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Action Plan
Good Health Situation of Population in Capital of Myanmar
Yangon Division
By
DR MYA THIDA AYE
5
KACHINSTATE
SHAN(N)
SAGAINGDIVISION
CHINSTATE
RAKHINESTATE
MANDALAYDIVISION
MAGWEDIVISION
BAGODIVISION
AYARWADDYDIVISION
YANGONDIVISION
KAYINSTATE
KAYAHSTATE
MONSTATE
TANINTHARYIDIVISION
Map of Myanmar, Map of Myanmar, State / Divisional TB CentersState / Divisional TB Centers
SHAN(S)SHAN(E)
LAOS
CHINA
INDIA
BANGLADESH
MandalayMandalay Division2.
Chin State
SittweRakhineState8.
BagoBagoDivision7.
KayinState
MawlamyineMon State6.
PatheinAyeyarwadyDivision5.
TaunggyiShan (South)4.
KayahState
MyintkyinaKachinState
KyaingtonShan (East)13
LashioShan (North)12.
MyeikTanintharyiDivision11.
MagwayMagwayDivision10.
MonywaSagaingDivision9.
3.
YangonYangon Division1.
TB Centers State/DivisionsS/D TB O
No. of districts with TB team = 45 / 63No. of townships with TB team = 56/324 No. of townships with TB staff = 46 / 324
Yangon Division (Geography)• Area -3927.1468 sq mile• Population -6293,724 • Districts - 4 Doctor population -1:11636 • Townships -45 Nurses population -1:8863• Wards -603 Midwive population -1:3412• Village -2124• Village tracts -634• Urban household -507829• Rural household -1805314
Epidemiology of TB
• ARI 1.66% (1972)• 1.5% (1994)• 154/100,000 ARI est.incidence(WHO 2004)• About 85,000 new cases of TB/year• HIV sero +ve among TB -4.5%(1995-1997)• MDR TB among new ss+ve cases & previously
treated cases :4%&15.5% respectively(2002-2003 country wide survey)
History of NTP
• NTP started 1966• Integrated with PHC 1978• Replaced with SCC 1994• Adopted DOTS 1997• Covered 100%DOTS 2003
DOTS COVERED TOWNSHIPSDOTS COVERED TOWNSHIPS(1994(1994--2003)2003)
18
144 153 153 153168
231
0
36
72
108
144
180
216
252
288
324
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003Year
Tow
nshi
ps
Existing DOTS Townships
310
259
324
Treatment outcome of new SS(+)cases (Yangon Division) (2004)
• New SS(+cases) 7377• CDR 156%• Cured 67%• Completion rate 8%• Defaulter rate 13%• Death rate 4%• Failure rate 3%• Estimated NSS(+) 4720
Situation analysis
• Stakeholder analysis(catetorisation)• The beneficiaries are :peoples in the city.program manager;patients;• Health workers• Potential opponents :uncooperative health staff• Implementing agencies:government.ministry of health,Division of • Health,NGOS,DOTS providers,supervisors,health workers,health
voluntiers• Decision maker:government,ministery of health,division of health,• Program manager,TB coordinator,patients• Funding agencies:Government,Global fund,WHO,JATA,JICA,
High defaulter rate Failure to do sputum check up at the end of 6 month treatment High death rate
Weak defaulter tracing
Weak supervision of healthstaff
Lack of staff
Low Cure Rate
Poor health situation of the population
Patients misunderstanding on length of treatment
Insufficient explanation about TB treatment by
health center staff
Health staffs are not giving much attention to TB services
Patient has lack of Knowledge about Treatment of TB
Patient does not have sufficient health
education
TB/HIV co-infection
Poor collaboration and implementation between
NTP & NAP
No proper budget allocated
Health staff does not talk
about the treatment of TB
completely
PROBLEM ANALYSIS
Problem analysis
• Problem tree• The core problem in Yangon Division is (Low cure rate) and the
causes of its problem are:• 1.High defaulter rate :which is due to• weak defaulter tracing• patients' misunderstanding of length of treatment of TB• 2.Failure to do sputum check up at the end of 6 month treatment• Because of lack of health knowledge about treatment of TB• 3.High death rate :because of TB/HIV co infection
• The effect of low cure rate lead to increase transmission of infection• In the community and then lead to• Poor health situation of the population.
