1. National Tuberculosis Control Program in Bangladesh : Progress Report Dr. Shamim Sultana Deputy Programme Manager, TB National TB Control Programme Directorate General of Health Services Mohakhali, Dhaka

2. BANGLADESH: Country Profile
Situated in South Asia
Population : million (2006 projected estimate, based on 2001 Census)
Area: 147,570 sq. km
Density: 953 per km2
GNP per capita: 444 US$
Administratively, it has-
Division: 6
District: 64
Sub District: 507

3. BANGLADESH: TB Situation
5th among 22 high TB burden
countries
ARTI: 2.14%
50% of adult population infected
Estimated new cases of TB (all forms) per year : 227 / population
Estimated new smear positive TB cases per year: 102/ population
TB Prevalence (all cases):
406/ pop

4. BANGLADESH: TB Situation
TB Mortality ( all cases per year) : 47/ population
Percent estimated new adult cases of TB co-infected with HIV : 0.1%
No representative DRS data available
Estimated New TB cases MDR: 1.8%
Estimated previously treated TB Cases MDR: 14%

5. BANGLADESH: TB Situation
DOTS strategy- implemented in November 1993
DOTS Coverage: almost 99%
TB Case Detection Rate 2006: 71.06%
Treatment Success Rate ( 2005): 91.51%
Source: WHO estimates of 2006

6. BANGLADESH: TB Situation
TB Case Detection Rates: (2006)
National : %
Divisional :
Dhaka %
Chittagong 75.0%
Rajshahi 61.4%
Khulna 75.6%
Barisal 90.9%
Sylhet 81.8%

7. Smear +ve Cases: Treatment Success and Case Detection Rates (%); Since 1993

8. TB Situation from 2004 - 2006 General/All cases in 2004
Year
2004
2005
2006
Country Population:
137 million
140 million
140.7 million
DOTS population coverage (%):
99%
Number of TB cases notified (all cases):
90,741
122,907
145,164
% Detection*:
31%
32%
45.07%
Number of pulmonary TB sputum-smear positive case:
62,228
88,576
101,988
46%
61%
71.06%
Success rate of smear positive cases (%)[cure plus completion] :
89%
91.51%
Please fill in table for 2002 and 2003.
*Percentage of cases notified out of estimated cases

9. TB Situation of 2006 Reporting Unit Pulmonary Positive Upazilla 75.51
Pulmonary Negative %
Extra Pulmonary New
Total
New
Relapse
Upazilla
75.51
2.23
14.07
8.19 82
Metro
47.87
6.58
27.54
18.01 13
CDC
42.97
4.23
35.24
17.57 5
70.26
2.90
16.89
9.95
100

10. Vision and Mission of NTP
Tuberculosis is no more a public health problem in Bangladesh
MISSION:
National Tuberculosis Program (NTP) aims to strengthen the effort of TB Control through effective partnership, mobilizing resources and ensuring quality diagnostic and treatment services under defined Directly Observed Treatment Short Course (DOTS) strategy. The service should be equally available to all people of Bangladesh irrespective of age, sex, religion, ethnicity, social status and race.

11. Vision and Mission of NTP (Cont.)
GOALS OF NATIONAL TB CONTROL PROGRAM
The overall goal of TB control is to reduce morbidity, mortality and transmission of TB until it is no longer a public health problem

12. Vision and Mission (Cont.)
OBJECTIVES OF NATIONAL TB CONTROL PROGRAM
- Reach and thereafter sustain the targets- achieving at least 70% case detection and 85% treatment success among TB cases under DOTS
In order to then,
- Reach the interim target of halving TB death and prevalence achieving the Millennium Development Goals set by 2015

