Yemen National Tuberculosis Program .ppt

TB in Yemen

1. NTP Report
Implementation and Challenges
Ministry of Public Health and Population
Primary Health Care Sector
GD of disease control
National tuberculosis control program
Sana’a, Yemen
Dr. Esam Mohammed Mahyoub

2. •Yemen currently faces one of the worst humanitarian crises in the
world.
•The conflict started in 2011, followed by war on Yemen since 2015,
millions of people face risks for their safety and basic human rights;
over 22 million people need humanitarian assistance
•The war has forced massive human displacement; over 2 million
people are estimated to be internally displaced with resulting loss of
homes and livelihood with implications for disease control
•Civilian and socio-economic infrastructures, including health
facilities have been attacked, destroyed or heavily damaged;
•Only 50 % of health care facilities are estimated to be fully
functional.
•Based on new classification of World Bank 2018, Yemen
classified as Low-income country *
* https://blogs.worldbank.org/opendata/new-country-classifications-income-level-2018-2019
The context

3. NTP Structure
Central level
National Tuberculosis Control Program
Governorat level
23 governorates, including four main centers
(with culture and DST lab in Sana'a, Aden, Taiz, Hodeidah
District Level
333 district TB centers and 281 TB laboratories for Smear
Microscopy
Peripheral level
2,551 health units (primary health care units).

4. Background of TB
•Annual incidence: 48 cases/100,000 Pop.
•Detection rate : 73%
•Mortality rate 6.8/100,000.
•TB case notification,2018 :-
-Total Notified cases = 9745
-Bacteriologically confirmed: 3116
-Clinically Diagnosed: 6629
•Treatment success rate: 90%
•Incidence of MDR cases :
-1.4 among new cases and 14.4 among previously treated cases
(as per 2010 survey).
-Enrolled MDR cases on treatment in 2018: 40 cases.

5. New S.
positive
RelapseOtherNeg
1Abyan 56 1 0 116 38 211 2.2
2Aden 237 36 11 470290 1044 10.7
3Albaidah 56 1 0 49 48 154 1.6
4Aldale 41 2 0 30 51 124 1.3
5Al-Hudeidah 515 41 7 334375 1272 13.1
6Al-Jawf 57 2 1 18 3 81 0.8
7Almahara 22 1 2 7 9 41 0.4
8AlMahweet 29 0 1 45 30 105 1.1
9Almukalla 61 6 2 17 50 136 1.4
10 Amran 73 5 0 49 102 229 2.3
11Thamar 149 5 2 182224 562 5.8
12Hajja 292 35 6 722232 1287 13.2
13Ibb 341 26 1 224413 1005 10.3
14Lahej 75 7 1 193 69 345 3.5
15Mareb 39 2 0 68 15 124 1.3
16Sadah 79 2 0 101 99 281 2.9
17Sana'a city 291 27 2 253856 1429 14.6
18.Sana'a gov 67 5 0 96 151 319 3.3
19Sayoun 17 1 1 17 18 54 0.6
20Shabwah 39 1 2 36 29 107 1.1
21Taiz 276 28 2 114323 743 7.6
22Raima 22 0 0 14 17 53 0.5
23Soqutra 7 0 0 32 0 39 0.4
2,841 234 413,1873,4429,745
Pulmonary TB cases
Gov's
S
EP Total % Notified TB Cases distributed by governorates 2018

6. 0
2
4
6
8
10
12
14
16
% of notified TB cases by Govornorate 2018

7. Treatment success rate & lost to follow up 2010-2017
0
10
20
30
40
50
60
70
80
90
100
20102011201220132014201520162017
Success rate
Lost to follow up

8. Trend of Case Detection Rate and Mortality Rate 2010-2018
0
10
20
30
40
50
60
70
80
90
100
201020112012201320142015201620172018
mortality case detection rate

