Regional Advocacy, Communication and Social

Mobilization Planning Workshop for

Tuberculosis Control

Amman, Jordan 13-17 April 2008

 Regional Advocacy, Communication and Social
Mobilization Planning Workshop for Tuberculosis Control

Amman, Jordan 13-17 April 2008

•Population: 5.6 million

•Surface area: 89,000 Sq.Km

Syria
•Middle income country: 1,208 JD Iraq
(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.
Saudi Arabia
Increase in chronic diseases, including
. chronic respiratory diseases (CRD)
 Various Health system in 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
Jordan University Hospital 517 531 540
King Abdullah University Hospital - 197 283
Private Sector 3348 3402 3532
 Health Centers of MOH
Type of Center 2001 2002 2003

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 Jordan
 Low TB burden: in 2007:
* 333 TB cases (all types) (in addition to 150 cases
Among foreigners transferred out)
* Incidence (all TB types): 6 / 100,000 population
* SS+ incidence: 1.8/100,000 population
* ARI : 0.04%
 TB incidence decreasing: 13/100 000 in 1992 
6 in 2007
 100% population DOTS coverage (1998)
 Case Detection Rate: 63% (2005)
 Success Rate: 87% (2006)
 Prevalence of MDR :5% (2006)
structure of TB control programme
in Jordan
 Structure of the Tuberculosis
Control in Jordan
The
The National
National TB
TB (NTP)
(NTP) in
in Jordan
Jordan is
is aa vertical
vertical
Programme
Programme

 At
At the
the Central
Central level
level the
the Chest
Chest Disease
Disease
Division
Division (in
(in Amman
Amman City),
City), responsible
responsible for
for
Tuberculosis
Tuberculosis control
control program
program throughout
throughout
the
the country
country including
including supplying
supplying medicines.
medicines.
The
The main
main role
role is
is planning,
planning, coordination
coordination and
and
supervision
supervision of
of the
the control
control activities.
activities.

 At
At the
the peripheral
peripheral level,
level, there
there are
are 12
12 chest
chest
centers
centers covering
covering the
the whole
whole country
country..
Distribution of Diagnostic TB
Centers in Jordan
 Goal
 Reduce mortality and morbidity and
transmission of tuberculosis, while preventing
drug resistance, until tuberculosis no longer
poses a threat to public health, and achieve
the Millennium Development Goals (Goal 6,
Target 8) by 2015
 OBJECTIVES
 Improve TB care for vulnerable populations in
Jordan (Refugees, poor, mobile) .

 Improve tuberculosis care for people

suffering from multi-drug resistant
tuberculosis and TB/HIV in Jordan

 Improve general tuberculosis care

Trends over time of the incidence of TB
in Jordan (per 100,000 pop. per year)
35
In c id e n c e R a te /1 0 0 ,0 0 0 p o p

30 28.9
27.8

25 25
23.2
21 21.1
20 19.2 18.9

14.8 16
15 14 14 12
12.8 13
11

10 11.5
10 10.5 8.3
9 6.4
6.4 5.8 6
7.8 6
5 6.2 6
5.3

0
Year
 Trends over time of the number of
new TB cases in Jordan
400

350

Pulmonary TB
300
Extra-pulmonary
TB
Number TB Cases

250
SS+ Pulmonary

200 Total TB

150

100

50

0
2002 2004 2006 Year
 CHALLENGES
 Low Detection Rate: TB case detection
for new sputum smear positive
pulmonary TB cases in 2005 was 63%
(target of 70%);

 MDR TB is increasing among Jordanians

(2% in 2004 , 5% in 2006)
 ACSM ACTIVITIES

JOR506 G02-T/NTP-MOH
 COMPONENT 1: PURSUING, OPTIMIZING AND SUSTAINING QUALITY DOTS

Activity Indic Budget Funding

N. ator (in USD) 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, One meeting is WHO
to plan and monitor activities of held yearly MOH
the NTP and to strengthen
commitment and financial
sustainability
NTP will play a key role in
activating CCM to assess needs Regular meetings
and requirements and to review every three GFATM
and revise action plans for TB months
control in Jordan.
At Governorate levels, TB
M&E Committees WHO
coordinators will reactivate M&E
meet biannually MOH
committees
 COMPONENT III: ENGAGE ALL CARE PROVIDERS

