Jordan TP Facts

8/6/2019 Jordan TP Facts

1/37

Regional Advocacy, Communication and SocialRegional Advocacy, Communication and SocialMobilization Planning Workshop forMobilization Planning Workshop for

Tuberculosis ControlTuberculosis Control

Amman, Jordan 13Amman, Jordan 13--17 April 200817 April 2008


2/37

Regional Advocacy, Communication and SocialRegional Advocacy, Communication and SocialMobilization Planning Workshop for Tuberculosis ControlMobilization Planning Workshop for Tuberculosis Control

Amman, Jordan 13Amman, Jordan 13--17 April 200817 April 2008


3/37

Population:Population: 5.6 million

Surface area: 89,000 Sq.Km

Middle income country: 1,208 JD

(}1,700 US $)

Demographic transition: life

expectancy: 71.5 years

Epidemiologic transition:

- Infant Mortality rate: 22/1000

live births

-Decrease in communicable diseases,

including TB.

Increase in chronic diseases, including

chronic respiratory diseases (CRD) .

Syria

Saudi Arabia

Iraq


4/37

Various Health system in JordanVarious Health system in Jordan

(1999(1999 2003)2003)2003

2002

2001

Country Health Data

979591Number of Hospitals

974393838982Hospital Beds

358734623357Ministry of Health

180117911760Royal Medical Services

540531517JordanJordan UniversityUniversity HospitalHospital

283197-King Abdullah University Hospital

353234023348Private Sector


5/37

Health Centers of MOH

200320032002200220012001Type of Center

525347Comprehensive Health Centers

340336338Primary Health Centers

259258258Peripheral Health Centers

353351351Maternity and Child Health Care Centers

121111Chest Diseases Centers

250247240Dental Clinic


6/37

TB control in JordanTB control in Jordan Low TB burden: in 2007:Low TB burden: in 2007:

* 333 TB cases (all types) (in addition to 150 cases* 333 TB cases (all types) (in addition to 150 cases

Among foreigners transferred out)Among foreigners transferred out)

* Incidence (all TB types): 6 / 100,000 population* Incidence (all TB types): 6 / 100,000 population

* SS+ incidence: 1.8/100,000 population* SS+ incidence: 1.8/100,000 population* ARI : 0.04%* ARI : 0.04%

TB incidence decreasing: 13/100 000 in 1992TB incidence decreasing: 13/100 000 in 1992pp

6 in 20076 in 2007

100% population DOTS coverage (1998)100% population DOTS coverage (1998)

Case Detection Rate: 63% (2005)Case Detection Rate: 63% (2005)

Success Rate: 87% (2006)Success Rate: 87% (2006)

Prevalence of MDR :5% (2006)Prevalence of MDR :5% (2006)


7/37

structure of TB control programmestructure of TB control programme

in Jordanin Jordan


8/37

The National TB ProgramThe National TB Program(NTP) of the Ministry of(NTP) of the Ministry of

Health is well organized, andHealth is well organized, andJordan belongs nowadays toJordan belongs nowadays tothe low prevalence countriesthe low prevalence countriesin the world.in the world.

The National TB ProgramThe National TB Program(NTP) of the Ministry of(NTP) of the Ministry of

Health is well organized, andHealth is well organized, andJordan belongs nowadays toJordan belongs nowadays tothe low prevalence countriesthe low prevalence countriesin the world.in the world.


9/37

Structure of the TuberculosisStructure of the TuberculosisControl in JordanControl in Jordan

The National TB (NTP) in Jordan is a verticalThe National TB (NTP) in Jordan is a verticalProgrammeProgramme

At the Central level the Chest DiseaseAt the Central level the Chest Disease

Division (in Amman City), responsible forDivision (in Amman City), responsible forTuberculosis control program throughoutTuberculosis control program throughoutthe country including supplying medicines.the country including supplying medicines.The main role is planning, coordination andThe main role is planning, coordination and

supervision of the control activities.supervision of the control activities.