9. Southern
governorates
22%
Northern
governorates
78%
TB burden Northern VS Southern governorates
2018

10. NTP Performance

11. Status of activities implementation during 1
st
semester of 2019
Activities Responsibility
Allocated
amount status %
Social Support to
MDR/XDR-TB patients Food
baskets similar approach
implemented in MER1 ,
IOM & NTP 6526.8
NTP request and plan has been
submitted to the IOM since April
2019
50%
Monthly Office Support Cost
for NTP central unit
NTP
28200
The amount of 5 months(Jan-May
2019) already spent remain only
June which is under process
90%
Bi-annual Supervision visits
undertaken by the NTP
Central Unit and NRL staff
(Sana'a and Aden). 14 high
priority governorates will be
visited once in a year.
NTP
4607
Activity has been fully
implemented
100%
Quarterly Supervision visits
carried out by the
Governorate TB
coordination units staff (GLS
and GCTs). Each
governorate will expected to
identify high priority districts
(up to 30% of all districts in
governorate).. NTP
16480
Activity has been fully
implemented in the northern
governorates.
100%

12. Status of activities implementation during 1
st
semester of 2019
Activities Responsibility
Allocated
amount status %
Support Transportation cost of
MDR Specimens’ from
peripheral labs to NRL for
culture and DST.
NTP 8824
The mount of Q1 has been spent
and Q2 under process.
50%
Mobile Team Staff Cost
(Undertake systematic TB
screening among refugees
and IDPs), the team consist of
one medical doctor ,one lab
person in addition to the driver
,
NTP 15960
The activity started in April 2019,
the camps visits already done by
NTP Mobile team, remaining
disbursing the allowance and
salaries of the team by IOM.
80%
TOT training on clinical and
programmatic management of
drug resistant TB cases for the
staff in charge of PMDT NTP 4930
The amount is not enough because
training should be facilitated by
international consultant either in
Yemen or in the region.
This trainingwill take place after
finalizing and updating the PMDT
guide line and transitionplan
0
Cost for complementry
services as investingations for
MDR/XDR-TB patient (ex.:
ECG, serum creatinine, liver
serum enzymes, audiometry,
NTP 1400
The activity has been
implemented.
100%

13. Status of activities implementation during 1
st
semester of 2019
Activities Responsibility
Allocated
amount status %
"Printing of the algorithm
and job aids (adapting the
existing guidelines) for
clinical professionals for the
use of Gene Xpert."
NTP and IOM 2000
The NTP finalize the algorithm
and will sent it to WHO for
review and approval before
printing.
20%
Performance based
incentives for NTP Central
staffs in Sana'a and Aden
NTP 71820
implemented 100%
Performance based
incentives for select staff in
four MDR TB centres-for 4
centers including culture
and DST lab.
NTP 25500
The mount of Q1 has been
disbursed and Q2 under
process.
50%
Performance based
incentives for governorate
level staffs (1 GCT and 1 GLS
per governorate
NTP 41400
The mount of Q1 has been
disbursed and Q2 under
process.
50%

14. Status of activities implementation during 1
st
semester of 2019
Activities Responsibility
Allocated
amount status %
Annual monitoring meetings of
district coordinators will be
conducted at governorate level
NTP 53718
Activity has been fully
implemented in the Northern
governorates.
100%
Monthly Office Support Cost for
NTP regional TB
centers(Aden,Taiz,Al-hudeidah)
governorates and Aden
Regional center to cover
(communication, Office support
cost, )
NTP 6000
The amount of Q1.has been spent
to the governoratesand Q2 under
process.
50%
Notice:All procurement activities IOM responsibility.

15. NTP Indicators in MER 2
Remarks AchievementTarget in
Q1.2019
Indicator
The target has been
exceeded 2815 (100%)2541
Number of notified cases of all
forms of TB-(i.e.
bacteriologically confirmed +
clinically diagnosed) Includes
new and relapse cases
1
Thetarget could not
be achieved due to
decrease in MDR
case detection.
12 (85.7%)14Number of cases with drug
resistant TB (RR-TB and/or
MDR-TB) that began second-
line treatment
2

16. NTP
Gaps, Challenges and Solutions

17. Gaps
•Based on the current situation of Yemen, we were expecting sufficient grant
to cover at least the important activities however, we surprised that GF
allocated very limited budget for NTP in MER 2.
•The planned NTP activities in MER2 not met the needs of NTP to insure
effective TB control and prevention and leads to decrease the program
performance andwill lead to a decline in the quality and quantity of TB
services.
•The allocated grant ignored many activities as follows:
Activities that's increasecase detection and notification rate: Screening of
TB contacts,Public-Private-MiX(PPM) engagement, Community
participation activities, High risk groups activities…..etc.
Health education activities: Printing and distribution of HE materials, HE
activities in Media TV and radio stations , community HE activities……..etc.
Quarterly Transportation of slides from peripheral laboratories in the
districts to the National reference laboratory NRL, Sana’a & Regional
Reference Lab, Aden, in the framework of External Quality assurance (EQA).
Gaps