N. Activity Indicator Funding source

3.1 PUBLIC-PUBLIC, AND PUBLIC-PRIVATE (PPM) APPROACHES:

GFATM
Setting up a database for all Database
stakeholders and focal persons Established
in all areas entitled to control
and manage TB cases.
GFATM
Forming a steering committee Steering
to plan and implement PPM Committee
strategy and to build Formulated
commitment.
GFATM
Developing the PPM Strategy PPM strategy
Developed and
printed
Train all TB care providers in all
areas responsible on TB case No.of TB care providers trained
management..
COMPONENT III: ENGAGE ALL CARE
PROVIDERS
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 All clinics dealing
dealing with TB cases. with TB cases
provided with
anti-TB drugs
3.1.7 Printing all guidelines and revised R&R Guideline and
formats needed for the TB-Care provider to revised R&R
ensure adherence to guidelines. format developed
and printed
3.1.8 Increase awareness of medical Schools’ staff No. of medical
and nursing schools’ staff about TB Schools’ staff and
problem through training. nursing schools’
staff trained
 COMPONENT III: ENGAGE ALL CARE
PROVIDERS
N. Activity Indicator
3.1. Increase awareness of medical No. of medical
9 Schools’ students and nursing Schools’
schools’ students about TB students and
problem through training nursing
schools’
students
trained
 INTERNATIONAL STANDARDS
FOR TB CARE (ISTC)
To translate and disseminate ISTC among ISTC
syndicate of physicians, private sector translated,
directorate, not for profit hospital and printed and
policlinics, and NGOs. distributed
Organize lectures and congress for all No. of
stakeholders about the international standards stakeholder
for TB care. attended
lectures
Measuring the impact of adherence to the Measurements
standards on quality of care and patient tools settled
satisfaction.
COMPONENT IV: EMPOWER PEOPLE WITH
TB, AND COMMUNITIES
Activity Indicator

NTP social Workers organize focus group discussion Established or not

with patients on patients’ charter
Orientation meetings with all policy makers
Establish a support Group for TB patients and their Support Group Established
families in collaboration with Jordanian Anti TB
Association (JATA)
Conducting KAP studies
TOT for health care providers
Conducting a campaign
Proportion. of attendance
KAP study conducted
No. of care providers
trained
No. of governorate
involved
No. of seminars conducted
COMPONENT IV: EMPOWER PEOPLE WITH
TB, AND COMMUNITIES
Production of health education materials (TV spots, No. of materials
Radio broadcasting, booklets, posters, etc…) For developed by type.
different target groups. 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 Care:
Setting up a complete database about national and Database is Done
international NGOs.
Orientation meeting with all NGOs focal persons to No of meetings
increase awareness about TB problem and to build conducted
commitment
Integrating international NGOs in fund raising and No of conferences
sharing in TB control through materials, conferences shared by NGOs,
and research. No of Materials
Orientation meeting with community leaders to No. of meetings
participate in TB fight 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:

Forming a task force to set up a national Task force

document for TB patients’ rights. formulated

Setting and printing a poster and booklets Posters and booklets

for TB rights printed

Disseminating the poster and booklets to Posters and booklets

all chest facilities, all partners and disseminated
private clinics.
 ENABLE 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
accompli
shed
 Monitoring and Evaluation (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 M&E
system

Key Indicators Baseline

Training for Governorate TB coordinators on surveillance  

including data verification and quality in terms of complet
eness, accuracy and timeliness through electronic templa
tes 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
Control
National Objectives Related Interventions

1- Improve TB care Empower community volunteers to support TB

Patients through establishment of volunteer
for vulnerable network between the NTP and all NGOs
populations in nationwide.
Jordan 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 to
increase awareness on TB among students schools
 ACSM Contribution to National TB
Control
National Objectives Related Interventions

1- Improve TB care Conducting KAP studies to

for vulnerable
populations in Assess the knowledge,
Jordan attitude and perception of
the population regarding TB;
ACSM Contribution to National TB
Control
2- Improve Developing and printing
tuberculosis TB/HIV guideline
care for people
suffering from multi-
drug resistant
tuberculosis and
TB/HIV in Jordan
 ACSM Contribution to National TB
Control
3- Improve NTP will play a key role in activating TB
coordinators to assess needs requirements
general and to review action plans for TB and to
tuberculosis reactivate M&E strategy (meeting on
quarterly basis).
care
Training and refresher training workshops
for 45 social workers and home visitors
related to TB
Translate and disseminate International
Standards for Tuberculosis Care (ISTC)
among syndicate of physicians, private
sector, not for profit hospital and policlinics,
and NGOs.
NTP social Workers organize 8 focus group
discussion with patients on patients’ charter
 ACSM Contribution to National TB
Control
3- Improve Conducting a study on Case
finding among tuberculosis
general suspects and barriers
tuberculosis interfering with their timely
care healthcare in mid and
northern Jordan
 CONCLUSIONS
Successful TB
Elimination

Highest
level of Support of
concerned
political international
organization

Reaching support
Global Target Community
compliance
Support and
Support of collaboration of
other governorate
concerned health
departments authorities
& sectors
Thank you