Low defaulter rate Routine sputum check up at the end of 6 month treatment Low death rate
defaulter tracing is improved
Good supervision of health
staff
Sufficient staff
High Cure Rate
Good health situation of the population
Patients knowledge on length of treatment
Is improved
sufficient explanation about TB treatment by
health center staff
Health staffs give much attention to improve TB services
Patient have moreKnowledge about Treatment of TB
Patient have sufficient health
education
Reduced TB/HIV
co-infection
Good collaboration and implementation between
NTP & NAP
proper budget allocated
Health staff talk About the treatment
Of TB completely
OBJECTIVE ANALYSIS
High defaulter rate(1)
Weak defaulter tracing
Weak supervisionof health staff
Lack of staff
Patients misunderstandingOf length of treatment
Insufficient explanation aboutTB treatment by health center
staff
Health staff are not giving much Attention to TB services
Poor health situation of the population
Low cure rate
High defaulter rateFailure to do sputum checkUp at the end of 6 month High death rate
Lack of health knowledgeAbout treatment of TB
Patient does not have Sufficient health education
Low defaulter rate(1)
defaulter tracingimproved
Good supervisionof health staff
Sufficient staff
Patients knowledge onlength of treatment is improved
sufficient explanation aboutTB treatment by health center
staff
Health staff give much Attention to improve TB services
Good health situation of the population
High cure rate
Low defaulter rateRoutine sputum check
Up at the end of 6 month Low death rate
Patients have more knowledgeAbout treatment of TB
Patient have Sufficient health education
Project selection
approach Defaulter tracing
Health education
TB/HIVcolloboration
Feasibility 4 4 3
Sustainability 4 4 3
Cost benefit 4 4 4
Availableresources
5 4 3
17 16 13
Project Design Matrix.
• PROJECT NAME: “Improvement of health situation of population in capital of Myanmar.
• DURATION: April 2006- April 2009.• TARGET AREA: Yangon Division.
TARGET GROUP:New sputum smear (+)ve TB patients.
Narrative Summarya Objectively Verifiable Indicators
Means of Verification
Important Assumptions
Overall Goal:To achieve good
health situation of population in capital of Myanmar.
Annual risk of infectionIs reduced from 1.5% to.8% by the end of March 2009.
•Annual Reports•Cohort Analysis •Health Indicators
government will permit to continue the project.
Project Purpose:To increase the cure
rate.
1.Cure rate is increasedfrom 67%to 85%in the end of March ,2009.
Township TB register, Quarterly Assessment register,Annual report of NTP.
Political commitment at Divisional level continue.
PROJECT DESIGN MATRIX.
Outputs1.Defaulter rate is decreased.
2.Patients”sputum check up at the end of 6 month treatment is increased.
1.Health workers defaultertracing is improved from30%to 60% by the end of 2000 March.
1.Follow up sputum check up increased from 20%to50% by 2009.
1.Quarterly reports from TB registersand treatment outcome.2.Laboratory reportand NTP annual report.
Activities: 1- Organize a workshop for health
workers.1-2 Conduct advocacy meeting
with stakeholders.1-3 Conduct group discussions
with mothers group, local leaders.
1-4 Provide health education to TB patients and to their families.
2- Plan for training programme for the health workers.
2-1 Conduct trainings for all health staff.
2-2 Distribute training materials.
3- Quarterly assessment and meeting of the TB officers.
Inputs:•NTP Staff •Facilitators•Printer materials.•Meeting places.•Training materials.•Global fund•IEC materials
Health facilities in Yangon Division• 1.Central hospitals 14• 2.200 beded hospitals 2• 3.150 beded hospitals 2• 4.100 beded hospital 1• 5.50 beded hospital 7• 6.25 beded hospital 11• 7.16 beded hospital 6• 8.station hospital 25• 9.primary T/S H C 28• 10.secondary 21• 10.RHC 77• 11.sub RHC 338• 12.MCH clinics 21• 13.school H clinics 21• 14.General practice 1553