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CDMO Review Meeting

CDMO Review Meeting. 21.01.10. RNTCP – Goal and Objectives. Goal The goal of TB control Programme is to decrease mortality and morbidity due to TB and cut transmission of infection until TB ceases to be a major public health problem in India.

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CDMO Review Meeting

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  1. CDMO Review Meeting 21.01.10

  2. RNTCP – Goal and Objectives Goal The goal of TB control Programme is to decrease mortality and morbidity due to TB and cut transmission of infection until TB ceases to be a major public health problem in India. Objectives as per the millennium development goals To achieve and maintain a cure rate of at least 85% of new sputum positive TB patients To achieve and maintain a case detection of at least 70% of new sputum positive TB patients The current focus is on achieving universal access to free quality assured TB services for all the patients in the community

  3. New Smear Positive Case Detection Rate, 2009 National Level- 72% < 60% (5 states) 60-69% (7 states) > 70% (8 states)

  4. Annualized New Smear-Positive Case Detection Rate and Treatment Success Rate in DOTS Areas, Orissa, 1999-2009 3Q* • Population projected from 2001 census • Estimated no. of NSP cases - 85/100,000 population per year (based on recent ARTI report)

  5. Low CDR and High Success High CDR and High Success NAYAGARH - CDR (57%) and Success (59%) High CDR and Low Success Low CDR and Low Success

  6. S u n d a r g a r h M a y u r b h a n j J h a r s u g u d a K e n d u j h a r B a l e s h w a r D e b a g a r h S a m b a l p u r B a r g a r h B h a d r a k S o n a p u r A n u g u l D h e n k a n a l J a j a p u r d a B a u d h N u a p a B a l a n g i r K e n d r a p a r a C u t t a c k N a y a g a r h J a g a t s i n g h a p u r K a n d h a m a l P u r i K a l a h a n d i K h o r d h a N a b a r a n g a p u r G a n j a m R a y a g a d a G a j a p a t i K o r a p u t M a l k a n g i r i NSP CDR RATE 3Q09 50% 50-70% >70%

  7. TB Suspects examined per 100,000 population*, 2000-2009 INDIA 158 Quarters * During RNTCP expansion phase, data for districts implementing partial quarters has been excluded

  8. S u n d a r g a r h M a y u r b h a n j J h a r s u g u d a K e n d u j h a r B a l e s h w a r D e b a g a r h S a m b a l p u r B a r g a r h B h a d r a k S o n a p u r A n u g u l D h e n k a n a l J a j a p u r d a B a u d h N u a p a B a l a n g i r K e n d r a p a r a C u t t a c k N a y a g a r h J a g a t s i n g h a p u r K a n d h a m a l P u r i K a l a h a n d i K h o r d h a N a b a r a n g a p u r G a n j a m R a y a g a d a G a j a p a t i K o r a p u t M a l k a n g i r i SUSPECT EXAMINED / LAKH / QTR- 3Q09 <100 100-150 >150

  9. Districts below the State Average

  10. All PHI are expected to refer more than 2% of their new adult OPD for sputum examination

  11. New Smear Positive Treatment success rate- 2008 National Level- 87% < 80% (0 states) 80-84% (3 states) > 85% (17 states)

  12. S u n d a r g a r h M a y u r b h a n j J h a r s u g u d a K e n d u j h a r B a l e s h w a r D e b a g a r h S a m b a l p u r B a r g a r h B h a d r a k S o n a p u r A n u g u l D h e n k a n a l J a j a p u r d a B a u d h N u a p a B a l a n g i r K e n d r a p a r a C u t t a c k N a y a g a r h J a g a t s i n g h a p u r K a n d h a m a l P u r i K a l a h a n d i K h o r d h a N a b a r a n g a p u r G a n j a m R a y a g a d a G a j a p a t i K o r a p u t M a l k a n g i r i NSP Success RATE 3Q09 <80% 80-84% >85%

