vKÁbNþúHbNþalsþIBIC sMrab; MgWrebg · RbeTskm

ÉksarENnaMGñkbNþúHbNþal

sMrab;

vKÁbNþúHbNþalsþIBICMgWrebg

dl;buKÁlik»sfsßankñúgRbeTskm<úCa

2005-2011

ÉksarENnaMGñkbNþúHbNþalsMrab;vKÁbNþúHbNþal

sþIBICMgWrebgdl;buKÁlik»sfsßan

kñúgRbeTskm<úCa

RbeTskm<úCa 2005 - 2011

ÉksarENnaMGñkbNþúHbNþalsMrab;vKÁbNþúHbNþal sþIBICMgWrebgdl;buKÁlik»sfsßan l i

esckIþEføgGMNrKuN

This training guide was prepared for review by the United States Agency for International Development (USAID) under USAID’s TB IQC Task Order 01, Contract No. GHN-I-00-09-00006. The primary authors are Hara Mihalea, PATH ACSM/PPM Technical Officer and H.E Yim Yann Former President of the Pharmacists Association of Cambodia. Barbara Bale provided editorial support. PATH would like to thank the following organizations and individuals without whose participation and support this work would not have been possible: His Excellency Dr. Mao Tan Eang, CENAT Director; Dr. Tea Bakhim, National PPM Focal Person; His Excellency Ph. Yim Yann, Ph. Mao Dareth former President of the Pharmacists Association of Cambodia; provincial health department directors and operational district directors in all PPM sites; PHD and OD pharmacy units, participating staff from pharmacies, DOTS health centers and referral hospitals; technical partners including the Japanese Anti-Tuberculosis Association and WHO; the PATH TB team in Cambodia, particularly Hou Samith, Chengli Bota and Heang Kim Hor and the USAID Cambodia Mission, particularly Dr. Chantha Chak and Kate Crawford for their support of and commitment to improving public health in Cambodia.


ii l ÉksarENnaMGñkbNþúHbNþalsMrab;vKÁbNþúHbNþal sþIBICMgWrebgdl;buKÁlik»sfsßan

GkSrkat; nigkarbMRBYj

BCG Bacille Calmette-Guerin- fñaMbgáarCMgWrebg

DOTSkarBüa)aledayRtYtBinitüpÞal;ry³eBlxøI KWCayuT§sa®sþénkarBüa)alCMgWrebg

EdleFVIeGayR)akdfaGñkCMgWelbfñaMEdlcaM)ac;rbs;eK

IEC B½t’man karGb;rM nigkarR)aRs½yTak;Tg

MDR TB BhusuaMénfñaMrebg

MHD mnÞIrsuxaPi)alraCFanIPñMeBj

NTP kmμviFICatikMcat;eraKrebg

OD kariyal½ysuxaPi)alRsukRbtibtþi

PAC smaKm»sfkarIkm<úCa

PATH kmμviFIbec©kviC¢asmRsbkñúgvis½ysuxPaB

PPM PaBCaédKUrvagesvasaFarN³ nigÉkCn sMrab;karGnuvtþyuT§sa®sþdUts_

SS+ kMhakviC¢man

TB eraKrebg

USAID TIPñak;garshrdæGaemriksMrab;karGPivDÆn_GnþrCati

WHO GgÁkarsuxPaBBiPBelak


ÉksarENnaMGñkbNþúHbNþalsMrab;vKÁbNþúHbNþal sþIBICMgWrebgdl;buKÁlik»sfsßan l iii

matika

esckþIepþIm >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> iv

esckþIsegçbvKÁnImYy²énsikçasala >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>vii

éf¶TI1 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>1

smasPaK I³ Gakb,kiriya-karBRgwgKuNPaBesvakmμEdlpþl;eday»sfsßan nig»sfsßanrg >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 2

vKÁTI 1 ³ esckþIepIþm nigkarrMBwgTuk >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 2

vKÁTI 2 ³ tYnaTIrbs;buKÁlik»sfsßan-rg kñúgkarelIkkMBs;suxPaBrbs;RbCaCn >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>3

vKÁTI 3 ³ ]bsKÁrbs;»sfsßan-rg kñúgkarbMeBjtYnaTI >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 7

segçbéf¶TI 1 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>8

éf¶TI 2 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>9

smasPaK II³ Epñkbec©keTssþIBICMgWrebg-PaBCaédKUesvardæ nigÉkCn kñúgkarGnuvtþyuT§sa®sþ {dUts_} >>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 10

vKÁTI 1 ³ B½t’mansþIBIRbvtþiCMgWrebg >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>10

vKÁTI 2 ³ kareFVIeraKvinicä½y karcMlg nigkarbgáarCMgWrebg >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 11

vKÁTI 3 ³ dMeNIrkarénkarbBa¢Ún >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>14

segçbéf¶TI 2 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 15

éf¶TI 3 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 17

smasPaK III³ karR)aRs½yTak;Tg - GnuvtþCMnajR)aRs½yTak;Tg edIm,IelIkkMBs;suxPaBshKmn_ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>18

vKÁTI 1 ³ RbsiT§PaBénCMnajR)aRs½yTak;Tg >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>18

vKÁTI 2 ³ karR)aRs½yTak;TgCamYyGtifiCn >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>20

segçbvKÁbNþúHbNþal >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>22

]bsm<½n§ I ³ bTbgðajB½t’manEpñkbec©keTssþIBICMgWrebg >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 23

]bsm<½n§ II ³ snÞanuRkménBaküCMgWrebg >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>29

]bsm<½n§ III ³ taragsMnYrsakl,g mun nigeRkaysikSa >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>31

]bsm<½n§ IV ³ TMrg;EbbbTvaytMélRbcaMéf¶ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>33


iv l ÉksarENnaMGñkbNþúHbNþalsMrab;vKÁbNþúHbNþal sþIBICMgWrebgdl;buKÁlik»sfsßan

esckþIepþIm

CMgWrebg KWCaCMgWqøgEdlbgáeday)ak;etrIeQμaH

mIkU)ak;etrIyUmTuyEb‘kKuyLÚsuIs EdlCaTUeTAekItman

enAkñúgsYt. vaRtUv)ancMlgBImnusSmñak;eTAmnusSmñak;

eTot tamry³karRsUbdMNk;TwktUc² EdlmanpÞúkemeraK

rebgecjBIbMBgk nigsYt eTAkñúgxül; enAeBlGñkCMgW

rebgsYt k¥k kNþas; niyay b¤esþaH. karmin)anBüa)al

GñkmanCMgWrebgskmμ nwgGaccMlgCamFüm 10 eTA 15

nak; erogral;qñaM. GñkEdl)anqøgemeraKrebg ehIysuxPaB

enAl¥ CaerOy²KμaneraKsBaØarebgeT edaysarRbB½n§karBar

rbs;eKCYyTb;)ak;etrIeGaysMgM. enAeBlEdlRbB½n§karBar

rbs;mnusSEdl)anqøgrebgenaHRtUv)ancuHexSay Biess

GñkEdl)anqøgemeraKeGds_ enaHCa»kasCaeRcInEdlnaM

eGayekIteTACarebgskmμ.

TUTaMgsklelak CMgWrebgsMlab;mnusSeRcInCag 2

lannak; kñúgmYyqñaM eTaHbIvaCaCMgWGacbgáar)an nigGacCa

sHes,Iy edayBüa)alCary³eBl 6 Ex. rebgEdlmin

suaMfñaM KWPaKeRcInCasHes,Iy RbsinebIGñkCMgWBüa)alcb;

edayrUbmnþRtwmRtUv nigTan;eBl. ebIkarBüa)almin)an

RtwmRtUveT eRcInCagBak;kNþalénCMgWrebgskmμnwgsøab;

kñúgeBl 5 qñaM.

km<úCasßitkñúgcMeNamRbeTsTaMg 22 kñúgBiPBelak

EdlmanbnÞúkCMgWrebgF¶n;F¶r ¬22 RbeTs esμI 80° én

BiPBelak¦. bc©úb,nñ GaMgsuIdg;énCMgWrebgRKb;sNæan

manRbmaN 500 nak; kñúgcMeNamRbCaCn 100 000 nak;

nigCMgWrebgsYtviC¢manebka manRbmaN 220 kñúgcMeNam

RbCaCn 100 000 nak;. cMnYnénkrNICMgWrebgfμI )anekIn

eLIg 3 dg kñúgTsvtSknøgmk. GRtaeRbvaLg;énkarqøg

CMgWeGds_kñúgcMeNammnusSeBjv½y ¬15-49 qñaM ¦ man

RbmaN 1/6° nigGRtaeRbvaLg;énkarqøgCMgWeGds_kñúg

cMeNamGñkCMgWrebg)anekIneLIgBI 2/5° ¬qñaM1995¦ eTA

10° ¬qñaM 2006¦.

esvaÉkCn)anedIrtYy:agsMxan;kñúgkarpþl;esvaEfTaM

suxPaB edayehtufa RbCaCnkm<úCamancMnYnKYrkt;sMKal;

rab;TaMgbBaðasuxPaBRsal nigF¶n;F¶rman; )anEsVgrkkar

EfTaMsuxPaBenAkñúgesvaÉkCn. CaerOy²esvaÉkCn

min)anTTYlkarGb;rMRtwmRtUv cMeNHdwg nigCMnajmankRmit

RBmTaMgmankarshkartictYcCamYyesvasaFarN³.

karBRgIk nigkarbBBa©ÚlénkarrYmshkarKñarvag

esvasaFarN³ nigÉkCn sMrab;karGnuvtþyuT§sa®sþdUts_

KMrU (PPM) nwgbegáIny:agxøaMgnUvGRtaRsavRCavkrNIrebg

nigeFVIeGaykareFVIeraKvinic½äy nigkarBüa)al)anl¥RbesIr

eLIg.

edaysarRbCaCnPaKeRcInCadMbUgEsVgrkkarBüa)al

CamYyesvaÉkCn. karBRgwgnUvCMnajénesvaÉkCnsMrab;

tYnaTId¾smRsbkñúgkarkMNt; nigRKb;RKgCMgWrebg RBmTaMg

karbegáInénkarTak;TgKñaBIesvaÉkCneTAesvadUts_

saFarN³ nwgmanplRbeyaCn_ dUcxageRkam ³

kat;bnßyPaByWty:avénkareFVIeraKvinicä½y edIm,I

Büa)alCMgWrebgRtwmRtUv. dUecñH vaeFIVeGayekIn

eLIgénGRtaRsavRCavCMgWrebg.

BRgwgPaBCaédKU nigTMnak;TMngrvagesvaÉkCn

nigsaFarN³kñúgkarRKb;RKg nigkMcat;CMgWrebg

tamry³RbB½n§bBa¢ÚnBIesvaÉkCneTAesva

saFarN³ EdlmandUts_.


ÉksarENnaMGñkbNþúHbNþalsMrab;vKÁbNþúHbNþal sþIBICMgWrebgdl;buKÁlik»sfsßan l v

etIÉksarENnaMenHsMrab;nrNa?

ÉksarENnaMenH KWEp¥keTAelIkmμviFIbNþúHbNþal

EdlRtUv)aneRbIR)as;sMrab;buKÁlik»sfsßan-rg EdlbegáIt

eLIg nigeFVIkarsakl,gedayGgÁkar PATH. enARbeTs

km<úCakavivtþn_BIvKÁbNþúHbNþal EdleFVIeLIgsMrab;buKÁlik

»sfssßan-rg kñúgkarelIkkMBs;GRtaRsavRCavrebg

sgS½yenAesvaÉkCn edIm,IbBa¢ÚneTAkan;esvasaFarN³

Edlman dUts_. enH KWCaEpñkényuT§sa®sþ PPM énkmμviFI

CatikMcat;eraKrebg nigpþl;mUlniFiBI USAID CamYyCMnYy

bec©keTsBIGgÁkar PATH. ÉksarENnaMenHeFIVeLIgkñúg

eKalbMNgsMrab;EckrMElkeTAGñkbNþúHbNþalCMgWrebg

énmnÞIrsuxaPi)alRkug mnÞIrsuxaPi)alextþ RsukRbtibtþi

nigsmaKm »sfkarIkm<úCa (PAC) Edl)ancUlrYmvKÁbNþúH

bNþalRKUbegÁal. ÉksarENnaMenH sMrab;GñkbNþúH-

bNþal edIm,IerobcMsikçasalary³eBl 3 éf¶ Edlman

cMNgeCIgfa {etIcat;EcggGtifiCnEdlsgS½yekItCMgWrebg

y:agdUcemþc?} sMrab;»sfkarI nigbBa©ÚlnUvCMnajR)as½y

Tak;TgpgEdr sMrab;buKÁlik»sfsßan-rg. GñkbNþúH-

bNþalepSg²eTot GaceRbIR)as;ÉksarenHpgEdr

edayGñkTaMgenaH)ancUlrYmvKÁbNþúHbNþaldMbUg.

eKalbMNgénsikçasala

enAeBlbBa©b;sikçasala sikçakamnwgGac ³

1- yl;dwgRbesIreLIgBIsßanPaBCMgWrebgénGtifiCn

begáIteGaymanbriyakasl¥sMrab;pøas;bþÚr\riyabf

karbgðajnUvCMnajR)aRs½yTak;TgsMrab;karGb;rM

dl;GtifiCn ehtudUecñHvaCYybegáInplRbeyaCn_

kñúgkarTTYl)ankarRsavRCavrkemeraKrebg nig

Büa)alCMgWrebgcb;RtwmRtUv.

2- bgðajnUvcMeNHdwgGMBIsßanPaBCMgWrebg nigkmμviFICati

kMcat;eraKrebgenAkm<úCa nigyl;dwgGMBItYnaTIrbs;

buKÁlik»sfsßan nig»sfsßanrg kñúgkarkMcat; nig

bgáarCMgWrebg.

matikaénÉksarENnaMGñkbNþúHbNþal CMgWrebgman ³

segçbmatikaénvKÁbNþúHbNþal

bBa¢IsMPar³caM)ac;sMrab;eRbIR)as;kñúgvKÁbNþúHbNþal

esckþIENnaMsMrab;éf¶nImYy²énvKÁbNþúHbNþal

kMnt;sMKal;bEnßmsMrab;GñkbNþúHbNþaledaypþl;

nUvB½t’manlMGitGMBImatika nigGMBIrebobGnuvtþn_

vKÁsikSanImYy².

cMnucKnøwHEdlRtUvcgcaM

eFIVEpnkarvKÁsikSa edayeRbIR)as;ÉksarENnaMenH

edayrYmbBa©ÚlnUvkMNt;sMKal;bEnßmrbs;GñkbNþúHbNþal

sMrab;vKÁsikSanImYy².

eRtomeRbIR)as;RkdaspÞaMgsFM nigviFIsa®sþ

epSg²eTot edayminBwgEtelIGKÁIsnI kuMBüÚT½r nig

Projector.

GñknwgRtUvkarGñkbNúþHbNþal 2 nak; EdlGac

dwknaMvKÁsikSa sRmbsRmYldMeNIrkar nigkt;Rta

lT§plkMLúgeBléf¶enaH.

Tukry³eBl 5 naTI éncugem:agéf¶nImYy² edIm,IbUk

srubcMnucKnøwHTaMgLay.

Tukry³eBl 5 eTA 10 naTI enAeBlcab;epþImem:ag

dMbUgénéf¶TI 2 nig TI 3 edIm,Ibgðajkarsegçbén

B½t’manRtlb;rbs;sikçakamBIéf¶mun².

eFVIkarcrcaCamYysikçakamepSgeTot RbsinebIGñk

RtUvkareBlevlabEnßm eRcInCageBlevlaEdlkMNt;

eGay.

RtUverobcMbnÞb; edIm,IeGaysikçakamGacGgÁúyCarag

knøHrgVg; minEmnCaCYreT

ral;RkdaspÞaMgsFM EdleRbIR)as;kMLúgeBl

sikçasala KYrbiTenAelICBa¢aMgénbnÞb;vKÁsikSa.


vi l ÉksarENnaMGñkbNþúHbNþalsMrab;vKÁbNþúHbNþal sþIBICMgWrebgdl;buKÁlik»sfsßan

vKÁsikSa KYrRtUv)aneRbIR)as;viFIsa®sþénkarcUlrYm

TaMgGs;Kña minEmneFIVkarbeRgónEtm:üagenaHeT.

RKb;sikçakammanbTBiesaFn_pÞal;xøÜn edIm,IEckrMElk

Kña. sYrnUvsMnYrebIk nigelIkTwkcitþeGaymankar

EckrMElknUvKMniterog²xøÜn.

sikçakamTaMgGs; KYrEtman»kasedIm,IGnuvtþnUvCMnaj

nigcMeNHdwgfμI².

cMnucsMxan;bMputEdlKYrcgcaM ³ minbeRgónGVIEdlGñkecH

TaMgGs;eT beRgónEtGVIEdlcaM)ac; edIm,I[eKGac

bMeBjkargar)anl¥.

sMPar³tMrUveGayman

RkdasspÞaMgFM

biuchWut

sáút

TMrg;cuHbBa¢I

kBa©b;ÉksarbNþúHbNþal ¬rebobvar³ Éksar

emeron B½t’mansMrab;sikçakam¦

sWmI

esovePAkt;Rta

biucsMrab;sikçakammñak;²

søakeQμaHsMrab;sikçakamnImYy²

Overhead projector b¤ Power Point

projector ¬ebIGaceTArYc¦

lixitbBa¢Ún

taragrayeQμaHesvaEfTaMsuxPaBdUts_

erobcMral;eBlcab;epþIménvKÁsikSanImYy²nUvsMPar³

EdlRtUvkar.

snøwkepÞógpÞat;sMrab;GñkbNþúHbNþal

1- eFVIkar):an;sμaneTAelIfvikaEdlcaM)ac;sMrab;vKÁsikSa.

2- eFIVkarGeBa¢Ijsikçakam edaymineGayeRcInCag

20 nak; kñúgvKÁsikSanImYy².

3- eFIVkarkk;bnÞb;sMrab;eFIVkarbNþúHbNþal. bnÞb;enaH

KYrEtCakEnøgs¶at; nigFMTUlay.

4- eFIVkarrMlwkÉksarENnaMGMBIvKÁsikSa nigyl;dwg

GMBIkalviPaK nigEpnkarénGgÁRbCuM

5- eFIVkarRtYtBinitüeTAelIsMPar³sMrab;eFVIkarbNþúH-

bNþalmuneBlcab;epþIm CaBiesseTAelI]bkrN_

eGLicRtUnic

6- bBa¢aTijsMPar³pÁt;pÁg;sMrab;karbNþúHbNþal

7- erobcMnUvsMPar³nanaepSgeTot

¬emIl {sMPar³} xagelI¦

8- GeBa¢IjePJóvkitþiyssMrab;ebIk nigbiTkmμviFI

9- bBa¢aTijGaharsMrn; nigePsC¢³. RtUvEteFIVeGay

c,as;las;favaRKb;RKan;sMrab;GñkbNþúHbNþal nig

GñksRmbsRmYl.

10- eFIVEpnkarbiTvKÁbNþúHbNþal

11-eFIVkarerobcMlixitbBa¢ak;karsikSapþl;eGaysikçakam

Edl)anbBa©b;nUvvKÁsikSaenaH ¬enAeBlNaEdlGac

)an¦

12-RtUvmanm:asIunftsMrab;ftrUbenAkñúgvKÁsikSa


ÉksarENnaMGñkbNþúHbNþalsMrab;vKÁbNþúHbNþal sþIBICMgWrebgdl;buKÁlik»sfsßan l vii

esckþIsegçbvKÁnImYy²énsikçasala

éf¶TI 1

smasPaKTI 1 ³ Gakb,kiriya

karBRgwgKuNPaB»sfsßan-rg

BiFIebIkvKÁ 45 naTI

vKÁTI 1 ³ karENnaM karrMBwgTuk nigkareFVIetsþmuneron 1 em:ag nig 30 naTI

vKÁTI 2 ³ tYnaTIrbs;buKÁlik»sfsßan-rg kñúgkarEklMGsuxPaBrbs;RbCaCn 2 em:ag nig 15 naTI

vKÁTI 3 ³ ]bsKÁkñúgkarbMeBjtYnaTIrbs;buKÁlik»sfsßan-rg 1 em:ag nig 30 naTI

srubeBlevlaedayminmansMrak 6 em:ag

éf¶TI 2

smasPaKTI 2 ³ B½t’manEpñkbec©keTssþIBICMgWrebg

PaBCaédKUrvagesvasaFarN³ nigÉkCn kñúgkarGnuvtþyuT§sa®sþdUts_

vKÁTI 1 ³ B½t’mansþIBIRbvtþiénCMgWrebg 1 em:ag nig 30 naTI

vKÁTI 2 ³ eraKsBaØaCMgWrebg karcMlg karkarBar nigTMnak;TMngrvagCMgWrebg nigCMgWeGds_ 3 em:ag

vKÁTI 3 ³ dMeNIrkarbBa¢Ún 1 em:ag nig 15 naTI

srubeBlevlaedayminmansMrak 5 em:ag nig 45 naTI

éf¶TI 3

smasPaKTI 3 ³ karR)aRs½yTak;Tg

karGnuvtþCMnajR)aRs½yTak;Tg edIm,IEklMGsuxPaBGtifiCn

vKÁTI 1 ³ karR)aRs½yTak;TgRbkbedayRbsiT§PaB 3 em:ag

vKÁTI 2 ³ karR)aRs½yTak;TgCamYyGtifiCn 1 em:ag nig 45 naTI

vKÁTI 3 ³ BiFIbiT nigBiFIEcksBaØabR½t 45 naTI

srubeBlevlaedayminmansMrak 5 em:ag nig 45 naTI

sikçasalasMrab;buKÁlik»sfsßan-rg sþIGMBI

{rebobRKb;RKgGñkEdlGacmanCMgWrebg}

smasPaK I³ Gakb,kiriya-karBRgwgKuNPaBesvakmμEdlpþl;eday»sfsßan

nig»sfsßanrg

vKÁTI 1 ³ esckþIepIþm nigkarrMBwgTuk

vKÁTI 2 ³ tYnaTIrbs;buKÁlik»sfsßan-rg kñúgkarelIkkMBs;suxPaB

rbs;RbCaCn

vKÁTI 3 ³ ]bsKÁrbs;»sfsßan-rg kñúgkarbMeBjtYnaTI

éf¶TI1


2 l ÉksarENnaMGñkbNþúHbNþalsMrab;vKÁbNþúHbNþal sþIBICMgWrebgdl;buKÁlik»sfsßan

smasPaKTI 1 ³ Gakb,kiriya-karBRgwgKuNPaBesva»sfsßan-rg

segçbéf¶TImYy² ³

vKÁTI 1 ³ karENnaM nigkarrMBwgTuk

enAkñúgvKÁnH sikçakamnwgman»kassÁal;KñaeTAvijeTAmk nig BiPakSakarrMBwgTukrbs;eK

vKÁTI 2 ³ tYnaTIrbs;buKÁlik»sfsßan-rg kñúgkarEklMGsuxPaBrbs;RbCaCn

sikçakamnwgBiPakSaGMBItYnaTI nigkarTTYlxusRtUvrbs;buKÁlik»sfsßan-rg k¾dUcCakarrMBwgTukrbs;

shKmn_

vKÁTI 3 ³ ]bsKÁkñúgkarbMeBjtYnaTIrbs;buKÁlik»sfsßan-rg

sikçakamnwgeronGMBI mUlehtucMbg ehtuGIV)anCabuKÁlik»sfsßan-rgminbMeBjtYnaTIrbs;BYkeK.