13. Areas of GO-NGO Collaboration in TB Control in Bangladesh
Area of Collaboration
Government
NGOs/ Partners
Implementation
Policy, Planning and Budgeting
National guidelines
Overall coordination
Infrastructure
Specific areas as per MoU
Case finding and Case Holding
Equipment/supplies
Diagnosis, Treatment, DOT , Follow-up, Management of complicated cases
Referral centres
Suspect identification, Referral for Diagnosis, Diagnosis and Treatment, DOT and Follow-up
Training
Training of Trainers (TOT)
Responsible for pertaining all forms of training/ orientation to all categories of GoB and NGOs/ Partners
Local training only for respective NGO staff as per NTP curricula, support government training

14. Areas of GO-NGO Collaboration in TB Control in Bangladesh (Contd.)
Area of Collaboration
Government
NGOs/ Partners
Drugs and Logistics Management
Central procurement
Distribution
Local storage
Local storage and distribution
Supply indent
Monitoring ,Supervision and Evaluation
Recording and Reporting
Overall Monitoring and Supervision
External and Internal Evaluation
Local Monitoring and Supervision
Participate in internal and external evaluation
Advocacy, Communication and Social Mobilization (ACSM)
Policy, Planning and Budgeting
Advocacy meetings with all stakeholders
National campaigns
Outreach activities at local community

15. ROLE OF THE NTP AND ITS IMPLEMENTING PARTNERS AT DIFFERENT LEVELS
Partners/Implementing agencies
NTP
Central Level
Responsible Persons: Director- MBDC & Line Director-TB/Leprosy, Deputy Director-MBDC , Asst. Director, Program Manager-TB, DPM-TB and MOs
Responsibilities: Policy formulation, Planning, Budgeting, Coordination with partners,Operational Guidelines, HRD, ACSM, EQA, Procurement and Supply of Drug and Logistics, MIS, Supervision, Monitoring & Evaluation and Operational Research
Responsible Bodies: Academic Institutes, NGOs and Professional Associations
Responsibilities: Civil society and private sector involvement,ACSM,Recording and Reporting, Supervision and Monitoring, Implementation of Operational Research

16. ROLE OF THE NTP AND ITS IMPLEMENTING PARTNERS AT DIFFERENT LEVELS (Contd.)
Partners/Implementing agencies
NTP
Responsible Persons: Divisional Director Health and Deputy Director, Health.
Responsibilities: Supervision and Monitoring according to NTP guidelines,
coordination with NTP and partners
Divisional level
Responsible Bodies: City Corporations, NGOs, Chest Hospitals, Academic Institutes, Corporate Health Services, Private Sectors and Prisons.
Responsibilities: Implementing DOTS, Management of referred cases,ACSM, Recording and Reporting , Supervision and Monitoring
Responsible Persons: Civil Surgeon
Consultant-Chest Disease Clinic,
MO and PO- TB-LEP
Responsibilities: Supervision, Monitoring and Evaluation, EQA,Training, technical guidance, coordination with NTP partners and implementing DOTS
District Level
Responsible Bodies: Academic Institutions, District Hospitals, Chest Disease Clinics, NGOs.
Responsibilities: DOTS Implementation, Management of referred cases, Supervision, Monitoring, Quality Assurance, networking with private providers, ACSM,Recording and Reporting, indenting for drugs and logistics.

17. ROLE OF THE NTP AND ITS IMPLEMENTING PARTNERS AT DIFFERENT LEVELS (CONT.)
Partners/Implementing agencies
NTP
Responsible Persons:UH&FPO, MO LTCA
Responsibilities: Implementation of DOTS, Supervision, Monitoring and Evaluation, Training, Recording and Reporting, Coordination with NTP partners
Responsible Bodies: UHC, NGO partners
Responsibilities: Identification of suspects, sputum collection and examination, Training, ACSM, DOT,Follow Up, Supervision, Recording and Reporting, and Indenting drugs and logistics
Upazila Level

