SOMALIA

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NATIONAL SITUATION ANALYSIS FOR PPM
SOMALIA
PPM planning and budgeting workshop Cairo 25-28
Feb 2007
Dr Ahmed Bede PPM FP Dr Abukar Ali Hilowle
NTP/SC Dr Aayid Munim STB\WHO SOM
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Somalia TB Centers by Region
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Introduction

• Geography
• Somalia lies in the horn of Africa.
• population estimated 8,495 696 ( 60 are
  nomadic) (UNDP)
• Population Density 1 / 10 Km
• Socio-Economic
• Among the 5 poorest countries (UNDP)
• GNI 130 (UNICEF)
• GNP 170-200 (UNICEF)
• Health Indicators
• Average life expectancy is (41-43)
• Mortality rate under five (per 1000 live births)
  is about 225 (WHOSIS).
• Primary school enrolment is 13-16.
• Primary school enrollment 13-16
• General situation and security
• Complex emergency.
• Long lasting civil war

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TB Epidemiology 2006

• DOTS case detection rate 71
• Treatment Success Rate 89
• Male/Female ratio 1.8 1
• Death Rate4
• The annual risk of infection (ARI) 2.26
• According Stýblo ratio
• new cases of smear positive\years 6895
• Smear negative extra pulmonary 11945
• TB-HIV co-infection 4.6

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Notification 1995 - 2006
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Treatment outcome 1995-2005

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PPM Rationale

• CDR 71.
• Utilization coverage of suspect TB 30
• Dense network of private sector
• private practitioners 95
• Policlinic (Private Hospitals) 102
• specialist clinics 50
• Pharmacists 500
• Mix Public-Private doctors in private sectors.

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PPM Objectives

• Maintain the achieved case detection rate
• Maintain TB Patients Adherence
• Improve health seeking behavior
• Empower community involvement
• Empower private practitioners involvement in TB
  control through workshop and training
• Contact tracing.
• Maintain success rate more than 85.
• To implement the PPM-DTS in a remote areas.

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Factors Influencing Health Provider Choice

• Distance Most TB centers are accessible
• Confidence in DOTs strategy
• Motivation of current achieved TB targets
• Free service

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NTP Preparedness

• Focal point / NTP team for PPM
• NTP is sensitive and recognized the PPM future
  impact
• PPM Team is in place and working.
• The focal person for PPM is identified .
• Budget head for PPM? How much?
• No budget is allocated under GFATM 4th round for
  PPM.
• Fidelis support (Finished )
• Demand a comprehensive support from other donors
  for scaling up PPM .
• PPM part of strategy / operational plan?
• Operational plan has been proposed in NSA.

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Main Constraints for NTP to Expand PPM

• Lack of sensitization of some private
  practitioners
• Adopting TB guidelines in the clinics
• Security and stability concerns in some places
• Minimal Financial contributions from MOH
• No national Regulatory agencies exist for medical
  services and drugs.
• Uncertainty of continuity of donor commitment and
  support to maintain proposed PPM initiatives.
• .

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Experiences From Existing PPM Initiatives

• Better understanding on PPM initiative
• NTP guidelines adaptation in private clinics
• Improvement of TB notification, quality care and
  accessibility
• Sharing national responsibilities on TB care in
  public and private sections
• Improvement on TB laboratory services of all
  partners
• Commitment of MOH and Politicians to scale up PPM
  activities

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Regulatory Environment

• WHO\UNICEF has regulation on TB drugs and
  essential drugs
• No national Regulatory agencies exist for medical
  services and drugs.
• MOH\NTP has no regulation for TB diagnostic and
  treatment in private clinics or facilities
• Anti TB drugs are sold freely in pharmacy\chemist
  regardless on medical prescription.

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Tentative Task Mix Table
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Preparedness of the NTP

• The NTP policies are passive case detection
  enhance by awareness.
• TB control activities has been carried out
  through a net work of 47 TB centers and
  hospitals.
• All services are free for TB patients
• Access to NTP through facilities of the public
  accomplished through Fidelis project to involve
  private sector, police, and military.
• Strengthen Fidelis project to be sustainable and
  comprehensive for Public-Public and
  Public-Private mix (PPM) approaches
• Strengthen integration with PHC in referring TB
  suspect.

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Thanks
Hilowle
Bede
NTP
PPM
Private Clinic-PPM Team