  13. S u n d a r g a r h M a y u r b h a n j J h a r s u g u d a K e n d u j h a r B a l e s h w a r D e b a g a r h S a m b a l p u r B a r g a r h B h a d r a k S o n a p u r A n u g u l D h e n k a n a l J a j a p u r d a B a u d h N u a p a B a l a n g i r K e n d r a p a r a C u t t a c k N a y a g a r h J a g a t s i n g h a p u r K a n d h a m a l P u r i K a l a h a n d i K h o r d h a N a b a r a n g a p u r G a n j a m R a y a g a d a G a j a p a t i K o r a p u t M a l k a n g i r i NSP CURE RATE 3Q09 <75% 75-85% >85%

  14. NGO Involvement • Sputum Collection: Nayagarh – 2 • Sputum Transport: Nayagarh – 2, Kendrapada – 9 • DMC Scheme: One each in Puri, jajpur, Kalahandi and Jharsuguda • LT Scheme: Jharsuguda 1 • TU Scheme: 1 in Malkangiri • Nil in: Adherence Scheme, Slum Scheme and TB HIV scheme

  15. PP Involvement • Only 2 Private Organizations involved under DMC scheme: one each in Sambalpur and Ganjam.

  16. Poor ACSM a) In spite of intervention by other partner agency like Lepra and The Union (apart from State Govt. initiative) TB awareness has not penetrated into the rural pockets. • Slum dwellers constitute a large percentage of urban population and the prevalence of TB is high amongst them. Awareness is still low in the slum population.

  17. DOTS Plus

  18. Progress of DOTS-Plus Programme(as on 30th September 2009) Intermediate Reference laboratory (IRL) at Anti TB Demonstration & Training Centre, Cuttack accredited on 10th Aug’ 09.

  19. The Way Ahead…. • Expansion of DOTS Plus activities to the rest of the State in a phased manner – the next two DOTS Plus sites planned at MKCG and VSS Medical Colleges. • DOTS Plus wards in these two medical colleges may be constructed through NRHM funds. Meeting conducted in VSS – they have agreed to give space for the ward. NRHM to take up. • Preparatory activities to be initiated for installation of LPA and Liquid Culture systems in the IRL at Cuttack. Four rooms identified in the ground floor of existing IRL – these have to be vacated and necessary civil works initiated.

  20. Launch of DOTS Plus • Four RNTCP districts of Cuttack, Ganjam, Khurda and Bhubaneswar taken up for DOTS-Plus activity in 2009-10 in 1st phase. • Three MDR-TB cases identified so far (two from Cuttack and one from Khurda). • CAT-IV treatment started for MDR-TB patients from 11th November 2009. Secretary Health inaugurated the event.

  21. FINANCE

  22. Total Expenditure April’09 – Sept’09 S u n d a r g a r h M a y u r b h a n j J h a r s u g u d a K e n d u j h a r B a l e s h w a r D e b a g a r h S a m b a l p u r B a r g a r h B h a d r a k S o n a p u r A n u g u l J a j a p u r D h e n k a n a l B a u d h N u a p a d a B a l a n g i r K e n d r a p a r a C u t t a c k BMC N a y a g a r h J a g a t s i n g h a p u r K a n d h a m a l P u r i K h o r d h a K a l a h a n d i G a n j a m N a b a r a n g a p u r R a y a g a d a G a j a p a t i > 70% K o r a p u t 50% - 69% 25-49% M a l k a n g i r i <25% SOE for Dec’09 not submitted

  23. S u n d a r g a r h M a y u r b h a n j J h a r s u g u d a K e n d u j h a r B a l e s h w a r D e b a g a r h S a m b a l p u r B a r g a r h B h a d r a k S o n a p u r A n u g u l J a j a p u r B a u d h B a l a n g i r K e n d r a p a r a C u t t a c k N a y a g a r h P u r i K h o r d h a G a n j a m G a j a p a t i Civil Works April 2009 - Sept 2009 D h e n k a n a l Nuapada J a g a t s i n g h a p u r BMC K a n d h a m a l K a l a h a n d i N a b a r a n g a p u r R a y a g a d a > 70% K o r a p u t 50% - 69% 25-49% M a l k a n g i r i <25% SOE for Dec’09 not submitted

