National TB Program Afghanistan - JICA · Afghanistan Health services and NTP • Afghanistan/MoPH has introduced integrate approach of ... 330 330 330 388 388 36 70 126 178 310 0

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National TB Program National TB Program AfghanistanAfghanistan

April 2,2006April 2,2006

AfghanistanAfghanistan

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Presentation outlinePresentation outline

• Afghanistan TB Facts and Figures• Afghanistan Health services and NTP• NTP Goal, objectives and Targets• Progress TB Control Program• The Way forward

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Afghanistan TB Facts and FigureAfghanistan TB Facts and Figure

•• Population: 28,51 MillionPopulation: 28,51 Million•• Literacy rate 15+: 29%Literacy rate 15+: 29%•• DOTS adopted in 1997DOTS adopted in 1997•• TB incidence: 333/100000TB incidence: 333/100000•• New SS+ cases: 150/100000New SS+ cases: 150/100000•• Case detection: 23% by 2004Case detection: 23% by 2004•• Treatment success: 86% Treatment success: 86%

by2004by2004•• 67% of patients are female67% of patients are female•• 75,000 new cases per year75,000 new cases per year•• 20,000 people die of TB / year20,000 people die of TB / year

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Afghanistan Health services and NTPAfghanistan Health services and NTP

• Afghanistan/MoPH has introduced integrate approach of health services via BPHS

• Currently BPHS is covering 75% of the country• 42 National and international NGOs implement BPHS• TB control activities are integrated within BPHS• From 1997-2004, only 202 HF were implementing DOTS• In 2005 NTP with support of all key stakeholders

developed National TB Operational Plan 2005-Jun 2006• As result of NTP Operational Plan all PH, DH, CHCs and

20% of BHCs will be implementing DOTS by June 2006 (562 HF)

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NTP NTP Vision and GoalsVision and GoalsVision

A TB-free country, with elimination of the disease as a public health problem by 2050

Goals 1 Ensure access to diagnosis, treatment and cure for each TB

patient2 Reduce deaths, disease, and transmission due to TB3 Reduce human suffering and socioeconomic burden amongst

families and communities4 Protect vulnerable populations from TB, TB/HIV and drug

resistant TB.

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TargetsTargets

1. MDG 6, Target 8: Halt and begin to reverse the incidence of TB by 2015. Epidemiological targets linked to MDGs: 1. Detect at least 70% of infectious TB cases and cure at least 85% of those cases by 2010.

2. Reduce the prevalence of and deaths due to TB by 50% by 2015.

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Progress in TB control programProgress in TB control program

• Ministry of Public Health (MoPH) consider TB as priority

• National TB Review Meeting, CCM and National TB Board are held regularly

• National TB guideline is Finalized developed• NTP has developed Operational Plan for 2005-

2006 • NTP strategic plan for 2006-2010 is approved• SoPs on TB Case Detection and TB Treatment

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DOTS coverageDOTS coverageMap of D OTS cov ra e B i t i t

Covered by DOTS

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Progress in TB control programProgress in TB control program

• NTP/JICA and GFMU laboratory situation analysis done as baseline for laboratory network

• TB training manuals for various categories of heath staff• IEC materials developed has been distributed • More than 20 provinces has been supervisory by

National team including celebration of WTB day in each region with NTP Team

• Training of 103 personnel aboard on TB management

• GDF approved three years Proposal of NTP • Submission of 5 Research proposal to TDR

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DOTS Coverage by YearDOTS Coverage by Year

DOTS Coverage % by Year

0

20

40

60

80

100

2000 2001 2002 2003 2004 2005

Year

DOTS

Cov

erag

e %

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Monitoring DOTS progressMonitoring DOTS progress

MONITORING DOTS

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

DOTS coverage (%) -- -- 12 11 14 15 12 38 53 68 81

DOTS notification rate (new and relapse/100 000 pop) -- -- 6 14 14 30 41 53 51 64 34

