1 National Tuberculosis Control Program in Bangladesh : Progress Report Dr. Shamim Sultana Deputy Programme Manager, TB National TB Control Programme Directorate.

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National Tuberculosis Control Program in Bangladesh :

Progress Report

Dr. Shamim SultanaDeputy Programme Manager, TB National TB Control Programme

Directorate General of Health ServicesMohakhali, Dhaka

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BANGLADESH: Country Profile

Situated in South AsiaPopulation : 140.70 million (2006 projected estimate, based on 2001 Census)Area: 147,570 sq. kmDensity: 953 per km2

GNP per capita: 444 US$Administratively, it has-

Division: 6District: 64Sub District: 507

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BANGLADESH: TB Situation5th among 22 high TB burden countriesARTI: 2.14%50% of adult population infectedEstimated new cases of TB (all forms) per year : 227 / 100000 population Estimated new smear positive TB cases per year: 102/ 100000 populationTB Prevalence (all cases): 406/100000 pop

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BANGLADESH: TB Situation

TB Mortality ( all cases per year) : 47/100000 populationPercent estimated new adult cases of TB co-infected with HIV : 0.1%No representative DRS data availableEstimated New TB cases MDR: 1.8%Estimated previously treated TB Cases MDR: 14%

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DOTS strategy- implemented in November 1993

DOTS Coverage: almost 99%

TB Case Detection Rate 2006: 71.06%

Treatment Success Rate ( 2005): 91.51%

Source: WHO estimates of 2006

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TB Case Detection Rates: (2006)

National : 71.06%

Divisional :

Dhaka 68.0%Chittagong 75.0%Rajshahi 61.4%Khulna 75.6%Barisal 90.9%Sylhet 81.8%

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Smear +ve Cases: Treatment Success and Case Detection Rates (%); Since 1993

91.5

71

0102030405060708090

100

Treat Success Case Detection

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TB Situation from 2004 - 2006

General/All cases in

2004

General/All cases in

2005

General/All cases in 2006

Year

2004 2005 2006

Country Population:

137 million 140 million 140.7 million

DOTS population coverage (%):

99% 99% 99%

Number of TB cases notified (all cases):

90,741 122,907 145,164 % Detection*: 31% 32% 45.07%

Number of pulmonary TB sputum-smear positive case:

62,228 88,576 101,988 % Detection*: 46% 61% 71.06%

Success rate of smear positive cases (%)[cure plus completion] : 89% 91.51%

*Percentage of cases notified out of estimated cases

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TB Situation of 2006

Reporting Unit

Pulmonary Positive

Pulmonary Negative

%

ExtraPulmonary

New%

Total%

New

%Relapse

%

Upazilla 75.51 2.23 14.07 8.19 82

Metro 47.87 6.58 27.54 18.01 13

CDC 42.97 4.23 35.24 17.57 5

Total 70.26 2.90 16.89 9.95 100

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Vision and Mission of NTP VISION: Tuberculosis is no more a public health problem in

Bangladesh

MISSION: National Tuberculosis Program (NTP) aims to

strengthen the effort of TB Control through effective partnership, mobilizing resources and ensuring quality diagnostic and treatment services under defined Directly Observed Treatment Short Course (DOTS) strategy. The service should be equally available to all people of Bangladesh irrespective of age, sex, religion, ethnicity, social status and race.

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Vision and Mission of NTP (Cont.)

GOALS OF NATIONAL TB CONTROL PROGRAM

The overall goal of TB control is to reduce morbidity, mortality and transmission of TB until it is no longer a public health problem

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Vision and Mission (Cont.)

OBJECTIVES OF NATIONAL TB CONTROL PROGRAM

- Reach and thereafter sustain the 2005 targets- achieving at least 70% case detection and 85% treatment success among TB cases under DOTS

In order to then, - Reach the interim target of halving TB

death and prevalence achieving the Millennium Development Goals set by 2015

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Area of Collaboration

Government NGOs/ Partners

Implementation Policy, Planning and Budgeting National guidelines Overall coordination Infrastructure

Specific areas as per MoU

Case finding and Case Holding

Policy, Planning and Budgeting Equipment/supplies Diagnosis, Treatment, DOT ,

Follow-up, Management of complicated cases

Referral centres

Suspect identification, Referral for Diagnosis, Diagnosis and Treatment, DOT and Follow-up

Training Policy, Planning and Budgeting Training of Trainers (TOT) Responsible for pertaining all

forms of training/ orientation to all categories of GoB and NGOs/ Partners

Local training only for respective NGO staff as per NTP curricula, support government training

Areas of GO-NGO Collaboration in TB Control in Bangladesh

MOTB

Add support training of govt. health staff at upazila and district level

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Area of Collaboration Government NGOs/ Partners

Drugs and Logistics Management

Central procurement Distribution Local storage

Local storage and distribution

Supply indent

Monitoring ,Supervision and Evaluation

Recording and Reporting

Overall Monitoring and Supervision

External and Internal Evaluation

Recording and Reporting

Local Monitoring and Supervision

Participate in internal and external evaluation

Advocacy, Communication and Social Mobilization (ACSM)

Policy, Planning and Budgeting

Advocacy meetings with all stakeholders

National campaigns

Outreach activities at local community

Areas of GO-NGO Collaboration in TB Control in Bangladesh (Contd.)