BYkeKnwgeronGMBIplb:HBal;EdlGacekItmancMeBaHsuxPaBrbs;GtifiCnenAeBlbBaðaenH)anekIteLIg.

vKÁuTI 1 ³ karENnaM nigkarrMBwgTuk

eKalbMNgénkarsikSa ³

enAcugbBa©b;énvKÁenH sikçakamnwgGac ³

1- sÁal;eQμaHGñkcUlrYm

2- yl;dwgBIkarrMBwgTukrbs;BYkeK

3- yl;BIkgVl;rbs;BYkeK nig¼b¤bTBiesaFn_nana

EdlTak;TgeTAnwgsuxPaBrbs;RbCaCnkm<úCa

srub ³ 1 em:ag nig 30 naTI

karerobcM ³

1- RkdasspÞaMgFM hWut nigsáút

2- erobcMkarENnaM nigsMPar³sMrab;smμPaBemesar

nigkUnesar

3- ftcMlgetsþmuneron edIm,IEckCUnsikçakam

viFIsa®sþ ³

CMhanTI 1 ³ sVaKmn_sikçakam nigENnaMBIskmμPaB

El,gemesar nigkUnesar

20 naTI

ENnaMsikçakamGMBIskmμPaBEl,g emesar nig

kUnesar ehIyR)ab;BYkeKeRkakedIrrkédKUeday

GñkmanrUbemesar rkédKUmanrUbkUnesar.

kalNasikçakam)anrkédKUehIy BYkeKRtUvkarsYr

BIKñaeTAvijeTAmknUvB½t’man dUcteTA ³

eQμaH

skmμPaBmYy EdlBYkeKcUlcitþeFIVenAeBlTMenr

karrMBwgTukmYy EdlBYkeKnwgTTYl)anBI

sikçasalaenH

esñIsikçakameGayRtlb;eTAkEnøgvij ehIy

1 KU² ENnaMKñaeTAvijeTAmkeTAkan;RkumFM

kt;RtakarrMBwgTukrbs;sikçakamenAelIRkdas

pÞaMgFM. minTan;maneyabl;elIkarrMBwgTukenA

eLIyeT. GñknwglMGitTaMgGs;enAcugbBa©b;

énvKÁ.

CMhanTI 2 ³ bgðajeKalbMNgénvKÁsikSa

25 naTI

esñI[sikçakamGan nigGñksRmbsRmYlbBa¢ak;bMPøW

CMhanTI 3 ³ bgðajrebobvar³énvKÁsikSa

15 naTI

eRbóbeFobrebobvar³CamYynwgkarrMBwgTukrbs;

sikçakam. GñkRbEhlCaEsVgrkeXIjnUvkarrMBwgTuk

rbs;sikçakamxøH² EdlnwgminGaceqøIytb)anenA

kñúgvKÁenHeT

bgðajeLIgvijnUveKalbMNgénsikçasala

RbsinebIcaM)ac; ehIybeBa©jnUvPaBesaksþay

eRBaHeBlmankMNt; edayminmanlT§PaB


ÉksarENnaMGñkbNþúHbNþalsMrab;vKÁbNþúHbNþal sþIBICMgWrebgdl;buKÁlik»sfsßan l 3

eqøIytbnUvkarrMBwgTukrbs;sikçakamRKb;Kña²

eLIy. eTaHbICay:agNak¾eday RtUveFIVeGay

sikçakamTukcitþfa GñknwgBüayameqøIytbkñúg

eBlvKÁepSgeTotenAeBlGnaKt.

CMhanTI 4 ³ ENnaMkareFIVetsþsakl,g ehIyENnaM

sikçakamGMBIrebobbMeBj

30 naTI

CakarsMxan;Nas;kñúgkarR)ab;sikçakamfa kareFIVetsþ

muneronminEmnRtwmEtsÞabsÞg;GMBIcMeNHdwgénCMgW

rebgrbs;BYkeKbu:eNÑaHeT bu:EnþsMxan;eTAelIkarpþl;

nUvkareqøIytb edIm,IEklMGvKÁeRkay²eTot.

vKÁTI 2 ³ tYnaTIrbs;buKÁlik »sfsßan-rg kñúgkarEklMGsuxPaB rbs;RbCaCn



1- yl;dwg nigGbGrkarrMBwgTukrbs;RbCaCn

cMeBaHKuNPaBesvarbs;»sfsßan-rg

2- yl;dwgBItYnaTI nigkarTTYlxusRtUvrbs;»sf-

sßan-rg EdlkMNt;edayRksYgsuxaPi)al.

srub ³ 2 ema:g 15 naTI

karerobcM ³

1- RkdasspÞaMgFM hVWt nigsáút

2- erobcMRkdaspÞaMgFMsMrab;skmμPaB karqøúH-

bBa©aMgGMBIxøÜnÉg CamYynwgxøwmsarxageRkam

¬k¦ etIGtifiCnyl;eXIjy:agNaGMBIxJMú

¬x¦ etIGtifiCnsgÇwmfa)anGVIBIxJMú

3- erobcMvIedGUsMrab;bgðaj {etIGñkKity:agdUcemþc

cMeBaH»sfsßan¼XøaMg»sfrbs;Gñk?}.

sakl,gcak;vIedGUCamunsin edIm,IeGayR)akd

favadMeNIrkar)anl¥.

4- erobcMeRsamsMbuRtCamYyRbFanbT 3

sMrab;skmμPaB {RkumBiPakSa}

viFIsa®sþ ³

CMhanTI 1 ³ ENnaMsikçakamtamry³skmμPaBkarqøúH-

bBa©aMgGMBIxøÜnÉg

30 naTI

eFVIkarbgðajvKÁenH. sYrsikçakamfa {ehtuGIV)anCa

buKÁlik»sfsßan-rgmansar³sMxan; ehIysMxan;

y:agdUcemþcenAkñúgvis½ysuxPaBenAshKmn_ ?

{eFIVkarkt;RtakareqøIytbrbs;BYkeKenAelIRkdas

pÞaMgsFM nigbiTenAelICBa¢aMg. TTYlsÁal;faGtifiCn

CamnusSsMxan;Nas;enAkñúgmuxCMnYjén»sfsßan-rg

ehIybuKÁlik»sfsßan-rg KYrEtcab;GarmμN_[)an

eRcInkñúgkaryl;dwgfa etIGVICakarrMBwgTukrbs;

GtifiCn. R)ab;sikçakamfa bnþiceTotBYkeKnwgemIl

vIedGU bu:EnþCadMbUgBnül;eTAsikçakamfa BYkeKnwg

BiPakSatamRkumtUc² ¬5 nak; kñúg 1 Rkum¦ nUvsMnYr

dUcteTA ³

1- etIxJúMCanrNa?

2- etIxJúMRtUveFIVGIVxøH?

3- etIxJúMRtUveFIVkargarxJúMy:agdUcemþc?

4- ehtuGIV)anCaxJúMRtUveFIVkargarTaMgenH?

5- etIGtifiCnyl;eXIjy:agNacMeBaHxJúM?

6- etIGtifiCnsgÇwmfa)anGIVBIxJúM?

kt;sMKal;TuknUvkareqøIytbrbs;sikçakamelI

RkdaspÞaMgsFMkñúg 2 kUeLan

etIGtifiCnyl;eXIjy:agNacMeBaHxJúM?

etIGtifiCnsgÇwmfa)anGIVBIxJúM?

biTvaenAelICBa¢aMg GñknwgRtUvbnSúIkareqøIytbrbs;

BYkeKeTAnwgBaküsMdIrbs;GtifiCneRkayBIemIlvIedGU



CMhanTI 2 ³ cak;vIedGU {etIGñkyl;y:agNaGMBI»sf-

sßan-rgrbs;Gñk?} vIedGU 10 naTI nwgbgðajGMBIBakü

sMdIrbs;GtifiCnxus²Kña. esñIsikçakam[ykcitþTukdak;

kñúgkarsþab;nUvGVIEdlGtifiCnkMBugniyay.

40 naTI rYmTaMgkarBiPakSa

eRkayBIemIlvIedGU ENnaMsikçakamtamry³kar

BiPakSaGMBIvIedGU. BiPakSaBImtieyabl;rbs;

GtifiCnCamYysikçakam

enAelIRkdaspÞaMgsFM kt;RtakareqøIytbrbs;

GtifiCn ehIybiTvasMrab;RkumBiPakSa

esñIsikçakamemIlnUvBaküsMdIrbs;BYkeK nigGtifiCn

rbs;BYkeK esñIsikçakamBinitüemIlfa etIBaküsMdI

sIuKñaeTAvijeTAmkEdr b¤eT. GñkminRtUvBiPakSava

lMGiteT.

esñIsikçakamcat;lMdab;énkareqøIytbrbs;GtifiCn

edayelIkTwkcitþsikçakameGayKitBIlMdab;dUcteTA ³

\riyabfrbs;buKÁlik

KuNPaBénplitpl

PaBgayRsYl

tMél

dMbUnμan B½t’man nigkarGb;rM

kMNt; nigkt;RtaGtifiCntMbn;nImYy² EdlPaKeRcIn

mankarrMBwgTuk b¤mtieyabl;

]TahrN_xøH²BIkaryl;eXIjrbs;GtifiCn

etIGtifiCnyl;y:agNacMeBaHxJMú?

BYkeKyl;eXIjfa xJúM>>>

CasmaCikmñak;énbuKÁliksuxaPi)al

CamnusSrYmshkarmñak;

CaGñkEdlmantMélmñak;-mansBaØabRt

CamnusSEdlmanRbeyaCn_mñak;

etIGtifiCnrMBwgfa)anGVIBIxJúM?

BYkeKrMBwgfanwg>>>

TTYl)anB½t’manRtwmRtUv

TTYl)annUvkarBnül;c,as;las;BIrebob

eRbIR)as;fñaMeBTü

CYyEklMGsuxPaBrbs;eK

TTYlfñaMmanKuNPaB

TTYlesvakmμmanKuNPaB

]TahrN_xøH²GMBIkaryl;eXIjrbs;buKÁlik

»sfsßan-rg

etIGtifiCnyl;eXIjdUcemþcBIxJúM?

BYkeKyl;eXIjfaxJúM>>>

mancMeNHdwgGMBIfñaMeBTü

manGakb,kiriyaCalkN³GaCIB b¤tam

viC¢aCIv³CaGñklk;fñaMeBTü

ykcitþTukdak;cMeBaHGtifiCn

lk;fñaMeBTünUvtMélsmrmü

sVaKmn_ nigCYyGtifiCn

etIGtifiCnrMBwgfa)anGVIBIxJMú?

BYkeKrMBwgfa>>>

TTYlfñaMRbkbedayRbsiT§PaB

TTYl)anesvakmμRbkbedayKuNPaB

TTYlB½t’manTak;TgnwgkareRbIR)as;fñaM



]TahrN_xøHéncMelIyEdlGacman

etIGVICakareqøIytbrbs;GñkeTAnwgrMBwgTukrbs;

GtifiCn?

GP½yeTasdl;GtifiCn ebIyWty:av

pþl;nUvkarENnaMGMBIkareRbIR)as;»sfeGay

)anRtwmRtUv nigc,as;las;

mancMnYnbuKÁlik nigfñaMRKb;RKan; edIm,IeqøIytb

nUvtMrUvkarrbs;GtifiCn

etIbuKÁlik»sfsßan-rg eFIVdUcemþc edIm,IkøayeTACa

Gñkskmμkñúgkarpþl;esvasuxPaBbzmenAkñúg

shKmn_rbs;BYkeK?

begáIncMeNHdwg nigCMnajrbs;BYkeK

manCMnajR)aRs½yTak;Tgl¥CamYyRbCaCn

kñúgshKmn_

cMNayeBlevlapþl;nUvB½t’manc,as;las;

RtwmRtUv nigsmRsbdl;GtifiCn

lk;fñaMkñúgtMélsmrmü

Kitfa {karCYyse®gÁaHCIvit KWCaskmμPaB

l¥bMput}

etIbuKÁlik»sfsßan-rg RtUvkarGVI edIm,IbMeBj)an

nUvtYnaTIrbs;BYkeK?

karENnaMKaMRT nigGaCJabNÑBIRksYgsuxaPi)al

karbNþúHbNþalCaerOy² edIm,IeFVIeGayRbesIr

eLIgnUvcMeNHdwg nigCMnajrbs;BYkeK

karpþl;mtirbs;GtifiCncMeBaH\riyabfbuKÁlik

»sfsßan-rg nigKuNPaBénesvakmμ

CMhanTI 3 ³ ENnaMsikçakamtamry³ {karBiPakSatamRkum}

Ca 2 Rkum

55 naTI

karBiPakSaRkumTI 1 ³ karrMBwgTukCasaFarN³cMeBaH

»sfsßan-rg

EcksikçakamCa 3 Rkum. esñIeKeGayeRCIserIsGñk

raykarN_. pþl;eRsamsMbuRtmYydl;RkumnImYy²

EdlmanRbFanbTsMrab;BiPakSa. esñIGñkraykarN_

énRkumnImYy²ebIkeRsamsMbuRt ehIyGannUv

RbFanbTénRkumrbs;BYkeK. Bnül;eTARkumnanafa

BYkeKRtUvkareFIVkarBiPakSaRbFanbTrbs;BYkeK

ehIyeqøIynUvsMnYrdUcteTA ³

RbFanbTTI 1 ³ etIGñkmankareqøIytby:agNa

cMeBaHGVIEdlCakarrMBwgTukrbs;GtifiCn?

RbFanbTTI 2 ³ etIbuKÁlik»sfsßan-rg

RtUveFIVdUcemþc edIm,IkøayeTACaGñkskmμkñúgkar

pþl;esvasuxPaBbzmenAkñúgshKmn_rbs;

BYkeK?

RbFanbTTI 3 ³ etIbuKÁlik»sfsßan-rg

RtUvkarkarKaMRTGVI EdleFIVeGaybuKÁlik»sf-

sßan-rg bMeBj)annUvtYnaTIkñúgkarpþl;esva

enAshKmn_rbs;BYkeK ?

R)ab;RkumnImYy²fa BYkeKnwgRtUveFVIbTbgðajnUvkar

BiPakSarbs;eKcMeBaHRkumFM. bTbgðajénRkumnImYy²

RtUv)anelIkTwkcitþ edaysYrsMnYrdUcteTA ³

etIGñkyl;RBmb¤eT? yl;RBmehtuGVI minyl;

RBmehtuGIV?etIGñkmanmtieyabl;EfmeToteT.

etIskmμPaBrebobenH R)akdfaRtwmRtUvsMrab;

GñkEdr b¤eT?

etI]bsKÁ b¤bBaðaGVIEdlGñkCYbRbTH?



karBiPakSaRkumTI 2 ³ tYnaTI nigkarTTYlxusRtUv rbs;buKÁlik»sfsßan-rg

erobcMRkdasspÞaMgFM 4 pÞaMg ehIybiTelICBa¢aMg.

cMNgeCIgrbs;RkdasspÞaMgFM mandUcxageRkam ³

RkdasspÞaMgFM TI 1 ³ tYnaTIrbs;buKÁlik»sf

sßan-rg

RkdasspÞaMgFM TI 2 ³ buKÁliklkçN³ nig

esvakmμénbuKÁlik»sfsßan-rg Rbkbeday

KuNPaB

RkdasspÞaMgFMTI 3 ³ karCH\Ti§BlEdlGacman

CalT§plénbNþa»sfsßanrg nigbuKÁlik»sf

sßan-rg EdlKμanKuNPaB.

RkdaspÞaMgFMTI 4 ³ »sfsßan¼rgKMrU

tYnaTIrbs;buKÁlik»sfsßan¼rgKMrU ³ eFIVkarBiPakSa

edayesñIsikçakamBinitüeLIgvij nigeFVIbBa¢InUvtYnaTI

rbs;BYkeKenAkñúgshKmn_ ehIyBYkeKxøÜnÉgeCOCak;

fa »sfsßan-rg nigbuKÁlikrbs;BYkeK )anbMeBj

tYnaTIkñúgkareFVI[RbesIreLIgnUvsuxPaBrbs;RbCaCn

km<úCa. kt;RtacMelIyelIRkdasspÞaMgFMCamYynwg

cMNgeCIgénkareqøIytb.

buKÁliklkçN³énbuKÁlik»sf¼rg nigesvakmμ

RbkbedayKuNPaB ³ CamYynwgRkumTaMgmUl

esIñsikçakameGaybMeBjnUvlkçN³lMGitdUcxag

eRkam ³ {bMeBjnUvtYnaTIenH »sfsßan¼rg RtUvEt

b¤eFVI>>>>>>>> }.

rMlwksikçakameGayeyageTAelIlkçN³lMGitrbs;

GtifiCn nigcMelIyrbs;BYkeKenAkñúgRkumBiPakSa.

kt;Rtamtieyabl;rbs;BYkeKelIRkdasspÞaMgFM.

karb:HBal;EdlCalT§plénesvakmμrbs;

»sfsßan-rg ³ esñIeGaysikçakameqøIynwgsMnYr

{etImanGIVekIteLIg RbsinebIbuKÁlikenA»sfsßan-rg

min)anpþl;esvaRbkbedayKuNPaB? {BiPakSaeday

eq<aHeTArkGIVEdlGacGviC¢manb:HBal;elIsuxPaB

rbs;RbCaCnenAshKmn_rbs;eK k¾dUcCab:HTgÁicelI

GaCIvkmμrbs;BYkeKEdr. kt;RtakarTTYlxusRtUv

TaMgenHenAelIRkdasspÞaMgFM.

»sfsßan-rgKMrU ³ eFIVkarBiPakSaCaRkummþgeTot

edaysYrsikçakamfa {»sfsßan-rgKMrU Ca»sfsßan-rg

y:agdUcemþc?} BiPakSaedayeq<aHeTAGIV EdlCakar

CH\Ti§BlviC¢maneTAelIsuxPaBrbs;RbCaCnenA

shKmn_rbs;eK k¾dUcCaeTAelIGaCIvkmμrbs;BYkeK

Edr. kt;RtacMelIyTaMgenHenAelIRkdasspÞaMgFM.

]TahrN_xøH²énkareqøIytb

tYnaTIrbs;buKÁlik»sfsßan-rgman ³

pþl;B½t’manRtwmRtUv nigsmRsb

pþl;karENnaMRtwmRtUv nigmanGtßRbeyaCn_

pþl;esvakmμelOn nigrYsrayrak;Tak;

bBa¢ÚnGtifiCneTAesvasaFarN³ ebIcaM)ac;

lkçN³sm,tþién»sfsßan-rgmanKuNPaB

»sfsßan-rg eFVIskmμPaBedayrYsray

rak;Tak;eTAkan;GtifiCn

buKÁlikmancMeNHdwg nigmanbTBiesaFn_

kñúgkarpþl;fñaM

»sfsßan-rgs¥at nigrkSa)any:agl¥

buKÁlikcUlrYmvKÁbNþúHbNþalCaerOy²

edIm,IeFVI[RbesIreLIgnUvcMeNHdwg nigCMnaj

»sfsßan-rg )ancuHeQμaHGnuBaØat

»sfRtUv)anerobcM nigRKb;RKgy:agRtwmRtUv

»sfmanKuNPaBl¥ nigRtUv)anlk;kñúgtMél

smrmü

»sfkarI nigbuKÁlikesøókBak;ÉksNæan

BN’senAeBllk;»sfplb:HBal; EdlGac

ekItman ehIyCalT§plsMrab;»sfsßan-rg

minmanPaBRbesIreLIgcMeBaHsuxPaBrbs;

GtifiCn nigshKmn_

karTTYl)annUvekrþ×eQμaHminl¥

)at;bg;GtifiCn

)at;bg;cMNUl

biT»sfsßan-rg



CMhanTI 4 ³ ENnaMsikçakamtamry³skmμPaB {BIr:amId

RbkbedayKuNPaB}

10 naTI

enAelIRkdasspÞaMgFM KUrrUbRtIekaNFMmYy rYcEckCa

bIcMENkedayKUsbnÞat;RsbKña. biT {BIra:mId

RbkbedayKuNPaB} enH enAelICBa¢aMg ehIyEck

RkdasBN’Caragkaer eTAeGayRKb;sikçakam.

esñIeGayBYkKat;eTAbiTRkdasenAkRmitmYYyNa

EdlKat;yl;faCaGaCIvkmμrbs;BYkKat;éf¶enH.

GnuBaØat[sikçakamTaMgGs;dwgfa RtUv)anmkdl;

eKaledA {KuNPaBeBjelj} EdlRtUv)antagenA

kMBUlénBIra:mId.

sikçakamEdleCOfa BYkeKRtUvmkdl;kRmitén

{KuNPaBeBjelj} KYrEtbiTRkdasenAelI

kMBUlénBIra:mId

sikçakamEdleCOfa BYkeKCitmkdl;eKaledA

KYrEtbiTRkdasenAkRmitTImYycab;BIcMnuckMBUl

énBIra:mIdsikçakamEdleCOfa BYkeKerobnwgCit

dl; {eKaledA} KYrEtbiTRkdasenAkRmitTIBIr

cab;BIcMnuckMBUlénBIra:mId

sikçakamEdleCOfa BYkeKq¶ayBIeKaledA KYrEt

biTRkdasenAkRmitTImYycab;BI)aténBIra:mId

kt;RtacMnYnenAelIkRmitnImYy²énBIra:mId nigrkSaTuk

RkdaspÞaMgFMenHtamry³sikçasala.

GñknwgeFIVskmμPaBdUcKñaenHenAcugbBa©b;én

sikçasala.

vKÁTI 3 ³ ]bsKÁkñúgkarbMeBjtYnaTI rbs;buKÁlik»sfsßan-rg



1- rkeXIjnUv]bsKÁEdlraraMgbuKÁlik»sfsßan-rg

kñúgkarbMeBjnUvtYnaTI

2- yl;dwgBIkarCH\Ti§Bly:agxøaMgkøacMeBaHsuxPaB

RbCaCnenAshKmn_ enAeBlEdlbuKÁlik»sf-

sßan-rg minGac b¤minbMeBjnUvtYnaTIrbs;BYkeK


karerobcM ³


2- erobcMeRsamsMbuRtBIrCamYynwgRbFanbTsMrab;

skmμPaBrbs; Rkumkargar

3- erobcMsMrab;karbgðajrbs;smaKm»sfkarIkm<úCa

viFIsa®sþ ³

CMhanTI1 ³ ENnaMsikçakamtamry³skmμPaB {Rkumkargar}

45 naTI

EbgEcksikçakamCaBIrRkum. esñIeGayRkumnImYy²

eRCIserIsGñkeFIVr)aykarN_mñak;. pþl;eGayRkum

nImYy² nUveRsamsMbuRtmanRbFanbTmYy.

GñkKYrmanRkummYytMNagbuKÁlik»sfsßan-rg

ehIymYyRkumeTottMNagGtifiCnrebg.

esñIeGayRkumbuKÁlik»sfsßan-rg eFIVbBa¢Ién

\riyabfrbs;buKÁlik»sfsßan-rg EdleFVIkar

EbgEckfñaMminsmRsb.

esñIeGayRkumtMNagGtifiCnrebg eFIVbBa¢Ién

\riyabfrbs;tMNagGtifiCnrebgEdleRbIfñaM

min)ansmRsb.

