Dr' Essam Azzam

1
Country Plan on PPM
E G Y P T

• Dr. Essam Azzam
• General Director of Chest Diseases
• Department,
• Executive Manager of NTP, Egypt
• MOHP

2
TB Situation in Egypt

• Tuberculosis is a major public health problem.
• Estimated around 19,000 new cases annually of
  which 9,500 smear positive cases.
• In 2002, NTP detected 4,889 SS cases
  representing about 50 of the expected cases.

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How to Improve the Case Detection Rate

• To reach detection rate 70. NTP proposes to
  collaborate with two other health care providers.
• First Health Insurance Organisation, a
  parastatal which covers almost half of the
  population. The HIO provides curative as well as
  preventive services through HIO hospitals,
  polyclinics, school clinics, specialized centers.
  The collaboration between the HIO and the NTP
  started since 1997.
• Second Private for profit practitioners It is
  estimated that these cover around 20 of TB
  patients. It is estimated that in Cairo there
  are 1650 private practitioners who see TB cases,
  but far fewer who treat them

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I. The Health Insurance Organisation

• Target population.
• The HIO covers 28.9 millions distributed as
  follows
• 4.2 millions newly born
• 16.6 millions students
• 6.6 millions employees
• 1.2 millions retired citizens
• 0.3 million widows
• Estimated number of new TB cases notified and
  treated.
• 2000 over two years. The number is less than that
  would be calculated using the annual rate of
  infection for Egypt. This is because of
• The age distribution of the target population.
• Different utilization of the health services..

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The Health Insurance Organisation (contd)

• Mode of collaboration.
• The NTP and the HIO updated the protocol of
  collaboration in 2002. This outlines a plan to
  establish 52 TB specialized centers all over the
  country. These centers are responsible for
• Diagnosis
• Registration
• Treatment
• Follow up
• Reporting of TB cases to the NTP.
• Strengthening of DOTS
• Contact tracing through notifying the chest
  clinics with the names of discovered cases to
  screen their families.

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The Health Insurance Organisation (contd)

• Activities ( 2 years )
• Phase 1 Orientation (3 months)
• Orientation meetings with the decision makers
  in the HIO
• Director general
• Central directors
• Executive directors.
• With other medical specialties in order to refer
  suspects to TB specialized centers
• Phase 2 Strengthening of TB specialised centres
  and DOTS implementation (18 months)
• Training courses (GCTs, Health Staff, Doctors,
  Nurses, Lab technician, HIO trainers (TOT) and
  Health Educators)
• Printing materials(NTP guidelines,TB and
  laboratory registers, Treatment cards, Quarterly
  reports and Health education materials)
• Phase 3 Evaluation (3 months)

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II. The Private For Profit Providers

• Target population.
• In Cairo and Alexandria Governorates.
• Population.
• 10 million.
• Expected number of new TB cases notified through
  private sector.
• 1000 over 2 years

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The Private For Profit Providers (contd)

• The NTP will begin collaboration with a large
  scale baseline survey (KAP)
• The project will then proceed by establishing and
  testing four different models of collaboration
• Supporting private providers to refer symptomatis
  to chest clinics
• Support chest physicians in the diagnosis and
  allow them to treat TB cases according to the NTP
  guidelines.
• Support chest physicians in the diagnose,
  treatment of TB and supply private chest
  physicians with TB drugs.
• Contracting private providers to diagnose and
  treat in collaboration with the health sector
  reform project of Egypt.

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The Private For Profit Providers (contd)

• Activities ( 2 years )
• Phase 1 Identifying private providers (3 months)
• Orientation workshops for partners.
• Design model of collaboration.
• Phase 2 Implementing interventions (18 months)
• Planning Workshops.
• Orientation workshops for partners.
• Supervision.
• Training.
• Printing materials.
• Phase 3 Evaluation (three months)
• Study design and implementation and analysis.
• Evaluation and monitoring.

10
Country Plan on PPM
Target Population
Expected TB Cases (2y)
Activities
Phase-1(3months)
Phase-2 (18 months
(Phase-3 (3months)
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Thank you