and Social Mobilization Planning Workshop for Tuberculosis Control

Amman, Jordan 13-17 April 2008

•

Population: 5.6 million

•

Surface area: 89,000 Sq.Km

•

Middle income country: 1,208 JD (



1,700 US $)

•

Demographic transition: life expectancy: 71.5 years

•

Epidemiologic transition:

-

Infant Mortality rate: 22/1000 live births

-

Decrease in communicable diseases, including TB.

Increase in chronic diseases, including chronic respiratory diseases (CRD) .

Syria Iraq Saudi Arabia

Various Health system in Jordan (1999 – 2003)

Country Health Data 2001 2002 2003 Number of Hospitals Hospital Beds Ministry of Health Royal Medical Services Jordan University Hospital King Abdullah University Hospital Private Sector 91 8982 3357 1760 517 3348 95 9383 3462 1791 531 197 3402 97 9743 3587 1801 540 283 3532

Health Centers of MOH

Type of Center Comprehensive Health Centers Primary Health Centers Peripheral Health Centers Maternity and Child Health Care Centers Chest Diseases Centers Dental Clinic 47 338 258 351 11 240 2001 2002 2003 53 336 258 351 11 247 52 340 259 353 12 250

TB control in Jordan

     

Low TB burden: in 2007: * 333 TB cases (all types) (in addition to 150 cases Among foreigners transferred out) * Incidence (all TB types): 6 / 100,000 population * SS+ incidence: 1.8/100,000 population * ARI : 0.04% TB incidence decreasing: 13/100 000 in 1992



6 in 2007 100% population DOTS coverage (1998) Case Detection Rate: 63% (2005) Success Rate: 87% (2006) Prevalence of MDR :5% (2006)

structure of TB control programme in Jordan

Structure of the Tuberculosis Control in Jordan

The National TB (NTP) in Jordan is a vertical Programme



At the Central level the Chest Disease Division (in Amman City), responsible for Tuberculosis control program throughout the country including supplying medicines. The main role is planning, coordination and supervision of the control activities.



At the peripheral level, there are 12 chest

centers covering the whole country.

Distribution of Diagnostic TB Centers in Jordan

Goal  Reduce mortality and morbidity and transmission of tuberculosis, while preventing drug resistance, until tuberculosis no longer poses a threat to public health, and achieve the Millennium Development Goals (Goal 6, Target 8) by 2015

OBJECTIVES

 Improve TB care for vulnerable populations in Jordan (Refugees, poor, mobile) .

 Improve tuberculosis care for people suffering from multi-drug resistant tuberculosis and TB/HIV in Jordan  Improve general tuberculosis care

Trends over time of the incidence of TB in Jordan (per 100,000 pop. per year)

35 30 25 20 15 10 5 14.8

14 27.8

28.9

12.8

21 25 23.2

21.1

19.2

18.9

16 14 11.5

13 12 11 10 10.5

9 8.3

7.8

6.2

6.4

6 5.8

6 5.3

6.4

6 0 Year 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006

Trends over time of the number of new TB cases in Jordan

150 100 50 0 400 350 300 250 200 Pulmonary TB Extra-pulmonary TB SS+ Pulmonary Total TB 2006 Year 2002 2004

CHALLENGES

 Low Detection Rate: TB case detection for new sputum smear positive pulmonary TB cases in 2005 was 63% (target of 70%);  MDR TB is increasing among Jordanians (2% in 2004 , 5% in 2006)

ACSM ACTIVITIES

JOR506 G02-T/NTP-MOH

COMPONENT 1: PURSUING, OPTIMIZING AND SUSTAINING QUALITY DOTS N.

Activity Indic ator Budget (in USD) Funding source 1.1 POLITICAL COMMITMENT WITH INCREASED AND SUSTAINED FINANCING: NTP will initiate one meeting per year headed by the Ministry of Health and members of a higher policy forum or a National board, to plan and monitor activities of the NTP and to strengthen commitment and financial sustainability One meeting is held yearly WHO MOH NTP will play a key role in activating CCM to assess needs and requirements and to review and revise action plans for TB control in Jordan.

Regular meetings every three months At Governorate levels, TB coordinators will reactivate M&E committees M&E Committees meet biannually GFATM WHO MOH

COMPONENT III: ENGAGE ALL CARE PROVIDERS N.

Activity Indicator Funding source 3.1 PUBLIC-PUBLIC, AND PUBLIC-PRIVATE (PPM) APPROACHES:

Setting up a database for all stakeholders and focal persons in all areas entitled to control and manage TB cases.

Database Established GFATM GFATM Forming a steering committee to plan and implement PPM strategy and to build commitment.

Steering Committee Formulated Developing the PPM Strategy PPM strategy Developed and printed GFATM Train all TB care providers in all areas responsible on TB case management.. No.of TB care providers trained

N.

COMPONENT III: ENGAGE ALL CARE PROVIDERS Activity Indicator

3.1.5

3.1.6

3.1.7

3.1.8

Supervisory visits to all TB control clinics Ensuring supply of anti-TB drugs to clinics dealing with TB cases.

No. of Conducted Visits All clinics dealing with TB cases provided anti-TB drugs with Printing all guidelines and revised R&R formats needed for the TB-Care provider to ensure adherence to guidelines.

