1. IMPROVING CASE FINDING ACTIVITIES THROUGH EFFECTIVE LABORATORY MANAGEMENT AND HEALTH EDUCATION IN THE NATIONAL TUBERCULOSIS PROGRAM OF PERU”
WILLIAM GARAY LOPEZ, MD

2. REPUBLIC OF PERÚ Área: 1´285,216 km2 Population: 27’946,774
Anual Growth Rate: 1,7%
Population of Lima and Callao: 8,7 millions (32.3% to total of population and 46% to urban population)
Tumbes
Loreto
Amazonas
Piura
Lamba-
yeque
Caja-
marca
San Martín
La Libertad
Ancash
Huánuco
Ucayali
de Pasco
Cerro
Junín
Madre de Dios
Al 2003 la población del Perú es de 27 millones 148 mil 101 habitantes. Lima concentra el 28% de la población total.
Lima
velica
Huanca-
Cusco
Ica
Apurimac
Ayacucho
Puno
Arequipa E s t r a t i f i c a c i ó n s e g ú n p o b l a c i ó n t o t a l p o r d e p a r t a m e n t o s
Moquegua 1 2 4 6 6 6 4 - 7 7 4 8 5 2 8 9 7 3 4 2 - 1 2 4 6 6 6 3
Tacna 5 5 7 5 2 - 9 7 3 4 1 2 9 4 2 1 5 - 5 5 7 5 1 9 9 4 5 2 - 2 9 4 2 1 4

3. BACKGROUND INFORMATION
Basic health services are partially management to the local health direction, except to private health services.
Lima, The Capital City has the most number of private physicians, clinics and hospitals (specialty and tertiary, both public and private)
Implementation of the DOTS Strategy: 100%
TB, all forms is the 25th leading cause of morbidity and 11th leading cause of mortality (2004)
In 2004 the case detection rate was 65% and the cure rate was 89,6%
77% of Tuberculosis patients are productive population.

4. TB SYMPTOMATICS DETECTED
1992 – 2004
- 0.8 %
- 6,4 %
- 6.6 %
Source: DGSP-Operational Reports of SSNPyCTB

6. Pacients Organization
STAKEHOLDERS ANALYSIS
BENEFICIARIES
POTENTIAL OPPONENTS
IMPLEMENTING AGENCIES
DECISION MAKERS
FUNDING AGENCIES
Patients
Pharmaceutical Industry
Regional Government
Ministry of Health
Government of Peru
Family and community
Pacients Organization
Provincial Government
People Health Direction
Health workers
Private practitioner
Districtal Government
Local Government
Global Fund
Health Centres
Private clinics
NGOs
National Tuberculosis Program
Patient's Organization
Supplies providers

7. PROBLEM ANALYSIS Low case detection rate
High Morbidity and mortality rates from TB
Low case detection rate
CORE PROBLEM
Low number of case finding activities
Lack of knowledge about TB of the community
Weak monitoring and evaluation of NTP
Inadequate health education of the community
Insufficient trained health staff to conduct monitoring
Limited monitoring and supervision activities
Different level in M and S among coordinators
Poor quality of Laboratories activities
HW has low knowledge on NTP activities
There is no ACS Plan that is being implemented
Community not receive Health education by HWs
Low budget for Monitoring and Supervision
Poor condition of Laboratories facilities
Lab Health Workers are not trained
No update on NTP provided to professionals
Low budget to monitoring and supervision
Multifunction of supervisors
Lack of IEC materials
No regular HE activities conducted by H facilities
Insufficient Laboratory supplies
Poor maintenance of microscopes
Lack of budget for training programs
PROBLEM ANALYSIS

8. OBJECTIVE ANALYSIS Low Morbidity and mortality rates from TB
High case detection rate
Number of case finding activities increased
Good knowledge about TB of the community
Monitoring and evaluation permanent of NTP
Adequate health education of the community
Sufficient trained health staff to conduct monitoring
Adequate monitoring and supervision activities
Coordinators
With good of knowledgeabout M and S
Quality of Laboratories activities improved
HWs has knowledge on NTP activities
ACS Plan is being implemented
Health education was provided by the HWs
Low budget for Monitoring and Supervision
Conditions of Laboratory facilities improved
Lab Health Workers were trained
Updates on NTP given to professionals
Low budget to monitoring and supervision
Multifunction of supervisors
Laboratory supplies were sufficient provided
IEC materials were sufficient provided
HE activities were conducted by H facilities
Maintenance of microscopes was improved
Budget for training programs provided
OBJECTIVE ANALYSIS

9. OBJECTIVE ANALYSIS Low Morbidity and mortality rates from TB
CASE FINDING AND HE APPROACH
Low Morbidity and mortality rates from TB
HE AND M AND E APPROACH
P-P
High case detection rate
O-G
Number of case finding activities increased
Good knowledge about TB of the community
Monitoring and Evaluation permanent of NTP
O-P
knowledge about TB by community is improved
Sufficient trained health staff to conduct monitoring
Adequate monitoring and supervision activities
Coordinators
With good of knowledgeabout M and S
Quality of Laboratories activities improved
knowledge about TB by HWs is improved
ACS Plan is being implemented
Health education was provided by the HWs
Low budget for Monitoring and Supervision
Conditions of Laboratory facilities improved
Lab Health Workers were trained
Updates on NTP given to professionals
Low budget to monitoring and supervision
Multifunction of supervisors
Laboratory supplies were sufficient provided
IEC materials were sufficient provided
Budget for training programs provided
HE activities were conducted by H facilities
Maintenance of microscopes was improved
OBJECTIVE ANALYSIS

