Progress and Plans for PPM in the Western

Progress and Plans for PPM in the Western Pacific Region Fifth PPM DOTS Subgroup Meeting Cairo, Egypt

Progress in TB control 2005 targets achieved and sustained l Regional Strategic Plan 2006 -2010 l Consistent with the Global Plan – Regional goal: reduce prevalence and mortality by half by 2010, relative to 2000 – PPM is an important component to the Plan and will be monitored as one of the core target relates to PPMD – coverage l All HBCs have national plans 2006 -2010 l Priority countries for PPM: Cambodia, China, Philippines, and Viet Nam

Progress in PPM activities l Regional training on PPM for participants from 9 countries conducted by WPRO in 2007 l PPM also included in the training course of the Research Institute of Tuberculosis, Tokyo l Review of PPM activities conducted by USAID in Philippines, planned in Cambodia

PPM DOTS in CHINA Type/size of private providers – Large: public hospitals – Small: private clinics, private health providers Model: Public-Public Mix – Hospitals refer patients to TB dispensary and report through Internet based surveillance system – TB dispensaries track reported patients – Fidelis projects in 8 provinces Stage – Scaling up, decentralising to county level Outcomes – Improved hospital-TB dispensary linkage contributed to achievement of the CDR target

PPM DOTS in CHINA. contd Progress – PPM working group formed at the national level – Training materials on PPM developed – Documentation of existing PPM models – Chinese translation of the ISTC available

PPM DOTS in CAMBODIA Type/size of private providers – Pharmacies, Private doctors, Laboratories. – Size unknown but mostly in urban areas. Model – – Providers REFER TB suspects to public sector Community-based DOTS in rural areas Stage – Phase I (pilot) through PATH and URC since 2005, recently RHAC – PATH focuses on Pharmacy DOTS, while URC model targets all providers

PPM DOTS in Cambodia. . contd Achievements and plans • Draft guidelines for PPM-DOTS developed • Phase II of PPM-DOTS to include provision for diagnosis and treatment services by private health care providers. • C-DOTS coverage: 50% of the health centres, plans to increase to > 80% of the health centres through GFATM R 7. • ISTC translated and widely disseminated • Prisons: assessment of TB control in prisons completed, activities initiated in three prisons with plans for further scale-up.

PPM DOTS in Cambodia Achievement in 2007 URC PATH/JICA RHAC Total Suspects referred 2217 3384 59 5660 Received at HCs 1372 1465 62 2899 306 1 535 489 3 814 S+ve TB 228 diagnosed Total TB 322 cases 535/19, 421(2. 7%) S+ve cases in the country were diagnosed through referrals from PPM sites Annual NTP Report 2007

PPM DOTS in VIETNAM Type/size of private providers – Growing private sector in urban areas – Drug vendors, physicians (includes Govt doctors in private practice) Model – Providers refer TB suspects to public sector Stage – Pilots in Hai Duong (2004), scale up to 17 provinces in mid 2007 – PPM projects in HCMC (PPs refer & manage cases)

PPM DOTS in VIETNAM. . contd Recent progress – National task force formed and focal person identified at the national level – PPM guidelines developed which now expand roles of private providers to diagnose and treat TB patients – ISTC translated to local language Plans – For 2006 -2010, one of the objective of the NTP is to implement PPMD in urban areas of 12 provinces/cities (with established or evolving private health sector)

PHILIPPINES: PPM Models Public-Private Mix – Private or public-initiated PPM-DOTS, offers full package – Facilitated by an intermediary with external funding – Phil. Health accreditation and benefit package Public-Public Mix – Non-NTP public hospitals refer to public DOTS centres or provide DOTS services PPM for MDR-TB – MDRTB suspects referred to DOTS-Plus site (private); undergo 6 months treatment at half way house. – Cont. phase administered at home by BHW (comm. volunteer) or staff of RHU (public) closest to patient

PHILIPPINES: Status • Overall coverage: 28/86 million population (33%) • 115 PPMD units installed, covering 28 million population • Over 3000 private physicians trained • In PPMD areas, 11% additional cases were identified through this approach Phil. CAT report, 2007

PHILIPPINES: Plans • Plans: By 2007/2008 – – 7000 PPs trained (100%) 216 PPM DOTS units installed All public hospitals DOTS/DOTS referring facility Phil. Health accreditation to 500 public DOTS facilities • Assess PPMD performance/contribution to NTP • Formalize inclusion of NTP policies in medical/ paramedical training curricula

Conclusion • Slow progress in Viet Nam and Cambodia – Insufficient human resources to coordinate with PPs, supervise and monitor activities – Support available through Global Fund for PPM is likely to expedite progress • Philippines: sustainability beyond project support – Expedite Phil. Health accreditation, increase its membership, tap local resources • ISTC not adequately promoted or used beyond local translation • Need to strengthen linkages with large hospitals, work in prisons • Need for standardised training materials for PPM

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