Introduction Thailand one of 22 countries which contain 80% of the estimated tuberculosis (TB) cases in the world. Thailand ranks 17 th among the 22 high-burden countries (HBCs) Low cure rates (17-68%). Patient compliance is the most serious problem in TB-control.

Background 1996 DOTS strategy was introduced in eight pilot districts 4-7 years later, DOTS covered all districts in each region/province Training and supervision are seen as a core active for improving Cohort report is seen as a tool for NTP monitoring and evaluation Cohort data report flow from DTC-PTC-RTC-NTC

Goals To achieve 100% DOTS coverage with sustained quality To achieve 70% case detection (PTB+>63/100,000) To achieve 85% success rate To reduce defaulted rate to less than 5% To reduce MDR-TB to less than 2%

MOPH DDC (TB cluster) Provincial Health OF District Hospital PCU 12 Regional /DPC (SALT cluster)

Political commitment has not been successfully communicated to the peripheral levels Decreased managerial capacity in the context Weakened financial basis of the NTP Decreased performance of the NTP Insufficient preparation for decentralized drug procurement

StaffPlace and duration At least one doctor per hospital At least one TB clinic staff per hospital At least one laboratory staff per hospital At least one DTC per district At least one health worker per health center At least one PTC per 500,000 population At least three RTCs per region One day at regional level Two days at regional level Three days at regional level Four days at regional level One day at district or provincial level Four days at regional level Four days at central level

Supervision The NTP has formulated a supervision plan covering all levels of the program as follows: Supervising staff LevelFrequency TB-Cluster RTC PTC DTC Health-center staff Regional level Provincial and district level District level Health-center level Patients’ home level (when supervised by family members) Once a year Trimesterly Monthly Weekly during intensive phase and monthly during continuation phase

The NTP should develop a standard mechanism for supervision and collaborative meetings. All health facilities should develop their own plans for supervision and meetings in accordance with NTP guidelines. The NTP should develop a training course focusing specifically on supervision skills.

Recording and Reporting The analysis of reports by program managers at the regional level is uneven. The content and depth of analysis of the reports shown to reviewers varied by region. Significant delays in forwarding and compiling reports were observed. Only 11 of 75 provinces had submitted reports. There are two parallel systems of reporting TB cases. One is for disease surveillance through Form 506 to the Bureau of Epidemiology, the other is for the NTP trimester report through form TB07 sent to the TB cluster

Four Competences Urban TB Control (9 Sub-contracts) Prison TB Control (3 Sub-contracts) HIV-TB integrated program (16 Sub-contracts) Cross-border TB control (3 Sub-contracts)

GFATM consolidated project activities Expand DOTS services and case detection Communities and outreach, education and case detection Surveillance and monitoring and evaluation Capacity building, training Network of laboratory and QA/QC system Integrated care with regular health systems, and HIV-TB services

The Result of Evaluation Areas On TB ControlGrade Urban TB controlB1 TB control of the bordersA2 TB and HIV/AIDSB2 TB-control in prisonsA2

Objectives Strengthen TB program-management at all levels Capacity-building, training of NTP human resources and improve quality of NTP Improve TB-information systems Expand TB programs, TB/HIV programs and increase collaboration of partnerships including private sectors Promote public awareness and TB education in the general population and marginalized populations, including TB/HIV-infected

THAILAND IMPLEMENTING THE STOP TB STRATEGY

DOTS Expansion Achievements 100 % DOTS coverage among health facilities under MOPH Established DOTS strategy to cover all 138 prisons nationwide Developed a comprehensive HR-development plan Introduced TB education in nursing school

DOTS Expansion Challenges Increasing laboratory capacity for EQA by using Lot Quality Assured Sampling and improving supervision, monitoring, and evaluation activities Strengthen laboratory capacity for sputum culture at intermediate laboratory levels Implementing DOTS in mega city Include a TB/DOTS chapter in all medical training curricula

DOTS Expansion Planned Activities Strengthen DOTS through improved supervision, monitoring and evaluation Finalize and implement HR development information system

TB/HIV, MDR-TB and Other Challenges Achievements Established national TB/HIV coordinating board Developed practice guidelines for collaborative TB/HIV activities and MDR-TB Trained health-care workers in collaborative TB/HIV activities Conducted third DRS Strengthened supervision, monitoring and evaluation in TB-control in mobile and cross- border populations and poor urban areas

TB/HIV, MDR-TB and Other Challenges Challenges Establishing mechanisms for NAP and NTP collaboration Developing TB/HIV training materials and curriculum Strengthening laboratory capacity in regional TB laboratories

TB/HIV, MDR-TB and Other Challenges Planned Activities Expand collaborative TB/HIV strategies to all administrative levels countrywide Develop further collaboration with NGOs working with migrants, mobile, and cross-border populations as well as the poor Pilot-testing of a practical guideline for MDR-TB Upgrade regional TB laboratories to reference laboratories

Strengthening Health Systems Achievements Developed collaboration between NTP and general hospitals and prison health services and conducted training for TB staff

Strengthening Health Systems Challenges Restructuring of health system, including the integration of tasks and rotation of staff Increasing numbers of illegal migrants and mobile and cross-border populations ineligible for universal health coverage Decentralization of budget-allocation system Improving computer-based recording and reporting system

Strengthening Health Systems Planned Activities Scale up collaborative activities with general public hospitals, prisons and military services Develop a list of standard indicators for TB management at all health facilities under MOPH

Involving All Care Providers Achievements Strengthened supervision, monitoring and evaluation of DOTS services in prisons

Involving All Care Providers Challenges Involving private practitioners and corporate health services in TB diagnosis and treatment

Involving All Care Providers Planned Activities Collaborate with academic institutions to introduce TB curriculum to nursing, medical, and public-health schools

Community TB Care and Advocacy, Communication & Social Mobilization Achievements Secured funding for community TB involvement from government and GFATM Appointed village health volunteers (VHVs) as community DOT-observers in pilot areas

Community TB Care and Advocacy, Communication and Social Mobilization Challenges Develop a national ACSM plan and technical capacity for ACSM at all levels

Community TB Care and Advocacy, Communication and Social Mobilization Planned Activities Scale up involvement of VHVs