Action Plan Prepared by : Ismat Ara Khusheed Deputy Director,PTP Sindh At JAPAN 2006
SINDH 100% DOTS Coverage since November 2003
GENERAL FEATURES Name; city district Government,Karachi Area ;3527sq.km Population Density;2795 per sq km Average housr hold size ; 7 Literacy rate ;60% Nos of town ;18 Nos of diagnostic centre ;55 Nos of treatment centres ;111 Average public transport fare ;Rs.10 one way Average time travel ;45 minutes one way by public transport. Large no of migrants who have flocked to karachi in search of opportunities.
Back Ground Karachi is the largest city of Pakistan and the capital of its southern province of Pakistan karachi is divided in to 18 towns every town is supervised by town health officer. Mega city is administered by city district Govt. Of karachi (CDGK).which has an elected city council each town has its own council and Nazim. Mega city like karachi pose a great challenge to community based urban DOT strategy the public sector cannot achieve the target of detecting all new TB cases hence PTP is in need of building partnership to bridge the gaps between public and private sectors prevailing in the urban DOTS.
Organogram Technical Support from NTP 4 NPOs and 1 Sociologist Secretary Health DG Health Director TB Control Program Deputy Director Hyderaba d Deputy Directo r Karachi Deputy Directo r Sukkur Deputy Directo r Larkan a
DEFAULT RATE % 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% 14% 16% 15% 17% 13% Q1, 03 Q2, 03 Q3, 03 Q4, 03 Q1, 04 Q2, 2004 14% 14% Q3, 2004
OUT COME Dots coverage 2003 100% New case detection sspos 52% Case detection of all type 63% Smear conversion 82% Success rate 86% Default rate 14%
Stakeholders Analysis Beneficiaries Implementing Agencies. Decision makers. Funding agencies Potential Opponents. Patient EDO THO BHU. RHC Teaching Hospital Ministry of Health National tuberculosis Moh Ptp GFATM General practioner Community people Partner agencies FIEDELIS CIDA WHO National Tuberculosis program CIDA WHO FIEDELIS Private Hospital quak EDO. NGO TB Association Gfatm Provisional Tubrtculosis program Quack hakeems Traditional healers
High defaulter rate Poor compliance to Treatment of TB patients Weak linkage bet. Diagnostic & treatment centers For case-holding activities Il-Legal migrant of TB Pt at karachi city Poor co- ordination Among facilities No proper home address Problem Analysis Pt develop drug resistant Difficulties to tress them
Poor compliance to Treatment of TB patients Side Effects Lack of knowledge Of TB patient Poor capacity of health workers Stop taking medicine IN Sufficient Health education Go to the alternative treatment HW has lack of knowledge Lack of training No funds Problem Analysis Very busy Too many responsibilities
Low defaulter rate good compliance to Treatment of TB patients Good linkage System bet. Diagnostic & treatment centers For case-holding activities Less migrant of TB Pt at karachi city Good co- ordination Among facilities permanent home address Objective Analysis Pt not develop drug resistant Easy to trace them
Good compliance to Treatment of TB patients Side Effects decreased Sufficient knowledge Of TB patient improved capacity Of health workers Continue taking medicine Sufficient Health education Stop alternative treatment HW has enough knowledge Adequate training Funds are available HW have time Objective Analysis Adequate responsibilities
Project Selection Sufficient HE to PT. Good Linkage system approach Economic development approach H.E AND economic development approach. Costs Benefit 5 4 3 4 Sustainability 3 3 3 5 Feasibility 4 4 2 5 Available resources. 4 3 3 3 16 14 11 17
Project selection Provisional tuberculosis programme should emphasize on effective case holding mechanism through health education and capacity building of health workers.
PDM Project Name: effective case holding mechanism through healtteducation and referral syatem. Target area: slums of six towns of Karachi city. Target group: The target population in slums and katchi abadies of six towns,of karachi is approximately 3 million Duration; 1-7-2006 TO 31-6-2009 Date; 23-2-2006. 2006.
Narrative Summary Overall Goal: To reduce the mortality and morbidity due to tuberculosis in Karachi. Project purpose; To reduce the default rate in Karachi. OUTPUTS. 1. Sufficient H.E is provided to TB patients and community. O. V. Indicators Means of Variation The mortality and morbidity is reduced by 10% by 2009 in 6 towns in Karachi. The default rate has reduced by half by the year 2009. 1- TB patient s knowledge on TB is increased by 30% by the year 2007. Health management and information system. Quarterly reports, Annual reports. -Project survey. -Project records on trainings conducted. -Monthly reports, Minutes of meeting. TB register. Important Assumptions Sindh health department continues to include PTP as one of the priority programmes. The population in the slum areas in 6 towns in Karachi do not increase drastically. The TB situation of migrant population do not become worsen.
2. Capacity of health workers is improved through training. 3- Good linkage between diagnostic & treatment centers established for effective case holding activities. 2-.. 50% of LHW have completed TB training by 2007. 3- Number of diagnostic centers that have monthly meeting with treatment centers increase by 80% in 2008. 4- Number of properly transfer out cases increase by 50% in 2008.
ACTIVITIES: 1-1Conduct 1Conduct base-line survey to identify causes of defaulter cases. 1-2. Interview & questionnaire to TB patients & families to identify their knowledge on TB. 1-3Conduct advocacy meetings with stakeholders. 1-4. IEC materials developed & distributed. 2- Develop supervisory guidelines. 2-33 Conduct workshop with HWs. 2-44 Conduct one day seminar every month. 2-55 Trainings conducted. 3- Directory furnished. 3-11 Monthly meeting with DC & TC. Inputs Personnel: long term expert, project leader, project co- ordinator. Short term experts as required. Equipment: vehicle, maintenance parts, POL and spare parts. Training material and IEC materials. Funding of workshops and meetings. Training facility Local cost. Facilities like DHDCoffice Trained workers continue to work for their facilities. Pre-conditions The NTP and CIDA support the project.
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