At the peripheral level, there are 12 chestAt the peripheral level, there are 12 chestcenters covering the whole countrycenters covering the whole country..

The National TB (NTP) in Jordan is a verticalThe National TB (NTP) in Jordan is a verticalProgrammeProgramme

At the Central level the Chest DiseaseAt the Central level the Chest Disease

Division (in Amman City), responsible forDivision (in Amman City), responsible forTuberculosis control program throughoutTuberculosis control program throughoutthe country including supplying medicines.the country including supplying medicines.The main role is planning, coordination andThe main role is planning, coordination and

supervision of the control activities.supervision of the control activities.

At the peripheral level, there are 12 chestAt the peripheral level, there are 12 chestcenters covering the whole countrycenters covering the whole country..


10/37

Distribution of Diagnostic TB CentersDistribution of Diagnostic TB Centers

in Jordanin Jordan


11/37

Goal

Goal

Reduce mortality and morbidity andReduce mortality and morbidity andtransmission oftuberculosis, while preventingtransmission oftuberculosis, while preventing

drug resistance, until tuberculosis no longerdrug resistance, until tuberculosis no longerposes a threatto public health, and achieveposes a threatto public health, and achievethe Millennium DevelopmentGoals (Goalthe Millennium DevelopmentGoals (Goal 66,,

TargetTarget 88) by) by 20152015


12/37

OBJECTIVESOBJECTIVES

Improve TB care for vulnerable populationsImprove TB care for vulnerable populationsin Jordan (Refugees, poor, mobile) .in Jordan (Refugees, poor, mobile) .

Improve tuberculosis care for peopleImprove tuberculosis care for peoplesuffering from multisuffering from multi--drug resistantdrug resistant

tuberculosis and TB/HIV in Jordantuberculosis and TB/HIV in Jordan

Improve general tuberculosis careImprove general tuberculosis care


13/37

Epidemiological SituationEpidemiological SituationEpidemiological SituationEpidemiological Situation


14/37

Trends over time of the incidence of TBTrends over time of the incidence of TB

in Jordan (perin Jordan (per 100100,,000000 pop. per year)pop. per year)

14

12.8

28.9

21

25

23.2

21.1

16

1413

6

5.3

6.4

6

18.9

6.2

27.8

14.8

19.2

11.5

1010.5

6

6.45.8

12

11

9

8.3

7.8

0

5

10

15

20

25

30

35

197

1980

1982

198

1986

198

1990

1992

199

1996

199

2000

2002

200

2006

Year

IncidenceRate/1


15/37

Trends over time ofthe number ofTrends over time ofthe number of

new TB cases in Jordannew TB cases in Jordan

0

50

100

150

200

250

300

350

400

2002 2004 2006 Year

NumberTBCa

Pulmonary TB

Extra-pulmonary

TB

SS+ Pulmonary

Total TB


16/37

CHALLENGESCHALLENGES

Low Detection Rate: TB case detectionLow Detection Rate: TB case detectionfor new sputum smear positivefor new sputum smear positive

pulmonary TB cases in 2005 was 63%pulmonary TB cases in 2005 was 63%(targetof 70%);(targetof 70%);

MDR TB is increasing among JordaniansMDR TB is increasing among Jordanians(2% in 2004 , 5% in 2006)(2% in 2004 , 5% in 2006)


17/37


18/37

ACSM ACTIVITIESACSM ACTIVITIES

JOR506 G02-T/NTP-MOH


19/37

COMPONENT 1: PURSUING, OPTIMIZING AND SUSTAINING QUALITY DOTS

N.

Activity Indic

ator

Budget

(in USD)

Funding

source

1.1 POLITICAL COMMITMENT WITH INCREASED AND SUSTAINED FINANCING:

NTP will initiate one meeting per

year headed by the Ministry of

Health and members of a higher

policy forum or a National board,

to plan and monitor activities of

the NTP and to strengthen

commitment and financial

sustainability

One meeting is

held yearly

WHO

MOH

NTP will play a key role in

activating CCM to assess needs

and requirements and to review

and revise action plans for TB

control in Jordan.

