PPM DOTS: Policy and Practice

1
PPM DOTS Policy and Practice

• Knut Lönnroth
• PPM DOTS Subgroup Secretariat
• Joint Meeting of the DOTS Expansion, TB/HIV and
  DOTS-Plus for MDR-TB Working Groups
• PPM Beyond DOTS, 16 October 2005, Versailles,
  France

2
Public Private Mix DOTS means
Approaches to link all relevant health care
providers to National TB Programmes in order to
foster International Standards for TB Care and
secure equity in access across the whole health
care system
3
All providers should

• Follow basic DOTS principles and use
  International Standards
• Provide quality assured anti-TB drugs free of
  charge
• Keep fees for tests and consultations at a
  minimum
• Accept supervision by and reporting to NTP

4
A potential role for everyone
5
NTP should

• Provide training adapted to the needs and
  conditions of the providers
• Provide drugs, equipment and stationary free of
  charge
• Coordinate, supervise, control quality
• Could be channelled through intermediaries such
  as NGO or medical association

6
Possible "contractual" mechanisms

• Informal agreements
• MoU
• Contracting
• Certification / accreditation
• Social franchising
• Reimbursement through specific TB-DOTS insurance
  package
• Non-financial incentives as important as
  financial (most initiatives have no direct
  financial incentives to providers)

7
Evidence base

• Over 20 countries with PPM experience

• Over 20,000 patients evaluated

• Treatment success around 80-90

• Improved case detection in all projects

• Cost-effective

• Reaches the poor

• Reduces burden for patients

8
Support for the scale up and mainstreaming of PPM
DOTS

• Stop TB Strategy
• Involve all care providers
• Implement International Standards for TB Care
• Global plan to stop TB 2006-2015
• Scale up of PPM DOTS in all regions
• MDGs No 6, No 1, etc.
• Engaging all health care providers to improve
  access, equity and quality of TB care - Guidance
  on implementing PPM DOTS. WHO/HTM/TB/2005.360.

9
"Guidance on PPM DOTS"

• National situation assessment
• Creating national resources
• Implementing PPM DOTS
• 3.1. Developing operational guidelines
• Formulating objectives
• Defining task mix
• Developing practical tools
• Training
• Certification
• Incentives and enablers
• Surveillance and monitoring
• 3.2. Guidance on local implementation
• Preparation
• Mapping
• Selection of providers

10
PPM Beyond DOTS

• DOTS Plus for MDR TB
• TB/HIV management
• Other health interventions