1. PARTNERSHIPS IN TB GBC WORKSHOP 15 October 2009 Lindiwe Mvusi

2. Ten Point Plan  Provision of strategic leadership and creation of Social compact for better health outcomes  Implementation of National Health Insurance (NHI)  Improving the Quality of Health Services  Overhauling the health care system and improve its management  Improved Human Resources Planning, Development and Management

3.  Revitalization of health infrastructure  Accelerated implementation of the HIV and AIDS strategic plan and the increased focus on TB and other communicable diseases  Mass mobilization for the better health for the population  Review of drug policy  Strengthening Research and Development

4. Strategic pillars  Political and managerial support  Availability of adequate resources  Effective programme management  Clear and complementary roles of all within the health system and our partners

5. Objectives  To strengthen the implementation of the DOTS strategy  To address TB and HIV, MDR and XDR-TB  To contribute to health systems strengthening  To work collaboratively with all care providers  To empower people with TB as well as communities  To coordinate and implement TB research  To strengthen infection control

6. Overall targets, 2011  Case detection rate: 70%  Treatment Success rate: >85%  Cure Rate: 85%

7. TB is a socio economic disease

8. Role of employers  To ensure a safe work place environment through –The development and implementation of clear workplace addressing; confidentiality, discrimination, length of time allowed for medical treatment and job modification when necessary. –Employees education on workplace policies –Implement environmental infection control measures to minimize risk of transmission of infection in the workplace.

9.  Conduct awareness and educational campaigns  Provide psychosocial support for employees who have TB such as –free treatment and services, –maintaining salary during treatment or providing compensation for loss of income, –free transport to health facilities, –food support and motivation of patients to continue treatment,

10.  Employee organizations –increasing awareness and understanding of the disease among employees. –advocating for employee health and safety as well as benefits –

11. For Profit Private Medical Sector  Identify TB suspects  Microscopy, culture and DST  Diagnose  Prescribe treatment  Supervise treatment  Defaulter tracing  Record keeping  Case notification  Drugs and supplies  Training  Surveillance  Quality assurance  Evaluation  Contact tracing

12. Role of other government departments Correctional services  Early detection and treatment  Prevention – infection control, IPT, improving living conditions  Referrals Schools  Infection control  Screening programmes  Education  Supportive environment for those with disease

13. Dept of Mineral Resources  Ensuring compliance to the law and guidelines  Monitoring  Early detection and treatment  Prevention – infection control, IPT, improving living conditions, dust control  Referrals – inter and intra country  Outreach to surrounding communities  Memorandum of agreement

14. Dept of Labour  Workplace policies  Education  Compensation Dept of Transport  Infection control in public transport –International travel (International Health Regulations)  Commuter education

15. Housing  Improving living conditions  Minimum standards to take ventilation into consideration Agriculture  Farming communities – education, improving living communities  Food security – gardening/ farming projects

16. Social Development  Poverty alleviation strategies  Food security  Social grants/ chronic illness benefit SAPS  Awaiting trial prisoners – access to care and proper referrals  Infection control

17. SAMHS  Sharing resources –access to services for surrounding communities  Early detection and treatment  Prevention – infection control, IPT, improving living conditions

18.  Sharing of resources to address inequities and strengthening health systems  Identification of key projects as part of social responsibility  Advocacy role  Joint monitoring

19. Role of NGO’s and Civil Society  Provision of treatment, care and support  Education and counselling of TB patients, families  Contact and defaulter tracing  Treatment literacy programmes  Facilitating referrals

20. Academic and research institutions  Conducting TB research  Forum for dissemination of research findings –National and International TB conferences First national conference 2008 Next 2 – 4 June 2010

21. Pharma and Diagnostic Industry  TB treatment  Vaccines  New diagnostic tools

22. Academic and training institutions  Pre-service curriculum including TB and HIV  In-service training  CME

23. Media  Increase the awareness and the knowledge about TB using all forms of media –Improve case detection and treatment adherence  Influence attitude and behavioral change, especially combat stigma and discrimination  Empower people affected by TB (literacy)  Dissemination of information

24. ACSM  Mobilise decision leaders’ commitment for TB  Increase awareness and knowledge about TB  Improve case detection and treatment adherence  Influence attitude and behavioural change, especially combat stigma and discrimination  Improve the quality of health care provided  Empower people affected by TB