10. PROJECT SELECTION 5 3 1 14 8 20 10 CRITERIA
CASE FINDING ACTIVITIES APPROACH
HEALTH EDUCATION APPROACH
MONITORING AND EVALUATION APPROACH
COMBINED CASE FINDING ACTIVITIES AND HEALTH EDUCATION APPROACH
COMBINED HEALTH EDUCATION AND MONITORING AND EVALUATION APPROACH
COST BENEFIT 5 3 1
FEASIBILITY
SOCIAL RISK
AVAILABLE RESOURCES
TOTAL 14 8 20 10

11. PROJECT NAME:
“Improving case finding activities through effective Laboratory management and health education in the National Tuberculosis Program of Peru”
DURATION: April April 2009
TARGET AREA: Peru country
TARGET GROUP: Health workers and community.
DATE: February 12, 2006

12. Objectively Verifiable Indicators Important Assumptions
PROJECT DESIGN MATRIX
Narrative Summary
Objectively Verifiable Indicators
Means of Verification
Important Assumptions
Overall Goal:
To achieved a case detection of 90% or more
The case detection rate will increased by 40% in 2009
Annual Reports
Cohort Analysis
Health Indicators
The new government will permit to continue the project.
Project Purpose:
Case finding activities are improved.
2. Good knowledge about TB by health workers and community.
The number of TB cases detected increased by 20% in 2009.
The number of major errors are reduced by Laboratory reduced by 50% in 2009.
The number of health workers with knowledge about TB increased by 30% in 2009.
The number of community with knowledgeable about TB increased in 20% in 2009.
KAP Survey about knowledge in health workers and community
National Institute for Health continue to support the NTP
Trained health workers will remain working with the health directions.

13. Outputs:
Quality of Laboratories
activities improved.
Health Workers increased knowledge on NTP activities
Knowledge about TB for the Community is improved.
The number of Laboratories with good equipment and supplies increase by 40% in 2009.
The number of Health workers with high knowledge about NTP increase by 50% in 2009.
The number of community with high health education about TB increase by 30% in 2009.
Annual Report of National Institute of Health
KAP Survey about knowledge in health workers and community
National Institute for Health continue to support the NTP
Assigned budget for KAP Survey

14. Conditions of Laboratory facilities improved.
Activities:
Conditions of Laboratory facilities improved.
Laboratory supplies were sufficient provided.
Maintenance of microscopes was improved.
Med Tech and laboratory technicians were trained.
Budget for training programs provided.
Updates on NTP given to Professionals (P,N,M)
ACS Plan is being implemented.
IEC materials were sufficiently provided.
Health education activities were conducted by H facilities.
Health education was provided by the HWs.
Inputs:
NTP Staff.
Funds
Facilitators.
Surveyors.
NTP Coordinators.
Printer materials.
Meeting places.
Training materials.
Preconditions:
Acceptance of the project by the authorities of Ministry of Health.
Acceptance of the project by the authorities of Regional Directions of Health.
Allowance of budget for activities proposal.
Good attitude of Regional Coordinators.
Active participation of Stakeholders.
Active participation of Community leaders.

15. Inputs Activities NTP Staff Funds
Facilitators
Surveyors.
NTP Coordinators.
Printer materials.
Meeting places.
Training materials.
Conditions of Laboratory facilities improved.
Laboratory supplies were sufficient provided.
Maintenance of microscopes was improved.
Health worked were trained in TB.
Med Tech and laboratory technicians were trained.
Budget for training programs provided.
Updates on NTP given to Professionals (P,N,M)
ACS Plan is being implemented.
IEC materials were sufficiently provided.
Health education activities were conducted by H facilities.
Health education was provided by the HWs.

16. ACTIVITIES 1.GOOD CONDITION OF LABORATORIES
2. CONTINUOUS TRAINING OF HEALTH WORKERS
2.1. Get meeting with Regional Directors for increase budget for training.
2.2. Initial survey about KAS of TBC in Health workers and community.
2.3. Training about TB for Health Workers.
2.4. Refresh Training to Laboratory Health Workers.
1.GOOD CONDITION OF LABORATORIES
1.1. Hold meeting for Laboratory Technicians to do situational analysis.
1.2. Invite a professional manteinance companies to do manteinance activities (fixying,cleaning,etc).
1.3. Supply of laboratory materials each quarter.
1.4. Maintenance of microscopes.
1.5.  Acquisitions of new microscopes for replace old of them.

17. ACTIVITIES IT´S POSSIBLE ? 3.2. Activities of the ACS Plan
3. IMPLEMENTATION OF ACS PLAN
3.1. Activities about ACS Plan
3.1.1.Submit of summary report about ACS Plan to stakeholders.
3.1.2.Presentation to ACS Plan to authorities.
3.1.3.Approbation of ACS Plan to authorities.
3.1.4.Meeting with stake holders about ACS Plan.
3.1.5.Meeting with community leaders about ACS Plan.
3.1.6.Workshop with coordinators about ACS Plan.
3.1.7.Training to coordinators in ACS.
3.2. Activities of the ACS Plan
3.2.1.Preparation of IEC materials.
3.2.2.Distribution of IEC materials.
3.2.3.Local theathers,festivals
3.2.4.Rally
3.2.5.Interchange experiences
3.2.6.Monitoring meetings of ACS activities.
3.2.7.Evaluation meetings of ACS activities.
IT´S POSSIBLE ?

18. YES!!!
IT´S POSSIBLE FOR THEM!!

19. THANKS FOR YOUR ATTENTION AND WELCOME TO PERU!!
SACCSAYHUAMAN
MACHU PICCHU
THANKS FOR YOUR ATTENTION AND WELCOME TO PERU!!
AREQUIPA