ISTC The Indonesian Experience Erlina Burhan Indonesian Society
ISTC The Indonesian Experience Erlina Burhan Indonesian Society of Respirology ISTC Task Force Indonesian Medical Association
Contents • • • Background Initiating ISTC Endorsement Key events Roll out of ISTC Conclusions
Back ground - Present practices & need for ISTC • TB care is standardized & implemented in the public sector mainly through the network of Primary Health Center’s and some hospitals • CXR is the commonly used diagnostic tool in hospitals & private practice • Sputum smear is very much underutilized in hospitals & private practice & sputum culture is uncommon • Many doctors are using other tests (serology test, PCR) instead of sputum testing • Treatment regimens vary considerably in private practice • Hence the need for a tool to bridge the NTP with Professional societies, Private sector & Hospitals • The Tool - ISTC
Process of introducing ISTC • March 2005 : Sensitization of key opinion leader during JEMM • July 2005: Introduction of ISTC draft to key opinion leaders (WHO/ KNCV) • August 2005: Introduce ISTC to professional organization • September 2005: Workshop for professional organization to develop a plan to endorse, socialize, disseminate and implement ISTC • September 2005: appoint ISTC team led by Indonesian Society of Respirology • October 2005: Various professional organization Meetings • November 2005: First National TB Congress with presentations on ISTC • December 2005: Finalizing Work Plan for socialization • Supported closely by the ATS with several visits from Dr Phil Hopewell and Ms Fran Du Melle
Process of Endorsement • January 2006: – First formal Endorsement Letter from Indonesian Society of Respirology – Introducing ISTC to the President of the Indonesian Medical Association and other Specialist Organizations (organized by Indonesian Society of Respirology) • February 2006: – Follow up meeting and Discussion with Indonesian Medical Association – Indonesian Medical Association endorse the standards in February 2006
Launch of ISTC • World TB Day 2006 : IDI (Indonesian Medical Association) formally endorsed the standards & launched by Minister of Health
Endorsement and Key Events • ISTC Task force at IMA was established • ISTC short version in Bahasa (incl addendum) Indonesia was published and disseminated • ISTC is included in various scientific meetings of professional organization
Roll Out ISTC With support from NTP, WHO, and KNCV; • Indonesian Society of Respirology has implemented: – Two days Workshops in 13 provinces in coordination with local chapters of professional societies & Provincial/District health authorities – ISTC Short version were delivered to all participants – All the topics were delivered as a CD and handout to participants • Indonesian Medical Association – Develop National Task Force – Socialization and establishment of Provincial TF in 12 provinces to ensure sustainability & local ownership – Development guideline for implementation TB in Private Practitioner – Piloting TB in PP through certification and accreditation scheme
TOPICS • • • Why & What of ISTC Epidemiology of TB Standard diagnosis Standard treatment Standard Public Health Responsibility MDR TB TB-HIV The Role of Chest X Ray Group work & discussions
The Role of Professional Organizations • Socialization and dissemination • Having ISTC as a topic in their annual meetings, scientific sessions and seminars • Meetings to socialize and dissemination the standards ( Hands on ) • ISTC articles in Journals
Conclusions • Involvement of key professional opinion leaders/champions, right from introduction is important for buy in, acceptance & endorsement • Professional society members relate more easily to ISTC than NTP guidelines since it is evidence based & more clinical oriented • ISTC can act as the bridge between the NTP, Professional societies & Private sector • NTP’s can outsource the socialization & roll out of ISTC to Professional organizations • A Hospital assessment study done on DOTS practices in 2007/8 in Public & Private hospitals acts as baseline data to evaluate the impact of ISTC in future.
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