Regional Advocacy, Communication and Regional Advocacy, Communication and Social Mobilization Planning Workshop for Social Mobilization Planning Workshop for
Tuberculosis ControlTuberculosis Control
Amman, Jordan 13-17 April 2008Amman, Jordan 13-17 April 2008
Regional Advocacy, Communication and Social Regional Advocacy, Communication and Social Mobilization Planning Workshop for Tuberculosis Mobilization Planning Workshop for Tuberculosis
ControlControl
Amman, Jordan 13-17 April 2008Amman, Jordan 13-17 April 2008
•Population: Population: 5.6 million
•Surface area: 89,000 Sq.Km
•Middle income country: 1,208 JD (1,700 US $)
•Demographic transition: life expectancy: 71.5 years
• Epidemiologic transition:
- Infant Mortality rate: 22/1000
live births
-Decrease in communicable diseases, including TB.
Increase in chronic diseases, including chronic respiratory diseases (CRD).
Syria
Saudi Arabia
Iraq
Various Health system in Various Health system in Jordan (1999 – 2003)Jordan (1999 – 2003)
Country Health Data
2001
2002
2003
Number of Hospitals 91 95 97
Hospital Beds 8982 9383 9743
Ministry of Health 3357 3462 3587
Royal Medical Services 1760 1791 1801
JordanJordan UniversityUniversity Hospital Hospital 517 531 540
King Abdullah University Hospital - 197 283
Private Sector 3348 3402 3532
Health Centers of MOH
Type of Center 2001 2001 2002 2002 20032003
Comprehensive Health Centers 47 53 52
Primary Health Centers 338 336 340
Peripheral Health Centers 258 258 259
Maternity and Child Health Care Centers 351 351 353
Chest Diseases Centers 11 11 12
Dental Clinic 240 247 250
TB control in JordanTB control in Jordan Low TB burden: in 2007: Low TB burden: in 2007:
* 333 TB cases (all types) (in addition to 150 cases* 333 TB cases (all types) (in addition to 150 casesAmong foreigners transferred out) Among foreigners transferred out) * Incidence (all TB types): 6 / 100,000 population * Incidence (all TB types): 6 / 100,000 population * SS+ incidence: 1.8/100,000 population* SS+ incidence: 1.8/100,000 population * ARI : 0.04% * ARI : 0.04%
TB incidence decreasing: 13/100 000 in 1992 TB incidence decreasing: 13/100 000 in 1992 6 in 20076 in 2007
100% population DOTS coverage (1998)100% population DOTS coverage (1998) Case Detection Rate: 63% (2005)Case Detection Rate: 63% (2005) Success Rate: 87% (2006)Success Rate: 87% (2006) Prevalence of MDR :5% (2006)Prevalence of MDR :5% (2006)
structure of TB control structure of TB control programme in Jordan programme in Jordan
Structure of the Structure of the Tuberculosis Control in Tuberculosis Control in
JordanJordanThe National TB (NTP) in Jordan is a The National TB (NTP) in Jordan is a vertical Programme vertical Programme
At the Central level the Chest Disease At the Central level the Chest Disease Division (in Amman City), responsible for Division (in Amman City), responsible for Tuberculosis control program Tuberculosis control program throughout the country including throughout the country including supplying medicines. The main role is supplying medicines. The main role is planning, coordination and supervision planning, coordination and supervision of the control activities.of the control activities.
At the peripheral level, there are 12 At the peripheral level, there are 12 chest centers covering the whole chest centers covering the whole countrycountry. .
The National TB (NTP) in Jordan is a The National TB (NTP) in Jordan is a vertical Programme vertical Programme
At the Central level the Chest Disease At the Central level the Chest Disease Division (in Amman City), responsible for Division (in Amman City), responsible for Tuberculosis control program Tuberculosis control program throughout the country including throughout the country including supplying medicines. The main role is supplying medicines. The main role is planning, coordination and supervision planning, coordination and supervision of the control activities.of the control activities.
At the peripheral level, there are 12 At the peripheral level, there are 12 chest centers covering the whole chest centers covering the whole countrycountry. .
Distribution of Diagnostic TB Distribution of Diagnostic TB Centers in JordanCenters in Jordan
GoalGoal Reduce mortality and morbidity and Reduce mortality and morbidity and
transmission of tuberculosis, while transmission of tuberculosis, while preventing drug resistance, until preventing drug resistance, until tuberculosis no longer poses a threat to tuberculosis no longer poses a threat to public health, and achieve the public health, and achieve the Millennium Development Goals (Goal 6, Millennium Development Goals (Goal 6, Target 8) by 2015Target 8) by 2015
OBJECTIVESOBJECTIVES
Improve TB care for vulnerable Improve TB care for vulnerable populations in Jordan (Refugees, poor, populations in Jordan (Refugees, poor, mobile) .mobile) .
