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Stop TB Partnership
Peru: An experience to share in TB management
Beijing, April 3rd. 2009
Oscar UgarteMinister of Health
Fuente: MINSA/DGSP/Estrategia Sanitaria Nacional de Prevención y Control de la Tuberculosis
COUNTRY PROFILE: PERU
Area: 1’285,216 km2
Popn. Density: 21 inh. per km2.
Pop growth rate: 2.9 %
Population: 27’595,462
(8.7 million in Lima and Callao)
Economical growth (PIB) 2008: 9.8 %
Source: NTP Ministry Of Health Peru
In 2008: 32,644 cases of TB (60% in Lima-Callao) and 1,845 cases of MD/XDR-TB (83% in Lima-Callao).
THE ALLIANCE RESULTS
0
50
100
150
200
250
300
MORBILITY 198.6 202.3 256.1 248.6 227.9 208.7 198.1 193.1 186.4 165.4 155.6 146.7 140.3 123.8 124.4 129.0 129.3 122.8INCID. TBC 183.3 192.0 243.2 233.5 215.7 196.7 161.5 158.2 156.6 141.4 133.6 126.8 121.2 107.7 107.7 109.7 109.9 104.41INCID. TBP FP 116.1 109.2 148.7 161.1 150.5 139.3 111.9 112.8 111.7 97.1 87.9 83.1 77.4 68.8 66.4 67.1 67.9 64.5
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
KEY ACTIONS FOR THE FULLFILMENT OF THE AIMS
Public Policies Civil Society Participation
Leadership Complementary Financing
• Multisectorial TB Plan • Stop TB Committee
• GF, USAID, SES (PIH), CARE, PAHO, WHO
• Technical Policies• Technical Permanent Committee• Advisory Committee• Efficiency in Management Levels• Integrated Attention
• National and Sectorial Reform• Health Universal Insurance• Increase in Budget
PERU: BASIC PRINCIPLES IN MDR-TB MANAGEMENT
1. To establish a National TB Program that is efficient, effective and integrated into general health care services
2. To assure free access to quality medication (through applicationto the Green Light Committee).
3. To coordinate with the community and local governments to establish strategies that help ensure treatment adherence of theTB patient.
4. To provide free access to drug sensitivity tests.
5. To design an appropriate TB treatment regimen for the patient.
POSITIONING THE NATIONAL TB CONTROL PROGRAM AS A FUNDAMENTAL ELEMENT IN ENSURING POLITICAL COMMITMENT
Fuente: DGSP-Informes operacionales de la ESNPyCTB
LABORATORY NET:
LEVELS OF ORGANIZATION
LNRM
LRR : 23
LNI : 42
LOCAL LABS: 1289
National References Lab
Regional Labs
Intermediate Labs )
Local Labs
5300 URM Sample Colected Unit
BUDGET FOR NATIONAL TB CONTROL PERÚ 1991-2008
Source: National Strategy for the Prevention and Control of Tuberculosis, Ministry of Health
Annual Average Budget 1991- 2005 USD 3,000,000
Millions $ USD
Annual Average Budget 2006-2008 USD 10,000,000
DOTS Strategy:POLITICAL
COMMITMENT
TARGET: UNIVERSAL ACCESS TO MDR TB DIAGNOSIS & TREATMENT BY 2015ACHIEVED IN PERU IN 2005
2. FINANCIAL SUPPORT FOR MDR TB TREATMENT EVOLUTION
Lima and Callao + 7 regions
Partners in Health Government ResourcesGlobal Fund
2001-2004
85.2 %
Lima and Callao
2008
98.7 %
Iincluded 5 more regions
2005-2007
97.0 %
1. GEOGRAPHICAL EXPANSION OF MDR TB TREATMENT
0%
20%
40%
60%
80%
100%
2001 2002 2003 2004 2005 2006 2007 2008
• Since 2006 Rapid methods have been implemented (GRIESS or MODS) in 5 Regional Labs • The second semester 2009, Lima and Callao will have implemented the universalization of
rapid methods (For All patients with smear + TB).
Evolution of the Use of Drugs Sensibility Test, Peru 1995-2007
STRENGTHEN LABORATORY SERVICES FOR ADEQUATE AND TIMELY DIAGNOSIS OF MDR TB AND XDR TB.
0
2000
4000
6000
8000
10000
12000
14000
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Second-line DST First-line DST
-
2005 : NRL Began performing SL
DST
2005 : The first line DST decentralized The NRL to 5 RL
Source: NTP Ministry Of Health Peru
1. Free and rapid diagnosis and treatment in order to reduce the number of cases of TB and MDR TB. Context of Universal Insurance, recently approved.
2. Improve MDR/XDR-TB treatment, through:
• Expanding MDR TB care nationwide.
• Increasing and sustaining of laboratory capacities.
• Drug supply, laboratory materials, technical assistance, external quality control, monitoring and evaluation.
• Quality of the drugs.• Capacity building of human resources.
3. Increased of public resources (actually MoH finance 70 %) and improve the execution of funds from projects financed by Global Fund, USAID, CDC, Partners In Health and others (actually 30 %).
4. Strengthening of multisectorial action, and participation of organizations of people affected by TB and other actors of civil society.
5. National regulation: Evaluation and training of the multi-disciplinary teams in regional and local levels, social support to MDR TB patients and intervention activities in high-risk areas including prisons.
Multisectorial Strategic Plan 2009-2018