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ROLE OF THE NTP AND ITS IMPLEMENTING PARTNERSAT DIFFERENT LEVELS

Central Level Central Level Responsible Bodies: Academic Institutes, NGOs and Professional AssociationsResponsibilities: Civil society and private sector involvement,ACSM,Recording and Reporting, Supervision and Monitoring, Implementation of Operational Research

Responsible Bodies: Academic Institutes, NGOs and Professional AssociationsResponsibilities: Civil society and private sector involvement,ACSM,Recording and Reporting, Supervision and Monitoring, Implementation of Operational Research

NTPNTP Partners/Implementing agencies

Partners/Implementing agencies

Responsible Persons: Director- MBDC & Line Director-TB/Leprosy, Deputy Director-MBDC , Asst. Director, Program Manager-TB, DPM-TB and MOsResponsibilities: Policy formulation, Planning, Budgeting, Coordination with partners,Operational Guidelines, HRD, ACSM, EQA, Procurement and Supply of Drug and Logistics, MIS, Supervision, Monitoring & Evaluation and Operational Research

Responsible Persons: Director- MBDC & Line Director-TB/Leprosy, Deputy Director-MBDC , Asst. Director, Program Manager-TB, DPM-TB and MOsResponsibilities: Policy formulation, Planning, Budgeting, Coordination with partners,Operational Guidelines, HRD, ACSM, EQA, Procurement and Supply of Drug and Logistics, MIS, Supervision, Monitoring & Evaluation and Operational Research

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ROLE OF THE NTP AND ITS IMPLEMENTING PARTNERSAT DIFFERENT LEVELS (Contd.)

Divisional level

Divisional level

Responsible Persons: Divisional Director Health and Deputy Director, Health.Responsibilities: Supervision and Monitoring according to NTP guidelines,coordination with NTP and partners

Responsible Persons: Divisional Director Health and Deputy Director, Health.Responsibilities: Supervision and Monitoring according to NTP guidelines,coordination with NTP and partners

District LevelDistrict Level Responsible Persons: Civil Surgeon Consultant-Chest Disease Clinic, MO and PO- TB-LEP Responsibilities: Supervision, Monitoring and Evaluation, EQA,Training, technical guidance, coordination with NTP partners and implementing DOTS

Responsible Persons: Civil Surgeon Consultant-Chest Disease Clinic, MO and PO- TB-LEP Responsibilities: Supervision, Monitoring and Evaluation, EQA,Training, technical guidance, coordination with NTP partners and implementing DOTS

Responsible Bodies: Academic Institutions, District Hospitals, Chest Disease Clinics, NGOs. Responsibilities: DOTS Implementation, Management of referred cases, Supervision, Monitoring, Quality Assurance, networking with private providers, ACSM,Recording and Reporting, indenting for drugs and logistics.

Responsible Bodies: Academic Institutions, District Hospitals, Chest Disease Clinics, NGOs. Responsibilities: DOTS Implementation, Management of referred cases, Supervision, Monitoring, Quality Assurance, networking with private providers, ACSM,Recording and Reporting, indenting for drugs and logistics.

Responsible Bodies: City Corporations, NGOs, Chest Hospitals, Academic Institutes, Corporate Health Services, Private Sectors and Prisons.Responsibilities: Implementing DOTS, Management of referred cases,ACSM, Recording and Reporting , Supervision and Monitoring

Responsible Bodies: City Corporations, NGOs, Chest Hospitals, Academic Institutes, Corporate Health Services, Private Sectors and Prisons.Responsibilities: Implementing DOTS, Management of referred cases,ACSM, Recording and Reporting , Supervision and Monitoring



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ROLE OF THE NTP AND ITS IMPLEMENTING PARTNERSAT DIFFERENT LEVELS (CONT.)