18. ROLE OF THE NTP AND ITS IMPLEMENTING PARTNERS AT DIFFERENT LEVELS (Contd.)
Partners/Implementing agencies
NTP
Responsible Persons: HI,AHI, HA, MA
Responsibilities: ACSM, Suspect identification and referral, DOT, Follow Up
Responsible Bodies: Health sub-centers, NGO partners.
Responsibilities:ACSM, Suspect identification and referral, DOT, Follow Up,Sputum collection and transportation to laboratory
Union/ward Level
Village Level
Responsible Persons: Community Health Workers (Shastho Shebikas), Village Doctors, Cured patients
Responsibilities: Suspect identification and referral, DOT, Follow Up

19. National / International Partnerships
(list of institution)
Type of Partnership
1. NGOs (BRAC, LTCC UPHCP, NSDP)
DOTS Service Delivery
2.NATAB
Civil Society Involvement in TB Control
3. ICDDR,B
Operations Research
4. Private Practitioners
DOTS Service Delivery and Collaborate With NTP NGO Partners
5. Academic Institutes, Public and Private Hospitals
DOTS Service Delivery, Referral Centres
Please identify all country partnerships, including financial/donor, technical, NGO, local agency, medical society, etc.

20. National / International Partnerships( Cont.)
(list of institution)
Type of Partnership
6. Corporate Sectors, Work Places
DOTS Service Delivery
7. Special Population ( Prison, Defences)
8. WHO
Technical Assistance
9. GFATM, CIDA, USAID, JICA,WB
Financial Assistance
10. RIT,KNCV,URC, IUATLD

21. Resource Mobilization :GFATM Grants
(US$ in million)
Principal Recipient
Government
NGO-BRAC
Total
Round 3
(Period: )
15.45
27.02
42.47
Round 5
(Period: )
26.45
19.52
45.97
41.9
46.54
88.44
Through this well established partnership Bangladesh was able to mobilize a significant amount of grant in 2004 and 2006 from the Global Fund to fight AIDS, TB and Malaria (GFATM) which gave momentum to the TB Control programme.

22. Current and Planned Activities
Increase case detection and maintain high cure rates through strengthening DOTS services including quality of lab services
Involve all health care providers
Create demand for services through comprehensive advocacy, communication and social mobilization
Strengthen the procurement and supply system
Strengthen supervision, monitoring and evaluation
Management of Multi Drug Resistant TB
TB/HIV collaborative activities

23. NTP Achievements Expansion of DOTS in Metropolitan Cities
Introduction of DOTS in prisons, academic institutions and workplaces
Sustaining strong collaboration between Government and Non-Government organizations
Access to the Global DOTS Expansion plan funded by CIDA, Global Drug Facility (GDF), Global Fund to Fight AIDS, TB and Malaria (GFATM) and strong technical support from WHO
Please describe the 3 major achievements accomplished in 2003 toward reaching the 2005 global TB targets.
Examples:
DOTS has been expanded to 20 districts
"x" number of hospitals started DOTS implementation
Funding for TB control covers all needs expressed in the national plan

24. NTP Achievements(Cont.)
5. Detection of estimated new smear positive cases under NTP increased to over 70% in 2006 as compared to 34% in 2002 and treatment success rate to over 91% (2005)
6. Establishment of External Quality Assurance of smear microscopy
Initiation of Prevalence Survey
Please describe the 3 major achievements accomplished in 2003 toward reaching the 2005 global TB targets.
Examples:
DOTS has been expanded to 20 districts
"x" number of hospitals started DOTS implementation
Funding for TB control covers all needs expressed in the national plan

25. NTP Achievements (Cont.)
8. Awareness campaigns initiated through mass media
9. Steps taken to function DRS and implementation of DOTS-Plus Project
10.Steps taken to implement PPM-DOTS, TB-HIV

26. Major Challenges Health Sector Reform
Effective partnership to cover hard to reach/special areas: Private Hospitals and Clinics, Expansion in Defense Hospitals, Prisons, Brothels, Slums and Industrial Units, homeless population in difficult terrains
Human Resource Capacity Development
MDR-TB and HIV-TB Co infection
Quality assurance of lab services
Uninterrupted supply of drugs
Strengthening of supervision and monitoring
Dependence on external funding

27. THANK YOU