1. Health Promotion and Diseases Prevention General Directorate FMoH National Tuberculosis & leprosy Prevention and Control PROGRAM Overview 5 th Annual TRAC Conference, 21-23 October 09, Jimma, Ethiopia

2. Outline 1. Introduction 2. Achievements to date 3. 2001 EFY Performance - TB - Leprosy 4. Challenges 5. The Way Forward

3. 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

4. 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.

5. Achievement to date

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

7. Achievement to date with WHO set targets

8. Proportion of Ppos, Pneg and EPTB

9. 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

12. 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.

13. 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

14. Performance of 2001 EFY 2. Leprosy Leprosy Case Finding and Grad II diablity:1992- 2001 EFY YearNew casesChild rate %Grade II disability (%)MB (%) 19924,73261381 19934,58471384 19944,94061586 19955,19361588 19964,78771488 19974,69871388 19984,09281175 19994,18771093 20004,4147991 20014,3027791

16. 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

17. 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 156579 4 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!!!

18. Missed Cases at different level

19. 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

20. 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

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

22. 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

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

24. 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

25. 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

26. 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

27. 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

28. 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 1,181 827 7S.N.N.P.R 16,246,619 26,482 18,537 8Gambela 331,483 540 378 9Hareri 198,020 323 226 10Addis Ababa 2,957,433 4,821 3,374 11Dere Dawa 370,269 604 422 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.

29. Lets Stop TB through Partnership !!