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

Amman, Jordan 13-17 April 2008 13-

Regional Advocacy, Communication and Social Mobilization Planning Workshop for Tuberculosis Control
Amman, Jordan 13-17 April 2008 13-

‡Population: 5.6 million ‡Surface area: 89,000 Sq.Km Syria ‡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) . Iraq

Saudi Arabia

Various Health system in Jordan (1999 2003)
Country Health Data Number of Hospitals Hospital Beds Ministry of Health Royal Medical Services Jordan University Hospital King Abdullah University Hospital Private Sector 2001 91 8982 3357 1760 517 3348 2002 95 9383 3462 1791 531 197 3402 2003 97 9743 3587 1801 540 283 3532

Health Centers of MOH
Type of Center
Comprehensive Health Centers Primary Health Centers Peripheral Health Centers Maternity and Child Health Care Centers Chest Diseases Centers Dental Clinic

2001
47 338 258 351 11 240

2002
53 336 258 351 11 247

2003
52 340 259 353 12 250

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 p 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 

The National TB Program (NTP) of the Ministry of Health is well organized, and Jordan belongs nowadays to the low prevalence countries in the world.

Structure of the Tuberculosis Control in Jordan
The National TB (NTP) in Jordan is a vertical Programme 

At the Central level the Chest Disease Division (in Amman City), responsible for Tuberculosis control program throughout the country including supplying medicines. The main role is planning, coordination and supervision of the control activities. At the peripheral level, there are 12 chest centers covering the 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 multituberculosis and TB/HIV in Jordan Improve general tuberculosis care  

Epidemiological Situation

Trends over time of the incidence of TB in Jordan (per 100,000 pop. per year) 100,
35 30
27.8 28.9

IncidenceRate /10

25 20 15 10 5
80 84

25 23.2 21 21.1 19.2 14.8 14 12.8 11.5 10 10.5 9 6.4 7.8 6.2 6 5.3 5.8 6 8.3 6.4 6 18.9 16 14 13 12 11

86

90

92

94

96

98

78

00

02

82

88

04

19

19

19

20

20

Year

20

19

19

19

19

19

19

19

19

20

06

0

Trends over time of the number of new TB cases in Jordan
400 350
Pulmonary TB

300 Number TB Case 250
Extra-pulmonary TB SS+ Pulmonary

200 150 100 50 0

Total TB

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 N.

Indic ator

Budget Funding (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, to plan and monitor activities of the NTP and to strengthen commitment and financial sustainability 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. At Governorate levels, TB coordinators will reactivate M&E committees

One meeting is held yearly

WHO MOH

Regular meetings every three months

GFATM

M&E Committees meet biannually

WHO MOH

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 Database stakeholders and focal persons Established in all areas entitled to control and manage TB cases. Forming a steering committee Steering to plan and implement PPM Committee strategy and to build Formulated commitment. Developing the PPM Strategy PPM strategy Developed and printed

GFATM

GFATM

GFATM

Train all TB care providers in all areas responsible on TB case management..

No.of TB care providers trained

COMPONENT III: ENGAGE ALL CARE PROVIDERS
N. 3.1.5 3.1.6 Activity Supervisory visits to all TB control clinics Ensuring supply of anti-TB drugs to clinics dealing with TB cases. Indicator No. of Visits Conducted All clinics dealing 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 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

3.1.8

COMPONENT III: ENGAGE ALL CARE PROVIDERS N. Activity Indicator No. of medical Schools¶ students and nursing schools¶ students trained 3.1. Increase awareness of medical 9 Schools¶ students and nursing schools¶ students about TB problem through training

INTERNATIONAL STANDARDS FOR TB CARE (ISTC) (ISTC)
To translate and disseminate ISTC among ISTC translated, syndicate of physicians, private sector printed and directorate, not for profit hospital and distributed policlinics, and NGOs. No. of Organize lectures and congress for all stakeholder stakeholders about the international standards attended for TB care. 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 Proportion. of attendance

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 KAP study conducted No. No. of care trained providers

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 international NGOs. Database is Done

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, No of Materials and research. Orientation meeting with participate in TB fight community leaders to No. of meetings conducted No of Volunteers supporting NTP

Empower community volunteers to support TB patients 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 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 Control
National Objectives Related Interventions 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 to increase awareness on TB among students schools

1- Improve TB care for vulnerable populations in Jordan

ACSM Contribution to National TB Control
National Objectives Related Interventions

1- Improve TB care for vulnerable populations in Jordan

Conducting KAP studies to Assess the knowledge, attitude and perception of the population regarding TB;

ACSM Contribution to National TB Control
2- Improve tuberculosis care for people suffering from multidrug resistant tuberculosis and TB/HIV in Jordan

Developing and printing TB/HIV guideline

ACSM Contribution to National TB Control
3- Improve general tuberculosis care
NTP will play a key role in activating TB coordinators to assess needs requirements and to review action plans for TB and to reactivate M&E strategy (meeting on quarterly basis). 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 general tuberculosis care
Conducting a study on Case finding among tuberculosis suspects and barriers interfering with their timely healthcare in mid and northern Jordan

CONCLUSIONS
Successful TB Elimination

Reaching Global Target

Highest level of political support
Community compliance Support of other concerned departments & sectors

Support of concerned international organization

Support and collaboration of governorate health authorities

Thank you

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