Health Promotion and Diseases Prevention General Directorate FMoH National Tuberculosis & leprosy Prevention and Control PROGRAM Overview 5 th Annual TRAC Conference, October 09, Jimma, Ethiopia

Outline 1. Introduction 2. Achievements to date EFY Performance - TB - Leprosy 4. Challenges 5. The Way Forward

Introduction Tuberculosis is one of the majeure Public health problem in Ethiopia The 1 st hospitalizing and the 3 rd killer disease Prevalence of all forms of TB is 579/100,000pop Incidence of all forms of TB, 379/100,000 pop Incidence of new smear positive TB, 163 /100,000

Introduction Ranked 7 th on PTB and the 3 rd on EPTB magnitude among high burden countries. Rate of MDR-TB is 1.6% and 11.8% among new and retreatment TB cases respectively Number of case are increasing every year and a total of 1,166,863 TB cases are identified and registered for Rx under DOTS for the last 10 years free of charge.

Achievement to date

Ten Year CDR of S+ve and all forms of TB Vs WHO estimate

Achievement to date with WHO set targets

Proportion of Ppos, Pneg and EPTB

Performance of 2001 EFY 1.Tuberculosis, - DOTS Expansion, CDR and TSR DOTS coverage By health Facility (Health Center and Hospital) Reaches 92% A total of 122 Hospitals, 1,450 HCs, 642 Clinics and 1,253 HPs are providing DOTS and among them 139 are Private Health Facilities. About 667 HFs providing TB/HIV collaborative activities A total 145,602 all forms of TB and 3,322 Retreatment Cases were Diagnosed and registered for treatment

Performance of 2001 EFY - MDR-TB The renovation of saint Peters hospital is being finalized. MDR-TB implementation Guideline and Infection control guideline is printed. Staff are trained on Case and program management of MDR-TB The smear conversion rate of the 1 st pilot cases is encouraging Drugs for the 1 st cohort of 45 cases are procured and imported to the country.

Performance of 2001 EFY 1.Capreomycin 1gram powder for inj 2. Amikacin 500mg/2ml inj 3. Levofloxacin 250mg TAB BL 4. Levofloxacin 500mg TAB BL 5.Ethionamide 250mg TAB 6.Ethambutol HCl 400mg TAB 7.Cycloserine 250mg CAP BL 8. PAS acid sachet eq. to 4 g 9.Pyrazinamide 400mg

Performance of 2001 EFY 2. Leprosy Leprosy Case Finding and Grad II diablity: EFY YearNew casesChild rate %Grade II disability (%)MB (%) 19924, , , , , , , , , ,

Challenges *** Despite the tremendous effort and service expansion: 1. Unacceptably Low Case Detection Rate, 34%+ 4 for the last decade. 2.Very High Proportion of Smear Negative (34%) and Extra Pulmonary (35%) TB 3.Fragile Drug Management System and poor adherence to the National Algorithm 4.Persistent Under reporting Problem Which negatively affect the CDR. 5.The DOTS Service still not accessible to all rural residents ( restricted to HCs and Hospitals ) 6.Low proportion of PLHVIs Screened for TB/ Missed opportunity

National Status and MDG Target S/N Outcome Indicators Target 2015 Achievement 2008/09 1 Case Detection Rate of Smear Positive (Infectious) TB >70%34% 2 Treatment Success Rate of identified Smear positive TB >85%84% Impact Indicator 3 Prevalence of all forms of Tuberculosis per 100,000 Population Mortality due to all forms of Tuberculosis per 100,000 Population 2092 Far away to achieve the MDGs targets by 2015 specially impact indicators of Prevalence and Mortality Reduction due to Tuberculosis!!!

Missed Cases at different level

Challenges at different level 1. National Level Weak coordination and harmonization among stakeholders Absences of standardized training material Insufficient trainings for GHWs 2. Regional Level Weak Planning and implementation capacity Un standardized reagent preparation, packaging and transportation(RRLs) Poor drug management 3. Zonal and District level Absence of trained staff at Zonal and Woreda Health Offices Under/incomplete reporting

Challenge Con. 4. Health facility: a.The national diagnostic algorism is not properly followed b. Weak diagnostic laboratory services Lack of SOP Work over load Capacity of laboratory Technicians Poor maintenance and calibration Quality of microscopes- light vs electrical microscope Absence of lab Quality assurance system C. Cases are largely missed t OPD level and In different wards Missed opportunity form HIV pool, contacts D. Poor recording and reporting

Challenges con. 5. Community level Low level of Awareness Low demand for care Limited Accesses to TB diagnosis and treatment

FRAMEWORK TO SHIFT THECDR CDR >70% Pursue high quality DOTS expansion & enhancement Lab networking & EQA - TB/HIV collaborati on M&E HEWs’ involvement / community mobilization

The way forward DOTS Expansion with system wide approach/HSS Intensified Case Finding High level coordination with One plan, One budget and one report

The way forward 1.Coordination Revitalize/establish coordinating mechanism-stop TB partnership and TWGs Keep TB as standing agenda at the steering committee meetings Develop Standardized training materials Massive training to GHWs Resource mobilization Extensive Mass media utilization

The way forward Strengthen M&E - Regular Supportive Supervision - HMIS expansion and updating of tools 2. Service Delivery DOTS Expansion - new HCs and HPs Engagement of all care providers-PPM-DOTS Introduction of PICT - Screening of PLHIV/Contacts and other high risk groups Revise and implement treatment regimen - EH RH Adopt best practices

The way forward Laboratory Strengthening -Laboratory Quality Assurance /EQA -Fast track procurement and distribution of florescent microscopes to high volume HFs -Lab Equipments – Quality microscopes, maintenance and calibration -Proper reparation, storage, packaging, labeling and distribution of lab supplies -Training of Laboratory technicians

The way forward HEP -Utilization of HEWs to the full potential - Awareness/ demand creation-CC - Identification and referral of Suspects/ Sputum - DOT/ Treatment Support - Devise appropriate strategy for pastoralist comminutes

S/NORegionTotal Population Total number of Expected Smear Positive TB Cases/Year (100%) 70% 1Tigray 4,659,809 7,595 5,317 2Afar 1,524,044 2,484 1,739 3Amhara 18,696,265 30,475 21,332 4Oromiya 29,332,386 47,812 33,468 5Somali 4,794,481 7,815 5,471 6Benishangul Gumz 724,545 1, S.N.N.P.R 16,246,619 26,482 18,537 8Gambela 331, Hareri 198, Addis Ababa 2,957,433 4,821 3,374 11Dere Dawa 370, National79,835,354130,132 91,092 Expected Number of Smear Positive TB Cases to be identified in 2002 E.C by region to achieve 70% CDR.

Lets Stop TB through Partnership !!