Improve tuberculosis care for people Improve tuberculosis care for people suffering from multi-drug resistant suffering from multi-drug resistant tuberculosis and TB/HIV in Jordantuberculosis and TB/HIV in Jordan
Improve general tuberculosis care Improve general tuberculosis care
Trends over time of the incidence Trends over time of the incidence of TB in Jordan (per 100,000 pop. of TB in Jordan (per 100,000 pop.
per year) per year)
1412.8
28.9
21
25
23.2
21.1
16
1413
6
5.3
6.4
6
18.9
6.2
27.8
14.8
19.2
11.510 10.5
6
6.4 5.8
1211
98.3
7.8
0
5
10
15
20
25
30
35
Year
Incid
enceR
ate
/100,0
00 p
op
Trends over time of the Trends over time of the number of new TB cases in number of new TB cases in
JordanJordan
0
50
100
150
200
250
300
350
400
2002 2004 2006 Year
Num
ber
TB
Cas
es
Pulmonary TB
Extra-pulmonaryTB
SS+ Pulmonary
Total TB
CHALLENGESCHALLENGES Low Detection Rate: TB case Low Detection Rate: TB case
detection for new sputum smear detection for new sputum smear positive pulmonary TB cases in 2005 positive pulmonary TB cases in 2005 was 63% (target of 70%);was 63% (target of 70%);
MDR TB is increasing among MDR TB is increasing among Jordanians (2% in 2004 , 5% in Jordanians (2% in 2004 , 5% in 2006) 2006)
ACSM ACTIVITIESACSM ACTIVITIES
JOR506 G02-T/NTP-MOH
COMPONENT 1: PURSUING, OPTIMIZING AND SUSTAINING QUALITY DOTS
N.Activity Indic
atorBudget
(in USD)Funding
source
1.1 POLITICAL COMMITMENT WITH INCREASED AND SUSTAINED FINANCING:
NTP will initiate one meeting per year headed by the Ministry of Health and members of a higher policy forum or a National board, to plan and monitor activities of the NTP and to strengthen commitment and financial sustainability
One meeting is held yearly
WHOMOH
NTP will play a key role in activating CCM to assess needs and requirements and to review and revise action plans for TB control in Jordan.
Regular meetings every three months
GFATM
At Governorate levels, TB coordinators will reactivate M&E committees
M&E Committees meet biannually
WHOMOH
COMPONENT III: ENGAGE ALL CARE PROVIDERS
N. Activity Indicator Funding source
3.1 PUBLIC-PUBLIC, AND PUBLIC-PRIVATE (PPM) APPROACHES:
Setting up a database for all stakeholders and focal persons
in all areas entitled to control and manage TB cases.
Database Established
GFATM
Forming a steering committee to plan and implement PPM
strategy and to build commitment.
Steering Committee
Formulated
GFATM
Developing the PPM Strategy PPM strategy Developed and
printed
GFATM
Train all TB care providers in all Train all TB care providers in all areas responsible on TB case areas responsible on TB case management.. management..
No.of TB care providers trainedNo.of TB care providers trained
N. Activity Indicator
3.1.5 Supervisory visits to all TB control clinics No. of Visits Conducted
3.1.6 Ensuring supply of anti-TB drugs to clinics dealing with TB cases.
All clinics dealing with TB cases provided with anti-TB drugs
3.1.7 Printing all guidelines and revised R&R formats needed for the TB-Care provider to
ensure adherence to guidelines.
Guideline and revised R&R
format developed and printed
3.1.8 Increase awareness of medical Schools’ staff and nursing schools’ staff about TB problem through training.
No. of medical Schools’ staff and
nursing schools’ staff trained
COMPONENT III: ENGAGE ALL CARE PROVIDERS
N. Activity Indicator
3.1.3.1.99
Increase awareness of medical Increase awareness of medical Schools’ students and nursing Schools’ students and nursing schools’ students about TB schools’ students about TB problem through trainingproblem through training
No. of medical No. of medical Schools’ Schools’ students and students and nursing nursing schools’ schools’ students students trainedtrained
COMPONENT III: ENGAGE ALL CARE PROVIDERS
INTERNATIONAL INTERNATIONAL STANDARDS FOR TB CARE STANDARDS FOR TB CARE
(ISTC(ISTC) ) To translate and disseminate ISTC among
syndicate of physicians, private sector directorate, not for profit hospital and
policlinics, and NGOs.
ISTC translated,
printed and distributed
Organize lectures and congress for all stakeholders about the international standards for TB care.
No. of stakeholder
attended lectures
Measuring the impact of adherence to the standards on quality of care and patient
satisfaction.
