1 / 13

COMPREHENSIVE APPROACH TO DOTS EXPANSION IN CAMBODIA

This article discusses the implementation and impact of a comprehensive approach to expanding the DOTS (Directly Observed Treatment, Short-course) strategy for tuberculosis control in Cambodia. It also highlights the achievements, challenges, and targets for the National Tuberculosis Program.

nmiller
Télécharger la présentation

COMPREHENSIVE APPROACH TO DOTS EXPANSION IN CAMBODIA

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. COMPREHENSIVE APPROACH TO DOTS EXPANSION IN CAMBODIA 4th DOTS Expansion WG Meeting Hague 7-8 / 10 / 2003Dr. Mao Tan Eang Director National Center for TB and Leprosy Control (CENAT), MoH, Cambodia

  2. I.Background A. General • Location :Western Pacific region, bordering with Thailand, Lao PDR and Viet Nam • Land area : 181 035 Km2 ( 24 provinces, 183 districts, ~1600 communes) • Population : 13 Million (in 2003) - 15.7 % in Urban & 84.3% in Rural - Under 15: 43% & Over 65 : 3.5 - Growth rate : 2.5% - Crude birth rate : 3.8% - Total fertility rate : 5.3 • GDP (1999) :US$ 310 per Capita • Adult Literacy Rate : 67.3 ( 79.5: male: 57: female )

  3. B.Tuberculosis • TB is a priority disease of MoH • High burden country among 22 in the world • NTP established since 1980 • High incidence and prevalence - Incidence rate of Sm+ TB (BK+) : 241/100,000 pop. - Incidence rate of all forms : 540/100,000 pop. • Death rate : 90/100,000 pop. ~ 10,000 deaths • HIV among TB patients: also high:8.4% in 2002 • TB cases will increase in the coming years,

  4. Before the reform(1995) 4 Levels: Central, Province, Disrict & Commune Based on administrative criteria Facilities: - Central MoH, Centers and Institutions - 8 Nat. Hosp. - 23 Prov. Hosp. - 164 Dist. Hosp. - 1267 Commune clinics After the reform New Health System: 3 Levels: Central, Province,Operational District (OD) Based on population & geography : Health Coverage Plan73 ODs Planned Facilities: - Central MoH, Centers and Institutions - 8Nat. Hosp. - 23 Prov. Referral Hosp. - 44 Dist. Referral Hosp. - 946 Health Centers II. Health Sector Reform

  5. III. DOTS Expansion in Cambodia DOTS started in Cambodia since 1994 • 3 Types of DOT: Hospitalization, Ambulatory and At home • From 1994 till 1999 • mainly DOT hospitalization • up to 1999 there were 145 TB Units in RH and HC former district public hospitals • Home care DOT:pilot in Phnom Penh since ‘ 97 • DOTS expansion to HC level: Why ? Start from Pilot project: • in September 1999 started in 9 HCs (CENAT/JICA):Ambulatory DOT  Evaluation  good result

  6. Comprehensive Approach for DOTS Expansion to HC: Systematic process: * Establishment of DOTS Expansion teams * Activities - Preparation visit: situation analysis - Sensitizing workshop: to get consensus - Technical training : to HC staff - Meeting before implementation: technique & logistics - Implementation: monitoring & supervision - Assessment workshop: after 3 month implementation - Routine monitoring and evaluation : biannual, yearly..

  7. Implementation Status • in 2000, expanding to 60 HCs (in 4 Model ODs) • 2001, National DOTS Expansion Plan adopted as part of Global DOTS Expansion Plan • By the end of 2001: 264 HC were providing DOTS • By the end of 2002: 386 HC were providing DOTS • Now 700 HC provide DOTS on top of 78 HC/FDH and out of 814 HC MPA ( 82%) • Plan for 2004 and 2005: cover all remaining health centers

  8. Impact of DOTS Expansion to HC • Increase case detection from 51 % to 57% • Economic impact: • reduction treatment related cost (e.g travel cost…) : amount ? • Increase income of patient family: amount ? • Impact on general health service utilization: may be increasing • Others :…..

  9. V . Other NTP Achievements • Policies & Strategies for TB Control 2001-2005 • Strategic Plan for TB Control 2001-2005 • TB Multi-Drug Resistance Survey • TB Prevalence Survey • TB/HIV Service in CENAT • Inter-agency Coordination Committee for TB Control (ICC)

  10. VI. Main Targets 2001-2005

  11. VII. Challenges for DOTS Expansion • Staff capacity and motivation • Service Quality VS free -of- charge services • Resources implication: human, $, material • TB/HIV • TB in children & Extra-pul. TB • Involvement of community, private sector including NGO and other institutions • IEC activities

  12. Thank You

More Related