Pharmacies: Partners in the Fight Against TB

PATH

Hara Mihalea CHE, MPHTuberculosis and Public Health Consultant

hara4communitydevelpment @gmail.com

Does PPM work?

Why Pharmacies?• They are utilized by the

majority.• They are convenient,

operating hours.• They are trusted.• They are in or close by to the

communities.• They are less expensive. • They offer confidentiality and

don’t ask to many questions.• Previous experience with RH,

CH, and immunization programs.

PATH PPM Model based on the:

Fundamentals of:• Forging partnerships.• Building local capacity and supporting

rather than leading.• Integration.• Flexibility.• Sustainability.

The PPM model used ACSM Approaches

• Advocacy: Policy, PPM guidelines, financial and human resource

mobilization.• Communication: Increase awareness of TB,

change of attitude and practices.

• Social Mobilization: Increase the involvement of key stakeholders and gain support for TB.

2004-20052 ODs in Phnom Penh2005-2006Total 4 ODs in Phnom Penh, Sihanouk Ville and Kampong Chan provinces2006-2007Kandal, Takeo and Kampong Speu province2008-20010Pursat, kratie, Battambang, Siem Ream, Banthey Meanchey provinces2011 transition

PPM-Pharmacy Referral Model

PPM-Pharmacy con.,

Capacity building Supportive tools/client materials

Achievements• PPM has informed MOH policy and guidelines for registration

of private pharmacies.• Banned the sales of anti-TB drugs and has supported the

establishment of quality control systems that closely monitor and respond to counterfeit and illegal drug activities.

• It has supported the NTP goals and objectives. • It has helped build the capacity of both private and public

providers to recognize, refer, and diagnose people with TB-like symptoms using a patient-centered approach.

Achievements cont.,

FY 04-05 (2 ODs)

FY 05-06 (15 ODs)

FY 06-07 (29 ODs)

FY 07-08 (29 ODs)

FY 08-09 (38 ODs)

FY 09-10 (37 ODs)

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000

199

1,268

4,262

2,950

9,043

8,325

94668

1,8991,489

4,4874,704

14 92 264 256737 867

PPM Referral Activity and TB Cases (all forms) Oct 2004 - Sep 2010

Referral Reported TB case (all forms)

Achievements cont.,

FY 04-05 (2 ODs)

FY 05-06 (15 ODs)

FY 06-07 (29 ODs)

FY 07-08 (29 ODs)

FY 08-09 (38 ODs)

FY 09-10 (37 ODs)

0

100

200

300

400

500

600

700

800

900

1000

1492

264 256

737

867

8=57% 26 =28%

158=60%154=60%

525=71%

588=68%

New Smear + Cases by Year (Oct 2004 - Sep 2010) PPM Contribution

TB case (all forms) BK+

Lessons Learned• The Cambodia PPM has taught us a number of

lessons that are currently guiding PPM program planning and implementation in Vietnam, India, and Tanzania.

• Implementing the PPM strategy is challenging and requires understanding, persistence, coordination and collaboration, and supportive supervision, feedback, and recognition are essential to success.

Lessons Learned cont.,1. the geographic location for PPM. 2. the partnerships created and how to sustain these

over time. 3. the human resources that are needed to take up the

additional workload. 4. the flexibility and innovative approaches applied.5. government support.6. Pharmacies in Cambodia participate and support

public health programs for reasons of merit-offering, professional development, and social status.

Thank you for your attentionvsrey@path,org

www.path.org

Comments/Questions?