Mobilizing Professional Medical
Associations and Promoting
ISTC
Report of group work: Group 1
Fifth meeting of the Subgroup on PPM for TB
care and control
EMRO, Cairo, Egypt, 3-5 June 2008
“Sabah alkhair “
from the group members
RV Asokan
 Mysoun Al Hasen
 Karin Bergstrom
 Erlina Burhan
 Mirtha Del Granado
 Mao Tan Eang
 Fran Du Melle
 Philip Hopewell
 Ghada Muhgazi
 Benjamin Nwobi
 Julia Seyer
 Andrew Suleh

1. Key recommendations to NTPs on
how to engage PAs (PMA) for TB
care
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NTPs should sensitize the PAs on TB care. The
goal is to involve the PAs as partners focusing
on the ISTC (Stop Tb Strategy). NTPs should
initially conduct a National Situation Analysis
(on the role of private sector in TB care and
identify the roles to performed by PAs).
The PAs should be involved in policy
formulation, preparation and dissemination of
national guidelines.
Key recommendations to NTPs on
how to engage PAs (PMA) for TB
care (cont)

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NTPs should support CMES, trainings,
journals, workshops, research etc to involve
members of PAs in TB care.
Global TB partners and the governments
should assist NTPs technically and financially
for PA activities.
Capacity building of NTPs to facilitate these
activities has to be undertaken
Certification of trained PAs, accreditation of
institutions and access to forum for the
members should be facilitated.
2. Key recommendations to the
PPM subgroup on facilitating
collaboration between NTPs
and PAs

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PPM subgroup should have adequate
representation from PAs.
It should provide guidance and technical
assistance to NTPs to engage PAs.
Create a forum where PAs can interact and
exchange experiences and ideas.
PPM subgroup should develop tools for M&E and
indicators for involvement of PAs.
3. Ways to access the effectiveness
of use of ISTC by professional
Medical Associations

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Facilitate information flow from
private sector either through NTPs
or Pas.
Periodic NSAs should be carried
out.
4. Suggestions on the
DEWG Paris meeting
agenda


Agenda item: developing national
coalitions of PAs
Agenda item: Role of the
International PAs
HOSPITAL DOTS LINKAGES
GRP 2
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Abu –Saad Refaat
Al Domainy Khadija
Awe A
Chakaya Jeremiah
Chin Daniel
Farghally Ayman
Kilicaslan Zeki
Uplekar Mukund
Wang Lixia
Wei Xiaolin
Zignol Matteo
Jan Voskens -
Facilitator
TOR
1. Issues and Challenges of involving
Hospital in TB control
2. Comments on the HDL guidelines:
terminology; content; presentation
3. Comments on the incorporation of
issues such as TB/HIV; MDR TB and
Infection control in HDL document.
4. Recommendation on next steps for HDL
guidelines
Issues and challenges of involving
Hospitals in TB control
Financial Issues
1. Hospitals not eager to loose their patients by
referring to the NTBP and thus loose income
2. Elaborate on Compensation mechanism.
1. Incentives to Hospitals.
2. Dilemma of Free drugs or affordable drugs
3. Insurance
Comments on the HDL guidelines 1
1. Specify the target audience for the document.
? NTBP ; ?Hospital Director; Decision is to
focuss on both.
2. The Document to be made simple; more
bullets, shorter sections, concise and easy to
read. remove duplications;
3. Contents to include short sections on Infection
Control, TB/HIV and MDR
4. The document be linked with the document on
‘‘ engaging all health care provider’’. Should it
be an annex of that document ?
Next Steps
1. To put the new comments together for final
draft.
2. Final draft forwarded to wider audience.
Including end users; hospitals , NTP for
comments.
3.
Printing of final document; distribution on web
and hard copies along with document on
engaging all health care providers.
+
Engaging the
Corporate Sector in TB
Control
+
The Team
Facilitator: Shaloo Puri Kamble
+ Engaging the Corporate Sector
An Overview

