Action plan Hoang Thi Thanh Thuy, MD NTP/ National Hospital of TB and Respiratory Diseases Viet nam
Insurances of qualified DOTs to reduce the high defaulter rate of TB treatment in 4 mountainous districts in Hagiang province- Vietnam
Viet Nam General information Capital: Ha Noi Area: 330,991 sq.km Population: 80,902,408 No. provinces : 64 District: 667 Communes: 10,557 Proportion of urban population to the whole : 25.8% GDP per capital: USD 415.4
Organization of NTP MOH Provincial Health Service Nat. Hospital of Tuberculosis and respiratory NTP Provincial Tuberculosis Center District Health Center TB Unit Commune Health Post Command line Technical line
Strategies of NTP Passive case detection = microscopy (districts as basic unit). DOTS (commune as basic unit) Integration into general health care system. BCG
NTP performance DOTS cover 100% districts, communes since 2000 Reach the WHO target of 70% case detection and 85% cured rate since 1997, still maintained those performance Cured rate and detection rate varied from region to region ( * mountainous areas) Case notification is increasing due to diagnose effort and HIV
NTP weakness Poor exercise of DOTS in the remote and mountainous areas (12-15% defaulter, delay, lab, ) Unexpanded network to : Private sector, NAP, other high risk groups, MDR Staff turn over Limited Scientific research
General Inf. Background of Target areas Ha giang province situate in the North-Est of VN, S= 5,800 km2, pop. 1,020,000 4 mountainous Districts :An, Bien, Can, Du 21 communes Economic: Poor districts 85% pop. are farmers, 55 % pop.are poor Culture level: 55% ilitarated Transport: 8km to Health center, by walking Social administration: People Committees, Party Organizations, CBOs
Background ( cont.) NTP performance: DOTS started since1996, given by Health staff Detected TB cases in past 5 year:100-120/year/district ( incl.50-60 AFB+) Treatment out come: cured 81%, defaulter 12% Surveys KAPB survey for TB pts: 75% poor, 85 % far, 30% unpleasant, Interview to 21 C.H.staff 20% untrained,70% at middle level Knowledge, 100% over workload High defaulter rate reduction of cured rate High burden of TB
Stakeholders analysis Categories Beneficiaries Decision makers Funding Agencies Implementing Agencies Community leaders Potential oppponents Supporting group TB patients Communal Health staff Community supporters MOH/ PHS NTP/ PTS Gov. of Vietnam Netherlands Gov. 4 DTUs Communal Health staff Community supporters Authorities: PPC/DPC /CPC no Party Os: PPO/ DPO /CPO Youth Unions
Problem tree Treatment outcome of TB in 4 mountainous Distrits in Hagiang province High TB burden High DR Low cured rate High default rate S don t trace when pts interupt Tx as required Pts don t feel comfortable on Health facilities Pts stop taking drugs when they feel better Pts themselves stop taking drugs when they have side effect Pts stop taking drugs when they feel like too long treatment Pts don t want to be known as TB (stigma) Inaccessible to the HC Lack of HS HS are lack of knowledge Poor Health staff attitude Long waiting Pts have poor knowledge about TB /treatment Poor public attitude to the TB pts Distance to DOTS Busy Under- trainned staff/he Lack of appropriate IEC activities for pts Lack of IEC for public
Project selection Pts. s Knowledge about TB improvement approach Public Knowledge about TB improvement approach Treatment supporter improvement approach Increase the accessibility to HC approach Target group TB patients, public public VHWs, Mass Orgs, Family, TB patients,hws, public Related Agencies MOH, NTP MOH, NTP Community leaders Community leaders MOH, MOT,NTP Inputs 5 5 5 1 Policy priorities 5 5 4 2 Feasibility 4 4 5 2 Sustainability 1 1 2 3 Total 15 15 16 8
