HELLO MY FRIEND HOW ARE YOU TODAY?. Maarten Bosman Birth cohort 1946 Married, two sons (men!! 34 and 27) “Tropical Doctor” in Tanzania 74-77 Khmer refugees.

HELLO MY FRIENDHOW ARE YOU TODAY?

Maarten Bosman

• Birth cohort 1946• Married, two sons (men!! 34 and 27)• “Tropical Doctor” in Tanzania 74-77• Khmer refugees ICRC 1980• “Family Doctor” in Netherlands 80-84• TB manager NTP in Kenya 84-89• TB consultant KNCV 89-98

• Stop TB initiative in WHO Geneva 99-2000

• Back in KNCV 2001

• MO stop TB for Vietnam, Lao and Cambodia since September 2002 in Hanoi

• October 2006 retired from WHO; independent TB consultant since

Interests/Experiences

Health Sector Reform

TB control in Nomads

Urban TB control

TB/HIV

Consultancies

• Bangladesh, Cambodia, China, Lao, Thailand, Vietnam

• Ethiopia, Ghana, Kenya, Mali, Mozambique, Tanzania, The Gambia, Somalia, Zambia

• Serbia

TB control: The Planning Cycle

Planning and Managing TB control

Objectives of the module• Knowledge acquired:

Basic principles of TB control (DOTS)

Planning and management of TB control• Skills acquired:

Assessment of quality of TB services

Reporting of findings and providing recommendations

The Stop TB Strategy of WHO

1. Pursue high-quality Dots expansion and enhancement

2. Address TB/HIV, MDR-TB and other challenges

3. Contribute to health system strengthening

4. Engage all care providers

5. Empower people with TB, and communities

6. Enable and promote research

Study Approach

Program Cycle Management• Problem or Situational Analysis• Planning and implementation of interventions• Quality assurance and performance audit by

supervision• Monitoring through HMIS• Analyzing and evaluation of results

Overall objective of TB control

Reduce transmission of TB in the community and in this way reduce the prevalence of M.tuberculosis

infected persons in the community

Purpose of TB control

To remove sources of infection of M.tuberculosis

from the community by early identification and cure of

infectious cases of TB

Strategy

• Political Commitment to control TB

• Laboratory network for direct microscopy

• Short-course chemotherapy and DOT

• Guaranteed supply of anti-TB drugs

• HMIS for monitoring and evaluation

TB Control Process

• (Self) referral of suspects

• Identification of suspects

• Examination of suspects

• Diagnosis of cases

• Registration for Treatment

• Providing and supervising treatment

• Case-holding

• Evaluating results

Functions NTP

• Conditions for different steps of the process meet defined standards

• Assure quality of interventions

• Secure necessary equipment, means and funds

• Monitor the process and evaluate outcome

• Plan and manage the process

Planning and managing the process

Levels

• The Community

• The District Health System

• The Intermediate Level

• The National Level

• Global? Sub-regional?

Training Methodology

• Interactive, problem solving oriented discussions

• Practical exercises in working groups

• Field visits

• Group presentations

AsiamAsiam181181,035 sq km,035 sq km

425 x 425 km425 x 425 km

MakaldiamMakaldiam

ChanigoliaChanigolia

14 million people in 200814 million people in 2008

Demography

Population 200814 millionAnnual Growth 2%Urban 20%Life expectancy 57yrInfant mortality 68Under 5 malnutrition36%

EconomyEconomy

GDP 8 billion US$GDP 8 billion US$

Agriculture 30%Agriculture 30%

Industry 26%Industry 26%

Services 44%Services 44%

Export 3.7 billion US$Export 3.7 billion US$

Import 4.7 billion US$Import 4.7 billion US$

Debt 3.5 billion US$Debt 3.5 billion US$

Is ASIAM a paradise?Is ASIAM a paradise?

Depends who you are:Depends who you are:

35% of people below poverty line35% of people below poverty line

High prevalence of High prevalence of

AIDSAIDS

TuberculosisTuberculosis

MalariaMalaria

High child mortalityHigh child mortality

ASIAM

A Case Study• Review of TB control in Asiam

1992, 1996 and 2002• Asiam R7 and R10 proposals to GFATM• Asiam data sets I, II and III• Set of exercises• Group work and presentations

Group 1

NGHIA HUYNH

KHANH PHAM

XINXU LI

KHAMLA CHOUMLIVONG

RACHEL SISMAR

MARIAH PRESTON

Group 2

HARDEW KAUR

NGOC DIEP BUI

THI MINH NGOC NGUYEN

KHAMLUB SENBOUNSOU

EDWIN HENRY DAIWO

KHIN ZAW

Group 3

OYUNTUYA TUMENBAYAR

PWINT HAYMAR NAING

NANG SARM PHONG

TRISASI LESTARI

THI THANH VAN NGUYEN

NICHOLAS GOHINO BUWAO

Group 4

ANH BINH LUONG

YULING ZHAO

FRANK UNDERWOOD

MA CECILIA VAGAY

MARK DUPI

SAORITH SENG