PARTNERSHIPS IN TB GBC WORKSHOP 15 October 2009 Lindiwe Mvusi

PARTNERSHIPS IN PARTNERSHIPS IN TBTB

GBC WORKSHOP

15 October 2009

Lindiwe Mvusi

Ten Point PlanTen Point Plan

Provision of strategic leadership and creation of Social compact for better health outcomes

Implementation of National Health Insurance (NHI)

Improving the Quality of Health Services

Overhauling the health care system and improve its management

Improved Human Resources Planning, Development and Management

Revitalization of health infrastructure Accelerated implementation of the HIV and

AIDS strategic plan and the increased focus on TB and other communicable diseases

Mass mobilization for the better health for the population

Review of drug policy Strengthening Research and Development

Strategic pillars

Political and managerial support Availability of adequate resources Effective programme management Clear and complementary roles of all

within the health system and our partners

Objectives

To strengthen the implementation of the DOTS strategy

To address TB and HIV, MDR and XDR-TB To contribute to health systems

strengthening To work collaboratively with all care

providers To empower people with TB as well as

communities To coordinate and implement TB research To strengthen infection control

Overall targets, 2011

Case detection rate: 70%

Treatment Success rate: >85%

Cure Rate: 85%

TB is a socio economic TB is a socio economic diseasedisease

The poor lack:•Food security

•Income stability •Access to health care

•Adequate housing

I ncome poverty TB disease

TB may lead to:•Loss of 20-30% of annual wages among poor•Global economic costs: $12 billion annually

•Increased Social stigma

Role of employers

To ensure a safe work place environment through – The development and implementation of

clear workplace addressing;• confidentiality, discrimination, length of

time allowed for medical treatment and job modification when necessary.

– Employees education on workplace policies– Implement environmental infection control

measures to minimize risk of transmission of infection in the workplace.

Conduct awareness and educational campaigns

Provide psychosocial support for employees who have TB such as – free treatment and services, – maintaining salary during treatment or

providing compensation for loss of income, – free transport to health facilities, – food support and motivation of patients to

continue treatment,

Employee organizations– increasing awareness and

understanding of the disease among employees.

– advocating for employee health and safety as well as benefits

–

For Profit Private Medical Sector

Identify TB suspects

Microscopy, culture and DST

Diagnose Prescribe treatment Supervise

treatment Defaulter tracing Record keeping

Case notification Drugs and

supplies Training Surveillance Quality assurance Evaluation Contact tracing

Role of other government departments

Correctional services Early detection and treatment Prevention – infection control, IPT, improving

living conditions Referrals

Schools Infection control Screening programmes Education Supportive environment for those with disease

Dept of Mineral Resources Ensuring compliance to the law and guidelines Monitoring Early detection and treatment Prevention – infection control, IPT, improving

living conditions, dust control Referrals – inter and intra country Outreach to surrounding communities Memorandum of agreement

Dept of Labour Workplace policies Education Compensation

Dept of Transport Infection control in public transport

– International travel (International Health Regulations)

Commuter education

Housing Improving living conditions Minimum standards to take ventilation

into consideration

Agriculture Farming communities – education,

improving living communities Food security – gardening/ farming

projects

Social Development Poverty alleviation strategies Food security Social grants/ chronic illness benefit

SAPS Awaiting trial prisoners – access to care

and proper referrals Infection control

SAMHS Sharing resources

– access to services for surrounding communities

Early detection and treatment Prevention – infection control, IPT,

improving living conditions

Sharing of resources to address inequities and strengthening health systems

Identification of key projects as part of social responsibility

Advocacy role Joint monitoring

Role of NGO’s and Civil Society

Provision of treatment, care and support

Education and counselling of TB patients, families

Contact and defaulter tracing Treatment literacy programmes Facilitating referrals

Academic and research institutions

Conducting TB research Forum for dissemination of

research findings – National and International TB

conferences• First national conference 2008• Next 2 – 4 June 2010

Pharma and Diagnostic Industry

TB treatment Vaccines New diagnostic tools

Academic and training institutions

Pre-service curriculum including TB and HIV

In-service training CME

Media

Increase the awareness and the knowledge about TB using all forms of media– Improve case detection and treatment

adherence Influence attitude and behavioral

change, especially combat stigma and discrimination

Empower people affected by TB (literacy)

Dissemination of information

ACSM

Mobilise decision leaders’ commitment for TB

Increase awareness and knowledge about TB Improve case detection and treatment

adherence Influence attitude and behavioural change,

especially combat stigma and discrimination Improve the quality of health care provided Empower people affected by TB

