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HELLO MY FRIEND
HOW ARE YOU TODAY?
Maarten Bosman
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Birth cohort 1946
Married, two sons (men!! 34 and 27)
“Tropical Doctor” in Tanzania 74-77
Khmer refugees ICRC 1980
“Family Doctor” in Netherlands 80-84
TB manager NTP in Kenya 84-89
TB consultant KNCV 89-98
• Stop TB initiative in WHO
Geneva 99-2000
• Back in KNCV 2001
• MO stop TB for Vietnam, Lao
and Cambodia since September
2002 in Hanoi
• October 2006 retired from WHO;
independent TB consultant since
Interests/Experiences
Health Sector Reform
TB control in Nomads
Urban TB control
TB/HIV
Consultancies
• Bangladesh, Cambodia, China, Lao,
Thailand, Vietnam
• Ethiopia, Ghana, Kenya, Mali,
Mozambique, Tanzania, The Gambia,
Somalia, Zambia
• Serbia
TB control: The Planning Cycle
Planning and Managing TB
control
Objectives of the module
• Knowledge acquired:
Basic principles of TB control (DOTS)
Planning and management of TB control
• Skills acquired:
Assessment of quality of TB services
Reporting of findings and providing
recommendations
The Stop TB Strategy of WHO
1. Pursue high-quality Dots expansion and
enhancement
2. Address TB/HIV, MDR-TB and other
challenges
3. Contribute to health system strengthening
4. Engage all care providers
5. Empower people with TB, and communities
6. Enable and promote research
Study Approach
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Program Cycle Management
Problem or Situational Analysis
Planning and implementation of
interventions
Quality assurance and performance audit by
supervision
Monitoring through HMIS
Analyzing and evaluation of results
Overall objective of TB control
Reduce transmission of TB in the
community and in this way reduce
the prevalence of M.tuberculosis
infected persons in the community
Purpose of TB control
To remove sources of
infection of M.tuberculosis
from the community by early
identification and cure of
infectious cases of TB
Strategy
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Political Commitment to control TB
Laboratory network for direct microscopy
Short-course chemotherapy and DOT
Guaranteed supply of anti-TB drugs
HMIS for monitoring and evaluation
TB Control Process
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(Self) referral of suspects
Identification of suspects
Examination of suspects
Diagnosis of cases
Registration for Treatment
Providing and supervising treatment
Case-holding
Evaluating results
Functions NTP
• Conditions for different steps of the process
meet defined standards
• Assure quality of interventions
• Secure necessary equipment, means and
funds
• Monitor the process and evaluate outcome
• Plan and manage the process
Planning and managing the
process
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Levels
The Community
The District Health System
The Intermediate Level
The National Level
Global? Sub-regional?
Training Methodology
• Interactive, problem solving oriented
discussions
• Practical exercises in working groups
• Field visits
• Group presentations
Chanigolia
Asiam
181,035 sq km
425 x 425 km
14 million people in 2008
Makaldiam
Demography
Population 2008
14 million
Annual Growth 2%
Urban 20%
Life expectancy 57yr
Infant mortality 68
Under 5 malnutrition
36%
Economy
GDP
8 billion US$
Agriculture 30%
Industry 26%
Services 44%
Export 3.7 billion US$
Import 4.7 billion US$
Debt 3.5 billion US$
Is ASIAM a paradise?
Depends who you are:
35% of people below poverty line
High prevalence of
AIDS
Tuberculosis
Malaria
High child mortality
ASIAM
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A Case Study
Review of TB control in Asiam
1992, 1996 and 2002
Asiam R7 and R10 proposals to GFATM
Asiam data sets I, II and III
Set of exercises
Group work and presentations
Group 1
NGHIA HUYNH
KHANH PHAM
XINXU LI
KHAMLA CHOUMLIVONG
RACHEL SISMAR
MARIAH PRESTON
Group 2
HARDEW KAUR
NGOC DIEP BUI
THI MINH NGOC NGUYEN
KHAMLUB SENBOUNSOU
EDWIN HENRY DAIWO
KHIN ZAW
Group 3
OYUNTUYA TUMENBAYAR
PWINT HAYMAR NAING
NANG SARM PHONG
TRISASI LESTARI
THI THANH VAN NGUYEN
NICHOLAS GOHINO BUWAO
Group 4
ANH BINH LUONG
YULING ZHAO
FRANK UNDERWOOD
MA CECILIA VAGAY
MARK DUPI
SAORITH SENG