Upazila LevelUpazila Level Responsible Persons:UH&FPO, MO LTCAResponsibilities: Implementation of DOTS, Supervision, Monitoring and Evaluation, Training, Recording and Reporting, Coordination with NTP partners

Responsible Persons:UH&FPO, MO LTCAResponsibilities: Implementation of DOTS, Supervision, Monitoring and Evaluation, Training, Recording and Reporting, Coordination with NTP partners

Responsible Bodies: UHC, NGO partnersResponsibilities: Identification of suspects, sputum collection and examination, Training, ACSM, DOT,Follow Up, Supervision, Recording and Reporting, and Indenting drugs and logistics

Responsible Bodies: UHC, NGO partnersResponsibilities: Identification of suspects, sputum collection and examination, Training, ACSM, DOT,Follow Up, Supervision, Recording and Reporting, and Indenting drugs and logistics



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ROLE OF THE NTP AND ITS IMPLEMENTING PARTNERSAT DIFFERENT LEVELS (Contd.)

Union/ward LevelUnion/ward Level

Responsible Bodies: Health sub-centers, NGO partners.Responsibilities:ACSM, Suspect identification and referral, DOT, Follow Up,Sputum collection and transportation to laboratory

Responsible Bodies: Health sub-centers, NGO partners.Responsibilities:ACSM, Suspect identification and referral, DOT, Follow Up,Sputum collection and transportation to laboratory

Responsible Persons: HI,AHI, HA, MA

Responsibilities: ACSM, Suspect identification and referral, DOT, Follow Up

Responsible Persons: HI,AHI, HA, MA

Responsibilities: ACSM, Suspect identification and referral, DOT, Follow Up Responsible Persons: Community

Health Workers (Shastho Shebikas), Village Doctors, Cured patients Responsibilities: Suspect identification and referral, DOT, Follow Up

Responsible Persons: Community Health Workers (Shastho Shebikas), Village Doctors, Cured patients Responsibilities: Suspect identification and referral, DOT, Follow Up

Village LevelVillage Level



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National / International Partnerships

Partnership (list of institution)

Type of Partnership

1. NGOs (BRAC, LTCC UPHCP, NSDP)

DOTS Service Delivery

2.NATAB Civil Society Involvement in TB Control

3. ICDDR,B Operations Research

4. Private Practitioners DOTS Service Delivery and Collaborate With NTP NGO Partners

5. Academic Institutes, Public and Private Hospitals

DOTS Service Delivery, Referral Centres

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National / International Partnerships( Cont.)

Partnership (list of institution)

Type of Partnership

6. Corporate Sectors, Work Places DOTS Service Delivery

7. Special Population ( Prison, Defences)

DOTS Service Delivery

8. WHO Technical Assistance

9. GFATM, CIDA, USAID, JICA,WB

Financial Assistance

10. RIT,KNCV,URC, IUATLD Technical Assistance

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Resource Mobilization :GFATM Grants

Principal RecipientGovernment

Principal RecipientNGO-BRAC Total

Round 3(Period: 2004-2009) 15.45 27.02 42.47

Round 5(Period: 2006-2011) 26.45 19.52 45.97

Total 41.9 46.54 88.44

(US$ in million)

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Current and Planned Activities Increase case detection and maintain high cure rates

through strengthening DOTS services including quality of lab services

Involve all health care providers Create demand for services through comprehensive

advocacy, communication and social mobilization Strengthen the procurement and supply system Strengthen supervision, monitoring and evaluation Management of Multi Drug Resistant TB TB/HIV collaborative activities

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NTP Achievements1. Expansion of DOTS in Metropolitan Cities

2. Introduction of DOTS in prisons, academic institutions and

workplaces

3. Sustaining strong collaboration between Government and

Non-Government organizations

4. Access to the Global DOTS Expansion plan funded by

CIDA, Global Drug Facility (GDF), Global Fund to Fight

AIDS, TB and Malaria (GFATM) and strong technical

support from WHO

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NTP Achievements(Cont.)5. Detection of estimated new smear positive

cases under NTP increased to over 70% in 2006 as compared to 34% in 2002 and treatment success rate to over 91% (2005)

6. Establishment of External Quality Assurance of smear microscopy

7. Initiation of Prevalence Survey

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NTP Achievements (Cont.)8. Awareness campaigns initiated through

mass media

9. Steps taken to function DRS and implementation of DOTS-Plus Project

10.Steps taken to implement PPM-DOTS, TB-HIV

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Major Challenges1. Health Sector Reform2. Effective partnership to cover hard to reach/special

areas: Private Hospitals and Clinics, Expansion in Defense Hospitals, Prisons, Brothels, Slums and Industrial Units, homeless population in difficult terrains

3. Human Resource Capacity Development4. MDR-TB and HIV-TB Co infection5. Quality assurance of lab services6. Uninterrupted supply of drugs7. Strengthening of supervision and monitoring8. Dependence on external funding

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THANK YOU

1 National Tuberculosis Control Program in Bangladesh : Progress Report Dr. Shamim Sultana Deputy Programme Manager, TB National TB Control Programme Directorate.

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