Regular meetings

every three

months

GFATM

At Governorate levels, TB

coordinators will reactivate M&E

committees

M&E Committees

meet biannually

WHO

MOH


20/37

COMPONENT III: ENGAGE ALL CARE PROVIDERS

N. Activity Indicator Funding source

3.1 PUBLIC-PUBLIC, AND PUBLIC-PRIVATE (PPM) APPROACHES:

Setting up a database for all

stakeholders and focal persons

in all areas entitled to control

and manage TB cases.

Database

Established

GFATM

Forming a steering committee

to plan and implement PPM

strategy and to build

commitment.

Steering

Committee

Formulated

GFATM

Developing the PPM Strategy PPM strategyDeveloped and

printed

GFATM

Train all TB care providers in allTrain all TB care providers in all

areas responsible on TB caseareas responsible on TB case

management..management..

No.of TB care providers trainedNo.of TB care providers trained


21/37

N. Activity Indicator

3.1.5 Supervisory visits to all TB control clinics No. of Visits

Conducted

3.1.6 Ensuring supply of anti-TB drugs to clinics

dealing with TB cases.

All clinics dealing

with TB cases

provided withanti-TB drugs

3.1.7 Printing all guidelines and revised R&R

formats needed for the TB-Care provider to

ensure adherence to guidelines.

Guideline and

revised R&R

format developed

and printed

3.1.8 Increase awareness of medical Schools staff

and nursing schools staff about TB

problem through training.

No. of medical

Schools staff and

nursing schools

staff trained

COMPONENT III: ENGAGE ALL CAREPROVIDERS


22/37

N. Activity Indicator3.1.3.1.

99

Increase awareness of medicalIncrease awareness of medical

Schools students and nursingSchools students and nursing

schools students about TBschools students about TB

problem through trainingproblem through training

No. of medicalNo. of medical

SchoolsSchools

students andstudents and

nursingnursingschoolsschools

studentsstudents

trainedtrained

COMPONENT III: ENGAGE ALL CAREPROVIDERS


23/37

INTERNATIONAL STANDARDSINTERNATIONAL STANDARDS

FOR TB CARE (ISTCFOR TB CARE (ISTC))To translate and disseminate ISTC among

syndicate of physicians, private sector

directorate, not for profit hospital and

policlinics, and NGOs.

ISTC

translated,

printed and

distributed

Organize lectures and congress for all

stakeholders about the international standards

for TB care.

No.

stakeholder

attended

lectures

Measuring the impact of adherence to the

standards on quality of care and patient

satisfaction.

Measurements

tools settled


24/37

COMPONENT IV: EMPOWER PEOPLE WITHCOMPONENT IV: EMPOWER PEOPLE WITH

TB, AND COMMUNITIE

STB, AND COMMUNITIE

SActivity Indicator

NTP social Workers organize focus group discussion

with patients on patients charter

Established or not

Orientation meetings with all policy makers Proportion. of attendance

Establish a support Group for TB patients and their

families in collaboration with Jordanian Anti TB

Association (JATA)

Support Group Established

Conducting KAP studies KAP study conducted

TOT for health care providers No. of care providers

trained

Conducting a campaign No. of governorate

involved

No. of seminars conducted


25/37

COMPONENT IV: EMPOWER PEOPLE WITHCOMPONENT IV: EMPOWER PEOPLE WITHTB, AND COMMUNITIESTB, AND COMMUNITIES

Production of health education materials (TV spots,

Radio broadcasting, booklets, posters, etc) For

different target groups.

No. of materials

developed by type.

No. of sites of

distribution.

School student awareness raising activities No. of schools

conductedawareness raising

activities

Celebrating the World TB day No. of sectors involved

Creating and updating a website of NTP Jordan Website created and

updated


26/37

Community participation in TB Care:Community participation in TB Care:

Setting up a complete database about national and

international NGOs.

Database is Done

Orientation meeting with all NGOs focal persons to

increase awareness about TB problem and to build

commitment

No of meetings

conducted

Integrating international NGOs in fund raising and

sharing in TB control through materials, conferences

and research.