»sfsßan-rgKMrU

RtUvmanGaC£ab½NÑ nig)ancuHeQμaHrYcehIy

s¥at nigmankarEfTaM)any:agl¥

manbuKÁlikEdlesøókBak;ÉksNæanBN’s

nigs¥at

buKÁlikmancMeNHdwg nigCMnaj

pþl;B½t’manRtwmRtUv nigsmRsb

lk;»sfEdlmanKuNPaB

erobcMRKb;RKg»sf)anRtwmRtUv

eKarBtamkarENnaMrbs;RksYgsuxaPi)al



biTéf¶TI 1

EføgGMNrKuNdl;sikçakamRKb;rUbsMrab;karcUlrYmry³eBleBjmYyéf¶rbs;BYkeK. EckcayTMrg;EbbbTvaytMél

RbcaMéf¶ nigsuMeGaysikçakambMeBj kñúgxN³EdlGñkRtUverobcM[manerobrykñúgbnÞb;bNþúHbNþal. esñIsikçakampþl;TMrg;

EbbbTvaytMélEdl)anbMeBjrYcmk[Gñk.

segçbéf¶TImYynUvGIV EdleyIg)aneron

TTYlsÁal;karrMBwgTuk nigtMrUvkarrbs;shKmn_ CaBiesskñúgkaryl;eXIj edIm,IpSBVpSay nigEklMGsuxPaB

yl;dwgBItYnaTI nigkarTTYlxusRtUvrbs;buKÁlik»sfsßan-rg kñúgkarbegáInesvakmμRbkbedayKuNPaB

sMKal;fa etIGIVEdlnaMeGay»sfsßan-rg EdlmanKuNPaB ehIypÞúyeTAvijGIVeTAEdlehAfa»sfsßan-rg

EdlRbkbedaybTdæan edIm,Idwgfa karEfTaMrbs;buKÁlik»sfsßan-rg GacmanplGviC¢maneTAelIsuxPaB

shKmn_ nig»sfsßandéT.

esñIeGayRkumnImYy²eLIgbgðajkic©karrbs;BYkeK ehIyenAeBlkarbgðajnImYy² sYreTAkan;Rkumfa etIBYkeKyl;

Rsb b¤minyl;Rsb. esIñeGaysikçakammanmtibEnßmeTotenAelIbBa¢I.

CMhanTI 2 ³ bgðajGñk]eTÞsnammkBIsmaKm»sfkarIkm<úCa b¤kariyal½y»sfénmnÞIrsuxaPi)alextþ ¼Rkug Edlnwgpþl;

bT]eTÞsnamGMBI {eKalneya)ay bTbBa¢a RkmsIlFm’} EdlTak;TgnwgCMgWrebg»sfsßan-rg.

45 naTI

TukeBlevlasMrab;karsYrsMnYr

GrKuNGñkeFVIbT]eTÞsnam

segçbéf¶TImYy ³

cUreRbIkMnt;RtasegçbénskmμPaBTaMgLayrbs;GñkEdlmineRcInCag 5 b¤ 6 cMnuc. karkt;RtaenH k¾CaCMnYy

EpñksμartIsMrab;sikçakampgEdr. cUrGanRbGb;xageRkam ³

sikçasalasMrab;»sfkarI sþIGMBI

{rebobRKb;RKgGñkEdlGacmanCMgWrebg}

smasPaK II³ Epñkbec©keTs sþIBICMgWrebg-PaBCaédKUesvardæ nigÉkCn

kñúgkarGnuvtþyuT§sa®sþ {dUts_}

vKÁTI 1 ³ B½t’man sþIBIRbvtþiCMgWrebg

vKÁTI 2 ³ kareFVIeraKvinicä½y karcMlg nigkarbgáarCMgWrebg

vKÁTI 3 ³ dMeNIrkarénkarbBa¢Ún

éf¶TI2



EpñkTI 2 ³ CMnajbec©keTsrebg-PaBCaédKUrvagesvasaFarN³ nigÉkCn kñúgkarGnuvtþyuT§sa®sþ {dUts_}

vKÁuTI 1 ³ savtar sþIBIRbvtþiénCMgWrebg



1- eGayniymn½y GIVCaCMgWrebg

2- yl;BIsßanPaBCMgWrebgenAkm<úCanaeBlbc©úb,nñ

3- yl;BIeKalbMNg nigeKaledAsMxan;énkmμviFICati

kMcat;eraKrebg rYmbBa©ÚlkarkMcat;eraKrebgeday

eRbIyuT§sa®sþ dUts_


karerobcM ³


2- erobcMkarbgðajenAkñúg overheads b¤ Power Point slides

BiFIebIk ³

sVaKmn_sikçakaméf¶TIBIr nigerobrab;[BYkeKnUv

esckþIsegçbxøI² Edl)anBIB½t’manRtlb;kñúgTRmg;

vaytMélRbcaMéf¶TI 1

segçbvKÁéf¶TI 2

vKÁTI 1 ³ savtar sþIBIRbvtþiCMgWrebg

vKÁenHpþl;eGaysikçakamRKb;rUbyl;dwgBIniymn½yénCMgWebg sßanPaBCMgWrebgenAkñúgRbeTskm<úCa

nigkmμviFICatikMcat;eraKrebg.

vKÁTI 2 ³ eraKvinicä½yCMgWrebg karcMlg nigkarbgáar

sikçakamnwgeronBIGIVeTAEdlCaeraKsBaØarebgGaMghVicsüúg rebobqøgénCMgWrebg RBmTaMgcMnucbEnßm

eTAelIkarTb;sáat;karcMlg nigTMnak;TMngrvagCMgWrebg nigCMgWeGds_.

vKÁuMTI 3 ³ rebobbBa¢Ún

enAkñúgvKÁenH sikçakamnwgeronBIrebobénkarbBa¢Ún nigrebobbMeBjTMrg;lixitbBa¢ÚnGñkCMgW

viFIsa®sþ ³

CMhanTI 1 ³ segçbxøI²rbs;sikçakamsßanPaBCMgWrebg

enARbeTskm<úCaeBlbc©úb,nñ

30 naTI

bgðajBIsßanPaBCMgWrebgenARbeTskm<úCaeBl

bc©úb,nñ Edl)anerobcMdUcmanB½t’mankñúg]bsm<½n§TI 1

sYrsikçakamTaMgGs; RbsinebIBYkeKmansMnYr

b¤RtUvkarsYrbBa¢ak;

CMhanTI 2 ³ BiBN’naTUeTAxøI² dl;sikçakamBIkmμviFICati

kMcat;eraKrebg nigBiPakSaGMBIsar³sMxan;éneKalbMNg

nigeKaledArbs;kmμviFICati

30 naTI

bgðajBIkmμviFICatikMcat;eraK Edl)anerobcMdUcman

B½t’mankñúg]bsm<½n§TI 1

Bnül;GMBIsar³sMxan;éneKalbMNg nigeKaledA

ehIyeFVIkarBiPakSaCamYysikçakam



vKÁuTI 2 ³ eraKvinic½äyCMgWrebg karqøg nigkarkarBar


edayenAcugbBa©b;énvKÁenH sikçakamnwgGac ³

1- erobrab;)anBIeraKsBaØaénCMgWrebg

2- erobrab;)anBIrebg RtUv)anqøgedayrebobNa

3- erobrab;)anBICMhan EdlGacykeTAbgáarkarqøg

CMgWrebg

4- yl;)anBIviFIsa®sþRsavRCavCMgWrebg nigktþa\T§iBl

5- erobrab;BITMnak;TMngrvagCMgWrebg nigCMgWeGds_

srub ³ 3 em:ag

karerobcM ³


2- erobcMkarbgðajenAkñúg overheads b¤ Power Point

slides BIviFIRsavRCavCMgWrebg nigktþaTaMgLay

EdleFVI[GRtaRsavRCavCMgWrebgmankRmitTab

CMhanTI 1 ³ eFVIkarbMpusKMnitdl;sikçakam sþIBI {etIGVICa

eraKsBaØaCMgWrebg ? :

30 naTI

EbgEcksikçakamCabIRkum. esñIeGayRkumnImYy²

cat;EcgeGaymanGñkeFIVr)aykarN_mñak;. R)ab;Rkum

TaMgGs;[smaCikkñúgRkumeqøIynUvKMnitpÞal;xøÜneTA

tamsMnYr}etIGVICaeraKsBaØaCMgWebg ? :

bnÞab;BIBYkeK)anbBa©b;nUvKMnit EdleK)anbeBa©jrYc

ehIy sikçakamTaMgGs;énRkumnImYy² nwgbgðajnUv

cemøIyrbs;BYkeK

skmμPaBenHbBa©b; edaypþl;CUnsikçakamnUveraK

sBaØaRtwmRtUvsþIBICMgWrebg

etIGVICaCMgWrebg?

rebg KWCaCMgW Edlbgáeday)ak;etrIeQμaH

mIkU)ak;etrIyUmTuyEb‘kKuyLÚsuIs EdlCa

TUeTAekItmanenAkñúgsYt ¬rebgsYt¦

¬niymn½yénGgÁkarsuxPaBBiPBelak¦

rebgCaCMgWqøg - vaqøgBImnusSEdlmanCMgWrebg

eTAGñkdéTtamkarTak;TgCak;lak;NamYy

rebgskmμ ¬CMgWrebg¦ KWenAeBlEdlRbB½n§

karBarrbs;ragkayminGaceFVIGVImYy)an edIm,I

RbyuT§RbqaMgnwgemeraKrebg ehtudUecñHehIy

)anCamankarbgácMlgeTAkñúgsYt b¤EpñkepSg²

énragkay dUcCa tRmgenam q¥wgxñg b¤xYrk,al

pÞúkemeraKrebg (Latent TB) (rebgGaMghVicsüúg)

mann½yfa mnusSmñak;RtUv)anqøgemeraKrebg bu:Enþ

emeraKminmanskmμPaBGIVTaMgGs;. GñkEdlpÞúk

emeraKrebg minmankarcMlgeTAGñkdéTeT ehIy

GñkdéT k¾minGacTTYlkarcMlgrebgBIGñkEdlpÞúk

emeraKrebgEdr. GñkpÞúkemeraKrebg BMumaneraK

sBaØaeT. RbmaN 10° énGñkpÞúkemeraKrebg

nwgGacvivtþn_eTACarebgskmμnaeBlxagmux

RbsinebIBYkKat;minTTYlkarBüa)alsMrab;rebg

GaMghVicsüúg.

CMhanTI 3 ³ eFVIkarbMpusKMnitdl;sikçakam sþIBI {etIGVICa

CMgWrebg ? :

30 naTI

EbgEcksikçakamCabIRkum. esñIeGayRkumnImYy²

cat;EcgeGaymanGñkeFIVr)aykarN_mñak;. R)ab;Rkum

TaMgGs;[smaCikkñúgRkumeqøIynUvKMnitpÞal;xøÜneTA

tamsMnYr{etIGVICaCMgWebg ? :

bnÞab;BIBYkeK)anbBa©b;nUvKMnitrYcehIy sikçakam

TaMgGs;énRkumnImYy² nwgbgðajnUvcemøIyrbs;BYkeK

skmμPaBenHbBa©b; edaypþl;CUnsikçakamnUvniymn½y

RtwmRtUvénCMgWrebg



eraKsBaØaCMgWrebg

RbCaCnEdlmansuxPaBl¥ ehIymanpÞúkemeraK

rebg (Latent TB) CaTUeTA BMumaneraKsBaØaeT

eraKsBaØaénrebgsYtskmμ man ³

- k¥kKμan b¤manmankMhak

b¤kMhaklayQam

- QWRTUg

- ht;

- RskTMgn;

- minXøanGahar

- Gs;kMlaMg

- RKunekþARsavRsajenAeBlresol

- EbkejIseBlyb;

eraKsBaØacMbgénCMgWrebgsYt KWk¥krauMér:elIsBI

2 b¤ 3 s)aþh_eLIgeTA. CaTUeTAk¥kruaMér: nwg

rYmpSMsBaØa 1 b¤eRcInkñúgcMeNameraKsBaØarebg

sYt BiessRskTMgn; nigEbkejIseBlyb;

karcMlgénCMgWrebg

CMgWrebgRtUv)anqøgBImnusSQWmñak;eTAmnusS

déTeTot tamry³xül;dkdegðImenAeBlGñk

CMgW k¥k kNþas; niyaysþI b¤xakesþaH

enAeBlEdlGñkCMgWrebgskmμ k¥k kNþas;

niyay b¤xakesþaH eKnwgbeBa©jnUvdMNk;TwktUc²

pÞúkedayemeraKrebgcUleTAkñúgxül; enAeBl

enaH GñkEdlsßitenACitGñkCMgW nwgRsUbcUltam

RcmuHnUvdMNk;TwktUc² EdlpÞúkedayemeraK

rebgTaMgenaH

enAeBlEdldMNk;tUc²pÞúkedayemeraKrebg

RtUv)anRsUbcUl dMNk;tUc²EdlFMCag )anCab;

enAEpñkxagelIénpøÚvdegðIm nigcab;epþImbgá[

maneraK. ÉdMNk;tUc²déTeTotGaccUleTA

dl;sYt nigcab;epþImbgáeraKenATIenaH.

karTb;sáat;karcMlgCMgWrebg

cak;fñaMbgáar eb es ehS dl;Tark cMeBaHRbeTs

EdlmaneRbv:aLg;CMgWrebgx<s; manpl-

RbeyaCn_GackarBarkumarkMu[manrebgF¶n;F¶r

BiessrebgeRsamxYr nigrebgmIlIEyr

ebIkbg¥Üc nigTVarenApÞH nigenAkEnøgEdlman

mnusSeRcIn dUcCa enAeragcRk salaeron

mnÞIreBTü edIm,IeGaymanxül;ecjcUlRKb;RKan;

EfTaMsuxPaBeGay)anl¥ nigbriePaKRKb;RKan;

CMhanTI 2 ³ BiBN’naTUeTAxøI²dl;sikçakamBIviFIsa®sþ

RsavRCavCMgWrebg nigsMrYlkarBiPakSakñúgRkumeTAelIktþa

TaMgLay EdleFVI[GRtaRsavRCavCMgWrebgmankRmitTab

45 naTI

bgðajBIviFIsa®sþRsavRCavCMgWrebg nigktþaTaMgLay

EdleFVI[GRtaRsavRCavCMgWrebgmankRmitTab

Edl)anerobcMdUcmanB½t’mankñúg]bsm<½n§TI 1

BiPakSaCamYysikçakamTaMgGs;GMBIbTBiesaFn_

Cak;Esþg EdlTak;TgnwgktþarYmpSMeFVI[GRtaRsavRCav

CMgWrebgmankRmitTab

CMhanTI 3 ³ eFVIkarbMpusKMnitdl;sikçakamsþIBI {etICMgWrebg

qøgy:agdUcemþc ?} nig {etIkarBarkarcMlgCMgWrebgdUcemþc ?}

45 naTI

EbgEcksikçakamCabIRkum dUcKñakñúgCMhanTI 1 Edr.

esñIeGayRkumnImYy² cat;EcgeGaymanGñkeFIV

r)aykarN_mñak;. R)ab;RkumTaMgGs;[smaCikkñúg

RkumeqøIynUvKMnitpÞal;xøÜneTAtamsMnY {etICMgWrebg

qøgy:agdUcemþc ?} nig {etIGñkkarBarkarcMlgCMgW

rebgdUcemþc ?}

bnÞab;BI BYkeK)anbBa©b;nUvKMnitEdlBYkeK)anbeBa©j

rYcehIy sikçakamTaMgGs;énRkumnImYy² nwgbgðaj

nUvcemøIyrbs;BYkeK

skmμPaBenHbBa©b; edaypþl;CUnsikçakamnUv

rebobRtwmRtUv sþIBIkarcMlgénCMgWrebg nig

viFIsa®sþRtwmRtUvkñúgkarkarBarkarcMlgénCMgW

rebg



CMhanTI 4 ³ eFVIkarbMpusKMnitdl;sikçakam sþIBI {etIemeraK

hIuvqøgdUcemþc nigGIVeTACaTMnak;TMngrvagCMgWrebg nigCMgW

eGds_?}

45 naTI

EbgEcksikçakamCabIRkum dUcBImunEdr. esñIeGay

RkumnImYy²cat;EcgeGaymanGñkeFIVr)aykarN_

mñak;. R)ab;RkumTaMgGs;[smaCikkñúgRkumeqøIynUv

KMnitpÞal;xøÜneTAtamsMnYr {etIemeraKhIuv qøgdUcemþc

nigGIVeTACaTMnak;TMngrvagCMgWrebg nigCMgWeGds_ ?}

bnÞab;BIBYkeK)anbBa©b;nUvKMnitEdlBYkeK)anbeBa©j

rYcehIy sikçakamTaMgGs;énRkumnImYy²nwgbgðaj

nUvcemøIyrbs;BYkeK

elIkTwkcitþeGayeRbIR)as;esvasuxPaBsaFarN³

cMeBaHRbCaCnEdlmaneraKsBaØarebg

Tak;TajshKmn_ nigGtifiCn cUlrYmEfTaM nig

karBarkuMeGayqøgCMgWrebg

elIkTwkcitþ[GñkCMgWTTYlkarBüa)al rhUtdl;

cb;tamrUbmnþBüa)alRtwmRtUv

RKb;GñkCMgWrebgsYt KYrEtxÞb;mat; nigRcmuH

CamYykEnSgRKb;eBlEdlBYkeK k¥k kNþas; b¤

niyaysþI

xÞb; mat; nigRcmuH RbsinebIGñk KWCaGñkEfrkSa

GñkCMgWrebgsYt

mnusSCaeRcInenAkñúgRbeTskm<úCamanpÞúk edayemeraKrebg ehWyk¾CaeRKaHfñak;mYy énkavivtþn_eTACarebgskmμ ³

RbsinebIBYkeKmanlkçxNÐNamYydUcxageRkam ³

manemeraKhIuv b¤CMgWeGds_ EdleFVI[RbB½n§

karBarcuHexSay.

kareRbIR)as;fñaM corticosteroids ry³eBlEvg

RbB½n§karBarcuHexSay EdlTak;TgeTAnwgPaB

manKP’fμI² b¤Gayu ¬PaBcas; nigTarkPaB

ekμgPaB¦

RskTMgn;elIsBI 10°

emeraKhIuvqøgeday

TMnak;TMngpøÚvePT ¬karrYmKña¦ CamYyGñk)anqøg

rYcehIy

kareRbIm¢úlrYmKña nig¼b¤ sWraMgCamYyGñkEdl

)anqøgrYcehIy

karcak;bBa©ÚlkñúgsrésQamEdlmanemeraKhIuv

BImþayeTAkUn ³ kUnekItBImþayEdlmanemeraK

hIuv. GacqøgemeraKhIuv mun b¤GMLúgeBlsMral

b¤tamry³karbMe)AedaH eRkayeBlsMral

emeraKhIuvminGacqøgtam

karefIb kNþas; k¥k pwkeBgCamYyKña b¤eday

stVl¥itxaMdUcCamUsCaedIm

TMnak;TMngrvagCMgWrebg nighuIv

GñkpÞúkemeraKrebg gayvivtþeTACarebgskmμ

ebIGñkenaHmanpÞúkemeraKhuIv. BIeRBaHemeraK

huIv eFVIeGayRbB½n§PaBsuaMnwgCMgWcuHexSay Edl

eFVIeGayvaminGacRbyuT§nwgCMgW)an dUcCa CMgW

rebgCaedIm

CMgWrebg KWCaCMgW»kasniyménGñkEdlman

hIuv. rebgpÞúk nwgeFVIkarvivtþenAeBlRbB½n§

karBarcuHexSay

GñkEdlpÞúkemeraKhuIv karekItmaneLIgCMgW

rebgsYt b¤rebgsrIragÁdéTeTot KWCamUlehtu

bBa¢ak;[dwgfa GñkenaHmanCMgWeGds__. Gac

niyaymYyEbbeTotfa GñkpÞúkemeraKhIuvpg

nigrebgskmμpg GñkenaHmanCMgWeGds_.

GñkEdlpÞúkemeraKhuIvpg nigpÞúkemeraKrebg

pg mankarRbQmmuxx<s; ¬800 dgeRcInCag¦

kñúgkarvivtþeTArkrebgskmμ ¬mCÄmNÐl

RtYtBinitü nigkarBarCMgWEpñkkMcat;CMgWrebg

shrdæGaemrik¦ (Centers for Disease Control and Prevention, Division of TB )

skmμPaBenHbBa©b; edaypþl;CUnsikçakamnUv

cMelIyRtwmRtUv sþIBIkarcMlgemeraKhIuv nig

TMnak;TMngCMgWrebg nigCMgWeGds_



CMhan 5 ³ ENnaMsikçakam GMBIkarpþl;dMbUnμaneTAGtifiCn

manCMgWrebg EdlkMBugTTYlkarBüa)al

15 naTI

sRmbsRmYlRkumBiPakSaxøI² GMBI {GVIRtUveFVIcMeBaH

GtifiCnmanCMgWrebgenA»sfsßan-rg}

bBa©b;skmμPaBedaypþl;CUnsikçakamnUvbBa¢IcMNuc

sMxan; GMBIGVIRtUveFVIcMeBaHGtifiCnrebgkñúg»sf-

sßan-rg.

cMNucsMxan;sMrab;karpþl;dMbUnμaneTAGtifiCnmanCMgWrebg EdlkMBugTTYlkarBüa)al

Bnül;eTAGtifiCnfa vamansar³sMxan;kñúgkar

TTYlTanfñaMrebgeTogTat; tamkarENnaMrbs;

buKÁliksuxaPi)al eTaHbIGtifiCnenaHTTYl

GarmμN_fasuxPaBxøÜnl¥RbesIrk¾eday.

ebIsinCaGtifiCncg;k¥Üt eRBaHEtelbfñaMrebg

edayRkBHKμanGahar enaHpþl;dMbUnμandl;BYk

eKeGaypwk kaehVexμAmYyEBg b¤mYydegðIm

¬Kμanxøaj; b¤eRbg¦

rMlwkGtifiCnfa etImansar³sMxan;y:agdUcemþc

kñúgkarTTYlTanfñaMrebgeTogTat;kñúgkarBüa)al

rebg[)ancb;cugcb;edImkñúgkarvilRtlb;eTA

mNÐlBüa)aledaydUts_ RbsinebIBYkeKman

bBaða.

vKÁuTI3 ³ dMeNIrkarénkarbBa¢Ún



1- yl;dwgdMeNIrkarénkarbBa¢ÚnGñksgS½ymanrebg

2- bMeBjTMrg;lixitbBa¢ÚnGñkCMgW


karerobcM ³


2- erobcMkarbgðajenAkñúg overheads b¤ Power Point

slides BiviFIsa®sþbBa¢Ún

3- ykmkCamYylixitbBa¢ÚnGñkCMgW edIm,Ibgðajdl;

sikçakamkñúgCMhanTI 1 nig[sikçakamTaMgGs;bMeBj

lixitenH kñúg {krNIsikSaTI 1 : nig :krNIsikSaTI 2 :

4- erobcMCaEpnTI EdlmanbBa¢ak;BIeQμaH nigTItaMgrbs;

mNÐlsuxPaB nigmnÞIreBTübEg¥k Edlpþl;esva

dUts_.

viFIsa®sþ ³

CMhanTI 1 ³ ENnaMsikçakamGMBIdMeNIrkarénkarbBa¢Ún

GtifiCnEdlsgS½yfa manrebg

30 naTI

bgðajdl;sikçakam GMBIdMeNIrkarbBa¢ÚnEdlerobcMrYc

edayeRbIR)as;B½t’manenAkñúg]bsm<½n§TI 1

CMhanTI 2 ³ bgðajsikçakamBITIkEnøg EdlBYkeKKYrEt

bBa¢ÚnGñksgS½yfamanrebgeTA

15 naTI

pþl;eGayBYkeKnUvbBa¢IeQμaH nigeRbIR)as;EpnTI edIm,I

Bnül;BITIkEnøgénmNÐlsuxPaB nigmnÞIreBTübEg¥k

Edlpþl;esvadUts_. mNÐlsuxPaB nigesÞIrEtRKb;

mnÞIreBTüsaFarN³TaMgGs;manesvareebg.