Monitoring and Evaluation

Data collection tools and registers Regular reporting – monthly, quarterly Supervision Evaluation

– Internal – External

Review– Internal– External

WHO TB ReviewWHO TB Review

Key findings and recommendations

Challenges / weaknessesChallenges / weaknesses

1. Apparent reliance on externally funded projects to support some critical service support initiatives such as DOT supporters and defaulter tracers

2. Inadequate mainstreaming of data from private sector into national surveillance information

3. Diagnosis of childhood tuberculosis and provision of IPT

RecommendationsRecommendations

1. Ensure adequate, increasing and sustained funding for basic TB services at provincial and district levels

2. Promote implementation of patient centred approaches to TB care: • Introduce a TB treatment initiation package incorporating pre-

treatment counselling, identification and orientation of a treatment supporter (buddy)

• address verification visit • family counselling to enhance likelihood of treatment adherence

3. Analyse the cost-effectiveness of various approaches put in place to improve case finding and treatment adherence


4. Enforce policy of active contact tracing and screening of close contacts of smear positive cases and M/XDR cases

5. Strengthen collaboration with all care providers including • general hospitals, correctional facilities, businesses and the

private sector to ensure universal provision of minimum standards of care

6. Conduct periodic TB prevalence surveys to determine disease burden and monitor impact of control interventions

7. Promote programme directed / focused operational research such as evaluation of service delivery models

AchievementsAchievements

1. Evidence of initiatives to engage the private sector (NGOs, the mining sector, corporate workplaces, GPs, private clinics and hospitals) as well as public sector providers (correctional facilities, military etc).....with well documented working models for their engagement

2. Systematic and effective linkages between hospitals and PHC system


1. No clear understanding of the extent of TB management in the private sector

2. No clear guidance on approaches to engage diverse private and public sector care providers

3. Ongoing PPM initiatives facing training, monitoring, supervision, drug supply, incentives and enablers, etc, challenges

4. Lack of collaboration with Medical Aid for TB care (unlike HIV programme)

5. Structural / managerial challenges related to linkages between DoH and correctional facilities and military services


1. Undertake a situation assessment to understand the current and future potential roles of non-DoH care providers in TB care and control

2. Develop national guidelines for engaging diverse private and public sector providers in TB care and control

3. Explore ways to collaborate with Medical Aid

4. Jointly with the Department of Correctional Services and Dept of Defence, prepare a simple manual outlining practical steps to organize TB control and care in these public sector facilities


1. ACSM focal point and plan in place at the national level; and existence of ACSM task teams in some provinces ..e.g. Gauteng 2. Availability of IEC materials in appropriate languages at most facilities3. Community workers such as health promoters, peer educators, social mobilization officer nurses and VCT counselors involved in giving TB related education.


4. Community based ACSM activities taking

place: door to door campaigns, road shows, consultation forum, TB in HIV campaigns, mass events for screening TB patients, world TB day etc5. NGOs and other stakeholders such as URC,TAC, CDC and companies like

Novartis are involved in ACSM activities, including training and development of materials


1. In adequate implementation of national TB Control ACSM plan…with poor coordination between national, province and district levels,…

2. Limited capacity to plan and implement ACSM activities at Provincial and district levels.

3. Activities conducted seldom linked to programme indicators.

Current ACSM activities mostly address patients and communities …with little focus on health care providers and opinion leaders


1. Develop and implement decentralized ACSM action plans at provincial and district level …. in line with national ACSM plan.. supported by a frame work for supervision and monitoring of ACSM activities

2. Conduct KAP surveys to guide future strategic planning and provide baseline for impact assessments.

3. Ensure sustenance of home based care providers to continue ongoing community based activities.

4. Use the opportunity of the robust HIV /AIDS ACSM and coordination channels for TB advocacy and coordination

5. Implement targeted ACSM activities aimed at improving programme performance indicators.

Overall conclusionOverall conclusion

1. South Africa has made significant progress in implementing all elements of The STOP TB Strategy in line with recommendations of the 2005 review and key indicators and targets specified in the 2007-2011 TB Control Strategic Plan. Quality of services and key control indicators are improving overtime

2. Despite significant progress by the NTP during the past four years, TB remains a public health problem of epidemic proportions in South Africa, hugely driven by the HIV/AIDS epidemic.

Thank you for listeningThank you for listening

Together we CAN beat Together we CAN beat TBTB

Documents

PARTNERSHIPS IN TB GBC WORKSHOP 15 October 2009 Lindiwe Mvusi