Key elements to develop a national strategic plan for TB control

Malgosia Grzemska

Stop TB Department

WHO, Geneva, Switzerland

EURO/TBTEAM

Regional Workshop on National Strategic Planning

Chisinau, Republic of Moldova, 8 – 11 October 2012

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Objectives

1. Explain the need for an NSP

2. Describe the key principles in an NSP for TB

3. Understand the 5 key components of the NSP

4. Conclusions

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Why is a strategic plan needed? • To reach goals and operational objectives for the NTP

• To set strategic interventions

• To specify activities to be implemented– Which activities?– What are the targets of these activities?– Where to implement these activities?– When to implement these activities?– Who will implement these activities?

• To set a budget and identify funding availability

• To operationalize the activities' implementation

• To monitor and evaluate the strategic interventions• To identify and plan the TA needs 3

A NSP should be in line with the National Health Plan

The 5 components of a NSP should be consistent

A NSP should include 5 components

The gaps, the objectives and the interventions should be consistent

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What are the key principles of a NSP?

What are the components of a strategic plan?

The description of the core plan

The budget plan

The monitoring and evaluation plan

The operational plan

The technical assistance plan

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1st component: the core plan

• Situation analysis:

- Health and health system context

- Analysis of TB burden

- Intervention measures undertaken to date

- Outcomes of these intervention measures

- Strengths

- Weaknesses

- Opportunities

- Threats

• Identification of the gaps 6

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Inappropriate formulations of gap analysis

1. The managerial capacity of the NTP should be strengthened :

More staff should be recruited at central level.

Cars should be purchased for supervision

2. PPM activities should be implemented

3. There is no community DOTS

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Example of a gap analysis (appropriate formulation)

1. The managerial capacity of the NTP is insufficient: The NTP central unit includes the NTP manager, 1 medical officer, 1 statistician and 2 clerks. Given their small number, they cannot cope with the requirements needed for strategic planning, management of NTP resources, guidelines’ development, training programmes’ development, supervision, development of surveillance capacities, monitoring and evaluation, and other tasks. As a result, the managerial and technical support capacities of the central unit are insufficient.

There are 125 health districts; all of them are assumed to be supervised and technically assisted by the small team of the NTP central unit which cannot fully play this role. There is no intermediate administrative level between the Ministry of Health and health districts.

1st component: the core (cont…)• Definition of clear goals in line with SMART criteria

• Specification of operational objectives:- Should match with the situation analysis

- Should be defined in SMART criteria terms

• Identification of strategic interventions

Each intervention should: - be clearly specified- have target(s) defined in SMART criteria- match with at least one strategic objective- include specific activities

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2nd component: the budgeting planShould:

• be fully consistent with the strategic core plan

• refer to each operational objective, each strategic

intervention and each activity identified in the core plan

• be established for each year of the plan

• establish the cost

• identify the funding contribution of the government and of each

partner for every year and for the overall period covered by the

plan

• identify the funding gap for every year and for the overall

period covered by the plan – Use WHO budget tool10

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Numbering system to ensure consistency in the plan

Goal: To decrease TB mortality to one death per 100,000 population by 2020.

Objective 1: To increase TB cure rate from 50% to 90% by 2017 onwards. 1.1. Improving and strengthening the managerial capacities at district level 1.1.1. Clear definition of the role of the managerial unit for TB control at

district level1.1.2. Reassignment and recruitment or of the appropriate staff according to the post descriptions in the Central Unit1.1.3. Appropriate training of the managerial staff at district level1.1.4. Organization of supervision activities from the district level1.1.5. Organization of training activities for health workers at district level

1.2. Implementation of TB drug treatment services in health facilities and community1.2.1. Appropriate drug supply and management1.2.2. Involvement of local community volunteer in treatment supervision 1.2.3. Enablers for the patient to come to the health facility for monitoring and after hospitalization 1.2.4. Provision of mobility means to the PHC workers to find identified defaulters

3rd component: the monitoring and evaluation plan

• Should be fully consistent with strategic core plan, the budgeting plan and the operational plan

• Refer to each operational objective and each strategic intervention identified in the core plan– include:

• Impact indicators (for the overall goals)• Outcome indicators (for the strategic objectives)• Output indicators (for the strategic interventions) • Process indicators (for some key activities)

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4th component: the operational plan

• Should clearly identify the activities (and sub-activities)

that need to be implemented along with the strategic

interventions they belong to

• refer to the operational objectives associated with these

strategic interventions (and activities)

• be consistent with the strategic core plan, the budgeting

plan and the monitoring and evaluation plan: the

activities, the strategic interventions and the operational

objectives highlighted in the operational plan must be the

same as those identified in the strategic core plan and the

budgeting plan

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4th component: the operational plan (cont…)

• The operational plan should be established and detailed

for the coming 1 or 2 years of the period covered by the

NSP

• The implementation of the activities should be indicated

on quarterly basis

• The operational plan should specify detailed information on

each activity to be implemented

• The activities that need technical assistance should be

highlighted

5th component: the technical assistance plan

• Should be based on the operational plan (implementation of)

• focus on the >1 year and include details:– Task: Briefly describe activity, terms of references– Estimated cost: estimated cost of the mission – Available funding & source: NTP, GF grants, partner budgets, etc.

for this activity? – Funding gap: Is there a funding gap needed to implement the

activity– Expert: national or international? expert identified? HR gap? – Responsible officer/partner in country– Timeframe: crucial to secure funding and best consultants – Global Fund grant activity reference and service delivery area:

Global Fund TA plan can be a subset of the national comprehensive TA plan

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6th component: the preparedness plan (optional)

• This 6th component needs to be seriously considered

in countries with fragile status or in protracted states

• The preparedness plan should be established for the

acute phase of any complex emergency, including

natural disaster

• The plan should focus on ensuring the availability and

access to TB treatment for the patients who were

treated for TB before the acute phase (Appendix 11, TB care

and control in refugee and displaced populations,

http://www.who.int/tb/publications/2007/en/index.html)

Conclusion• Country ownership• Clear identification of priorities in TB control needs

and inherent interventions• Estimates of budget needed• Resource mobilization from government and local and

international partners/donors• Efficient involvement and contribution of GF and

potential donors in the implementation of the NSPs through relevant funding mechanisms

• Establishment of sound TA plan based on operational plan

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Thank you!

http://www.stoptb.org/countries/tbteam/default.asp

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