DOTS notification rate (new ss+/100 000 pop) -- -- 3 8 7 12 19 25 24 29 48

DOTS case detection rate (new and relapse, %) -- -- 2 4 4 9 12 16 15 19 34

DOTS case detection rate (new ss+, %) -- -- 2 5 5 8 13 17 16 19 32

DOTS case detection rate (new ss+)/coverage (%) -- -- 16 49 36 54 104 44 30 28 43

DOTS treatment success (new ss+, %) -- -- 45 33 87 86 84 87 86 86 86

DOTS re-treatment success (ss+, %) -- -- -- -- -- -- -- -- -- --

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Case Notification TrendCase Notification Trend

0

10

20

30

40

50

60

70

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Re-treatment

Relapse

New extrapulmonary

New ss-/unk

New ss+

Notifications have increased dramatically since 1997 as DOTS services have expanded

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Treatment Success TrendTreatment Success Trend

0

85

1995 1996 1997 1998 1999 2000 2001 2002 2003

% o

f coh

ort (

new

ss+

cas

es)

Unfavourableoutcome

Completed

Cured

Treatment success above or close to 85% target since 1999; proportion confirmed high in 2003 cohort

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Health facilities providing TB servicesHealth facilities providing TB services

No of Health Facilities providing DOTS

10 3679

131202

537

0

100

200

300

400

500

600

2000 2001 2002 2003 2004 2005

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Case NotificationCase Notification

Cases notified by year

9,58112,871 13,616

18,405

22,207

0

5,000

10,000

15,000

20,000

25,000

2001 2002 2003 2004 2005

Year

Cas

es

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Case notifications by age and sexCase notifications by age and sex

0

10

20

30

40

50

60

70

80

90

100

0-14 15-24 25-34 35-44 45-54 55-64 65+

Not

ifica

tion

rate

(new

ss+

/100

000

pop

)

Women

Men

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Districts Covered by DOTSDistricts Covered by DOTS

330 330 330

388 388

36

70

126

178

310

0

50

100

150

200

250

300

350

400

450

2001 2002 2003 2004 2005

Year

No

of d

istric

ts w

ith a

t lea

st o

ne T

B c

ente

r

Expected

Covered

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Health facilities providing TB services in Health facilities providing TB services in Kabul ProvinceKabul Province

13

48

0

10

20

30

40

50

60

2004 2005

Year

No

of H

F pr

ovid

ing

TB s

ervi

ces

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The Way ForwardThe Way Forward

1.1. Pursuing, optimizing and sustaining quality DOTSPursuing, optimizing and sustaining quality DOTS

1.1 DOTS Expansion1.1 DOTS Expansion1.2 Political commitment1.2 Political commitment1.3 Capacity building1.3 Capacity building1.4 Drug management1.4 Drug management1.5 Strengthening of Laboratory system1.5 Strengthening of Laboratory system1.6 Disease surveillance1.6 Disease surveillance1.7 Monitoring and supervision1.7 Monitoring and supervision1.8 Program Evaluation1.8 Program Evaluation

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The Way ForwardThe Way Forward

2. Adapting DOTS to respond to TB/HIV, MDR-TB and other special challenges

2.1 TB/HIV Joint Activities2.2 DOTS Plus (DOTS+) 2.3 TB and Gender Issues2.4 TB Among the Poor and other Vulnerable Groups

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The Way ForwardThe Way Forward3. Contributing to health system strengthening

Improving quality and efficiency of general services in respiratory illnesses using the Practical Approach to Lung Health (PAL)

4. Initiating Public-Private Mix (PPM) Implementing Public-Private Mix approaches

5. Empowering patients and communitiesIEC for patient empowerment, community involvement, CHW trainingfor community-based DOTS

6. Enabling and promoting research and developmentDeveloping a national framework for operational research and building local capacity in operational research

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Many Thanks