Strategic Planning for NTPs

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Strategic Planning for NTPs

• EMRO NTP Managers Meeting 2004
• Holger Sawert

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TB budget data 2003
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Making a plan a general framework
GOALS
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The general framework in TB control

• Goal
• Eliminate TB as a public health problem
• Objectives
• Detect and cure cases
• Products
• DOTS
• Activities/Process
• Training, supervision, supply of drugs/reagents
  etc
• Inputs
• staff, equipment, drugs, reagents etc.

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Stages of NTP development
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Determining the program stage
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DOTS and Beyond DOTS

• Most NTPs are in stage I or stage II, i.e., cure
  rate is below 85, detection below 70
• For these programs, ensuring quality
  implementation of the five DOTS components is the
  absolute priority
• Quality DOTS will ensure high cure rates and may
  also be sufficient to achieve high case detection

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TB Control The 5 components of DOTS

• Political commitment

• Diagnosis by microscopy

• Adequate supply of SCC drugs

• Directly observed treatment

• Monitoring, Management

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Setting the standards

• Commitment
• sufficient funding for all activities available
  at all levels
• Diagnosis
• labs well equipped, QA system in place
• Drugs
• drugs of good quality available at all centers at
  all times
• DOT
• all patients have appropriate supervisor
• Quality
• all training, supervision, monitoring according
  to guidelines
• records complete, reports adequate and timely

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Example of Task Analysis
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The management cycle
Planning
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Strategic evaluation
Goals achieved?
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Indicators for strategic planning

• Goals achieved?
• Prevalence, mortality
• Objectives achieved?
• Cure rate, case detection rate
• Planned activities and products produced?
• Process indicators for DOTS components

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Interaction planning and monitoring
GOALS
Process indicators
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Process indicators for DOTS

• Commitment
• Proportion of total financial requirements met
• Proportion of implementation units with adequate
  budget
• Diagnosis
• Proportion of units adequately equipped and
  supplied
• Proportion of symptomatics examined with 3 smears
• Proportion of units with adequate QA results
• Drugs
• Proportion of treatment units with stockouts
• Proportion of drugs that concur to standard
  quality criteria
• DOT
• Proportion of cases receiving adequate DOT
• Monitoring, development, management
• Proportion of staff trained
• Proportion of planned supervision and monitoring
  activities actually performed
• Proportion of units with accurate, complete and
  timely reports

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Example of a Problem Tree
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Turning problems into actionable objectives
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Actionable objectives
?

• Increase cure rate!
• Ensure uninterrupted
• drug supply!
• Design new drug
• logistics system!

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Thinking more deeply
Treatment centers not supervised
No money for per diems
NTP budget too low
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Thinking more deeply
Ensure supervision
Provide per diems
Provide transport
Ensure staff availability
Buy cars/ Advocacy ?
Money from MOH/donors
Employ staff/ Advocacy ?
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The management cycle
Planning buy drugs for 20,000 pts.
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Interaction Planning, monitoring, problem
analysis
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Obtaining actionable objectives
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Strategic activities based on problem analysis

• NTP can chose cheapest drug supplier
• obtain drug price quotes from several suppliers
• Advocacy to minister to allow alternative
  procurement
• Central level warehouse available
• construct new warehouse at central level
• Regional warehouses functional
• renovate warehouses at provincial level
• National drug logistics system available
• Hire consultant to design new drug logistic
  system
• revise national training material to include new
  drug logistic system (print separate brochure?)
• print and distribute new drug order forms
• hold training course on drug logistics with
  PTCs/DTCs
• include drug logistics in PTC supervision
  checklist

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The management cycle
Planning
Buy drugs for 20,000 pts.

• obtain drug price quotes from several suppliers
• Advocacy to minister to allow alternative
  procurement
• construct new warehouse at central level
• renovate warehouses at provincial level
• Hire consultant to design new drug logistic
  system
• revise national training material to include new
  drug logistic system (print separate brochure?)
• print and distribute new drug order forms
• hold training course on drug logistics with
  PTCs/DTCs
• include drug logistics in PTC supervision
  checklist

Drug procurement, distribution

Drug stockouts in 30 of all centers
No stockouts
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Challenges

• Making planning an important NTP activity
• E.g., annual planning workshop with staff from
  peripheral levels, in time for MOH budget
  submission
• Including process indicators in NTP monitoring
  system
• WHO indicator manual
• Little experience
• Collect actionable data
• Avoid data drowning

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Group exercise

• Each group to consider one DOTS component
• Are there problems with this component?
• Identify process indicators
• Analyze problems with problem tree
• Convert problem tree into activity tree
• Do the same exercise for other DOTS components!