Clarification of concepts and definitions
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Sharing of country experiences
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Process of engaging the corporate sector- concrete steps for NTP
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Contribution and advantages of engaging the corporate sector
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The significance of an interface in facilitating NTP – business sector collaboration
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Importance of advocacy for NTP-business sector collaboration
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The role of community and trade unions in bottom-up facilitation of NTP-business sector
collaboration
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Need to build evidence base on initiatives engaging the corporate sector
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Need for practical guidance and tools for NTP to engage the corporate sector
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Linking with existing mechanisms and platforms….DONT REINVENT THE WHEEL !
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Recommendations for
national TB programmes
•
First get internal buy-in and then external buy-in
•
Prioritize and engage potential and existing
stakeholders (NGOs, business associations, FAIR
TRADE organizations, etc.) to act as intermediaries
(NTP overstretched!)
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Need assessment and mapping of
industries/companies to prioritize sectors, groups or
regions for initial engagement
•
Assist PPM subgroup in documenting successful
initiatives in country
•
Develop guidance or framework for involvement of
corporate sector
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Recommendations for
national TB programmes
•
Design appropriate messages for
reaching out to the corporate sector
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Disseminate corporate self assessment
tool to companies through interfaces as
part of a mapping and information
collection exercise
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Promote of inclusion of TB services in
health insurance packages
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Design, implement and enforce
regulations for TB control (?)
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Recommendations
to PPM Subgroup
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Document existing corporate sector
initiatives and build evidence base
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Measure advantages or benefits of corporate
sector engagement in TB control which will
help in designing messages to convince NTP
staff and companies to get involved
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Facilitate dissemination and follow up of self
assessment tool as part of a global mapping
exercise and also building evidence base
•
Identify and draw lessons from other disease
programmes which are engaging the
corporate sector and/or piggy back on
existing mechanisms (for example:HIV in the
workplace programmes)
+
Recommendations
to PPM Subgroup
•
Coordinate with ILO and other
agencies/partners working in this area
(collaborative working group)
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Work with ILO to exert their influence
with trade unions to initiate workplace
programmes
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Collaborate with ACSM working group
to jointly work on engaging the private
sector and to push bottom up
facilitation of NTP-business sector
collaboration (PCTC)
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Organize missions for NTP staff to visit
successful initiatives
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Recommendations on
collaborative partnership
among GHI, GBC and
the PPM Subgroup
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Document, develop tools and guidance in tandem
with GHI and GBC
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Support GHI and GBC in conducting national/regional
sensitization workshops for business managers,
etc.…..provide technical assistance
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Work together on putting TB control on the World
Economic Forum and GBC global meeting agendas
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Other Salient Points/Ideas
 Collaborate
with global accreditation
agencies (ISO) to insert TB control as
one of the essential criteria for
certification
 Stigma
and discrimination- addressing
this
 Including
corporate initiatives in Global
Fund Dual track financing applications
 Putting
TB on the agenda of local
economic development agendas
+
Thank You!
Coordination of TA among
Partners
Group 5
Wilfred Nkhoma
Aziz Mohamed Abdel
PK Mitra
Eva Nathanson
Ohkado Akihiro
Seita Akihiro
Cheri Vincent
Sara Massaut
Vishnu Kamineni
General Remarks
Good discussion but not enough information
to address the issues and expected
outcomes.
– Incomplete list of planned TA at country level
(only 4 partners: JATA, WEF, The Union and
LHL)
– Missing partners: ATS, WHO and KNCV etc.
PPM specific TA
• Current information provided by only 4 partners
• Countries receiving TA: India, Philippines,
Pakistan, Yemen,Cambodia, Bangladesh,
Zambia, S. Africa, China, Namibia
