IMPROVING CASE FINDING ACTIVITIES THROUGH EFFECTIVE LABORATORY MANAGEMENT AND HEALTH EDUCATION IN THE NATIONAL TUBERCULOSIS PROGRAM OF PERU” 2006-2009 WILLIAM GARAY LOPEZ, MD

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

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.

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

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

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

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

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

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

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

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.

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

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.

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.

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.

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 ?

YES!!! IT´S POSSIBLE FOR THEM!!

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