25. Monitoring and Evaluation  Data collection tools and registers  Regular reporting – monthly, quarterly  Supervision  Evaluation –Internal –External  Review –Internal –External

26. WHO TB Review Key findings and recommendations

27. Challenges / weaknesses 1.Apparent reliance on externally funded projects to support some critical service support initiatives such as DOT supporters and defaulter tracers 2.Inadequate mainstreaming of data from private sector into national surveillance information 3.Diagnosis of childhood tuberculosis and provision of IPT

28. Recommendations 1.Ensure adequate, increasing and sustained funding for basic TB services at provincial and district levels 2.Promote implementation of patient centred approaches to TB care: Introduce a TB treatment initiation package incorporating pre- treatment counselling, identification and orientation of a treatment supporter (buddy) address verification visit family counselling to enhance likelihood of treatment adherence 3.Analyse the cost-effectiveness of various approaches put in place to improve case finding and treatment adherence

29. Recommendations 4. Enforce policy of active contact tracing and screening of close contacts of smear positive cases and M/XDR cases 5.Strengthen collaboration with all care providers including general hospitals, correctional facilities, businesses and the private sector to ensure universal provision of minimum standards of care 6.Conduct periodic TB prevalence surveys to determine disease burden and monitor impact of control interventions 7.Promote programme directed / focused operational research such as evaluation of service delivery models

30. Achievements 1.Evidence of initiatives to engage the private sector (NGOs, the mining sector, corporate workplaces, GPs, private clinics and hospitals) as well as public sector providers (correctional facilities, military etc).....with well documented working models for their engagement 2.Systematic and effective linkages between hospitals and PHC system

31. Challenges / weaknesses 1.No clear understanding of the extent of TB management in the private sector 2.No clear guidance on approaches to engage diverse private and public sector care providers 3.Ongoing PPM initiatives facing training, monitoring, supervision, drug supply, incentives and enablers, etc, challenges 4.Lack of collaboration with Medical Aid for TB care (unlike HIV programme) 5.Structural / managerial challenges related to linkages between DoH and correctional facilities and military services

32. Recommendations 1.Undertake a situation assessment to understand the current and future potential roles of non-DoH care providers in TB care and control 2.Develop national guidelines for engaging diverse private and public sector providers in TB care and control 3.Explore ways to collaborate with Medical Aid 4.Jointly with the Department of Correctional Services and Dept of Defence, prepare a simple manual outlining practical steps to organize TB control and care in these public sector facilities

33. Achievements 1. ACSM focal point and plan in place at the national level; and existence of ACSM task teams in some provinces..e.g. Gauteng 2. Availability of IEC materials in appropriate languages at most facilities 3. Community workers such as health promoters, peer educators, social mobilization officer nurses and VCT counselors involved in giving TB related education.

34. Achievements 4. Community based ACSM activities taking place: door to door campaigns, road shows, consultation forum, TB in HIV campaigns, mass events for screening TB patients, world TB day etc 5. NGOs and other stakeholders such as URC,TAC, CDC and companies like Novartis are involved in ACSM activities, including training and development of materials

35. Challenges / weaknesses 1.In adequate implementation of national TB Control ACSM plan…with poor coordination between national, province and district levels,… 2.Limited capacity to plan and implement ACSM activities at Provincial and district levels. 3.Activities conducted seldom linked to programme indicators.

36.  Current ACSM activities mostly address patients and communities …with little focus on health care providers and opinion leaders

37. Recommendations 1.Develop and implement decentralized ACSM action plans at provincial and district level …. in line with national ACSM plan.. supported by a frame work for supervision and monitoring of ACSM activities 2.Conduct KAP surveys to guide future strategic planning and provide baseline for impact assessments. 3.Ensure sustenance of home based care providers to continue ongoing community based activities.

38. 4.Use the opportunity of the robust HIV /AIDS ACSM and coordination channels for TB advocacy and coordination 5.Implement targeted ACSM activities aimed at improving programme performance indicators.

39. Overall conclusion 1.South Africa has made significant progress in implementing all elements of The STOP TB Strategy in line with recommendations of the 2005 review and key indicators and targets specified in the 2007-2011 TB Control Strategic Plan. Quality of services and key control indicators are improving overtime 2.Despite significant progress by the NTP during the past four years, TB remains a public health problem of epidemic proportions in South Africa, hugely driven by the HIV/AIDS epidemic.

40. Thank you for listening Together we CAN beat TB