Guideline revised and R&R format developed and printed Increase awareness of medical Schools’ staff and nursing schools’ staff about TB problem through training.

No. of medical Schools’ staff and nursing schools’ staff trained

N.

COMPONENT III: ENGAGE ALL CARE PROVIDERS Activity Indicator

3.1.

9 Increase awareness of medical Schools’ students and nursing schools’ students about TB problem through training No. of medical Schools’ students and nursing schools’ students trained

INTERNATIONAL STANDARDS

FOR TB CARE (ISTC)

To translate and disseminate ISTC among syndicate of physicians, private sector directorate, not for profit hospital and policlinics, and NGOs.

ISTC translated, printed and distributed Organize lectures and congress for all stakeholders about the international standards for TB care.

No. of stakeholder attended lectures Measuring the impact of adherence to the standards on quality of care and patient satisfaction.

Measurements tools settled

COMPONENT IV: EMPOWER PEOPLE WITH TB, AND COMMUNITIES Activity Indicator

NTP social Workers organize focus group discussion with patients on patients’ charter Established or not Orientation meetings with all policy makers Proportion. of attendance Establish a support Group for TB patients and their families in collaboration with Jordanian Anti TB Association (JATA) Support Group Established Conducting KAP studies KAP study conducted TOT for health care providers Conducting a campaign No. of care providers trained No. of governorate involved No. of seminars conducted

COMPONENT IV: EMPOWER PEOPLE WITH TB, AND COMMUNITIES Production of health education materials (TV spots, Radio broadcasting, booklets, posters, etc…) For different target groups.

No. of materials No. developed by type.

of sites of distribution.

School student awareness raising activities Celebrating the World TB day No. of conducted schools awareness raising activities No. of sectors involved Creating and updating a website of NTP Jordan Website created and updated

Community participation in TB Care:

Setting up a complete database about national and international NGOs.

Database is Done Orientation meeting with all NGOs focal persons to increase awareness about TB problem and to build commitment No of meetings conducted Integrating international NGOs in fund raising and sharing in TB control through materials, conferences and research.

No of conferences shared by NGOs, No of Materials Orientation meeting with community leaders to participate in TB fight No. of meetings conducted Empower community volunteers to support TB patients No of Volunteers supporting NTP Integrating the women lead NGOS to support the NTP.

No.. of women lead NGOs involved n NTP activities

PATIENTS’ CHARTER FOR TUBERCULOSIS CARE:

Forming a task force to set up a national document for TB patients’ rights.

Task formulated force Setting and printing a poster and booklets Posters and booklets for TB rights printed Disseminating the poster and booklets to all chest facilities, all partners and private clinics.

Posters and booklets disseminated

Activity ENABLE AND PROMOTE RESEARCH Indicator

NTP in collaboration with WHO and other partners identify the main research areas for next five year Conducting two studies per year Number of studies accompli shed

Monitoring and Evaluation (M&E) activities

Key Indicators Baseline

Establishment of M&E task force within the National TB program Training and refresher training workshops for 45 social workers and home visitors related to TB

Upgrading of Surveillance and strengthening M&E system

Key Indicators Baseline

Training for Governorate TB coordinators on surveillance including data verification and quality in terms of completeness, accuracy and timeliness through electronic templates in 3 days duration workshops for 40 staff.

NTP will supply the TB management units (TBMU) with computers and printers resources and other equipments (CDs, flash memories …..etc needed for ENRS implementation based on needs

ACSM Contribution to National TB Control

National Objectives Related Interventions 1- Improve TB care for vulnerable populations in Jordan

Empower community volunteers to support TB Patients through establishment of volunteer network between the NTP and all NGOs nationwide.

Orientation meetings (1 every quarter) with Concerned NGOs focal persons, influential leaders to increase awareness about TB problem and to build commitment Outreach educational sessions to increase awareness about TB Production of health education materials (Broadcasting, booklets, posters, etc…) For different target groups.

Educational sessions conducted to increase awareness on TB among students schools

ACSM Contribution to National TB Control

National Objectives 1- Improve TB care for vulnerable populations in Jordan Related Interventions

Conducting KAP studies to Assess the knowledge, attitude and perception of the population regarding TB;

ACSM Contribution to National TB Control

2- Improve tuberculosis care for people suffering from multi drug resistant tuberculosis and TB/HIV in Jordan

Developing and printing TB/HIV guideline

ACSM Contribution to National TB Control

3- Improve general tuberculosis care

NTP will play a key role in activating TB coordinators to assess needs requirements and to review action plans for TB and to reactivate M&E strategy (meeting on quarterly basis).

Training and refresher training workshops for 45 social workers and home visitors related to TB Translate and disseminate International Standards for Tuberculosis Care (ISTC) among syndicate of physicians, private sector, not for profit hospital and policlinics, and NGOs.

NTP social Workers organize 8 focus group discussion with patients on patients’ charter

ACSM Contribution to National TB Control

3- Improve general tuberculosis care Conducting a study on Case finding among tuberculosis suspects and barriers interfering with their timely healthcare in mid and northern Jordan

CONCLUSIONS

Successful TB Elimination Reaching Global Target Highest level of political support Community compliance Support of other concerned departments & sectors Support of concerned international organization Support and collaboration of governorate health authorities

Thank you