  24. S u n d a r g a r h M a y u r b h a n j J h a r s u g u d a K e n d u j h a r B a l e s h w a r D e b a g a r h S a m b a l p u r B a r g a r h B h a d r a k S o n a p u r A n u g u l J a j a p u r B a u d h N u a p a B a l a n g i r K e n d r a p a r a C u t t a c k N a y a g a r h P u r i K h o r d h a G a n j a m G a j a p a t i Payment of honorarium to DP April’09 – Sept’09 Dhenkanal Jagatsingpurg Kandhamal Kalahandi Nowarangpur Rayagada Koraput > 70% 50% - 69% 25-49% Malkanagirii <25% SOE for Dec’09 not submitted

  25. S u n d a r g a r h M a y u r b h a n j J h a r s u g u d a K e n d u j h a r B a l e s h w a r D e b a g a r h S a m b a l p u r B a r g a r h B h a d r a k S o n a p u r A n u g u l J a j a p u r B a u d h N u a p a B a l a n g i r K e n d r a p a r a C u t t a c k N a y a g a r h P u r i K h o r d h a G a n j a m G a j a p a t i IEC April’09 – Sept’09 D h e n k a n a l d a BMC J a g a t s i n g h a p u r K a n d h a m a l K a l a h a n d i N a b a r a n g a p u r R a y a g a d a > 70% K o r a p u t 50% - 69% 25-49% M a l k a n g i r i <25% SOE for Dec’09 not submitted

  26. S u n d a r g a r h M a y u r b h a n j J h a r s u g u d a K e n d u j h a r B a l e s h w a r D e b a g a r h S a m b a l p u r B a r g a r h B h a d r a k S o n a p u r A n u g u l J a j a p u r B a u d h N u a p a B a l a n g i r K e n d r a p a r a C u t t a c k N a y a g a r h P u r i K h o r d h a G a n j a m G a j a p a t i Training April 2009 - Sept 2009 D h e n k a n a l d a J a g a t s i n g h a p u r BMC K a n d h a m a l K a l a h a n d i N a b a r a n g a p u r R a y a g a d a > 70% K o r a p u t 50% - 69% 25-49% M a l k a n g i r i <25% SOE for Dec’09 not submitted

  27. S u n d a r g a r h M a y u r b h a n j J h a r s u g u d a K e n d u j h a r B a l e s h w a r D e b a g a r h S a m b a l p u r B a r g a r h B h a d r a k S o n a p u r A n u g u l J a j a p u r B a u d h N u a p a B a l a n g i r K e n d r a p a r a C u t t a c k N a y a g a r h P u r i K h o r d h a G a n j a m G a j a p a t i NGO / PP Support April’08- Sept’08 D h e n k a n a l d a BMC J a g a t s i n g h a p u r K a n d h a m a l K a l a h a n d i N a b a r a n g a p u r R a y a g a d a > 70% K o r a p u t 50% - 69% No Budget M a l k a n g i r i <25% SOE for Dec’09 not submitted

  28. S u n d a r g a r h M a y u r b h a n j J h a r s u g u d a K e n d u j h a r B a l e s h w a r D e b a g a r h S a m b a l p u r B a r g a r h B h a d r a k S o n a p u r A n u g u l J a j a p u r B a u d h N u a p a B a l a n g i r K e n d r a p a r a C u t t a c k N a y a g a r h P u r i K h o r d h a G a n j a m G a j a p a t i Misc. April’09 – Sept’09 D h e n k a n a l d a BMC J a g a t s i n g h a p u r K a n d h a m a l K a l a h a n d i N a b a r a n g a p u r R a y a g a d a > 70% K o r a p u t 50% - 69% 25-49% M a l k a n g i r i <25% SOE for Dec’09 not submitted

  29. S u n d a r g a r h M a y u r b h a n j J h a r s u g u d a K e n d u j h a r B a l e s h w a r D e b a g a r h S a m b a l p u r B a r g a r h B h a d r a k S o n a p u r A n u g u l J a j a p u r B a u d h N u a p a B a l a n g i r K e n d r a p a r a C u t t a c k N a y a g a r h P u r i K h o r d h a G a n j a m G a j a p a t i Contractual Services April’09 – Sept’09 D h e n k a n a l d a BMC J a g a t s i n g h a p u r K a n d h a m a l K a l a h a n d i b N a a r a n g a p u r R a y a g a d a > 70% K o r a p u t 50% - 69% 25-49% M a l k a n g i r i <25% SOE for Dec’09 not submitted

