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HELLO MY FRIEND HOW ARE YOU TODAY?

HELLO MY FRIEND HOW ARE YOU TODAY?. Maarten Bosman. 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.

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HELLO MY FRIEND HOW ARE YOU TODAY?

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  1. HELLO MY FRIENDHOW ARE YOU TODAY?

  2. Maarten Bosman • 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

  3. 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

  4. Interests/Experiences Health Sector Reform TB control in Nomads Urban TB control TB/HIV

  5. Consultancies • Bangladesh, Cambodia, China, Lao, Thailand, Vietnam • Ethiopia, Ghana, Kenya, Mali, Mozambique, Tanzania, The Gambia, Somalia, Zambia • Serbia

  6. TB control: The Planning Cycle

  7. 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

  8. The Stop TB Strategy of WHO • Pursue high-quality Dots expansion and enhancement • Address TB/HIV, MDR-TB and other challenges • Contribute to health system strengthening • Engage all care providers • Empower people with TB, and communities • Enable and promote research

  9. Study Approach 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

  10. 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

  11. 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

  12. Strategy • 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

  13. TB Control Process • (Self) referral of suspects • Identification of suspects • Examination of suspects • Diagnosis of cases • Registration for Treatment • Providing and supervising treatment • Case-holding • Evaluating results

  14. 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

  15. Planning and managing the process Levels • The Community • The District Health System • The Intermediate Level • The National Level • Global? Sub-regional?

  16. Training Methodology • Interactive, problem solving oriented discussions • Practical exercises in working groups • Field visits • Group presentations

  17. Chanigolia Asiam 181,035 sq km 425 x 425 km 14 million people in 2008 Makaldiam

  18. Population 2008 14 million Annual Growth 2% Urban 20% Life expectancy 57yr Infant mortality 68 Under 5 malnutrition 36% Demography

  19. 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$

  20. Is ASIAM a paradise?

  21. Depends who you are: 35% of people below poverty line High prevalence of AIDS Tuberculosis Malaria High child mortality

  22. ASIAM 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

  23. Group 1

  24. Group 2

  25. Group 3

  26. Group 4

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