• TB Team is current coordinating mechanism
– List of consultants (32) but are they experts and/or
active?
– Activities planned—only 3 TA planned specifically for
PPM, are there more? (not including GF and reviews)
Gaps in geographical coverage
• Information provided to group does not allow
accurate identification of gaps
• Group discussions reveal gaps in the AFRO
region:
– Francophone—language issues
• Is TA being provided at all?
• Non-HBC not seen as priority at the global level
• Eastern Europe
– What is happening and is there a need?
TA Duplication
• TA is often partner driven
• Lack of communication and coordination
with NTP
• Existing capacity at NTP to identify,
coordinate and monitor TA—not optimally
utilized
• PPM TA needs to be based on and in
alignment w/National Strategic Plan
Recommendations
• Improved systematic documentation of TA (TB
TEAM)—regular updating of planned missions
– Including partner contributions
• Address non-HBC needs – generic and PPM
specific
• Mapping/categorization of countries based on
PPM needs (low/middle income, insurance etc.)
• Translate critical guidelines in major operating
languages—e.g. Francophone countries
• Improved coordination with NTP to avoid
duplication—based on perceived needs of NTP
Other issues
• Increase use of TB TEAM
• Include HSS consultants in PPM missions
• Common definition of PPM as supporting
component to Stop TB Strategy
• Avoid fragmented approaches to PPM
(TB/HIV, MDR and IC)
Measuring PPM Contributions to
TB Control
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Dr Hassan Sadiq
Dr. Martin Gninafon
Dr. Hee Jin Kim
Dr. Mtanios Saade
Dr. Alfonso Tenorio
Dr. Shafiullah
Talukder
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Dr. Felix Salaniponi
Dr. Jaime Lagahid
Dr. Aayid Munim
Dr. Salah-Eddine
Ottmani
• Guy Stallworthy
Proposed Global Indicators of PPM Contribution to
TB Control
• Number and % of private facilities actively involved in:
– Referring suspects
– Diagnosing TB cases
– Managing TB patients
• Number and % of notified cases diagnosed by the
private sector
• Number and % of notified cases managed in private
sector
Practical steps to implement a PPM
monitoring system at national level
• Estimate the total number of private providers
• Introduce/revise recording and reporting tools to
identify role of private providers
– Design revised tools
– Train staff
– Test new tools
– Revise new tools
– Introduce new tools nationwide
Advocacy for PPM Monitoring at National
Level
To private sector
• Regular consultations (with professional associations,
private providers, etc) to understand importance of
monitoring within context of ISTC
To Ministry of Health
• Explain benefits to TB control from increased resources
dedicated to monitoring contribution of private sector
Both
• Ensure ownership by reviewing monitoring data in PPM
coordination/management committees that involve both
public and private sector representation
Assessing PPM Contribution to MDR-TB
• No, % of private and public non-NTP
providers involved in MDR diagnosis and
treatment according to international
(WHO, Union) standards
• No, % of DST conducted by private and
public non-NTP labs
• No, % of 2nd line treatments managed by
private and public non-NTP providers
Assessing PPM Contribution to TB/HIV
• Private sector participation in TB/HIV
coordinating body
• #, % of private TB diagnostic centres that
offer VCT
• #, % of TB cases diagnosed in private
sector who receive VCT
• #, % of people testing positive for HIV in
private sector who are screened for TB
Group 6:
Patient and community
perspectives participation
in PPM
HAI El Tilib
SA Hamid
B Kaboru
BA Kumar
F Ledoux
R Malmborg
I Nyasulu
C Gordon
K Inaba
S Baghdadi
L Velebit
MoH, Sudan
Damien Foundation, Bangladesh
WHO HQ
Community Health Nurse, India
TB/HIV advocate, Cameroon
LHL, Norway
WHO Malawi
World Care Council Facilitator
WHO South Sudan
WHO EMRO
WHO HQ
General remarks
Issues of patient and community empowerment to
be addressed are part of, yet beyond the scope
of the work of the PPM Subgroup…
• Low CDR = TB commonly not perceived as
Health priority and/or is highly stigmatized
• Sensitization of the general population
• Patient and community empowerment
Recommendations
• To NTPs, @ national/subnational level: Ensure
patient representation and participation in the
national PPM coordinating body (and
subnational levels where activities are present)
• To PPM Subgroup: Ensure that ISTC and PCTC
are promoted and used hand in hand
– in documents, trainings (e.g. Sondalo), international
meetings
– All references to ISTC should be
ISTC/PCTC
Recommendations
• Handbook for the implementation of ISTC has
already been prepared.
• Why wasn't the same done for PCTC????
– PPM Subgroup to commit to developing a handbook
for the implementation of PCTC as well
• WHO HQ, WHO Regional Offices, and Stop TB
Partners to more actively promote the adoption
of PCTC as part of national guidelines at
country-level
Recommendations
WHO to:
• a) more pro actively facilitate capacity
building of patient and community groups
ie. TA for Global Fund dual track proposals
• b) to facilitate translation of PCTC in all
UN languages.
Action point
• Previously initiated MoU (inclusion of the
Charter in the TB drug kits) WCC and
GDF to be followed up at DEWG (core
immediately
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