CMhanTI 3 ³ bgðajsikçakamGMBIrebobbMeBjTMrg;lixit

bBa¢ÚnGñkCMgW nigBnül;BICMhanTaMgGs;EdlcaM)ac;

15 naTI

CMhanTI 4 ³ ENnaMsikçakamGMBI {krNIsikSaTI1}

nig {krNIsikSaTI 2}

15 naTI

CYyBYkeKkñúgkarbMeBjTMrg;lixitbBa¢ÚnGñkCMgW ebIsin

caM)ac;. pþl;nUvcMelIyRtwmRtUveTAsMnYrenAkñúgkrNI

sikSa eRkayBIsikçakam)anbBa©b;skmμPaB

¬cMelIyRtwmRtUvCaGkSrdit¦.



krNIsikSaTI 1

elak Ekv sam:at Gayu 25 qñaM \LÚvenH

sñak;enApÞHelx 18 pøÚvelx 374 TYlsVayéRB 1

x½NÐcMkarmn RkugPñMeBj.

Kat;mansuxPaBminsUvl¥ Kat;k¥kmYyEx

ehIy. Kat;EbkejIs ehIyekþAxøÜnenAeBlyb;

RskTMgn; nigminGacjúaM)an. Kat;minEdleTACYb

evC¢bNÐiteT nigmineRbIfñaMGVITaMgGs;BImunmk.

1- etIGaceTArYceT cMeBaHelak Ekv sam:at

sgS½yfamanCMgWrebg ?

k- )aT¼cas+

x- eT

2- RbsinebIKat;sgS½yfamanrebg etIGñkKYr

eFIVGVI?

k- pþl;fñaMKat;elb

x- bBa¢ÚnKat;eTABüa)alCamYyRKUbUraN

K- bBa¢ÚnKat;eTAesvasuxPaBsaFarN³

Edlmanesvarebg

3- etImnÞIreBTü b¤mNÐlsuxPaBmYyNaEdlGñk

KYrEtbBa¢ÚnKat;eTA? GaRs½yTItaMgkñúgEpnTI

4- bMeBjTMrg;lixitbBa¢ÚnGñkCMgW BinitüemIlTMrg;

EdlbMeBjrYcral;ehIy RtwmRtUvb¤eT.

krNIsikSaTI 2

GñkRsI v:n Cata Gayu 40 qñaM kMBugsñak;enA

pÞHelx 16 pøÚvelx 374 TYlsVayéRB 1

x½NÐcMkarmn RkugPñMeBj.

Kat;mansuxPaBminsUvl¥eT Kat;k¥krauMér:mYy

ExehIy ekþAxøÜn QWRTUg RskTMgn; nigjúaMminsUv

)an. Kat;)anTTYlkarftsYt nig)anelbfñaMtam

evC¢bBa¢a. eTaHbICay:agNak¾edayGakar³eraK

rbs;Kat;minFUrRsaleLIy

1- etIvaGaceTArYceT cMeBaHelakRsI v:n Cata

sgS½yfamanCMgWrebg?

k- )aT¼cas+

x- eT

2- RbsinebI)aT¼cas+ etIGñkKYreFIVGIV?

k- pþl;fñaMKat;elb

x- bBa¢ÚnKat;eTABüa)alCamYyRKUbUraN

K- bBa¢ÚnKat;eTAesvasuxPaBsaFarN³

Edlmanesvarebg

3- etImnÞIreBTü b¤mNÐlsuxPaBmYyNaEdlGñk

KYrEtbBa¢ÚnKat;eTA? GaRs½yTItaMgkñúgEpnTI

4- bMeBjTMrg;lixitbBa¢ÚnGñkCMgW BinitüemIlTMrg;

EdlbMeBjrYcral;ehIy RtwmRtUvb¤eT.

segçbéf¶TI 2 énGIVEdleyIg)aneron

niymn½yénCMgWrebg nigeraKsBaØarbs;va

CMgWrebgRtUv)anqøg nigGackarBar)anedayrebobNa

yl;BIninñakarénCMgWrebgenAkñúgRbeTskm<úCa sÁal;BItYnaTIrbs;kmμviFICatikMcat;eraKrebg

yl;BITMnak;TMngrvagCMgWrebg nigeGds_

eFIVeGaymankargayRsYl sþIBIdMeNIrkarbBa¢ÚnGtifiCnsgS½yfamanrebg nigsÞat;CMnajkñúgkarbMeBjTMrg;

lixitbBa¢ÚnGñkCMgW

biTéf¶TI 2EføgGMNrKuNdl;sikçakamRKb;rUbsMrab;karcUlrYmry³eBleBjmYyéf¶rbs;BYkeK. EckcayTMrg;EbbbTvaytMél

RbcaMéf¶ nigsuMeGaysikçakambMeBj kñúgxN³EdlGñkRtUverobcM[manerobrykñúgbnÞb;bNþúHbNþal. esñIsikçakampþl;TMrg;

EbbbTvaytMél Edl)anbMeBjrYcmk[Gñk.

vKÁbNþúHbNþalsMrab;buKÁlik»sfsßan-rg

eTAelIRbFanbT {rebobRKb;RKgGtifiCn

sgS½ymanCMgWrebg}

smasPaK III³ karR)aRs½yTak;Tg - GnuvtþCMnajR)aRs½yTak;Tg

edIm,IelIkkMBs;suxPaBshKmn_

vKÁTI 1 ³ RbsiT§PaBénCMnajR)aRs½yTak;Tg

vKÁTI 2 ³ karR)aRs½yTak;TgCamYyGtifiCn

éf¶TI3



EpñkTI 3 ³ karR)aRs½yTak;Tg- karGnuvtþCMnajR)aRs½yTak;Tg edIm,IeFVI[RbesIreLIgsuxPaBshKmn_

vKÁuTI 1 ³ CMnajR)aRs½yTak;TgRbkbedayRbsiT§PaB



1- erobrab;ktþacaM)ac;sMrab;CMnajR)aRs½yTak;Tg

RbkbedayRbsiT§PaB

2- rkeXIjnUv]bsKÁedlraraMgkarR)aRs½yTak;Tg

RbkbedayRbsiT§PaB

3- bgðajCMnajsþab;y:agskmμ

srub ³ 3 em:ag

karerobcM ³

1- RkdasspÞaMgsFM hVWt nigsáút

2- DVD {sþIBIkarskmμPaBrYmKñarvagbuKÁlik»sfsßan-

rg nigGtifiCn : ]bkrN_ DVD

3- erobcMsarsMrab; {lMhat;énCMnajR)aRs½yTak;Tg :

4- erobcMkarbgðajedayeRbI overheads b¤ Power

Point slides GMBIdMeNIrkarénkarR)aRs½yTak;Tg

Edl)anerobcMehIy edayeRbIR)as;B½t’mantam

]bsm<½n§ 1

5- ftcMlgsac;erOg {sMnYrGVIEdlRtUvsYr} eGayeTA

2 Rkum

segçbvKÁéf¶TI 3

vKÁTI 1 ³ CMnajR)aRs½yTak;TgRbkbedayRbsiT§PaB

enAkñúgvKÁenHsikçakamsikSaGMBICMnajR)aRs½yTak;TgRbkbedayRbsiT§PaB EdlnIgCYyBYkeKeGaybMerI

GtifiCn nigGPivDÆn_GaCIvkmμrbs;BYkeKkan;EtRbesIreLIg k¾dUcCaedaHRsay]bsKÁkñúgkarR)aRs½y

Tak;TgpgEdr.

vKÁTI2³ karR)aRs½yTak;TgCamYyGtifiCnEdlbgákarlM)ak

enAkñúgvKÁenHCYy[sikçakamdwgBIrebobTak;TgCamYyGtifiCnbgákarlM)ak EdlraraMgkarR)aRs½yTak;Tg.

BiFIebIk ³

sVaKmn_sikçakaméf¶TI 3 nigerobrab;[BYkeKnUvesckþI

segçbxøI² Edl)anBIB½t’manRtlb;kñúgTRmg;vaytMél

RbcaMéf¶TI 2

viFIsa®sþ ³

CMhanTI 1 ³ sYreTAsikçakam {etIkarR)aRs½yTak;TgCaGIV?}

10 naTI

elIkTwkcitþ[sikçakamRKb;KñacUlrYm. sresrKMnit

rbs;sikçakamenAelIRkdasspÞaMgFM

bgðaj Slides GMBIniymn½yénkarR)aRs½yTak;Tg

KWCakarpøas;bþÚrnUvB½t’man b¤kardwg ¬KMnit/ mtieyabl;/

CMnaj/ cMeNHdwg¦ rvagmnusS.

CMhanTI 2 ³ esñIeGaysikçakamKitGMBItYnaTIrbs;buKÁlik

»sfsßan-rg kñúgkarkarR)aRs½yTak;TgCamYyGtifiCn

nigcMraj;ykcMelIyBYkeK.

10 naTI

kt;RtacMelIyrbs;sikçakamenAelIRkdasspÞaMgFM

]TahrN_xøH²éncMelIy

sþab;bBaða b¤sMeNIrbs;GtifiCn

pþl;RbwkSa nigB½t’man

CYyGtifiCnEdlGacsgS½ymanCMgWrebg nig

bBa¢ÚnBYkeKeTAmNÐlsuxPaB



cMelIyKMrU ³

PaBeCaKC½y ³

- karniyayc,as;² nigyWt²

- kareRbIR)as;BaküEdlgayRsYlyl;

- kareRbIR)as;BaküFmμta-samBaØ

- karrkSakarTak;TgedaypÞal; KWEPñkTl;EPñk

- karbgðajkareKarBdl;GtifiCn

]bsKÁ ³

- karniyayelOneBk nigminsUvc,as;

- mineKarBGtifiCn

- erIseGIg

- minmanPaBrYsrayrak;Tak;

CMhanTI 3 ³ ENnaMsikçakamGMBIskmμPaB {karTMnak;TMng

TTYl)aneCaKC½y nig]bsKÁkñúgkarR)aRs½yTak;Tg}

1 em:ag

EcksikçakamCa 4 Rkum. esñIeGayRkumnImYy²cat;

taMgGñkeFIVr)aykarN_mñak; edIm,IsegçbnUvcMnucsMxan;²

pþl;eGayRkumnImYy²nUvRbFanbTmYy nigBnül;BI

kic©kar ³ BIrRkumnwgBiPakSa nigkt;RtaBIGIV EdlCakar

)aRs½yTak;TgTTYl)aneCaKC½yCamYyGtifiCnEdl

GacsgS½ymanCMgWrebg nig 2 RkumeTot nwgBiPakSa

nigkt;RtanUvGIVEdlCa]bsKÁenAkñúgkar)aRs½yTak;Tg

rbs;BYkeKCamYyGtifiCn EdlGacsgS½ymanCMgWrebg

bnÞab;BIBYkeK)anbBa©b;karBiPakSaehIy esñIeGayGñk

eFIVr)aykarN_eLIgbgðajnUvcMelIyrbs;Rkum

cak; DVD {skmμPaBeqøIyqøgrvagbuKÁlik»sf-

sßan-rg nigGtifiCn} segçbmtieyabl; nigeFIV

esckþIsniñdæan EdlTak;TgeTAnwgtYnaTIrbs;buKÁlik

»sfsßan-rg enAkñúgkarR)aRs½yTak;TgCamYy

GtifiCn. Bnül;sikçakamfaenAeBlEdlRbCaCn

eFVIkarR)aRs½yTak;Tg CYnkalkarR)aRs½yTak;Tg

enaHTTYl)aneCaKC½y nigCYnkalbraC½y bu:EnþeyIg

GaceronsURtBIrebobeFIVkarR)aRs½yTak;Tg EdlGac

[)anRbesIrCagmun.

CMhanTI 4 ³ ENnaMsikçakamGMBIEl,g {CYrénkarR)aRs½y

Tak;Tg}

20 naTI

EcksikçakamCa 2 Rkum. esñIsikçakamenAkñúgRkum

nImYy²QrCaCYr. GñkQrTImYyénRkumTaM 2 RtUv

)aneXIj nigGansar Edl)ansresrenAelIRkdas

tUcmYy. sarenaHRtUv)anbBa¢ÚnBImnusSmñak;eTA

mnusSmñak;eTotCabnþbnÞab; edaykarxSwbdak;Rtecok

GñkbnÞab;. GñkcugeRkayEdlTTYlsar RtUvsresr

sarenaHenAelIkþarexon b¤RkdasspÞaMgFM.

RkumTI 1 ³ sikçakamminGnuBaØateGaysYrbBa¢ak;

GMBIsareLIy

RkumTI 1 ³ sikçakamminGnuBaØateGaysYrbBa¢ak;

GMBIsareLIy

RkumTI 2 ³ sikçakamRtUv)anGnuBaØateGay

sikçakamsYrbBa¢ak;GMBIsar

eRkayBIRkumnImYy²)anbMeBjkic©kar ehIy)an

sresrsarenAelIkþarexonenaH bgðajsaredIm nig

eRbóbeFobvaCamYysarrbs;RkumnImYy². BiPakSa

GVIEdlekIteLIgenAkñúgRkumnImYy². BiPakSaehtuGIV

)anCasarrbs;RkumTI 2 esÞIrEtdUceTAnwgsaredIm.

CMhanTI 5 ³ bgðaj Slides GMBIviFIsa®sþR)aRs½yTak;Tg

EdlmanRbsiT§PaB nigBiPakSay:ageBjeljenAkñúg

RkumFM.

35 naTI

bgðaj Slides sþIBIviFIsa®sþR)aRs½yTak;Tg nig

BiPakSanUvRbFanbTdUcteTA ³

CMnajniyay

CMnajR)aRs½yTak;TgedaypÞal;mat;

CMnajsþab;

CMnajR)aRs½yTak;Tgedaykayvikar

CMhanTI 6 ³ ENnaMsikçakamtamry³skmμPaB

{sMnYrGIVEdlRtUvsYr}

45 naTI

EcksikçakamCa 2 Rkum. esñIeGayRkumnImYy²

eRCIserIsGñkeFIVr)aykarN_mñak;. Gansac;erOg

dUcxageRkam ³



suPI Ca®sIþemm:ay manGayu 40 qñaM rs;enACamYykUn

eBjv½y 3 nak;.

suPI lk;bbreGayekμg²enAsalakñúgPUmi.

Kat;)ank¥k 6 ExehIy.

esñI[sikçakamBiPakSaelIsac;erOgenHkñúgRkumrbs;

BYkeK nigeFIVbBa¢IsMnYr EdlBYkeKRtUvkarsYr suPI

edIm,IerobcMeGay)ansmrmü RtwmRtUv nigRsbtam

sßanPaBrbs;Kat;.

esñI[GñkeFVIr)aykarN_kñúgRkumnImYy² GannUvsMnYr

rbs;BYkeK. GñksRmbsRmYlnwgsresrnUvsMnYr

rbs;RkumTaMgBIrenAelIRkdasspÞaMgFM nigEcksMnYr

TaMgenaHCaBIrcMENk. cMENk ¬1¦ CasMnYrebIk nig

cMENk ¬2 ¦ CasMnYrbiT.

enAcugbBa©b;énlMhat; esñI[sikçakambþÚrsMnYrbiT

TaMgGs;eTACasMnYrebIkvij. esñIbBa¢ak;fa etIman

sar³sMxan;y:agNasMrab;buKÁlik»sfsßan-rg

sYrsMnYrebIkenAeBleFIVkar)a:n;RbmaNsßanPaBrbs;

GtifiCn edIm,IeFIVeGayyl;dwgkan;EtRbesIrnUvbBaða

ehIyGacpþl;nUvB½t’manRtwmRtUv nigdMbUnμan.

vKÁTI 2 ³ karR)aRs½yTak;TgCamYyGtifiCn


enAcugbBa©b;énvKÁenH sikçakamKYrman ³

1- PaBRbesIreLIgkñúgkarR)aRs½yTak;TgCamYyGtifiCn

EdlbgákarlM)ak


karerobcM ³

1- RkdasspÞaMgsFM hVWt nigsáút

2- ftcMlgsac;erOg {bEgVrsßanPaBbBaðaeGayeTACa

»kas} edIm,Ipþl;eTAeGay 2 Rkum

3- enAelIRkdaspÞaMgFM KUrtaragFMEdlmankUeLan

{karTTYlxusRtUv¼kic©kar GaceFIV minGaceFIV ehtuGIV

minGaceFVI} Edl)anerobrab;enAkñúgCMhanTI 3

4- ftcMlgsMnYr edIm,I[sikçakamTaMgGs;bMeBjeRkay

eBleron (post-test)

viFIsa®sþ ³

CMhanTI 1 ³ dwknaMkarBiPakSaGMBI]bsKÁEdlbuKÁlik

»sfsßan-rg RbQmenAeBlGtifiCncUlmksYrrkkar

Büa)alCak;lak; EtminR)ab;BIeraKsBaØa b¤kMLúgeBlén

karmaneraKsBaØa ehIyCaerOy²minmanectnaeFIVtam

dMbUnμanbuKÁlik»sfsßan-rgeT.

10 naTI

Bnül;sikçakamfa vKÁenHnwgepþatelIfa etIeFVIy:agdUc-

emþc edIm,IedaHRsay]bsKÁ nigrebobbEgVrsßanPaB

TaMgenHeTACa»kassMrab;GtifiCneronBIrebg.

CMhanTI 2 ³ ENnaMsikçakamtamry³skmμPaB

{bEgVrsßanPaBbBaðaeGayeTACa»kas}. eKalbMNgén

skmμPaBenHnwgbgðajrebobR)aRs½yTak;TgEdlman

Gtßn½y nigCYydl;GtifiCnEklMGesvakmμ»sfsßan-rg

nigdwknaMeGayGaCIvkmμRbesIreLIg.

45 naTI

EcksikçakamCa 2 Rkum. RkumTI 1 CabuKÁlik]sf-

sßan-rg nigRkummYyeTotCaGtifiCn

RkumTI 1 ³ BinitüeLIgvijnUvsac;erOg dUcteTA ³ RbsinebI

nrNamñak;CabuKÁlik»sfsßan-rg etIGñkcat;EcgGtifiCn

enHy:agdUcemþc?

sarin Caburs)anerobkarrYcehIy manGayu 32 qñaM

CamYyTarkmanGayu 6 Ex

Kat;eFIVcMNakRsukeTAeFIVkarCakmμkrsMNg;enA

RkugPñMeBj

Kat;)ank¥k 6 ExehIy ehIyTTYlGarmμN_fa

enOyht;Nas;

Kat;mk»sfsßan-rgrbs;Gñk edIm,IsuMTijfñaM

Kat;Rbjab;eTAeFIVkar Kat;mincg;sþab; b¤eqøIynUvsMnYr

rbs;GñkeT

RkumTI 2 ³ bgðajeLIgvijnUvsac;erOg dUcteTA ³ RbsinebI

GñkCaGtifiCnkñúgeBlGnaKtenAeBlGñkmanbBaðasuxPaB

epSgeTotekIteLIg etIGñkRtlb;mkrk»sfsßan-rg

dEdleTot b¤eT?



sux sM CaburserobkarrYcehIy manGayu 32 qñaM

CamYykUntUc 2 nak;.

Kat;ebIk»sfsßanmYyenATIRkug EdlmanmnusS

eRcIn. Kat;manPar³CYykargarRkumRKYsarrbs;Kat;

pgEdr. dUecñaH Kat;EtgEtRbjab;Rbjal;.

GñkeFIVcMNakRsukeTAeFIVkarCakmμkr.

Gñkmk»sfsßanrbs; sux sM edIm,IsuMTijfñaMk¥k.

sMelokbMBak;rbs;GñkkxVk;dUcsMelokbMBak;eBlGñk

kMBugeFIVkarenAkardæansMNg;. sux sM ykcitþTukdak;

bnþicbnþÜceTAelIGñk esÞIrEtminemIlmkGñk. Kat;

lk;eGayGñknUvTwksIur:Uk¥k BisarmunGaharéf¶Rtg;.

esñIeGayRkumnImYy² cat;taMgGñkeFIVr)aykarN_mñak;

edIm,IBiPakSakargarrbs;BYkeK nigkt;RtacMelIyrbs;

BYkeKenAelIRkdasspÞaMgFM. RkumnImYy²nwgbgðaj

CMhanTI 4 ³ cugbBa©b;énvKÁ Rtlb;eRkayeTArkskmμPaB

{BIra:mIdRbkbedayKuNPaB}

10 naTI

esñIeGaysikçakambiTRkdasBN’enAelIRkdas

{BIra:mIdRbkbedayKuNPaB} edayKitfa etIBYkeK

enAkRmitNaBIeKaledA bnÞab;BI)anTTYlkarbNþúH-

bNþal. eRbóbeFoblT§plTaMgenHCamYylMhat;

TImYy {BIra:mIdRbkbedayKuNPaB} EdlBYkeK)aneFIV

enAeBlcab;epþImvKÁsikSa.

]TahrN_éncMelIy

karTTYlxusRtUv¼kic©kar GaceFIV minGaceFIV ebIGñkminGaceFIV)an Bnül;faehtuGIV

pþl;karGb;rM B½t’man nigdMbUnμan

pþl;B½t’manBIeraKsBaØaénCMgWrebg karBüa)al

pþl;B½t’manGMBIbNþaj X min)andwgBIbNþajNamYyenAkñúgshKmn_

Büayamrk[eXIjGñkCMgWrebgsgS½y

elIkTwkcitþGñkrebgsgS½yeGayeTAmNÐlsuxPaB

bBa¢ÚnGtifiCneTAmNÐlsuxPaB

EcksMPar³Gb;rMsmRsb X eyIgminmansMPar³ IEC eT

nUvlT§plénkarBiPakSarbs;BYkeK. enAeBlcb;kar

bgðajnImYy² dUcteTA ³

esñIsYrsikçakamEdlenAsl; ³ {etIGñkyl;RBm b¤eT?

RBm ehtuGIV? minyl;RBm ehtuGVI ? etIGacEklMG

karR)aRs½yTak;TgedayrebobNa?}

CMhanTI 3 ³ srubvKÁenH edaykaresñIeGaysikçakameFIV

bBa¢InUvral;karTTYlxusRtUvrbs;buKÁlik»sfsßan-rg

Edl)anBiPakSaBIvKÁxus²KñaenAkñúgvKÁsikSa.