18. •Minimize the M&E activities as Meetings and Supervision visits at
all NTP levels.
•No Support for MDR transition plan 2019-2020.
•No Support for LTBI plan 2019-2020.
•Weak patient supports.
•Lack of operational cost for NTP at goveronrateslevel.
•Loss of human Resource at central and governorates level due to
high turnover and lack of motivation (no salary)
Gaps

20. •Looking for other sources for supporting the implementation of important
NTP activities
•Support of new MDR transition plan and LTBI plan 2019-2020.
•Many of the health centers that affected partially or completely
•Many medical equipment for TB diagnosis have been lost.
•Number of internally displaced population increased
•Estimated 1/3 (about 4000-6000 patients) of TB patients directly/ indirectly
affected in the conflict areas.
•Develop electronic data management systems to ensure good data quality
and fast reporting.
•Support running cost of TB centers in the governorates to cover the daily
needs of these facilities.
•Rehabilitation of damaged TB centers.
ChallengesChallenges

21. •Financial Support to critical staff at the central and governorates level to
maintain TB services
•Supporting rehabilitation of the main 4 TB centers in (Aden, Taiz,
AlHudiedah and Sana’a). These centers have not rehabilitated or
maintained since the establishment in 1984 through the support of JICA.
Furthermore, the TB lab in needs to upgrade.
•Support the operational researches and Epidemiological surveys that
aim to identify gaps, promote the use of new diagnostic tools and
assessment the implemented TB control strategies and policies.
•delay in procurement process at IOM.
•IOM dealing with two TB programs in Sana'a and the other in Aden,
that’s makes NTP disable to assess the implementation rate and money
absorptions.
•NTP faces difficulties in obtaining procurement documents from IOM
which required for documentation and for review purposes by relevant
parties.
Challenges

22. Solutions
•IOM and NTP should find other sources for supporting the implementation
of important NTP activities, to ensure effective TB control and prevention.
•NTP seek support of IOM and WHO to cover the cost of new MDR
transition plan and LTBI plan 2019-2020.
•Support from WHO is critical –both from the regional level and the country
office to:
Implementation of TB national survey.
Developing, Updating and review the National Lab. guidelines, SOPs…. etc.
Technical support to implement the operational researches.
Establishing the electronic data management system.
Request GF to increase NTP budget based on the country situation and
World bank classification.
WHO office in Sana’a contact with EMRO to send the report of last NTP disk
review.
Technical support.

23. Solutions
•IOM is the principle recipient for NTP grant and belonging to international
organization and the Strengthen of collaboration and coordination with IOM is very
important for:
Smooth implementation of MER 2 plan.
Additional fund from IOM to cover the new MDR transition plan and LTBI plan
2019-2020.
Accelerate the establishing of LPA unit at NTP central level as per the promise of
IOM.
Continuous contact with GF to cover the missing NTP activities.
NTP appreciating and thanking support of IOM to some activities not included in GF
plan ( activation of bactic system, Training on Gene-xpert, world TB day activities
and supporting the salary of PSM officer) and we request the continuation and
support to critical staff to maintain NTP services as head of departments at NTP.
accelerate the process of procurement at IOM ( Local market procurements,
running cost related procurements…etc) .
Provide NTP with copy of the procurements documents.
Provide NTP with implementation reports from both NTP ( Sana’a and Aden) to
assess the implementation and shortage as well as to evaluate the money
absorption among two programs .
Solutions

24. Solutions
•Coordination between MOPH&P and Organizations that’s supports health sector in
the country to unify the rate of daily allowance of health staff during the
implementation of various activities to avoid turnover of staff from program to
another.
•Approve the training activities due to important of these activity to improve the
health worker performance and to maintain acceptable quality level of delivered
TB services
•The MOPH&P must issue a circular to all health offices in governorates, districts
and health facilities to include all health staff in the incentives of the organizations,
especially those working in tuberculosis control , as they do not receive any
amounts from any party.

25. TB has killed
more people
but
Receives less
funding

26. Thank you