  30. Thank You

  31. Low cure rate (82%)

  32. Matter of Concern… • Death Rates in all districts are above the expected norm of <4% except: • Anugul, Baleswar, Dhenkanal, Jagatsinghpur, Khurda and Puri

  33. Why are so many new sputum negative cases dying?

  34. Why are so many new sputum negative cases defaulting treatment?

  35. Prescription Audit of Anti TB Drugs SECY. HEALTH HAS DIRECTED THE DC OF ODISHA TO SEE THAT NO ANTI TB DRUG BE SOLD WITH OUT PRESCRIPTION BY A REGISTERED MEDICAL PRACTIONER.

  36. Vacancy status of key contractual posts(as per PM report of 3rd and 2nd Qtr 09) To be appointed by the respective district: • Senior Treatment Supervisor- 2 (Mayurbhanj – 1, Kalahandi – 1) • Senior TB Laboratory Supervisor- 10 (One each in Sundergarh, Rayagada, Khurda, Cuttack, Bargarh, Baleswar, Balangir and Angul and Two in Mayurbhanj) To be appointed by NRHM at the State level: • Laboratory Technician (RNTCP)-29 • Total LT sanctioned (DMC)-546 NRHM moved on 02-06-08 to initiate process of recruitment of contractual Laboratory Technician (LT)

  37. Vacancy status – State Level(to be appointed by NRHM at the State level) • One Microbiologist for ATD&TC, Cuttack • One Contractual MO – VSS Medical College, Burla • Contractual MO – one each at DTC Koraput and Nuapada • One Accountant Post at State TB Cell • Communication facilitator: One each at Koraput and Baripada

  38. Drug Management • DTOs to stick to the timetable for quarterly indent of Anti TB Drugs. • Return the short expiry drugs at least 6 months before the date of expiry. • Any surplus drug not likely to be utilized should be returned back to the SDMU. • The practice of sending drug boxes to the PHI through the STS in motorcycle should be stopped. • Necessary steps to be taken to ensure that the MO-TCs send the drug boxes to the concerned PHI as per schedule. • The person handling the TB drugs at the District level should be well versed with Pro-MIS. All receipts and expenditure should be made online through Pro-MIS.

  39. The Programme Indicators (1) a) Suspects Examined / Lakh / Quarter Norm >150 State Achievement = 137 Major Causes of low suspects examination: • Block wise referrals not monitored at CDMO review meetings • Referrals from PHC (N) very low / not monitored • Sub Center wise referrals not monitored at Block level • Referrals from other Care providers / NGOs / PPs negligible

  40. The Programme Indicators (2) b) Annualized new sputum +ve case detection / lakh Norm: NSP Case Detection Rate > 60 / lakh / year NSP Case Detection Rate (%) >70% State Achievement – 57 / Lakh / year (67%)

  41. The Programme Indicators (3) c) Annualized total case detection rate Norm – 230 / Lakh / year State Achievement – 131 / lakh Major Causes: • Low detection of NSN and EP Cases • Diagnostic algorithm not followed • Defective X Ray machines / shortage of X-Ray technicians • Suboptimal involvement of Medical Colleges / Private Practitioners • Very Low Detection of Retreatment Cases • Improper history taking

  42. Poor Access to Health Facility • Difficult demographic profile of the State. • Lack of manpower (mostly LTs) to manage microscopy centers as per need.

  43. Initial Defaulters • Defined as diagnosed as sputum positive TB in the Lab but failed to get registered for treatment. • During last Quarter 482 diagnosed TB cases did not turn up for treatment, which constitute 7% of the total cases detected. • Although some of these would have started treatment and will get registered in the subsequent quarter, there are many cases which are missed out completely after diagnosis. • Had these been initiated on treatment, the case detection in the State could have been substantially higher.

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