10 naTI

esñIeGayBYkeKBinitüemIlGIVEdlBYkKat;GaceFVI nig

minGaceFVI)anedayeRbItaragdUcenAkñúg]TahrN_

éncMelIyxageRkam

segçbvKÁsikSa ³

eRbIR)as;nUvkMNt;RtaTaMgLay Edlmankñúgry³eBl

3 éf¶ edaysegçbmin[eRcInCag 5-6 cMNuc. enHCakar

rMlwksMrab;sikçakam. eRbIR)as;RbGb;xageRkamCaesckþI

ENnaM.



segçbnUvGIVEdleyIg)aneronry³eBl 3 éf¶

cMeNHdwg nigkaryl;BICMgWrebg eraKsBaØarbs;va karqøg nigkarkarBar

cMeNHdwgGMBIsßanPaBbc©úb,nñénCMgWrebgenAkñúgRbeTskm<úCa nigtYnaTIénkmμviFICatikMcat;eraKrebg

cMeNHdwg nigkaryl;BItYnaTIrbs;buKÁlik»sfsßan-rg enAkñúgkarcUlrYmkat;bnßyPaBrIkraldalénCMgWrebg

rebobR)aRs½yTak;Tg EdlmanRbsiT§PaBCamYyGñkCMgWrebgsgS½y nigCamYyGtifiCn

rebobbMerIeGayshKmn_rbs;eyIg nigrIkrayCamYyGaCIvkmμrIkcMerIn

CMhanTI 5 ³ EckTMrg;B½t’manRtlb; nigsMnYrsakl,geRkaysikSaeTAkan;sikçakamTaMgGs; edIm,IbMeBj

30 naTI

RbmUlTMrg;TaMgGs; nigEføgGMNrKuNdl;sikçakamsMrab;karcUlrYm nigkarxitxMRbwgERbg

RbKl;viBaØabnbRt RbsinebIsmRsb

BiFIbiTvKÁsikSa



]bsm½<n§ 1 ³ B½t’manEpñkbec©keTs GMBICMgWrebgsMrab;bTbgðajéf¶TI 2 ³ B½t’man sþIBIRbvtþiCMgWrebg

vKÁuTI1 ³

B½t’mansMrab;bgðaj sþIBIsßanPaBCMgWrebgbc©úb,nñenAkñúgRbeTskm<úCa

RbeTskm<úCa

cMnYnRbCaCnkñúgRbeTs 14 197 000

cMNat;fñak;sklén 22 RbeTs

EdlmanbnÞúkCMgWrebgx<s;

21

cMnYn)a:n;sμanénkrNIrebgfμI 70 949

GaMgsIudg; )a:n;sμanRKb;krNIrebgfμI

¬kñúg 100 000 nak;¦

500

cMnYnRbCaCnRKbdNþb;edaydUts_ 100°

GaMgsIudg)a:n;sμan;krNIrebgfμI ebkaviC¢man

¬kñúg 100 000 nak;¦

220

GRtaRsavRCavkrNIrebgfμI ebkaviC¢man 62°

GRtaBüa)aleCaKC½y ¬krNIfμIebkaviC¢man

cuHbBa¢IBüa)alqñaM 2005¦

93°

eRbv:aLg; HIV enAkñúgGaMgsIudg;krNICMgW

rebg

10°

PaKryénrebgsuaMfñaM ¬2005¦ 3>1°

RbPBTinñn½y ³ karkMcat;CMgWrebgskl ³ kaBinitüemIl

karerobcMEpnkar karpþl;hirBaØvtßú ³ r)aykarN_rbs;

GgÁkarsuxPaBBiPBelakqñaM 2008 edayEp¥kelITinñn½y

qñaM 2006.

Date source : Global Tuberculosis Control : surveillance, planning, financing : WHO report 2008 based on data from 2006 unless otherwise stated 4 UNAIDS, Cambodia response, 2007

CMgWrebgbnþkøayeTACakgVl;suxPaBsaFarN³d¾

sMxan;mYyenAkñúgRbeTskm<úCa. r)aykarN_sþIBICMgWrebg

qñaM 2008 rbs;GgÁkarsuxPaBBiPBelak (WHO) )an

bBa¢ak;fa RbeTskm<úCa CaRbeTsmYyEdlmanGRtaCMgW

rebgx<s;kñúgsklelakkñúgcMNat;fñak;TI 21 kñúgcMeNam

RbeTs 22 EdlmanbnÞúkCMgWrebgF¶n;F¶r. esÞIrEt 2¼3

énRbCaCnkm<úCamanpÞúkedayemeraKrebg ehIyRbCaCn

km<úCasøab;RbmaN 13 000 nak; kñúg 1qñaM² edaysarCMgW

enH. enAqñaM 2006 GaMgsIudg)a:n;sμanénCMgWrebgenAkñúg

RbeTskm<úCaman 500 krNI kñúgcMeNam 100 000 nak;

ehIyGRtasøab;man 92 nak; kñúgcMeNam 100 000 nak;.

ticCagBak;kNþalénkrNICMgWrebg Edl)an)a:n;sμan

cMnYn 70 949 nak; enAkñúgRbeTskm<úCaRtUv)aneFIVeraK

vinic½äy. GñkEdlmin)aneFIVeraKvinic½äy min)anTTYlBüa)al

eT Cajwkjab;bNþaleGaysøab;. kmμviFICatikMcat;eraK

rebg)ancab;epþImGnuvtþkarBüa)alCMgWrebg edayyuT§sa®sþ

dUts_ (DOTS) enAkñúgqñaM 1994. dUts_ (DOTS) bc©úb,nñ

manenARKb;mnÞIreBTübEg¥kcMnYn 68 mNÐlsuxPaBcMnYn

853 nigbu:sþ×suxPaBcMnYn 40 enAkñúgRbeTskm<úCa.

RbeTskm<úCarkSa)anGRtaCasHes,IyeRcInCag 85°

nigGRtaRsavRCavelIs 60°.

CMgWrebgCaCMgWmYyEdlCaGñksMlab;d¾FMCageKsMrab;

GñkmanemeraKeGds_. GRtaeRbv:aLg; HIV Edl)an

)a:n;sμanenAkñúgRbeTskm<úCakñúgcMeNamGayu 15-49 KW

1/6° (0/9-2/6°) kñúgqñaM 200711. GgÁkarsuxPaB

BiPBelak)a:n;sμaneRbv:aLg; HIV kñúgcMeNamkrNICMgW

rebgmanRbmaN 10°.

1 USAID, Cambodia Response, 2007



B½t’mansMrab;bTbgðajsþIBIkmμviFICati kMcat;eraKrebg

kmμviFICatikMcat;eraKrebgRbeTskm<úCa begáIteLIg

eRkamkarTTYlxusRtUvrbs;mCÄmNÐlCatikMcat;eraKrebg

nighg;sin (CENAT). kmμviFICatikMcat;eraKrebgman

mnÞIreBTübEg¥kfñak;kNþal fñak;extþ nigfñak;Rsuk Edlman

TItaMgmnÞIrBiesaFn_. kñúgqñaM 1994 kmμviFICatikMcat;eraK

rebg)aneFVIvimCÄkarkargarrebg BImnÞIreBTübEg¥kextþ

eTAmnÞIreBTübEg¥kRsuk ehIykñúgqñaM 1999 eFVIvimCÄkar

eTAmNÐlsuxPaB. dUcenHenAqñaM 2003 mNÐlBüa)al

EdlmanTItaMgmnÞIrBiesaFn_rebg maneRcInCag 145 mNÐl

suxPaBmancMnYn 700 kMBugGnuvtþyuT§sa®sþdUts_.

bc©úb,nñenH kmμviFICatikMcat;eraKrebgmanmnÞIr-

BiesaFn_cMnYn 180 enAkñúgRbeTs rYmbBa©ÚlTaMgmnÞIr-

BiesaFn_bEg¥krbs; CENAT EdlTTYlxuskñúgkarerobcM

sMPar³bNþúHbNþal bNþúHbNþalGñkbec©keTsmnÞIr-

BiesaFn_ nigcuHGPi)al nigFanaKuNPaBénmnÞIrBiesaFn_

fñak;extþ. man 24 mnÞIrBiesaFn_fñak;extþ TTYlbnÞúkcuH

GPi)al nigbNþúHbNþalbuKÁlikmNÐlsuxPaBkñúgkar

eFVIPñaskMhak nigeFVIr)aykarN_eTAeGay CENAT.

eKaledA eKalbMNg nigyuT§sa®sþrbs;kmμviFI CatikMcat;eraKrebgkm<úCa ³

cUlrYmcMENkkñúgkarelIkkMBs;suxPaBRbCaCnkm<úCa

edIm,IcUlrYmcMENkkñúgkarGPivDÆesdækic© sgÁmkic©

karkat;bnßyPaBRkIRk edayeFVIkarkat;bnßyGRtaQW

nigGRtasøab;bNþalmkBICMgWrebg.

pþl;kareFIVeraKvinic½äy nigBüa)alCMgWrebg edaymin

Kitéfø

rkSaGRtaCasHes,IyeRcInCag 85° nigGaRta

RsavRCavy:agtic 70°

»sfsßanrbs;RsukRbtibtþi TTYlxusRtUvTukdak;XøaMg

nigeFIVkarEbgEckeGayTan;eBlevladl;mNÐl

Büa)alrebg ¬manmnÞIrBiesaFn_rebg ¦ nigmNÐl

suxPaBEdlpþl;esvadUts_ nigTTYlxuskñúgkar

EfrkSa sþúksuvtßiPaB sþúkbMrug nigtamdanéf¶put

kMNt;rbs;fñaM.

buKÁliksuxaPi)alRtUvR)akdfa fñaMrebgRtUv)aneRbI-

R)as;RbRBwtþeTAtamBiFIsarrbs;fñak;Cati ehIyKYr

KNna[)anRtwmRtUv»sfRtUveRbIR)as;.

ksagsmtßPaBbuKÁlikedaysgát;F¶n;eTAelIkar

bNþúHbNþalbnþGaRs½yeTAnwgkartMrUvkarcaM)ac;

karBRgIkeRKagdUts_ énkmμviFICatikMcat;eraKrebg edIm,IBRgwgsmasPaKsMxan;²R)aMényuT§sa®sþ dUts_

1- eFIVeGaymanesßrPaBnUvkarebþCJaxagneya)ay edIm,I

begáInFnFanmnusS nigfvika nigcat;TukkarkMcat;CMgW

rebgCaGaTiPaBenATUTaMgRbeTs nigsßitenAkñúgRbB½n§

suxaPi)al

2- eFVI[TTYl)ankarBinitükMhakedaymIRkUTsSn_

manKuNPaBsMrab;RsavRCavkrNIrebg ¬ykcitþTuk

dak;Biess nigCakarcaM)ac;cMeBaHkrNIEdlman

emeraKeGds_ ehIynigRkumRbQmmuxeRKaHfñak;;

epSg²eTot dUcCa Gñkrs;enAkñúgdMbUlRKYsar nig

buKÁlikkñúgsßab½n.

3- eFIVeGaymankarBüa)aleday»sfKImI sþg;darEdl

manry³eBlxøI rYmbBa©ÚlTaMgkarsegátedaypÞal;

kñúgeBlBüa)al.

4- minmankarraMgsÞHkñúgkarpÁt;pÁg;»sfEdl)anFana

KuNPaB nigGacTukcitþ)ankñúgkarlT§kmμ»sf nig

RbB½n§Eckcay.

5- manRbB½n§kt;RtacuHbBa¢I nigeFIVr)aykarN_sþIBIlT§pl

énkarBüa)al nigskmμPaBepSg²eTot EdlTak;Tg

nwgkarrIkcMerInrbs;kmμviFI. TaMgenH KWCamUldæan

EdlmanlkçN³CaRbB½n§sMrab;RtYtBinitütamdan

kmμviFI nigEktMrUvbBaðaEdl)anrkeXIj.



vKÁuTI 2 ³

B½t’mansMrab;bTbgðaj sþIBIkarRsavRCavkrNIrebg nigktþaEdlBak;B½n§nwgGRtaRsavRCaveXIjkrNIrebg

viFIsa®sþénkarRsavRCavkrNIrebg

RbvtþievC¢sa®sþrYmbBa©ÚlnwgehtukarN_sgÁm RKYsar

evC¢sa®sþ ehIynigTidæPaBmuxrbrrbs;GtifiCn

karBinitükMhakedaymIRkUTsSn_ (SSM) KWCakargay

bMput EdlmantMélefak cMNayry³eBlxøIGac

RsavRCavRKb;RbePTemeraKEdlmanenAkñúgkMhak

¬kMhakl¥ KWxakecjBICeRmAénsYt¦.

kargarbNþúHemeraK tMbn;mYycMnYnminGacGnuvtþ)an

eT. dUcenH karBinitükMhakedaymIRkUTsSn_ KWCa

meFüa)ayEdlmanRbsiT§PaB edIm,IkñúgkarRsavRCav

CMgWrebg. karbNþúHemeraK KWCaviFIsa®sþmYy edIm,I

bBa¢ak;elIeraKvinicä½yCMgWrebg. karbNþúHemeraK

caM)ac;RtUvmanmnÞIrBiesaFn_ÉkeTs.

kareFVIetsþ Tuy Eb‘KUlIn (tuberculine) elIEs,k

eRbIsMrab;KaMRTkarRsavRCavrkeXIjGñkCMgWrebg

ehIyPaKeRcInGnuvtþelIkumar.

ktþarYmBak;B½n§nwgGRtaRsavRCaveXIjkrNIrebg kñúgRbeTskm<úCa

karRsavRCavrkeXIjkrNIIrebgskmμ KWCakarcaM)ac;

kñúgkargarkMcat;CMgWrebg. karrkeXIjkrNIrebgskmμ)an

qab;Tan;eBl KW)ankat;bnßykarqøgenAkñúgshKmn_.

eRkamrUbPaBGnuvtþdUts_ kmμviFICatikMcat;eraKrebgBwgEp¥k

elIkarbgðajxøÜnrbs;GtifiCnenAKøInik edIm,IeFVIkarvaytMél

eraKsBaØarebgsgS½y bu:EnþmanehtuplCaeRcInEdlbNþal

[GñkCMgWrebgsgS½y minGaceTAmNÐlBüa)alrebg

EdlGacCH\T§iBlelIGRtaRsavRCavCMgWrebg.

]TahrN_xøH²én]bsKÁkñúgkarminGacTTYl)anesvakmμ

rebg

esdækic©

PaBsμúKsμajénviFIeTArkkarEfTaM

¬]> karBwgEp¥kelIfvika¦

tMélénkarEsVgrkkarEfrkSa

¬éføeFVIdMeNIr karciBa©wmCIvit¦

lTVPaBénkarcMNaysMrab;éføesvakmμ

RbCaCncl½t nigRbCaCneFIVcMNakRsuk

PUmisa®sþ

cMgayBImNÐlBüa)alrebg

¬nigQWF¶n;F¶r ehIyRtUveFVIdMeNIr¦

FatuGakas ¬TwkCMnn; ekþA¦

sgÁm nigvb,Fm’

erIseGIg nigxøaceKnireTs

xøac)at;bg;kargar

cMeNHdwg nigkaryl;dwgBICMgWrebgmankRmitTab

xVHxatB½t’manGMBIlTVPaBrbs;esva nigkarBüa)al

edayminKitéfø

BaküccamGaram nigkarP½nþRclMGMBIkarcMlg

karBüa)al kareFVITukçeBlelbfñaM

ninñakarénGRtarkeXIjkrNIrebgsYtfIμ nigGRta

Büa)aleCaKC½y qñaM 1994-2006 kñúgRbeTskm<úCa

qñaM GRtaRsavRCav

krNIrebgsYtfμI ¬°¦

GRtaBüa)aleCaKC½y

énkrNIrebgsYtfμI ¬°¦

1995 40 91

1996 34 94

1997 44 91

1998 47 95

1999 53 93

2000 51 91

2001 48 92

2002 57 92

2003 59 ?

2006 65% 93%



RbB½n§suxaPi)al

Tinñn½yBit dUcCa cMnYnGñkCMgWrebgbc©úb,nñ nig

kar)a:n;sμanelIslub

Gakb,kiriyaminl¥rbs;buKÁlikcMeBaHGtifiCn

Kary;ldwgtictYcGMBIesvakmμrbs;GtifiCn

nigshKmn_

xVHxatlTVPaBbBa©ÚlesvarYmKñay:agTUlMTUlay

¬]> rebg nigeGds_¦

xVHxatesvakmμCMnYsEdlmanRbsiT§PaB

CuM rtna Gayu 53 qñaM maneraKsBaØarebg

ehIyrs;enACIvPaBy:agBi)akkñúgTIRkugPñMeBj

niyayfa {xJúMmindwgBIkEnøgEdlTTYlkarBüa)al

edayminKitéføeT BIeRBaHxJúMminGacéllkTijfñaM

)aneT}. nagniyayfa mNÐlBüa)alrebgeday

minKitéfø manTItaMgenACitpÞHrbs;Kat; b:uEnþKat;

)armÖfa cUlBüa)alenAkñúgmnÞIreBTü Kat;Gac)at;bg;

eBlevlaeRcInExeBk.

bNþajB½t’manéntMbn;)anbBa©ÚlKña (IRIN)

kariyal½yGgÁkarshRbCaCatiPñMeBj sMrab;kar

sRmbsRmYlénkargarmnusSFm’ 7 sIha 2008

KMnitmYycMnYn edIm,IbMeBjtMrUvkar ³

begáItviFIsa®sþRsavRCavkrNIfμI nigRKb;RKg edIm,I

bMeBjPaBxVHxatrvagkrNIRsavRCavbc©úb,nñ nig

eKaledA

eFVI[RbesIrRtwmRtUveLIgnUvkar)a:n;sμan GaMgsIudg;

rebgrbs;fñak;Cati edayBRgWg nigBRgIkkarGegát

RsavRCav.

kmμviFICatikMcat;eraKrebg shkarCamYykmμviFI

RbyuT§nwgCMgW HIV/AIDS edIm,IeFIVeGayR)akdfa

kareFVIeraKvinicä½y nigBüa)alRbkbedayRbsiT§PaB

nigTan;eBl

GnþraKmn_tamkarRsavRCavskmμelIRkumeKaledA

Cak;lak; dUcCa smaCikRKYsarénGtifiCnmanCMgW

rebg nigviC¢manmanhIuv RbCaCnEdlRtUv)anbgçaMgTuk

nigGñkEdltaMgTIlMenAENnNan;tan;tab;.

cUrcgcaMfa ³

karRsavRCavCMgWrebgtammUldæanshKmn_ enAEtmin

GacTb;sáat;karrIkraldalénrebgGaMghViúcsüúg ¬latet TB¦

EdleKminmaneraKsBaØa.

vKÁTI 3 ³

B½t’mansMrab;karbgðajsþIBIdMeNIrkarbBa¢ÚnGñkCMgW

1> RbsinebIGtifiCnenA»sfsßan-rg RtUv)ansgS½yfa

manCMgWrebg buKÁlikKYrEt ³

pþl;nUvB½t’man sþIBIsavtarCMgWrebgeTAGtifiCn

Bnül;eTAGtifiCnfaCMgWrebgGacBüa)al)an

pþl;B½t’manGMBIdMeNIrkarbBa¢Ún BIGñkpþl;esva

suxPaBÉkCn eTAesvasuxPaBsaFarN³

ENnaMGtifiCn[EsVgrkfñaMenAesvasuxPaBsaFarN³

EdlmanesvadUts_ enACitpÞH

2> RbsinebIGtifiCnyl;RBmcUlrYmesvasuxPaB

saFarN³EdlmanesvadUts_ buKÁlik»sf¼rg KYrEt ³

ykTMrg;lixitbBa¢ÚnGñkCMgW nigbMeBjRKb;B½t’manenA

kñúgRbGb;EpñkxagelIénTMrg;lixitbBa¢ÚnGñkCMgWenA

TMB½rTImYy ¬TMrg;lixitbBa¢Ún RtUvEtbMeBjedayGñk

pþl;esvasuxÉkCn minEmnGtifiCneT¦

EhkBIrTMB½renAxageRkam ¬BN’páaQUk nigBN’ébtg¦

ehIyR)ab;GtifiCn[RbKl;eTAGñkpþl;esvasuxPaB

saFarN³ enAeBlBYkKat;eTAdl;mNÐlBüa)al

manesvadUts_

buKÁlik»sfsßan-rg KYrEtrkSaTuksnøwkBN’s

xagelIsMrab;TukCaÉksar



3> enAeBlGtifiCneTACYbGñkpþl;esvasuxPaBsaFarN³

GtifiCnnwgRbKl;TMrg;lixitbBa¢ÚnsnøwkBN’páaQUk

nigBN’ébtgeTA[Gñkpþl;esvasuxPaBsaFarN³

buKÁliksuxaPi)alnwgsaksYrGtifiCnGMBIRbvtþiCMgW

rbs;BYkeKeFIVkarBinitüragkay nigesñIeGayGtifiCn

xakykkMhak

kMhakrbs;GtifiCnnwgeFIVkarBinitürkemeraKrebg

buKÁliksuxaPi)alnwgeGayTMrg;lixitbBa¢ÚnBN’

páaQUkeTAGtifiCnvij edIm,IrkSaTuk

GtifiCnnwgrkSaTukTMrg;BN’páaQUkenH ehIykan;yk

vaRtlb;eTACYbbuKÁliksuxaPi)alvijtamkarENnaM

eRkayBIkareFIVeraKvinicä½ycb;sBVRKb; buKÁliksuxaPi)al

nwgRbKl;TMrg;BN’páaQUkCamYyevC¢bBa¢a ebIcaM)ac;

eTAGtifiCnvij

4> RbsinebIeraKsBaØarbs;GtifiCnminFUrRsal

buKÁlik»sfsßan-rg KYrEtENnaMeGayGtifiCn

sgS½ymanrebg Rtlb;eTAesvasuxPaBsaFarN³

dEdl nigpþaMeGayGtifiCnpþl;TMrg;BN’páaQUkeTA

buKÁliksuxaPi)al

5> RbsinebIkarBinitüeTAeXIjGtifiCnmanemeraKrebg

GtifiCnnwgRtUv)anBüa)aledaydUts_ enAesva

suxaPi)alsaFarN³.



éf¶TI 3 ³ CMnajR)aRs½yTak;Tg

vKÁuTI 1 ³

B½t’mansMrab;bTbgðajsþIBIkarR)aRs½yTak;Tg

EdlmanRbsiT§PaB

1- dMeNIrkarénkarR)aRs½yTak;Tg

Tl;muxKña ¬pÞal; b¤minpÞal;¦

BaküsMdI b¤kayvikar

rvagmnusSBIrnak; b¤eRcIn

2- CMnajkñúgkarniyay

kñúgkarR)aRs½yTak;TgTaMgGs; manGñkepJI nigGñk

TTYl. tYnaTIrbs;GñkepJI KYrEt ³

sarmanPaBc,as;las;

sÁal;Gñksþab; etIRbvtþi nigbTBiesaFn_rbs;

Gñksþab; KWCaGIV?

