DOTS and Beyond. PPMD and Beyond.

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DOTS and Beyond. PPMD and Beyond.

• Rosalind G. Vianzon, MD, MPH
• NTP Manager
• Department of Health
• Manila, Philippines

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85
Reaching 85/70 through D. O. T. S.
Synchronize TB management among TB
Service Providers
Improve Treatment Success
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Improve QUALITY NTP-DOTS services
Engage the Private Sector into
NTP
Increase CDR
Detect MORE cases Find the Missing cases
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Stages of Establishing DOTS ()

• 1) Stage I - DOTS Maturation
• - operationally stable
• - provides DOTS services with quality
• - DOTS Certified based on the DOTS
• certification standards and criteria
• - with evidence of financial viability
• for DOTS implementation
• (DOTS accredited)

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Stages of Establishing DOTS ()

• 2) Stage II - PPMD Maturation
• - maturation of the approach to implement DOTS
  and to engage the Private.
• - high level of private sector participation
  either through
• DOTS service provision (Private facility)
• OR Referrals from Private Physicians
• - high utilization of existing DOTS services
• both by Public and Private sectors.

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PPMD Approach to Engage the Private
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PPMD Approach to Engage the Private
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Example of PPMD Matrix
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DOTS () Activity

• An advance stage of DOTS implementation
• Matured DOTS
• Evolves from successful DOTS implementation
• Targets
• a) Service Providers
• should include the Private Sector--? PPMD
• (high source of MDR cases)
• b) Service Seekers (Clients)
• Non-MDR TB cases
• Potential (Risk) MDR TB cases
• True MDR cases

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Stages of Establishing DOTS ()

• 3) Stage III - DOTS () Implementation
• a) Initiation stage
• - new and additional activities for
• an already existing DOTS facility
• - expression of commitments from all key
  stakeholders

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Stages of Establishing DOTS ()

• 3) Stage III - DOTS () Implementation
• b) Maturation stage
• - mainstream DOTS () activities
• into NTP-DOTS
• - activities anchored on the
• agreed set of policies, standards
• specific for DOTS ()
• - creation of an expert body
• DOTS Consilium

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DOTSPPMD Unit
DOTS Unit
IMPLEMENTATION
Stage II PPMD Maturation
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• Systems In-placing
• Logistics system
• Monitoring system
• Unit policies for
• Defaulter action

• Assessment of
• infrastructure
• Managerial Capacity
• - Technical potential
• - Operational feasibility

Advocacy to parties concerned
Capability Building
Laboratory Enhancement

• Solicit commitments
• Agree on terms of functions
• Promote ownership from the start

DOTS () PPMD Unit
DOTS PPMD Unit
MOU
Equipped Human Resources
IMPLEMENTATION
Baseline Survey
Quality Assured Lab (DST)
Stage III DOTS () Implementation
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Triad of Stepsfor DOTS () Scale-up

• Maintain quality DOTS services
• Scale-up PPMD installation while enhancing the
  existing ones (PPMD is the interface between DOTS
  DOTS )
• Allow DOTS () to mature in a stepwise fashion