No of conferences

shared by NGOs,

No of Materials

Orientation meeting with community leaders to

participate in TB fight

No. of meetings

conducted

Empower community volunteers to support TB patients No of Volunteerssupporting NTP

Integrating the women lead NGOS to support the NTP. No.. of women lead

NGOs involved n

NTP activities


27/37

PATIENTS CHARTER FOR TUBERCULOSIS CARE:PATIENTS CHARTER FOR TUBERCULOSIS CARE:

Forming a task force to set up a national

document for TB patients rights.

Task force

formulated

Setting and printing a poster and bookletsfor TB rights

Posters and bookletsprinted

Disseminating the poster and booklets to

all chest facilities, all partners and

private clinics.

Posters and booklets

disseminated


28/37

ENABLE AND PROMOTE RESEARCHENABLE AND PROMOTE RESEARCH

Activity Indicator

NTP in collaboration with WHO and other partners

identify the main research areas for next five year

Conducting two studies per year Number of

studies

accomplished


29/37

Monitoring and Evaluation (M&E)Monitoring and Evaluation (M&E)

activitiesactivitiesKey Indicators Baseline

Establishment of M&E task force within the National TB

program

Training and refresher training workshops for 45 social workers

and home visitors related to TB


30/37

Upgrading of Surveillance and strengthening M&EUpgrading of Surveillance and strengthening M&E

systemsystem

Key Indicators Baseline

Training for Governorate TB coordinators on surveillance

including data verification and quality in terms of

completeness, accuracy and timeliness through

electronic templates in 3 days duration workshops for

40 staff.

NTP will supply the TB management units (TBMU) withcomputers and printers resources and other

equipments (CDs, flash memories ..etc needed for

ENRS implementation based on needs


31/37

ACSM Contribution to National TBACSM Contribution to National TB

ControlControlNational Objectives Related Interventions1- Improve TB care

for vulnerable

populations in

Jordan

Empower community volunteers to support TB

Patients through establishment of volunteer

network between the NTP and all NGOs

nationwide.

Orientation meetings (1 every quarter) with Concerned

NGOs focal persons, influential leaders to increase

awareness about TB problem and to build

commitment

Outreach educational sessions to increase

awareness about TBProduction of health education materials

(Broadcasting, booklets, posters, etc) For

different target groups.

Educational sessions conducted to

increase awareness on TB among students schools


32/37


ControlControlNational Objectives Related Interventions1- Improve TB care

for vulnerable

populations in

Jordan

Conducting KAP studies totoAssessthe knowledge,Assessthe knowledge,

attitude and perception ofattitude and perception ofthe population regardingthe population regardingTB;TB;


33/37


ControlControl

2- Improve

tuberculosis

care for peoplesuffering from multi-

drug resistant

tuberculosis and

TB/HIV in Jordan

Developing and printing

TB/HIV guideline


34/37


ControlControl3- Improve

general

tuberculosis

care

NTP will play a key role in activating TB

coordinators to assess needs requirements

and to review action plans for TB and to

reactivate M&E strategy (meeting on

quarterly basis).Training and refresher training workshops

for 45 social workers and home visitors

related to TB

Translate and disseminate International

Standards for Tuberculosis Care (ISTC)among syndicate of physicians, private

sector, not for profit hospital and policlinics,

and NGOs.

NTP social Workers organize 8 focus group

discussion with patients on patients charter


35/37


ControlControl3- Improve

general

tuberculosis

care

Conducting a study on Casefinding among tuberculosissuspects and barriersinterfering with their timelyhealthcare in mid andnorthern Jordan


36/37

Support andcollaboration ofgovernoratehealthauthorities

Community

compliance

Support ofother

concerneddepartments

& sectors

CONCLUSIONSCONCLUSIONS

Highest

level ofpoliticalsupport

Successful TBElimination

ReachingGlobal Target

Support of

concernedinternationalorganization


37/37

Thank youThank you

Documents

Jordan TP Facts