EksMrYlsareTAGñksþab;

eCosvagkarkat;sMdI begáItsMelgG‘UGr

EsVgyl;karyl;dwgrbs;Gñksþab; nigEsVgrk

kareqøIytb

segátkarsMEdgTwkmuxrbs;Gñksþab; nigkayvikar

sYrsMnYr edIm,IBinitüemIlkaryl;dwgGMBIsar

3> CMnajR)aRs½yTak;TgedayBaküsMdI

eRbIsMnYrebIkEdlelIkTwkcitþsMrab;cMelIy ³

etIGñkKitGMBIGVI>>>>>>>? {ehtuGIV>>>}/ {dUcemþc>>>}/

{GIVRbsinebI>>>?}

sYr {ehtuGIV)anCaGñkniyayGBa©wg?RbsinebI

GtifiCneqøIyFmμta {)aT¼cas+} b¤ {eT}

dwgBIrlksMelgrbs;Gñk nigniyayyWt²

ehIyc,as;²

eFIVeGayR)akdfaGñkTTYlniyayeRcInCagGñk

karbkRsayedaykarniyayeLIgvijnUvBakü

rbs;Gñk. GñkGacBinitükaryl;dwgedayCMruj

karniyayKña.

segçbkarBiPakSa edIm,IBinitükaryl;RBmrbs;

GñkepJI nigGñkTTYl

4> CMnajsþab;

sMrab;karR)aRs½yTak;TgEdlmanRbsiT§PaB EtgEt

Gnuvtþkarsþab;skmμ. karsþab;skmμ KWenAeBlEdlGñk

sþab;kMBugsþab;y:agRbugRby½tñBIGIV EdlGñkniyaykMBug

niyay ehIyfatamnUvGVIEdlKat;)anniyayRtlb;eTA

Kat;vij edIm,IeFVIeGayR)akdfaGñksþab;)anyl;sarenH

y:agRtwmRtUv.

karbiunRbsBV edIm,IeRbIsMrab;karsþab;skmμ ³

karniyayeLIgvij ³ Gñksþab;faeLIgvijnUvGIVEdlGñk

niyay )anniyayedayeRbIBaküdEdl²

karbkRsay ³ Gñksþab;eqøIytby:agelOnnUvGIVEdl

Gñkniyay )anniyayedayeRbIBakürbs;xøÜnpÞal;

minEmnBaküdEdl²eT

karsegçb ³ Gñksþab;eqøIytby:agelOnnUvcMnuc

sMxan;²énkarBiPakSa

GarmμN_eqøIytby:agrh½s ³ Gñksþab;manGarmμN_

eqøIytby:agelOn Kat;eCOfa GñkniyaykMBug

BiesaFn_

karsYrsMrab;kareFIVeGayyl;c,as;¼karbBa¢ak; ³

Gñksþab;sYrsMnYr edIm,IeFIVeGayc,as; b¤bBa¢ak;nUvGVI

EdlGñkniyay)anniyay

eFVI[RbesIreLIgnUvsmtßPaBrbs;Gñkkñúgkarsþab;)anl¥

R)ab;xøÜnGñkfa {xJúMeFIV[xøÜnrbs;xJúM sþab;)any:agl¥}

ykcitþTukdak;cMeBaHGñkniyay edayemIl nig

eFIVskmμPaB

eRbIkayvikar edIm,IeGayGñkniyaydwgfa Gñkcab;

GarmμN_ nigykcitþTukdak;tamry³TMnak;TMngEPñk/

gk;k,al.l.

kuMkat;sMdIGñkniyay. sþab;KMnitTaMgmUl

sYrsMnYr edIm,IeFIVeGaykan;Etc,as;enAeBlGñkmin

yl;

GPivDÆCMnajsþab;skmμ niyayeLIgvij nigsegçb

eFIVeGayl¥ edIm,IeCosvagkarvinic½äy b¤karvaytMél

GIVEdlGñkniyay)anniyay

eCosvagkarbgðajTMnas; ¬edayBaküsMdI - kay-

vikar¦

eCosvagRsemIRsém- revIrvay ¬karKitGMBIGIVmYy

epSgeTot enAeBlEdlGñkkMBugEtsþab;¦



]bsm½<n§ 2 ³ snÞanuRkménbec©ks½BÞrebg

snÞanuRkménbec©ks½BÞrebg

CMgWrebgskmμ KWCaCMgWmYy EdlemeraKrebgekItkUn

ekItecAeRcIn ehIyvayRbhareTAelIEpñkxus²Kñaén

ragkay. rebgmanBIrTMrg; ³ 1¦ karpÞúkemeraKrebg

(latent TB) nig 2¦ CMgWrebg ¬rebgskmμ¦. GñkpÞúkemeraK

rebgKμaneraKsBaØaeT ehIyminGaccMlgeTAGñkepSgeT.

GñkmanCMgWrebg ¬rebgskmμ¦ maneraKsBaØa nigGaccMlg

eTAGñkepSgeTot. eraKsBaØaCMgWrebgskmμ rYmman

Gs;kmøaMg/ RskTMgn;/ ekþAxøÜn/ minXøanGahar/ RsavRsaj/

nigEbkejIsenAeBlyb;. eraKsBaØaepSg²eToténCMgW

rebgskmμ GaRs½yelIemeraKrebgrIklUtlas;enAkEnøg

NamYyénrUbragkay. RbsinebICMgWrebgskmμenAkñúgsYt

¬rebgsYt¦ eraKsBaØaGacrYmmanTaMgk¥kruaMér: QWkñúgRTUg

nigk¥kFøak;Qam.

BCG : Calmette and Guérin KWCava:k;saMgsMrab;

bgáarCMgWrebg begáIteLIgedayviTüasa®sþCnCati)araMg.

BCG min)aneRbIy:agTUlayenAshrdæGaemrikeT bu:Enþva

RtUv)anpþl;eGayTark nigkumar sMrab;RbeTsEdlmanCMgW

rebgF¶n;F¶r.

karftsYt KWCarUbPaBmYyenAkñúgRTUg. karftsYt

KWeFVIeLIgedaykardak;taMghIVl nigkaMrsIμGiuc Edlqøgkat;

sYt. evC¢bNÐitGacemIltamry³hVIlenHfa etImanxUcxat

sYtedayemeraKrebgEdr b¤eT.

GñkEdlrs;enACitsñiT§CamYyGñkCMgWrebg KWmnusS

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s)þah_ edIm,IbBa¢ak;BIeraKvinicä½yrebg.

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ethambuhol b¤ E

isoniazid (H)

pyrazinamide (Z)

rifampicin (R)

streptomycin (S)

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epSgeToténragkayeRkABIsYt ¬Ca]TahrN_/ Rkelon/

q¥wgxñg/ xYrk,al/ kUnkNþúr¦.

karqøghIuv KWCakarbgáedayvIrusEdlbMpøajRbB½n§

PaBsuaMrbs;mnusS CaehtubNþal[eTACaCMgWeGds_

(Acquired Immunodeficiency Syndrome). mnusS

mñak;pÞúkemeraKrebg nighIuv KWCakarRbQmeRKaHfñak;x<s;

bMputkñúgkarvivtþeTACarebgskmμ.

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CMgWrebgskmμCamYyGñkEdlmanpÞÚkemeraKrebg. INH

KWCafñaMmYykñúgcMeNamfñaM 4 mux EdlCajwkjab;eRbIedIm,I

Büa)alCMgWrebgskmμ.

rebgGaMghVicsüúg ( Latent TB infection ) KWCa

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enAkñúgxøÜnmnusSeLIy. GñkEdlmanrebgGaMghVicsüúg

KμaneraKsBaØaeT minmanGarmμN_faQWfáat; rebgGaMghVic-

süúg minGaccMlgeTAGñkepSgeLIy nigCaerOy² lT§pl

etsþTuyEb‘KUlInelIEs,kviC¢man. bu:EnþvaGacvivtþeTACaCMgW

rebgskmμ RbsinebIGñkrebgGaMghVicsüúg min)anTTYlkar

Büa)albgáar.



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EdlemeraKrebgsuaMnwgnaMrebg y:agticBIrmux BiessfñaM

H nig R

mIkU)ak;etrIy:UmTuyEbKuyLÚsIus KWCaemeraK

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QuanfiFERON-TB® Gold (QFT) KWCakareFIVetsþ

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sMlab;va)an.

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mIRkUTsSn_.

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GaMghiVcsüúg.

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enAkñúgRKYsar.

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CMgWrebgsYt.

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déTeToteLIy.

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rbs;BYkeK.

9 CMgWrebgCaCMgWF¶n;F¶r b:uEnþGacBüa)al)an.

10 GñkCMgWrebgGacbBaÄb;karelbfñaM)an kalNaBYkeKElgmaneraKsBaØa.

11 buKÁlik»sfsßanmantYnaTIsMxan;kñúgkarcab;GtifiCnsgS½ymanrebg

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12 karRsavRCavCMgWrebgTan;eBlevla GacbBaÄb;karqøgCMgWrebgkñúgshKmn_.



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Rbus buKÁlik»sfsßan

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l>r cUrKUs RtUv b¤xus XøaEdl)anGFib,ayxageRkamenH RtUv xus

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BYkeK.X

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....................................................................................................................................................................................................................

....................................................................................................................................................................................................................

....................................................................................................................................................................................................................

A TrAiners Guide

FOR

A Workshop on TuberculosisF O R P H A R M A C y S TA F F I N C A M B O D I A

2005-2011

In Cambodia 2005 - 2011

A Trainers Guide for A Workshop On Tuberculosis For Pharmacy Staff l 39

Acknowledgments

This training guide was prepared for review by the United States Agency for International Development

(USAID) under USAID’s TB IQC Task Order 01, Contract No. GHN-I-00-09-00006. The primary authors are

Hara Mihalea, PATH ACSM/PPM Technical Officer and H.E Yim Yann Former President of the Pharmacists

Association of Cambodia. Barbara Bale provided editorial support. PATH would like to thank the following

organizations and individuals without whose participation and support this work would not have been

possible: His Excellency Dr. Mao Tan Eang, CENAT Director; Dr. Tea Bakhim, National PPM Focal Person;

His Excellency Ph. Yim Yann, Ph. Mao Dareth former President of the Pharmacists Association of

Cambodia; provincial health department directors and operational district directors in all PPM sites;

PHD and OD pharmacy units, participating staff from pharmacies, DOTS health centers and referral

hospitals; technical partners including the Japanese Anti-Tuberculosis Association and WHO; the PATH TB

team in Cambodia, particularly Hou Samith, Chengli Bota and Heang Kim Hor and the USAID Cambodia

Mission, particularly Dr. Chantha Chak and Kate Crawford for their support of and commitment to

improving public health in Cambodia.


40 l A Trainers Guide for A Workshop On Tuberculosis For Pharmacy Staff

BCG Bacille Calmette-Guérin – a vaccine for tuberculosis

DOTSDirectly Observed Therapy, Short-course, a strategy of treatment for tuberculosis that ensures clients take their required medication

IEC Information, Education, Communication

MDR TB Multi-Drug Resistant Tuberculosis

MHD Municipal Health Department

NTP National Tuberculosis Control Program

OD Operational District

PAC Pharmacist Association of Cambodia

PATH Program for Appropriate Technology for Health

PPMPublic Private Mix, a strategy to strengthen linkages between public and private health providers

SS+ Sputum Smear positive

TB Tuberculosis

USAID United States Agency for International Development

WHO World Health Organization

Acronyms And AbbreviAtions



tAble oF contents

INTRODUCTION ............................................................................................................................................................................ 42

OVERVIEW OF WORKSHOP SESSIONS ................................................................................................................................ 45

DAy ONE ........................................................................................................................................................................................... 47

COMPONENT I: ATTITUDE - STRENGTHENING THE QUALITY OF SERVICE FROM PHARMACIES AND DEPOTS ...................................................................................................................47

SESSION 1: INTRODUCTIONS AND EXPECTATIONS .................................................................................... 48

SESSION 2: THE ROLE OF PHARMACY AND DEPOT STAFF IN IMPROVING PEOPLE’S HEALTH .................................................................................................................................... 49

SESSION 3: CHALLENGES FOR PHARMACIES AND DEPOTS IN FULFILLING THEIR ROLES .............................................................................................................................................. 53

DAY ONE SUMMARY ...................................................................................................................................................................54

DAy TWO .......................................................................................................................................................................................... 55

COMPONENT II: TB TECHNICAL SKILLS - PUBLIC AND PRIVATE SECTOR PARTNERSHIPS IN THE IMPLEMENTATION OF DOTS .....................................................................55

SESSION 1: TB BACKGROUND INFORMATION.................................................................................................. 56

SESSION 2: TB DIAGNOSIS, TRANSMISSION AND PREVENTION ............................................................ 57

SESSION 3: THE REFERRAL PROCESS ..................................................................................................................... 60

DAY TWO SUMMARY ..................................................................................................................................................................62

DAy THREE ....................................................................................................................................................................................... 63

COMPONENT III: COMMUNICATION - APPLYING COMMUNICATION SKILLS TO IMPROVE COMMUNITY HEALTH ...................................................................................................63

SESSION 1: EFFECTIVE COMMUNICATION SKILLS.......................................................................................... 64

SESSION 2: COMMUNICATING WITH CLIENTS ................................................................................................. 66

WORKSHOP SUMMARY .............................................................................................................................................................67

ANNEX I TB TECHNICAL INFORMATION FOR PRESENTATIONS. ................................................................ 69

ANNEX II GLOSSARY OF TB TERMS ............................................................................................................................ 75

ANNEX III PRE AND POST TEST QUESTIONNAIRE ............................................................................................. 77

ANNEX IV DAILY EVALUATION FORMS .................................................................................................................... 79



Tuberculosis (TB) is an infectious bacterial disease caused by Mycobacterium tuberculosis, which most commonly affects the lungs. It is transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease. When infectious people cough, sneeze, talk or spit, they propel TB bacilli into the air. A person needs only to inhale a small number of these to be infected. Left untreated, each person with active TB disease will infect on average between 10 and 15 people every year. In healthy people, infection with M. tuberculosis often causes no symptoms, since the person’s immune system helps to keep the bacteria dormant. When a TB infected person’s immune system is weakened, as in people with HIV infection, the chances of becoming sick with active TB are greater2.

Although globally TB kills more than 2 million people a year, it is preventable and curable by treatment with a six-month course of antibiotics. TB that is not resistant to medication is almost always cured if the person complies with the treatment regimens, and antibiotics are started early. Without proper treatment, more than half the people with active tuberculosis will die within five years3.

Cambodia is among 22 countries that jointly account for 80% of the world’s TB burden. The current incidence of TB is 500 per 100,000 population and that of new smear positive pulmonary (lung) TB is 220 per 100,000.

introdUction

2 World Health Organization http://www.who.int/tb/en/

3 ibid and http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/10903.html reviewed by Harvard Medical School

4 Global Tuberculosis Control: surveillance, planning, financing: WHO report 2008

The number of new TB cases has tripled over the past decade. The estimated adult HIV prevalence rate (aged 15-49) for 2005 is 1.6% and HIV prevalence among TB clients has increased from 2.5% (1995) to 10% (2006)4.

Private providers play an important role in health care service delivery, and a substantial proportion of people in Cambodia seek care in the private sector for simple as well as serious health problems. However, often the private sector is unregulated, has limited knowledge and skills, and there is little collaboration with the public sector.

The development and introduction of a public private mix (PPM) model will greatly increase TB detection rates and improve diagnosis and treatment. Because the majority of people first seek treatment in the private sector, strengthening the skills of private providers for an appropriate role in TB assessment and management, and developing linkages from the private sector to public DOTS services will have an immediate impact on:

Reducing the diagnostic delay for appropriate TB treatment, thus increasing case detection

Strengthening private and public linkages and partnerships in TB management and control through a referral system to public DOTS services



WHO IS THIS GUIDE FOR?This guide is based on widely used global training curricula for pharmacy staff developed and tested by PATH. In Cambodia its adaptation evolved from training workshops held for pharmacy and depot staff to promote case detection of suspected TB cases within the private sector for referral to public DOTS services. This is part of the PPM strategy of the National TB Control Program (NTP) and is supported by funds from USAID with technical assistance from PATH. The guide is intended for distribution to the TB trainers of the Municipal Health Departments, Provincial Health Departments, Operational Districts, and the Pharmacy Association of Cambodia (PAC) who have attended a trainer of trainers’ course. The guide contains instructions for trainers to conduct a 3 day workshop entitled “How to manage possible TB clients” for pharmacists and also includes communication skills for pharmacy and depot staff. Other trainers may also use this guide, provided they too have attended an initial training.

OBJECTIVES OF THE WORKSHOPBy the end of the training workshop the participants will be able to:

1. Better understand the situation of the TB client, create a positive atmosphere for behavior change communication, demon-strate effective communication skills for client education, and thereby promote the benefit of access to TB testing and adherence to TB treatment

2. Demonstrate knowledge about the TB situation and the National TB Program in Cambodia, and understand the role of the pharmacy and depot staff in TB control and prevention

THIS TB TRAINER’S GUIDE CONTAINS:

An overview of the contents of the workshop

A list of all the materials needed for the workshop

The session outlines for each day of the workshop

Additional notes for the trainers, which provide details on the content and how to approach each specific session

KEy POINTS TO REMEMBER

Plan the workshop using this guide. Included in each session are trainer’s notes for that session

Be prepared to use flip charts and other methods not dependent on electricity and the availability of projectors and computers

You will need 2 trainers who can take it in turns to lead the sessions, facilitate the process and keep notes on outputs during the day

Allow 5 minutes at the end of each day to summarize the key points

Allow 5 to 10 minutes at the beginning of day two and three to present a summary of the previous day’s participant feedback

Negotiate with participants if you need more time than allocated

Arrange the room so that participants sit in a semi-circle and not in rows

All the training flip charts used during the workshop should be taped onto the walls of the training room throughout the workshop



The workshop uses a participatory approach. Do not give lectures - the participants all have experiences to share. Ask open-ended questions and encourage the sharing of opinions

Every participant should have the opportunity to practice new skills and knowledge

Most important point to remember: Do not teach all you know – teach only what providers need to know to do their job well

MATERIALS REQUIREDFlip chart paper

Marker pens

Tape

Registration forms

Training packages (agenda, handouts,information for participants)

Folders

Notebooks

Pens for each participant

Name badges for each participant

Overhead projector or Power Point projector (when possible)

Referral forms

TB DOTS health services list

See the “Preparation” section at the beginning of every session for information on the materials needed to prepare for individual session activities

CHECKLIST FOR TRAINERS1. Estimate budget needs for the workshop

2. Invite participants - no more than 20 participants per workshop

3. Book a training room. It should be quiet and spacious

4. Review the workshop guide and be familiar with the schedule and session plans

5. Check training equipment before starting, especially electronic equipment

6. Order training supplies

7. Prepare training materials (see “Materials” above)

8. Invite guests to opening and closing ceremonies

9. Order snacks and drinks. Ensure that there is enough for trainers and facilitators

10. Plan the closing ceremony

11. Prepare certificates of participation to hand out to participants who have completed the workshop (whenever applicable)

12. Have a camera available to take photographs of the workshop



OVERVIEW OF WORKSHOP SESSIONS

DAy ONEComponent I: Attitude

Strengthening the Quality of Pharmacies and Depots

opening ceremony 45 minutes

Session 1: Introductions, Expectations and Pre-test 1 hour 30 minutes

Session 2: The Role of Pharmacy and Depot Staff in Improving People’s Health 2 hours 15 minutes

Session 3: Challenges of Pharmacies and Depots in Fulfilling Their Roles 1 hour 30 minutes

Total time without breaks 6 hours

DAy TWOComponent II: TB Technical Information

Public and Private Sector Partnerships in Implementation of DOTS

opening ceremony 45 minutes

Session 1: TB Background Information 1 hour 30 minutes

Session 2: TB Diagnosis, Transmission and Prevention, and the Relationship between TB and HIV 3 hours

Session 3: The Referral Process 1hour 15 minutes

Total time without breaks 5 hours 45 minutes

DAy THREEComponent III: Communication

Applying Communication Skills to Improve Client Health

Session 1: Effective Communication Skill 3 hour

Session 2: Communicating with Clients 1 hour 45 minutes

Session 3: Closing ceremony and presentation of certificates 45 minutes

Total time without breaks 5 hours 30 minutes

comPonent i: AttitUde - strengtHening tHe QUAlity oF service From PHArmAcies And dePots

SESSION 1: INTRODUCTIONS AND EXPECTATIONS

SESSION 2: THE ROLE OF PHARMACY AND DEPOT STAFF IN IMPROVING PEOPLE’S HEALTH

SESSION 3: CHALLENGES FOR PHARMACIES AND DEPOTS IN FULFILLING THEIR ROLES

worksHoP For PHArmAcists on ‘How to mAnAge Possible tb clients’dAy1



METHODSTEP1: Welcome participants and introduce the “Lock and Key” icebreaker activity

20 minutes

Give participants the Lock and Key activity instructions and ask them to go and find their partner by matching the “locks” with the “keys.” Once participants have found their partners they need to find out the following information about each other:

Name

One activity they like to do in their free time

One expectation they have from this workshop

Ask participants to come back and introduce each other to the larger group

Record each participant’s expectations on a flip chart. Do not yet comment on the expectations. You will address these at the end of the session

COMPONENT I: ATTITUDE - STRENGTHENING THE QUALITy OF SERVICE FROM PHARMACIES AND DEPOTS

summary of day one sessions

Session 1: Introductions and Expectations In this session participants will have the opportunity to get to know each other and to discuss their expectations from the workshop.

Session 2: The Role of Pharmacy and Depot Staff in Improving People’s Health Participants will discuss pharmacy and depot roles and responsibilities as well as the communities’ expectations.

Session 3: Challenges of Pharmacies and Depots in Fulfilling Their Roles Participants will learn about the main reasons why pharmacies and depots do not fulfill their roles. They will also learn about the possible impact on client health when this happens.

SESSION 1: INTRODUCTIONS AND EXPECTATIONS

LEARNING OBJECTIVESBy the end of this session, the participants

should be able to:

1. Know the names of co-participants

2. Understand their expectations from the workshop

3. Understand their personal concerns and/or experiences in dealing with the health

problems of Cambodian people

Total: 1 hour 30 minutes

PREPARATION1. Bring flip charts, markers, and tape

2. Prepare instructions and materials for the “Lock and Key” activity

3. Make copies of the pre-test form to be handed

out to each participant



STEP 2: Review the learning objectives for the workshop

25 minutes

Facilitate group discussions on the participants understanding of the three overall learning objectives of the workshop

STEP 3: Introduce the workshop agenda

15 minutes

Compare the agenda with the list of participant expectations. You may find that some of the participants’ expectations will not be addressed in this workshop.

Review the training objectives, if needed, and express regret that because of the limited time it will not be possible to address everyone’s expectations. However, reassure the participants that you will try to address these issues during other workshops in the future.

STEP 4: Introduce the pre-test and give participants instructions on how to fill them out.

30 minutes

It is very important to tell participants that the pre-test is not only to test their current knowledge of tuberculosis but most importantly to provide feedback for improving the workshop sessions.

SESSION 2: THE ROLE OF PHARMACy AND DEPOT STAFF IN IMPROVING PEOPLE’S HEALTH

LEARNING OBJECTIVES:By the end of this session, the participants should be able to:

1. Acknowledge and appreciate the public’s expectations of pharmacies and drug stores in terms of the quality of services

2. Better understand the roles and responsibilities of pharmacies and depots as defined by the Ministry of Health

Total: 2 hours 15 minutes


2. Prepare flip charts for the “Reflections of Me” activity, with the following categories:

(a) “How my clients perceive me”

(b) “What my clients expect from me”

3. Prepare the “What do you think of your pharmacy/depot?” video for viewing. Try playing the video once beforehand to ensure that you can operate the equipment

4. Prepare envelopes with 3 topics for the “Group Discussion” activity

METHODSTEP1: Guide participants through the “Reflections of Me” activity.

30 minutes

Introduce the session. Ask participants “Why and how are pharmacy staff important in the community’s health?” Record their responses on a flip chart and post it on a wall. Acknowledge that the client is the most important person in the pharmacy/depot business, and as pharmacy and depot staff, they would be most interested in knowing how their clients see them and what their clients expect from them. Tell the participants that in a short while they will be watching a video with a number of pharmacy clients, but first explain to the participants that they will take a short time in small groups (5 people per group) to brainstorm the following questions:

1. Who am I?

2. What is my job and what do I do?

3. How do I do this job?

4. Why do I do this job?

5. How do my clients perceive me?

6. What do my clients expect of me?

Record participants responses on the flip chart in two columns

How do my clients perceive me?



What do my clients expect of me?

Post these up; you will need to match their responses to the clients’ statements after the video.

