1. Progress and plans for PPM in the WHO Region of the Americas Fifth PPM Subgroup Meeting 3 - 5 June, Cairo

2. Regional PPM Progress

3. Strategic Lines of the Regional TB Plan for the Americas 1. Strengthening and/or expansion of quality DOTS 2. Implementation and/or strengthening of the TB/HIV collaborative activities, MDR-TB prevention and control and strategies for unattended populations 3. Contribution to health system strengthening 4. Involvement of all health providers 5. Empowerment of affected populations and their communities, and implementation of ACSM strategies 6. Operational, clinical and epidemiological research

4. % of the population with access to health care according to provider - PPM countries 2007 PROVIDER CATEGORY DORBOLELSBRAMEXECU %%% MoH6030 40804228 Public Insurance725 2065721 Private Insurance20 143 Total Pub sect + Insurance8755601009949 For-profit or non profit Private Services12 526 Without coverage13 3335127 TOTAL100 The TB control is integrated in PHC by the MoH. Salud en las Americas, OPS/OMS 2007 Regional PPM Progress

5. PPM activities in priority countries Priority countriesNational Situation assessment conducted PPM focal person appointed PPM Operational guidelines developed DORPilot areaYes BOLPilot areaYes BRAPilot areaYes ELSNonYes MEXPilot areaYes ECUYes

6. Results from PPM surveys in Latin America Regional PPM Progress

7. ProviderBOL BRAELSDOR.% TB dx % TB Ttx % TB dx % TB Ttx Ref.% TB dx % TB Ttx Ref.% TB dx % TB Ttx Public93.294.486.898.997.8100 87.7 76.7 Private4.53.313.21.12.20012.3 23.3 Results from PPM surveys in Latin America Regional PPM Progress

8. * In process (MEX, ELS and URU) ACTIVITIES 2006-2007 Number Of countries PPM in the national action plan10 Carried out the PPM survey protocol* (In pilot areas) 6 Carried out the PPM survey protocol (Whole country) 1 Map Providers (In a pilot area)6 Map Providers (Whole country)1 Assess NTP capacity for PPM6 Selection of providers (Prioritization)6 Defining the “task mix”2 ISTC Endorsement by the MOH*2 Regional PPM Progress

9. To date, most of the NTPs have carried out alliances with other suppliers specially with the public sector not previously involved (hospitals, public insurance, prisons, military and police health services and others). Other initiatives have been carried out with the universities and professional societies and to a lesser extent with NGOs and for-profit private sector. The NTPs’ experience engaging private pharmacies and traditional medicine is scarce. Regional PPM Progress

10. Countries with PPM initiatives in place MEX ELS DOR BOL BRA ECU Countries planned to initiate PPM COL GUA PAR URU PPM Regional PPM Progress

11. PPM contribution to TB control in El Salvador

12. Mexico National meeting to present the PPM objectives and action lines Verification of degree of involvement of the NTP and the private sector Validation of evaluation form for each state involved Draft of validated National Standards of Care based on the ISTC and national TB norms Agreements with the industry and federal laboratory Agreements with schools of medicine and nursing Agreements with national pharmacies association Agreements with national private hospital association Nine states (25%) already with PPM activities Regional PPM Progress

13. Brazil Agreement between the Ministry of Health and the Business and Industrial sector (SESI) for the diagnosis and treatment of TB in patients found in the work force of the sector. Notification and reference of all TB cases within the health system (SUS) with guarantee of diagnosis and TB drugs financed by the MoH. National Brazilian consensus for TB management with wide involvement of Pneumology Society, TB Research network and schools of medicine. Ministerial resolution endorsing a TB control plan for prisons, indigenous population and TB/HIV. Regional PPM Progress

14. Brazil Provider groupInvolvementContribution Professional associations Yes Corporate SectorYes HospitalsYes Informal providersNO Private laboratoriesYes PrisonYes Industrial SectorYes

15. Weakness of the NTP leadership in some countries Limited experience in coordination, integration and alliances with other actors Public and private insurance security focused on curative care Segmented and disorganized private sector with limited interest. Scarce knowledge of the role and coverage of the private sector, including private pharmacies. Scarce knowledge of the participation of tradicional medicine Constraints and challenges for PPM implementation in the Americas

16. Opportunities for PPM implementation in The Americas PPM included in the Regional TB plan and several country plans, some with specific budgets and indicators. PPM activities supported by the GFATM Existence of technical and financial support from partners Free TB drugs available Some positive pilot experiences in countries and expansion already underway ISTC available and Regional implementation guidelines developed National Stop TB partnerships already organized in 4 countries: Brazil, Honduras, Mexico and Peru

17. Expand the PPM initiative at country level in BOL,ECU, DOR, BRA, MEX. Carry out the PPM surveys in four countries (COL, PAR, GUAT, URU) and implement the PPM initiative Promote the adoption of the ISTC and the Patient chart  improve the quality on DOTS among all health providers. Disseminate the implementation guidelines for the ISTC The adoption of the ISTC is recognized as a great opportunity to reach the objectives of TB control in the Region. Regional Priorities 2008-2009

18. Strengthen advocacy efforts to include PPM activities in all TB country plans and Global Fund projects Conduct PPM consultant training workshops at Regional level Continue and strengthen technical support to countries for PPM planning and implementation including effective engagement of private laboratories and involvement of informal health care providers and pharmacies. Regional Priorities 2008-2009

19. The Americas involving all health providers in TB Control THANK YOU !