Measurements tools settled
COMPONENT IV: EMPOWER PEOPLE COMPONENT IV: EMPOWER PEOPLE WITH TB, AND COMMUNITIESWITH TB, AND COMMUNITIES
Activity Indicator
NTP social Workers organize focus group discussion with patients on patients’ charter
Established or not
Orientation meetings with all policy makers Proportion. of attendance
Establish a support Group for TB patients and their families in collaboration with Jordanian Anti TB
Association (JATA)
Support Group Established
Conducting KAP studies KAP study conducted
TOT for health care providers No. of care providers trained
Conducting a campaign No. of governorate involved
No. of seminars conducted
COMPONENT IV: EMPOWER PEOPLE COMPONENT IV: EMPOWER PEOPLE WITH TB, AND COMMUNITIESWITH TB, AND COMMUNITIES
Production of health education materials (TV spots, Radio broadcasting, booklets, posters, etc…) For
different target groups.
No. of materials developed by type.
No. of sites of distribution.
School student awareness raising activities No. of schools conducted
awareness raising activities
Celebrating the World TB day No. of sectors involved
Creating and updating a website of NTP Jordan Website created and updated
Community participation in TB Community participation in TB Care:Care:
Setting up a complete database about national and international NGOs.
Database is Done
Orientation meeting with all NGOs focal persons to increase awareness about TB problem and to build
commitment
No of meetings conducted
Integrating international NGOs in fund raising and sharing in TB control through materials, conferences
and research.
No of conferences shared by NGOs,
No of Materials
Orientation meeting with community leaders to participate in TB fight
No. of meetings conducted
Empower community volunteers to support TB patients No of Volunteers supporting NTP
Integrating the women lead NGOS to support the NTP. No.. of women lead NGOs involved n
NTP activities
PATIENTS’ CHARTER FOR TUBERCULOSIS CARE:PATIENTS’ CHARTER FOR TUBERCULOSIS CARE:
Forming a task force to set up a national document for TB patients’ rights.
Task force formulated
Setting and printing a poster and booklets for TB rights
Posters and booklets printed
Disseminating the poster and booklets to all chest facilities, all partners and
private clinics.
Posters and booklets disseminated
ENABLE AND PROMOTE RESEARCHENABLE AND PROMOTE RESEARCH
Activity Indicator
NTP in collaboration with WHO and other partners identify the main research areas for next five year
Conducting two studies per year Number of studies
accomplished
Monitoring and Evaluation Monitoring and Evaluation (M&E) activities(M&E) activities
Key Indicators Baseline
Establishment of M&E task force within the National TB program
Training and refresher training workshops for 45 social workers and home visitors related to TB
Upgrading of Surveillance and strengthening Upgrading of Surveillance and strengthening M&E systemM&E system
Key Indicators Baseline
Training for Governorate TB coordinators on surveillance including data verification and quality in terms of completeness, accuracy and timeliness through electronic templates in 3 days duration workshops for 40 staff.
NTP will supply the TB management units (TBMU) with computers and printers resources and other equipments (CDs, flash memories …..etc needed for ENRS implementation based on needs
ACSM Contribution to National TB ACSM Contribution to National TB ControlControl
National Objectives Related Interventions
1- Improve TB care for vulnerable populations in Jordan
Empower community volunteers to support TB Patients through establishment of volunteer network between the NTP and all NGOs nationwide.
Orientation meetings (1 every quarter) with Concerned NGOs focal persons, influential leaders to increase awareness about TB problem and to build commitment
Outreach educational sessions to increase awareness about TB
Production of health education materials (Broadcasting, booklets, posters, etc…) For different target groups.
Educational sessions conducted toincrease awareness on TB among students schools
ACSM Contribution to National TB ACSM Contribution to National TB ControlControl
National Objectives Related Interventions
1- Improve TB care for vulnerable populations in Jordan
Conducting KAP studies to to Assess the knowledge, Assess the knowledge, attitude and perception attitude and perception of the population of the population regarding TB;regarding TB;
ACSM Contribution to National ACSM Contribution to National TBTB
ControlControl2- Improve
tuberculosiscare for peoplesuffering from multi-drug resistant tuberculosis and TB/HIV in Jordan
Developing and printingTB/HIV guideline
ACSM Contribution to National ACSM Contribution to National TBTB
ControlControl3- Improve
general tuberculosis care
NTP will play a key role in activating TBcoordinators to assess needs requirementsand to review action plans for TB and toreactivate M&E strategy (meeting onquarterly basis).
Training and refresher training workshopsfor 45 social workers and home visitorsrelated to TB
Translate and disseminate InternationalStandards for Tuberculosis Care (ISTC)among syndicate of physicians, privatesector, not for profit hospital and policlinics,and NGOs.
NTP social Workers organize 8 focus groupdiscussion with patients on patients’ charter
ACSM Contribution to National ACSM Contribution to National TBTB
ControlControl3- Improve
general tuberculosis care
Conducting a study on Case finding among tuberculosis suspects and barriers interfering with their timely healthcare in mid and northern Jordan
Support and collaboration of governorate health authorities
Community
compliance
Support of other
concerned departments & sectors
CONCLUSIONSCONCLUSIONS
Highest level of
political support
Successful TB Elimination
Reaching Global Target
Support of concerned
international organization
Thank youThank you
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