STEP 2: Play the “What do you think of your pharmacy/depot?” video. The 10-minute video will present brief statements from various clients. Ask participants to pay close attention to what the clients are saying.

40 minutes including discussion

After watching the video direct the participants through the video discussion. Discuss the clients’ feedback with the participants

On the second flip chart record clients’ responses and post it up for the group discussion

some examples of pharmacy staff perceptions

How do clients’ perceive me?They perceive that I...

Have knowledge about drugs and medicines

Have a professional appearance

Pay attention to clients

Sell drugs and medicines at an appropriate price

Am welcoming and helpful to clients

What do the clients expect from me?

They expect to …

Receive effective drugs and medicines

Feel better after taking drugs and medicines

Receive a quality serviceReceive information regarding drugs

and medicines

some examples of clients’ perceptions

How do clients perceive me? They perceive that I...

Am a member of the health staff

Am a cooperative person

Am someone with a license

Am a helpful person

What do clients expect from me?

They expect to...

Receive accurate information

Receive a clear explanation of how to use drugs and medicines

Be helped to improve their health

Receive quality drugs

Receive a quality service

Ask the participants to look at the two sets of statements (theirs and their clients). Ask participants to see whether the two sets of responses match each other. You do not have to discuss these in detail.

Ask participants to organize their clients’ feedback into subject groups. Encourage the participants to think about the following categories:

Behaviors of staff

Quality of products

Facilities

Cost

Advice, information and education

Determine and record which of the areas clients have most expectations or comments.

STEP 3: Guide the participants through two “Group Discussions”.

55 minutes

The first group discussion: public expectations of pharmacies and drugs stores



some examples of possible responses

What are your reactions to what clients expect from you?

Apologize to clients if late

Provide clear instruction on using drugs properly

Have sufficient number of staff/drugs to respond to the needs of clients

How can pharmacy and depot staff become more active as primary health care providers in their communities?

Increase their knowledge and skills

Have positive communication with people in the communities

Divide the participants into 3 groups. Ask them to identify a reporter. Give each group one envelope containing the topic for discussion. Ask the reporter of each group to open the envelope and read out their groups’ topic. Explain to the groups that they need to work within their group to discuss their topic and answer the following questions:

Topic 1: What are your reactions to what clients expect from you?

Topic 2: How can pharmacy and depot staff become more active as primary health care providers in their communities?

Topic 3: What kind of support do phar-macy and depot staff need in order to fulfill their community service role?

Inform each group that they will have to present their groups’ discussion to the larger group. Following each group’s presentation, encourage comments from the participants by asking the following questions:

Do you agree? Why or why not? Do you have any additional comments?

Would this kind of action be a realistic one for you to do?

What obstacles or problems might you encounter?

The second group discussion: roles and responsi-bilities of pharmacy/depot staff

Prepare four flip charts and post them on the wall. Title the flip charts as follows:

Flip chart 1: Roles of pharmacy and depot staff

Flip chart 2: Characteristics and services of quality pharmacy and depot staff

Flip chart 3: Possible impact as a result of substandard pharmacies and unqualified pharmacy and depot staff

Flip chart 4: Ideal pharmacies/depots

Roles of pharmacy and depot staff: Make this discussion a group effort; ask the participants to review and list the roles that their clients (the community) and they themselves believe pharmacies, depots and their staff play in improving the health of the Cambodian people. Record the answers on the flip chart with the corresponding title

The characteristics and services of quality pharmacy and depot staff: With the entire group, ask participants to complete the following statement: “To perform this role, pharmacies and depots must be or do………” Remind the participants to refer to the clients’

Spend time to provide clear, correct and accurate information to clients

Sell drugs at an appropriate cost

Think that “saving life is the best action”

What kind of support do the pharmacy and depot staff need in order to fulfill their community service role?

Supportive guidelines and a license from the Ministry of Health

Regular training to improve their knowledge and skills

Feedback from clients on behavior of pharmacy staff and quality of service



STEP 4: Guide the participants through the “Quality Pyramid” activity

10 minutes

On a flip chart, draw a large triangle divided by three equally spaced horizontal lines. Post this “Quality Pyramid” on a wall, and give each participant a small square of colored paper. Ask them to go up and stick their paper on the level they feel that their pharmacy business is at today. Let participants know that the goal is to reach “full quality” which is represented here at the tip of the pyramid.

some examples of responses

The roles of pharmacy and depot staff are to:

Provide correct and appropriate information

Provide accurate and helpful advice

Provide a friendly and quick service

Refer clients to public sector as necessary

Characteristics of quality pharmacies and depots

Staff act with friendliness to clients

Staff have knowledge and experience in providing drugs

The store is clean and well-maintained

The staff regularly participate in training to increase awareness, knowledge and skills

The pharmacy is registered

Drugs and medicines are managed properly

Drugs and medicines are of good quality and are sold at an appropriate cost

Pharmacists and staff wear uniforms while at work

Possible impact as a result of substandard pharmacies and depots

No improvement in clients/communities health

Acquisition of a negative reputation

Loss of clients

Loss of income

Closing of pharmacies/drug stores

Ideal pharmacies/depots

Are licensed and registered

Are clean and well-maintained

Have pharmacy staff that wear clean, white uniforms

Staff have knowledge and skills

Provide correct and accurate informa-tion

Sell quality drugs and medicines

Manage drugs and medicines properly

statements and their own answers in the group discussion. Record their comments on the appropriate flip chart.

Possible impact as a result of substandard pharmacy service: Again as a group, ask the participants to answer: “What happens if staff at pharmacies and depots do not provide a quality service?” Direct the discussion towards the possible (negative) impact on the health of the people in their communities, as well as the impact on their business. Record the responses on the flip chart.

Ideal pharmacies/depots: Again as a group, ask the participants: “How would you describe an ideal pharmacy or depot?” Direct the discussion towards the possible (positive) impact on the health of the people in their communities, as well as the impact on their business. Record the responses on the flip chart.



Participants who believe that they have reached the level of “full quality” should stick their paper on the top of the pyramid

Participants who believe that they are close to reaching the goal should stick their paper on the first line from the top of the pyramid

Participants who believe they are quite near the “goal” should stick their paper on the second line from the top of the pyramid

Participants who believe they are far from the “goal” should stick their paper on the first line from the bottom of the pyramid

Note the numbers on each line of the pyramid and keep this flip chart posted throughout the workshop. You will perform this same activity at the end of the workshop.

SESSION 3: CHALLENGES FOR PHARMACIES AND DEPOTS IN FULFILLING THEIR ROLES

LEARNING OBJECTIVES:

By the end of this session, the participants should be able to:

1. Identify circumstances in the pharmacy/depot that prevent staff from responsibly fulfilling their role

2. Understand the serious impact on the health of communities when staff of pharmacies/de-pots can not or do not fulfill their roles



2. Prepare two envelopes with topic cards for the “Group Work” activity

3. Prepare the classroom for the PAC Presentation.

METHOD

STEP 1: Guide the participants through the “Group Work” activity

45 minutes

Divide the participants into 2 groups. Ask each group to assign a reporter. Give each group one card containing their assignment. You should have one group representing pharmacy/depot staff and one group representing possible TB clients.

Ask the pharmacy group to come up with a list of behaviors among pharmacy staff that leads to inappropriate drug dispensing.

Ask the possible TB client group to come up with a list of behaviors among possible TB clients that could lead to inappropriate drug use.

Ask each group to present their assignment, and following each presentation, ask the group whether they agree or disagree. Ask participants to add to the lists.

STEP 2: Introduce the speaker from PAC who will give a presentation on “Policies, Regulations, and Guidelines related to TB and pharmacies”.

45 minutes

Allow some time at the end of the presentation for questions

Thank the speaker



day one summary of what we have learnt

To recognize both the expectations and the needs of the community, specifically in regard to the promotion and improvement of health

To understand the roles and responsibilities of pharmacists and depot staff in providing a quality service

To identify what constitutes a quality pharmacy, and in contrast, what defines a substandard pharmacy

To understand how substandard care from pharmacies and depots can negatively affect the health of the community and pharmacists livelihoods

CLOSE

Thank participants for their contributions throughout the day. Distribute the daily evaluation forms and let participants fill them in while you tidy the training room. Ask participants to give you the completed forms.

DAy ONE SUMMARy

Using the notes kept on the outputs of activities during the day summarize the day’s proceedings in no more than 5 or 6 key points. This will also serve as a mental reinforcement for participants. Use the box below as a guide.

comPonent ii: tb tecHnicAl skills - PUblic And PrivAte sector PArtnersHiPs in tHe imPlementAtion oF dots

SESSION 1: TB BACKGROUND INFORMATION

SESSION 2: TB DIAGNOSIS, TRANSMISSION AND PREVENTION

SESSION 3: THE REFERRAL PROCESS




COMPONENT II: TB TECHNICAL SKILLS - PUBLIC AND PRIVATE SECTOR PARTNERSHIPS IN THE IMPLEMENTATION OF DOTS

summary of day two sessions

Session 1: TB Background InformationThis session provides participants with information on the definition of TB, the TB situation in Cambodia, and the National TB Program.

Session 2: TB Diagnosis, Transmission and PreventionParticipants will learn what symptoms accompany a TB infection, how TB is transmitted, tips to prevent transmission, and the relationship between TB and HIV.

Session 3: The Referral ProcessIn this session, participants will learn how the referral process works and how to fill out referral forms.

SESSION 1: TB BACKGROUND INFORMATION

METHOD

STEP 1: Brief the participants on the current status of TB in Cambodia

30 minutes

Give a presentation on the current status of TB in Cambodia, prepared using the information in Annex I

Ask participants if they have any questions or need clarification

STEP 2: Give participants an overview of the National TB Control Program and discuss its main objectives and goals

30 minutes

Give a presentation on the National TB Control Program, prepared using the information in Annex I

Explain the main objectives and goals and discuss with participants

LEARNING OBJECTIVESBy the end of this session, the participants should be

able to:

1. Define what tuberculosis is

2. Understand the current TB situation in Cambodia

3. Understand the main objectives and goals of the National TB Program including the DOTS TB control strategy



2. Prepare presentations on overheads or Power Point slides

OPEN

Welcome the participants to Day Two and give them a brief summary of their Day One feed-back collated from the daily evaluation forms



STEP 3: Guide participants through the “What is TB?” brainstorming activity

30 minutes

Divide the participants into 3 groups. Ask each group to assign a reporter. Ask the group to brainstorm answers to the following question: “What is TB?”

After they have finished brainstorming, partici-pants of each group will present their answers

Finish the activity by providing the participants with the correct definition of TB

what is tb

TB is an infectious bacterial disease caused by Mycobacterium tuberculosis, which most commonly affects the lungs (pulmonary TB) (WHO definition)

It is a communicable disease – a disease that can be transferred from an infected person to another by a specific kind of contact

Active TB (TB disease) is when the body’s immune system is unable to fight off the TB bacteria, therefore causing infection in the lungs or other parts of the body like the kidneys, spine, or brain

Latent TB (TB infection) means the person is infected with the TB bacteria, but the bacteria are inactive. People with latent TB are not infectious - it is not possible to catch TB from someone with latent TB – and they have no symptoms. Approximately 10% will go on to develop active TB at a later stage if they do not receive treatment for latent TB

SESSION 2: TB DIAGNOSIS, TRANSMISSION AND PREVENTION

LEARNING OBJECTIVES:

By the end of this session, the participants should be able to:

1. Describe the symptoms of TB

2. Describe how TB is transmitted

3. Describe steps that can be taken to prevent transmission of TB

4. Understand TB case detection methods and influencing factors

5. Describe the relationship between TB and HIV

Total: 3 hours

PREPARATION

1. Bring flip charts, markers, and tape

2. Prepare presentation on overheads or Power Point slides on TB case detection and factors associated with low TB detection rates

STEP 1: Guide participants though the “What are the Symptoms of TB?” brainstorming activity

30 minutes

Divide the participants into 3 groups. Ask each group to assign a reporter. Ask the group to brainstorm answers to the following question: “What are the Symptoms of TB?”

After they have finished brainstorming, partici-pants of each group will present their answers.

Finish the activity by providing the participants with correct information on TB symptoms



the symptoms of tb

In healthy people, infection with Mycobacterium tuberculosis often causes no symptoms (latent TB)

The symptoms of active TB of the lung are:

- Coughing, sometimes with sputum or blood

- Chest pains

- Shortness of breath

- Weight loss

- Cannot taste food well

- Loss of appetite

- Fatigue, tiredness

- High fever in the evenings

- Night sweats

A chronic cough of more than 2 weeks is the main symptom of lung TB. Usually the chronic cough will appear with one or more of the above symptoms, particularly weight loss and night sweats

tb transmission

TB is transmitted from person to person through the air during coughing, sneezing, speaking or spitting

When a person infected with active TB coughs, sneezes, talks or spits droplets containing the TB bacteria enter the air where they can be inhaled by those around them

When the droplets with the TB bacteria are inhaled, the larger droplets become lodged in the upper respiratory tract and begin infection. Some droplets may reach the lungs and begin infection there

Preventing tb

Single dose BCG vaccination following negative Mantoux test gives 70-80% protection

Open windows and doors at home and in crowded places, such as factories, schools, hospitals to ensure adequate ventilation

Keep healthy and eat nutritional foods

Encourage utilization of public health services by people with TB symptoms

Involve communities and clients in TB care and prevention

Encourage completion of correct treatment regimen

People with active TB should cover their mouth and nose with a handkerchief every time they cough, sneeze or speak

STEP 2: Give participants an overview of the different case detection methods and facilitate a group discussion on factors associated with low TB detection rates

45 minutes

Give a presentation on TB case detection and factors associated with TB detection rates prepared using the information in Annex I.

Discuss with participants their real life experiences of factors associated with low TB detection rates

STEP 3: Guide participants through the “How is TB Transmitted and “How can it be Prevented?” brainstorming activity

45 minutes

Divide the participants into the same 3 groups as under Step 1. Ask each group to assign a

reporter. Ask the groups to brainstorm answers to the following questions: “How is TB transmitted? How do you prevent TB transmission?”

After the participants have finished brainstorming, participants of each group will present their answers.

Finish the activity by providing the participants with correct information on TB transmission and how to prevent it



STEP 4: Guide participants through the “How is HIV Transmitted and “What is the Relationship between TB and HIV?” brainstorming activity

45 minutesDivide the participants into the same 3 groups

as before. Ask each group to assign a reporter. Ask the groups to brainstorm answers to the following questions: “How is HIV transmitted? and “What is the relationship between TB and HIV?”

After the participants have finished brain-storming, participants of each group will present their answers.

Finish the activity by providing the participants with correct information on HIV transmission and its relationship with TB

Cover your mouth and nose if you are a caregiver for someone with active TB

many people in cambodia have latent tb and are at risk of developing active tb if they have any of the following conditions:

a disease such as HIV or AIDS which weakens the immune system

a long-term user of medications containing corticosteroids

a weakened immune system because of recent pregnancy or age (elderly and infancy)

more than 10% underweight

Hiv is transmitted by:

sexual contact (intercourse) with an infected person

sharing needles and/or syringes with someone who is infected

transfusion of infected blood or blood clotting factors

Mother-to-child: babies born to HIV-infected women may become infected before or during birth or through breastfeeding after birth

Hiv cannot be transmitted by:

Kissing, sneezing, coughing, sharing cups, or by bites from insects such as mosquitoes

relationship between tb and Hiv

Latent TB is much more likely to become active TB in someone with HIV. This is because HIV weakens the immune system, which makes it harder for the body to fight off diseases like TB

TB is an HIV related opportunistic infection – TB infection takes advantage of the weakened immune system

In HIV infected people, TB infection of the lungs or anywhere else in the body is considered an AIDS-defining condition. In other words, a person with both HIV and active TB has AIDS

People who are co-infected with both HIV and latent TB have an up to 800 times greater risk of developing active TB disease (Centers for Disease Control and Prevention, Division of TB Elimination, USA)



STEP 5: Guide participants on advising a TB client who is undergoing treatment

15 minutes

Facilitate a short group discussion on “What to do for the TB client in the pharmacy/depot”

Finish the activity by providing the participants with the list of key points on what to do for the TB client in the pharmacy/depot.

key points for advising a tb client undergoing treatment

Explain to the client it is important to keep taking the TB drugs regularly as instructed by the health staff even if the client feels better

If it is hard for the client to swallow the tablets (some are big), tell them to go back to the DOTS facility and discuss it with the health staff (alternatives may be possible)

If the client experiences nausea because of taking the TB drugs on an empty stomach, advise them to have a cup of black coffee or piece of bread (but no fat or oils)

Remind the client how important it is to take the TB drugs regularly, to complete the treatment and to go back to the DOTS facility if they have any problems

SESSION 3: THE REFERRAL PROCESS

LEARNING OBJECTIVES:By the end of this session, the participants should be able to:

1. Understand the process for referring a TB suspect

2. Fill out TB referral forms



2. Prepare presentation on overheads or Power Point slides of the referral process

3. Bring copies of the TB referral forms to show participants in Step 1 and to give participants to fill out in “Case Study 1” and “Case Study 2”

4. Prepare a map with the names and locations of health centers and hospitals in the area that provide DOTS services

METHODSTEP 1: Guide participants through the process of referring a client with suspected TB

30 minutes

Give a presentation on the referral process prepared using information in Annex I

STEP 2: Show participants where they should refer suspected TB patients

15 minutes

Give them a list of names and use a map to explain the locations of health centers and hospitals that provide DOTS services. Most health centers and almost all public hospitals have TB services

STEP 3: Show participants how to fill out the TB referral form and explain all the necessary steps.

15 minutes



STEP 4: Guide participants through “Case Study 1” and “Case Study 2”

15 minutes

Assist them to fill out referral forms if necessary. Provide the correct answers to the questions in the case studies after participants have completed the activity (the correct answers are in bold)

mcase study 1

Mr. Keo Samath, 25 years old, is now living at house number 18 on road 374 in Toul Svay Prey 1 of Chamkarmon district in Phnom Penh city. He is not well; he has had a cough for 1 month. He sweats at night with fever, is losing weight, and cannot eat. He has never seen a doctor or used medicines before.

1. Is it possible that Mr. Keo Samath may have TB?

a. Yes

b. No

2. If he is suspected of having TB, what should you do?

a. Give him drugs

b. Refer him to a traditional healer

c. Refer him to a public health service provider that has TB services

3. Which hospital or health center should you refer him to? Refer to the map

4. Fill out the referral form Check it is done correctly

case study 2

Mrs. Vorn Cheata, 40 years old, is living at house number 16 on road 374 in Toul Svay Prey 1 of Chamkarmon district in Phnom Penh city. She is not well. She has had a chronic cough for one month, fever, pain in her chest, weight loss, and loss of appetite.

She has had her chest x-rayed and has taken all the drugs prescribed; however, her condition has not yet improved.

1. Is it possible that Mrs. Vorn Cheata may have TB?

a. Yes

b. No

2. If yes, what should you do?

a. Give her drugs

b. Refer her to a traditional physician

c. Refer her to a public health service provider that has TB services

3. Which hospital or health center should you refer her to? Refer to the map

4. Fill out the referral form Check it is done correctly



DAy TWO SUMMARy

Using the notes kept on the outputs of activities during the day summarize the day’s proceedings in no more than 5 or 6 key points. This will also serve as a mental reinforcement for participants. Use the box below as a guide.

CLOSE

Thank participants for their contributions throughout the day. Distribute the daily evaluation forms and let participants fill them in while you tidy the training room. Ask participants to give you the completed forms.

day two summary of what we have learnt

The definition of tuberculosis and its symptoms

How TB is transmitted and can be prevented

Understanding of the current trend of TB in Cambodia, recognizing the role of the National TB Program

Understanding of the link between TB and HIV

To be comfortable with the process of referring a suspected TB client and to be adept at filling out referral forms



comPonent iii: commUnicAtion - APPlying commUnicAtion skills to imProve commUnity HeAltH

SESSION 1: EFFECTIVE COMMUNICATION SKILLS.

SESSION 2: COMMUNICATING WITH CLIENTS




COMPONENT III: COMMUNICATION - APPLyING COMMUNICATION SKILLS TO IMPROVE COMMUNITy HEALTH

summary of day three sessions

Session 1: Effective Communication SkillsIn this session, participants learn about effective communication skills that will help them better serve their clients and develop their business, as well as barriers to communication.

Session 2: Communicating with Challenging ClientsThis session helps participants to know how to deal with clients who present challenges to clear communication.

SESSION 1: EFFECTIVE COMMUNICATION SKILLS

METHOD

STEP 1: Ask participants the question, “What is communication?”

10 minutes

Encourage everyone’s participation. Write ideas on a flip chart and post

Show overhead slide of definition:Communication is an exchange of information or feelings (ideas, opinions, skills, knowledge) between people

STEP 2: Ask the participants to think about what the role of pharmacy and depot staff is in client communication and elicit their responses

10 minutes

Record participants’ responses on a flip chart

LEARNING OBJECTIVESBy the end of this session, the participants should be

able to:

1. Describe factors necessary for effective communication

2. Identify barriers to effective communication

3. Demonstrate active listening skills

Total: 3 hours


2. DVD ‘Pharmacists and Client Interactions’ and DVD equipment

3. Prepare two messages for “Lines of communi-cation” exercise

4. Prepare presentation on overheads or Power Point slides of communication approaches prepared using information in Annex I

5. Print out copies of the scenario from “What Questions to Ask” to give to each of two groups

OPEN

Welcome the participants to Day Three and give them a brief summary of their Day Two feedback collated from the daily evaluation forms

examples of responses

to listen to the clients problem orrequest

to provide advice and information

to help identify possible TB clients and refer them to a health center



sample responses:

Successes:

- Speaking clearly and slowly

- Using words that are easy to understand

- Using local words

- Keeping eye contact

- Showing respect to the client

Barriers:

- Speaking too quickly and not being clear

- Being disrespectful to the client

- Being discriminatory

- Not being friendly

STEP 3: Guide participants through the “Communication Successes and Barriers to Communication” activity.

1 hour

Divide participants into 4 groups. Ask each group to assign a reporter to summarize key points. Give each group one topic and explain the task: two groups will discuss and record what made a communication successful in their work areas concerning health communi-cation with a possible TB client and two groups will discuss and record what were the barriers in their health communication with a possible TB client

After they have finished their discussion, ask the reporters to present their group’s responses

Show the DVD ‘Pharmacists and Client Interactions’. Summarize the ideas and develop a conclusion concerning the role of pharmacy staff in communicating with clients. Explain to the participants that when people communicate, sometimes the communication is successful, sometimes the communication fails but we can learn how to be better communicators.

STEP 4: Guide participants through the “Lines of Communication” activity

20 minutes

Divide participants into 2 groups. Ask partici-pants in each group to form a long line. The first person at the head of the line will be shown a message written on a piece of paper. The message must be passed from one person to another in the line by whispering in the next persons’ ear. The last person to receive the message should write the message on the board.

Group 1: Participants are not allowed to ask for clarification of the message

Group 2: Participants are allowed to ask for clarification of the message

After each group has completed the task and written the message on the board, present the original message and compare it with each groups’ message. Discuss what happened in each group. Discuss why the group 2 message is most likely to be closer to the original message.

STEP5: Present slides on effective communication approaches and discuss fully in the large group.

35 minutes

Present slides of communication approaches and discuss the following topics:

Speaking skills

Verbal communication skills

Listening skills

Non-verbal communication skills

STEP 6: Guide participants through the “What Questions to Ask” activity

45 minutes

Ask participants to form 2 groups. Ask each group to assign a reporter. Read out the following scenario.

Sophy is a 40-year-old widow with three teenage children.

