IPHO-Maguindanao October 2005 – September 2009. GOAL Reduce TB Morbidity and Mortality in...
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Transcript of IPHO-Maguindanao October 2005 – September 2009. GOAL Reduce TB Morbidity and Mortality in...
IPHO-Maguindanao
October 2005 – September 2009
GOAL Reduce TB Morbidity and Mortality in Maguindanao
STRATEGICOBJECTIVES
Increase detection rate of smear positive TB cases from 69% to 75 % by September 2009
Increase cure rate of smear positive TB cases from 72% to 85% by September 2009
Target Population: 475,056 individuals aged 15 and above living in Maguindanao province.
Major Strategies:
•Quality Assurance
•Capacity Building
•Behavior Change Communication
•Advocacy and Social Mobilization
TB situation in Maguindanao
Five Elements of D.O.T.S Gaps/Challenges
Political Commitment Shortage of staff (medical technologists) & funding for TB program from LGUs.
Case detection through
Quality assured bacteriology
5 functioning laboratories; 7 medtechs; 19 microscopes; insufficient training; no systematic quality control activities.
Standardized treatment, with supervision and patient support (DOT)
Geographic distance of patients to health centers deterrent in supervised treatment; many patients complete tx. w/o lab confirmation.
An effective drug supply and management system
Existing supplies insufficient to treat all cases.
Monitoring & Evaluation System Data not readily available; delays in data entry & submission of reports; no cohort analyses.
Department of HealthAutonomous Region in Muslim Mindanao
Integrated Provincial Health Office: Program Coordinators
District level: 4 Hospitals, serve as Lab ValidationCenters *quality control*
Municipal level: 28 RHUsHuman Resources: 13 MTs, Doctors, Nurses
TB Activities:Med Tech receives smearing, reads & sends report to BHS
Nurse supervises RHUs.Midwives smear & stain samples, send them to MTs with
MotoristReceive results, sends them to BHS, DOTS.
Barangay Health Stations: Midwives provide primary health care, Including TB activities: receive sputum samples from patients, and give
results to patients, DOTS
Health and Nutrition Posts: Barangay Health WorkersTB Activities: receive sputum samples from patients, give results to patients,
DOTS
Irregular supervision of RHUs & BHSs
Motorist transportsmeared samplesand results from
RHUs t Lab. Validation
Center
Some patientsasked to come back to BHS or
HNP for samplingor results
1 Med tech/ 4 municipalities not
available all days/week
Midwives lack smearing skills
BHWs lack smearing
skills
Innovation one:Improving access with BHWs role expansion
• Training in DOTS, and sputum collection & smearing– DOTS: 2-day– Sputum Collection & smearing: 5-day training (didactic 2 days;
practicum 3 days)
• 116 BHWs with 2 major roles:1. Collecting sputum & smearing– Transport slides (no MOW)– Recording
2. As treatment partner
Innovation two:Microscopists on Wheels
• Private transport group (mostly single motorcycle) plying at remotest area volunteered to provide services for TB control & prevention.– Free or discounted fare for TB patients & symptomatics– Free transport of slides or specimen– Promote TB awareness & free services of RHU
• Membership: voluntary• Loose support group or formally organized• Process used:
– RHU recommended transport group from their area
– Gen. orientation & core group formation @ provincial level
– Follow-up meeting @ RHU level.
Innovation threeTB Club
• Serves as a peer-support group to ensure patient’s treatment compliance& reduce stigma.• Activities:
– sharing and encouragement among members to motivate adherence to treatment regimen
– cured patients giving testimonies and serving as peer-educators– contact tracing– case referral
• Membership: voluntary• Structure: flexible, formally organized or loose-group.
Table 1. Percentage Contribution of Support Groups to Case Finding in 10 Municipalities,
Maguindanao,PhilippinesSupport Groups
No. of symptomatics referred
No. referred who turned positive
Total No. of Smear Positives
% Contribution
MOW 65 27 96 28.125
TB Clubs 39 6 96 6.25
Table 2. Percent Contribution of BHWS to Case Finding in __ Municipalities,Maguindanao Philippines, July-September 2007
Support
Group
No. of Slides Smeared
No. turned positive
Total no. of smear positive cases (RHUs)
% contribution of BHWs
BHWs
LESSONS LEARNED: INNOVATIONS
• Spirit of volunteerism abounds even in the poorest of communities; people just need to be given the right opportunities.
• Explore promising practices from other projects that can be replicated, adapted or enhanced.
• Develop a common framework or mechanism to implement MOWs or TBClubs across the municipalities but allow some flexibility for operationalization.
• Mechanisms for sustaining the enthusiasm of volunteer health workers should be part of the overall plan.
• Actively engage the support of the local government to provide incentives to the volunteer health workers.
• A good documentation of the contribution of the support groups is a must to demonstrate their effectiveness.
Operations Research on Gender Inequalities
Objective: To determine the nature of disparities in the no. of cases detected for men and women; particularly , whether these disparities are related to
inequalities in access to TB care services for women in Maguindanao.
Methodology:
Sampling: 5 randomly chosen high performing RHUs
Data Collection: Clinical Observations, exit interviews, FGD and records review
Operations Research on Gender Inequalities
Objective: To determine the nature of disparities in the no. of cases detected for men and women; particularly , whether these disparities are related to inequalities in access to TB care services for women in Maguindanao.
Methodology: Sampling: 5 randomly chosen high performing RHUs Data Collection: Clinical Observations, exit
interviews, FGD and records review
FINDINGS and Opportunities for increasing the standard of quality of care
• No difference between sexes regardingsatisfaction with quality of care, but more female clients reported to have received complete information on TB treatment regimen• Patient’s treatment card does not include sex disaggregated data to
trace contacts.• More women registered as symptomatics but less were asked to
provide sputum samples.• More female clients were asked to bring their contacts.• Female clients were poorer than male clients.• More female clients perceived lack of privacy during consultation.• More female clients preferred face-to-face communication.• More female clients came from same barangay where the RHU is
located, a concern of where women seek care if they don’t live near the RHU.
• Few gave suggestions on how to improve the services of RHU but women recommended giving the medicines for a week supply to save time and fare while men recommended improving information.
• Include sex disaggregated data on the contacts in the treatment card• Increase active case finding among male patients for female contacts• The first TB screening for both sexes’ clients should be done in
private ward.• Ensure complete examination and request of sputum samples to
symptomatic male and female.• Increase awareness among general population for the gratuity of the
TB drugs and where they can seek TB services.• Ensure all female and male clients receive their first dose of
treatment.• Increase awareness among all TB clients & BHWs, esp. service be
negotiated with MOW for female clients living in underserve area.• Increase face-to-face activities for both clients to increase access.• Increase awareness among both clients about the role of the BHWs
as treatment partners.• Use the TB Clubs as a forum where female clients provide feedback
about the TB services and recommendations to improve it.
Proposed Interventions
for gender-sensitive TB control