Project selection Treatment outcome of TB in 4 mountainous Distrits in Hagiang province DR is reduced TB burden is reduced Cured rate is increased Default rate Is reduced Pts will be raced on time when they interupt Tx Pts will feel comfortable on Health facilities Pts will continue taking drugs when they feel better Pts will report to Tx supporter when they have side effect Pts are awared about the length of treatment Stigma is reduced Accessibilities to the HC are increased Number of Tx. supporters is increased Tx. Sup. have good knowledge Tx. Sup. have good attitude Waiting Time is reduced Knowledge about TB to patients is increased good public attitude to the TB pts Tranportation is improved More sub- C.H.C be developed More village H.Ws, volunteers and family members are involved Tx. Supporter incl. HS are well trained schedule for priority work is made appropriate IEC activities for pts be provided appropriate IEC activities for public be provided
PDM Project name: Insurances of qualified DOTs to reduce the high defaulter rate Target area: 4 mountainous districts in Hagiang province- Vietnam Duration: Jan 2007- Dec. 2008 Target group: TB patients, treatment supporters incl. Health staff, Local population Verifiable. No: 1 Date Feb. 22, 2006
PDM Narrative summary Objectively verifiable Indicators Means of Verification Important Assumptions Overall Goal Reduce the TB burden in 4 mountainous districts of Hagiang - Vietnam The cured rate of Annual 81 % among new performance report SS+ in 2004 will from district and be increased to 87% provincial levels in 2008 Unchanged Treatment Regiment by NTP Stable Health facility structure at peripheral levels Strong political commitment from provincial to communal levels Project purpose Reduce the default rate of TB patients in 4 mountainous districts in Hagiang -Vietnam The default rate of 12 % among new SS+ in 2004 will be reduced to 3 % in 2008 Annual performance report from district and provincial levels Unchanged Treatment regiment Stable Health facility structure at peripheral levels Strong political commitment Stable Health facility structure
PDM Narrative summary Objectively verifiable Indicators Means of Verification Important Assumptions Outputs 1. Involved more skilled treatment supporters 2. Knowledge about TB treatment to patients is improved 1. At least 5 people per commune will be skillful involved in supporting treatment by April 2007 2. 90% TB patients registered in 4 districts from July 2007 to Nov.2008 have good knowledge about TB treatment 1.1.Meeting report along with the volunteers agreement. 1.2. Interview the treatment supporters and TB patients 2. Interview the TB patients Stable Health facility structure -Strong political commitment 3. Awareness about TB among local communities is improved 3. 70% of local people have good knowledge and attitude to TB 3. 2nd KAPB survey
PDM Narrative summary Important Assumptions Activities 1.1. Conduct meeting with the communities leaders, representatives of Mass Organizations, CBOs 1.2.Develop the brochures briefing on TB treatment for patient s supporter 1.3.Training on treatment supporting for Health staff and volunteers 1.4. Community based DOT by treatment supporters 2.1.Develop the appropriate HE materials on treatment for TB patients 2.2.Provide the HE on treatment for all TB patients by the Health staff prior to and during treatment 2.3.Conduct the peer group education by cured TB patients 3.1.Develop the appropriate HE materials on TB for local population 3.2.Distribute the HE materials on TB to population 3.3. Local TV, Radio programe feature TB regularly 3.4.Conduct the community seminar on TB Stable Health facility structure at peripheral levels Strong political commitment from provincial to communal levels Trained health staff and volunteer continue working as treatment supporter and TB propagator
PDM Input Personnel: Manager and experts of NTP, Staff of Provincial TB Station, staff of District TB Unit/ District Health Center, Volunteers / Community Based Organizations Communal Health staff Equipment: Visual equipment Budget: Conduct meeting for advocacy Training for Health staff and volunteer ( accommodation, travel cost, DSA) Cost for design and produce, printing HE materials and programme Incentive for volunteer Incentive for community seminar participants Resources: The Netherlands Embassy:$30,000 WHO: $10,000 GFTAM: $8,250 Government of Vietnam: $15,000 Total : $ 63,250 Precondition Support from the MOH, Provincial Health Service, Provincial People Committee