Sophy sells rice soup to children at a local school.

She has had a cough for the last six months.



Ask participants to discuss this scenario in their groups and come up with a list of questions that they need to ask Sophy in order to appro-priately and correctly manage her condition.

Ask the reporter of each group to state the questions suggested by their group. The facilitator will write down the questions both groups came up with on a flip chart and categorize them as either (1) open-ended or (2) close-ended questions.

At the end of the exercise, ask participants to change all closed-ended questions to open- ended questions. Emphasize how important it is for pharmacy/depot staff to ask open-ended questions when assessing a client’s condition in order to better understand the problem and provide correct information and advice.

SESSION 2: COMMUNICATING WITH CLIENTS

LEARNING OBJECTIVEBy the end of this session, the participants should have:

1. Improved their ability to communicate with challenging clients



2. Print out copies of the scenario in “Turning Problem Situations into Opportunities” to hand out to the two groups

3. On a flip chart, draw a large table with the columns, “Responsibilities/Tasks, Can Do, Cannot Do, Why Cannot Do” as described in Step 3

4. Make copies of the post-test to be handed out to all the participants

METHODSTEP 1: Lead a discussion about the challenges pharmacy and depot staff face when clients come in asking for specific treatments, do not provide symptoms or the duration of the symptoms, and are often unwilling to follow the staff’s advice.

10 minutes

Explain to the participants that this session will focus on how to handle challenging situations with clients and how to turn these situations into opportunities for clients to learn about TB

STEP 2: Guide participants through the “Turning Problem Situations into Opportunities” activity. The objective of this activity is to show how meaningful communication will help clients, improve pharmacy services, and in turn will lead to better business.

45 minutes

Divide the class into two groups; one group will be pharmacists and the other group clients

Group 1: Review the following scenario: if you were the pharmacy/depot staff, how would you manage this client?

Sarin is a 32-year-old married man with a six month old baby.

He migrated to work as a construction worker in Phnom Penh.

He has had a cough for the last month and has been feeling very tired.

He comes to your pharmacy asking for medicine.

He is in a hurry to go off to work and doesn’t want to listen to or answer your questions.

Group 2: Review the following scenario: if you were the client, would you come back to the same seller in the future if you had other health problems?

Sok Sam is a 32-year-old married man with 2 small children.

He runs a pharmacy in a busy town.

He also helps his family with their business so is always in a hurry.



You are a migrant worker who comes to Sok Sam’s pharmacy to ask for medicine for a cough.

Your clothes are dirty as you are working on a construction site.

Sok Sam pays you little attention, hardly looking at you.

He sells you a bottle of cough syrup before rushing off to lunch.

Ask each group to assign a reporter, to discuss their assignment and record their responses on the flip chart. Each group will present the

Examples of responses

Responsibilities/Tasks Can Do Cannot DoIf you cannot do,

explain why

Provide education, information and advice

Provide information on free TB diagnosis, treatment

Provide information on networking XNot aware of any network in my community

Attempt to identify TB suspects

Motivate TB suspects to visit the health center

Refer clients to the health center

Distribute appropriate IEC materials X We have no IEC materials

results of their discussion. Following each presentation, ask the rest of the participants: “Do you agree? Why or why not? How could the communication improve?”

STEP 3: Wrap up the session by asking the participants to list all the pharmacy/depot staff responsibilities discussed from the different sessions in the workshop.

10 minutes

Ask them to check what they can do and cannot do using the table format as in the examples of responses below.

STEP 4: End the session by going back to the “Quality Pyramid” activity.

10 minutes

Ask participants to post the pieces of paper according to how far they feel they are from the goal after going through this training workshop. Compare these results with the first “Quality Pyramid” exercise they did at the beginning of the workshop.

WORKSHOP SUMMARyUsing the notes kept on the outputs of activities during all three days summarize the workshop proceedings in no more than 5 or 6 key points. This will also serve as a mental reinforcement for participants. Use the box below as a guide.



summary of what we have learnt in the last 3 days

Knowledge and understanding of TB, its symptoms, transmission, and prevention

Knowledge of the current state of TB in Cambodia and the role of the National TB Program

Knowledge and understanding of the role of pharmacy and depot staff in contributing to reducing TB infection and disease

How to communicate effectively with TB suspects and clients

How to serve our communities and enjoy a prosperous business

STEP 5: Distribute feedback forms and post-tests to the participants for them to fill out

30 minutes

Collect the forms and thank participants for their participation and hard work

Present completion certificates if appropriate

Close the workshop



AnneX i: tb tecHnicAl inFormAtion For PresentAtions

DAy TWO: TB BACKGROUND INFORMATION

SESSION 1:

INFORMATION FOR A PRESENTATION ON THE CURRENT STATUS OF TB IN CAMBODIA

Tuberculosis continues to be a significant public health concern in Cambodia. The World Health Organization’s (WHO) Global TB Report 2008, states that Cambodia has one of the highest rates of TB worldwide, ranked 21 among the 22 high burden countries. Almost two-thirds of all Cambodians carry the tuberculosis bacterium, and approxi-mately 13,000 Cambodians die per year from the disease. In 2006, the estimated incidence of TB in Cambodia was 500 cases per 100,000 people, and the TB mortality rate was 92 deaths per 100,000 people.

Less than half of the estimated 70,949 TB cases in Cambodia are diagnosed. When undiagnosed, and therefore untreated, TB is often fatal. To assist in TB treatment, the National TB Control Program began Directly Observed Therapy, Short-Course (DOTS) implementation in 1994. DOTS is now available in all of Cambodia’s 68 referral hospitals, 853 health centers, and 40 health posts. The country has maintained a TB treatment cure rate of more than 90% and a case detection rate of over 60%.

TB is one of the biggest killers of people living with HIV. The estimated prevalence rate of HIV in Cambodia among those 15-49 years is 1.6% [0.9-2.6] % in 20075. WHO estimates the HIV prevalence among TB cases to be 10%.

Cambodia

Country population 14,197,000

Global rank out of 22 high burden countries

21

Estimated number of new TB cases 70,949

Estimated incidence (all new cases per 100,000 population)

500

DOTS population coverage 100%

Estimated incidence (new sputum smear positive [ss+] per 100,000 population)

220

DOTS detection rate (new ss+) 62%

DOTS treatment success (new ss+ cases, 2005 cohort)

93%

HIV prevalence in incident TB cases 10%

Of previously treated TB cases, % MDR-TB (2005)

3.1%

Data source: Global Tuberculosis Control: surveillance, planning, financing: WHO report 2008 based on data from 2006 unless otherwise stated



INFORMATION FOR A PRESENTATION ON THE NATIONAL TB CONTROL PROGRAM

Cambodia’s National TB Control Program (NTP) operates under the responsibility of the National Center for Tuberculosis and Leprosy Control (CENAT). It comprises TB referral hospitals, provincial TB centers and district TB units. In 1994, TB control was decentralized from provincial hospitals to district hospitals and in 1999 to health centers. As of 2003, more than 145 TB units and 700 health centers are implementing the DOTS strategy.

There are 180 laboratories in the country including the TB reference laboratory of CENAT, which is responsible for the development of training materials, training of laboratory technicians, and supervision and quality assurance of the provincial laboratories. There are 24 provincial laboratories with responsibility for the supervision and training of health center staff in sputum smear microscopy and reporting to CENAT.

THE CAMBODIA NTP HAS THE FOLLOWING GOAL, OBJECTIVES AND STRATEGIES:

Contributing to socio-economic development and poverty reduction in Cambodia by reducing the morbidity and the mortality rates due to tuberculosis

Providing TB diagnosis and treatment free of charge

Maintaining a high cure rate of more than 85% and high case detection of at least 70%

OD pharmacies will be responsible for proper storage and timely distribution to the TB units and Health Centers providing DOTS; and responsible for maintaining the buffer and security stocks and monitoring expiry dates of drugs.

Health personnel will ensure that TB drugs are used according to the national protocol and should adhere to the rational use of drugs.

Build staff capacity giving emphasis on continuing training according to identified needs.

THE EXPANDED DOTS FRAMEWORK OF THE NATIONAL TB PROGRAM REINFORCES THE FIVE ESSENTIAL COMPONENTS OF A DOTS STRATEGy:

1. Sustained political commitment to increase human and financial resources and make TB control a nationwide priority integral to the national health system

2. Access to quality-assured TB sputum microscopy for case detection among persons presenting with, or found through screening to have, symptoms of TB (most importantly, prolonged cough). Special attention is necessary for case detection among HIV- infected people and other high-risk groups, such as household contacts of infectious cases and people in institutions

3. Standardized short-course chemotherapy for all cases of TB under proper case management conditions, including direct observation of treatment. Proper case management conditions imply technically sound and socially supportive treatment services

4. Uninterrupted supply of quality-assured drugs with reliable drug procurement and distribu-tion systems

5. Recording and reporting system enabling outcome assessment of all patients and assessment of overall programme perfor-mance. This is the basis for systematic programme monitoring and correction of identified problems.



SESSION 2:

INFORMATION FOR A PRESENTATION ON TB CASE DETECTION AND FACTORS ASSOCIATED WITH TB DETECTION RATES

TB case detection methods

The medical history includes facts about the social, family, medical, and occupational aspects of the client’s life.

Sputum Smear Microscopy (SSM) The simplest laboratory test is the examination of sputum (matter coughed up from the lungs) for the detection of a certain type of bacteria. It is cheap and is performed in minutes.

Culture testing is not available in many areas. Although smear microscopy is an effective way to detect TB, bacteriologic culture is a more sensitive method for confirming TB diagnosis. Culture testing is usually performed by specialized bacteriological TB laboratory services.

The Tuberculin Skin Test is widely used as a supportive second line test to identify patients actively infected with tuberculosis and mostly used with children

Factors associated with TB case detection rates in Cambodia

Detecting active TB cases is critical in TB control. Early detection of active TB disease reduces the pool of infectious individuals in the community and therefore limits transmission. Under DOTS, TB programs rely on clients to present themselves to TB clinics for evaluation of their symptoms but there are a variety of reasons why TB suspects may not attend TB services which influence case detection rates.

Some examples of constraints or obstacles to accessing TB services

Economic complexity of pathway to access care

(e.g. financial dependence)

costs of seeking care (transport, subsistence)

ability to pay for services

mobile and migrant populations

Geographic distance from TB services

(and too sick to travel)

climate (floods, heat)

Social and cultural stigma and fear of being ostracized

fear of losing work

low level of knowledge and awareness of TB

lack of information about the availability of services and free treatment

myths and misconceptions about transmission, treatment, side effects

Health system accurate data as current TB numbers rely

heavily on estimates

unfavorable staff attitudes towards clients

poor perception of services by clients and communities

lack of availability of integrated compre-hensive services (e.g. TB and HIV)

lack of effective peripheral services

trends in dots detection rates and treatment success 1994-2006 in cambodia

yeardots new

smear-positive case detection rate (%)

dots new smear-positive

treatment success (%)

1995 40 91

1996 34 94

1997 44 91

1998 47 95

1999 53 93

2000 51 91

2001 48 92

2002 57 92

2003 59 ?

2006 65% 93%



Chun Ratana, 53, who has TB symptoms and lives in cramped conditions in a Phnom Penh slum, says “I don’t know where to get free treatment, because I can’t afford drugs,” she said. A free tuberculosis treatment centre is situated near her house, but she fears being hospitalized because she could

lose too many months of work.

Integrated Regional Information Networks (IRIN), Phnom Penh UN Office for the Coordination of Humanitarian Affairs, 7 August 2008

Efforts are needed to:

develop new case finding and management methods to bridge the gap between current and target case detection

improve the accuracy of national estimates of TB incidence by reinforcing and expanding routine surveillance

TB control programs work with HIV/AIDS programs to ensure prompt and effective diagnosis and treatment

active case-finding interventions for specific target groups, such as family members of HIV positive TB clients, confined populations and people living in overcrowded settlements

Remember that community-based TB detection still does not catch carriers of TB infection (latent TB) who show no symptoms.

SESSION 3:

INFORMATION FOR A PRESENTATION ON THE REFERRAL PROCESS

1. If a client at a pharmacy/depot is suspected of having TB, staff should:

Give the client background information on TB

Explain to the client that TB can be treated

Give information about the referral process from private to public health service providers

Advise the client to seek medical help at the nearest public health service facility that provides DOTS services

2. If the client wishes to attend the TB services at a public health service facility, pharmacy/depot staff should:Take a TB referral form and fill out all

the information in the box located in the upper section of the form on the first page (the referral form must be filled out by the private health service provider, not the client)

Tear off the bottom two sheets (they are pink and green) and tell the client to give them to the public health service provider when he/she goes to the public DOTS facility

Pharmacy/depot staff should keep the upper white sheet for their own records

3. When the client goes to the public health service provider:The client will give the health staff the pink

and green sheets of the referral formHealth staff will ask the client about their

medical history, do a physical examination, and ask the client to provide a sputum sample. They may have a chest X-ray too

The sample of the client’s sputum will be tested for TB

The health staff will give the pink referral form back to the client for the client to keep

The client will keep this form and bring it back to the public health service provider as instructed by the health staff

After TB diagnostic tests are completed, the health staff will give the client back the pink referral form along with any necessary prescriptions

4. If there has been no improvement in the client’s symptoms:The pharmacy/depot staff should advise

the TB client to return to the same public health service provider and give the health staff the pink referral form

5. If the client is positive for TB:The client will be provided with DOTS

treatment at the public health facility



Paraphrase by repeating statements in your own words. You can check understanding by reinforcing statements.

Summarize the discussion to check that both sender and receiver agree

4. Listening skills

For effective communication always practice active listening. Active listening is when the listener is listening carefully to what the speaker is saying and repeats what she/he said back to her/him to make sure that the listener has understood the message correctly.

Techniques to use for active listening:

Restating: the listener repeats what the speaker said using the same words

Paraphrasing: the listener reflects back what the speaker said using her/his own words, not the same words

Summarizing: the listener reflects back the major points of the discussion

Reflecting feeling: the listener reflects back the feelings he/she believes the speaker is experiencing

Asking for clarification/confirmation: the listener asks a question to clarify or confirm what the speaker said

Tips to improve your ability to listen well:

Tell yourself “I’m going to let myself listen well”

Pay attention to the way the speaker looks and acts

Use actions to let the speaker know you are interested and pay attention by maintaining eye contact, nodding, etc

Do not interrupt the speaker. Listen to the whole idea

Ask questions to clarify when you do not understand

Develop active listening skills, restating, paraphrasing/summarizing

DAy THREE: COMMUNICATION SKILLS

SESSION 1:

INFORMATION FOR A PRESENTATION ON THE REFERRAL PROCESS

1. Information for a presentation on effective communication

Face to face (direct or indirect)

Verbal or non-verba

Between 2 persons or more

2. Speaking skills

In all communication, there is a sender and a receiver. The role of the sender should be to:

Be clear about the message

Know the listener, what is the background and experience of the listener?

Adapt the message to the listener

Present the message clearly and use clear language

Avoid interruptions, noise

Check the listener’s understanding and seek feedback

Observe the listener’s facial expression and other non-verbal signs

Ask questions to check understanding of message

3. Verbal communication skills

Use open-ended questions that encourage responses: “What do you think about……?” “Why…”, ”How…”, ”What if..?”

Ask, “Why do you say so?”, if clients respond with a simple “yes” or “no”

Be aware of your tone of voice, and speak slowly and clearly

Be sure the receiver talks more than you do



Do your best to avoid judging or evaluating what the speaker said

Avoid showing disapproval (verbal or non-verbal)

Avoid day dreaming (thinking about something else while you should be listening)

5. Non-verbal communication skills

Maintain eye contact with the person you are speaking to. If a group, maintain eye contact with everyone in the group as you speak. Don’t appear to favor certain people in the group

Don’t move around while you are speaking. It is distracting

Acknowledge what people say by nodding, smiling, or other actions that show you are listening

It’s important to appear relaxed and at the same time to be direct and confident



AnneX ii: AnneX ii glossAry oF tb terms

Active TB disease – an illness in which TB bacteria multiply and attack different parts of the body. There are two forms of TB: 1) TB infection (latent TB) and 2) TB disease (active TB). People with TB infection have no symptoms and cannot spread TB to others. People with TB disease (active TB) have symptoms and can spread TB to others. The symp-toms of active TB disease include weakness, weight loss, fever, loss of appetite, chills, and sweating at night. Other symptoms of active TB disease depend on where in the body the bacteria are growing. If active TB disease is in the lungs (pulmonary TB), the symptoms may include a persistent cough, pain in the chest and coughing up of blood.

BCG – a vaccine for TB named after the French scientists who developed it, Calmette and Guérin. BCG is not widely used in the United States, but it is often given to infants and small children in other countries where TB is common.

Chest x-ray – a picture of the inside of the chest. A chest x-ray is made by exposing a film to x-rays that pass through the chest. A doctor can look at this film to see whether TB bacteria have damaged the lungs.

Contact – a person who has spent time with a with active TB.

Culture – a test in the laboratory to see whether there are TB bacteria in a sputum specimen or other body fluids. TB bacteria grow very slowly so it can take up to 4 weeks to confirm a TB diagnosis.

Directly observed therapy short-course (DOTS) – this is a way of helping clients take their medicine for TB. The client will meet with a health care worker every day or several times a week at a convenient place. This may be the TB clinic, the client’s home or work, or any other convenient location. The client takes their TB medicine while the health care worker watches.

Drugs used to treat TB - all first-line anti-tuberculosis drug names have a standard three-letter and a single-letter abbreviation:

ethambutol is EMB or E

isoniazid is INH or H

pyrazinamide is PZA or Z

rifampicin is RMP or R

streptomycin is STM or S

The USA commonly uses abbreviations and names that are not internationally recognized: rifampicin is called rifampin and abbreviated RIF; streptomycin is commonly abbreviated SM.

Extra-pulmonary TB – is active TB disease in any part of the body other than the lungs (for example, the kidney, spine, brain, or lymph nodes).

HIV infection – infection with the human immunodeficiency virus, the virus that causes AIDS (acquired immunodeficiency syndrome). A person with both latent TB infection and HIV infection is at high risk for active TB disease.

INH or isoniazid – a medicine used to prevent active TB disease in people who have latent TB infection. INH is also one of the four medicines often used to treat active TB disease.

Latent TB infection – a condition in which TB bacteria are alive but inactive in the body. People with latent TB infection have no symptoms, don’t feel sick, can’t spread TB to others, and usually have a positive skin test reaction. But they may develop active TB disease if they do not receive treatment for latent TB infection.

Multi-drug resistant TB (MDR TB) – active TB disease caused by bacteria that are resistant to two or more of the most important medicines: INH and RMP.

Mycobacterium tuberculosis – the bacteria that cause latent TB infection and active TB disease.

Negative – usually refers to a test result. If a TB skin test reaction is negative, the client probably does not have TB infection.



Positive – usually refers to a test result. If a TB skin test reaction is positive, the client probably has TB infection.

Pulmonary TB – this is active TB disease that occurs in the lungs, usually producing a cough that lasts 3 weeks or longer. Most active TB disease is pulmonary.

QuantiFERON-TB® Gold (QFT) – a blood test used to find out if a client is infected with TB bacteria. The QFT measures the response to TB proteins when they are mixed with a small amount of blood.

Resistant bacteria – these are bacteria that can no longer be killed by a certain medicine.

Smear – a rapid screening test for TB to see whether there are TB bacteria in a sputum specimen. To do this test, lab workers smear the sputum on a glass slide, stain the slide with a special stain (acid fast stain) and look for any TB bacteria on the slide under a microscope. This test allows the health staff to receive a preliminary report within 24 hours.

Sputum – is phlegm coughed up from deep inside the lungs. Sputum is examined for TB bacteria using a smear; part of the sputum can also be used to do a culture.

TB skin test – a test that is often used to detect latent TB infection. A liquid called tuberculin (or PPD) is injected under the skin on the lower part of the arm. If there is a positive reaction to this test, it means the client probably has latent TB infection.

Transmission – the way a disease is spread from one person to another. Tuberculosis is spread through the air, when people who have active pulmonary TB cough, sneeze, speak, or spit, they expel infectious droplets. People with prolonged, frequent, or intense contact with a person with active TB are at particularly high risk of becoming infected, and a person with active but untreated TB can infect 10–15 other people per year.



AnneX iii: Pre And Post test QUestionnAire

PLEASE CHECK THE APPROPRIATE BOXES REGARDING yOUR BACKGROUND:

Male Pharmacy Staff

Female Pharmacist

Other, please specify ............................................................................................................

no. mark the following statements as true or false true False

1 TB is a hereditary disease (family disease) that passes down from one person to another in the family

2 A person that coughs for a long time (more than two weeks) maybe has lung TB

3 Only elderly people get TB

4 A person who has TB should not share the same food and clothes with other people

5 TB treatment (DOTS) is free at the government health centers

6 TB germs can pass from one person with active TB to others when that person talks or coughs without covering his/her mouth

7 To prevent TB from spreading to others in the family/community, people receiving treatment for TB must be isolated

8 Pharmacy staff can be an important health resource to TB clients and their families

9 TB is a serious but curable disease

10 TB clients can stop their medicine once their symptoms are gone

11 Pharmacy staff can play a major role in finding possible TB clients and referring them for evaluation and treatment

12 Early detection stops TB from spreading among communities



no. mark the following statements as true or false true False

1 TB is a hereditary disease (family disease) that passes down from one person to another in the family X

2 A person that coughs for a long time (more than two weeks) maybe has lung TB X

3 Only older people get TB X

4 A person who has TB should not share the same food and clothes with other people X

5 TB treatment (DOTS) is free at the government health centers X

6 TB germs can pass from one person with active TB to others when that person talks or coughs without covering his/her mouth X

7 To prevent TB from spreading to others in the family/community, people receiving treatment for TB must be isolated X

8 Pharmacy staff can be an important health resource to TB clients and their families X

9 TB is a serious but curable disease X

10 TB clients can stop their medicine once their symptoms are gone X

11 Pharmacy staff can play a major role in finding possible TB clients and referring them for evaluation and treatment X

12 Early detection stops TB from spreading among communities X

PLEASE CHECK THE APPROPRIATE BOXES REGARDING yOUR BACKGROUND:

Male Pharmacy Staff

Female Pharmacist

Other, please specify ............................................................................................................



TB WORKSHOP FOR PHARMACy/DEPOT STAFF

DAILy EVALUATION (DAy ONE)

not Helpful Helpful very Helpful

Games

The role of pharmacy/depot staff in improving people’s health

Exercise: Reflection of ME

What do you think of the video on your pharmacy?

Group work

Law-Policies Guidelines

needs improvement good very good

Knowledge of facilitator on topic

Facilitator managed and prepared properly

Facilitator provided appropriate explanations

Facilitator was welcoming

Facilitator was punctual

venue yes no

Room was comfortable

Room was spacious

Time was appropriate for each session

Refreshments offered were satisfactory

If you have any additional comments, please provide them below:

....................................................................................................................................................................................................................

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AnneX iv: dAily evAlUAtion Forms




DAILy EVALUATION (DAy TWO)


Games

Recap of day one

State of health in Cambodia

TB status in Cambodia

Goal and objectives of National TB Control Program

Group discussion on TB definition, symptoms, transmission, prevention and TB/HIV

The importance of DOTS

Facilitation needs improvement good very good






venue yes no


Room was spacious



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DAILy EVALUATION (DAy THREE)


Games

Recap of day one

Factors for effective communication

Barriers to effective communication

Active listening skills

Activity: What questions to ask

Facilitation needs improvement good very good






venue yes no


Room was spacious



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