Transcript Document
Country Progress Report Cambodia 9 th Technical Advisory Group and National TB Programme Managers meeting for TB control in the Western Pacific Region Manila, Philippines 9 -12 December 2014 TB Epidemiology • Population: 15 million • Highest prevalence(764/100,000),incidence ( 411/100,000) and death(63/100,000) among 22 HBC TB (2012) • Prevalence (all forms) declined at an average of 5 % per year (from 2000 to 2012) • incidence( all forms ) declined at an average of 3 % per year (from 2000 to 2012) • Death rate declined at an average of 4.6 % per year(20002012) • Prevalence far higher in population over 55 (about 3 times) • HIV prevalence among TB patients: 6.3 in 2006 • HIV prevalence among aldult pop: 0.7 % in 2013 • MDR-TB: 1.4% in new and 10.5% in retreatment cases (2006) Major successes • Good DOTS coverage:100% at HC level 1314 health facilities are providing TB services( including 1090 HCs) • • • • • Identifying more than 2/3 of incident cases Big decline in prevalence,incidence and death Achieving MDG Two prevalence surveys conducted Clear policy, plan and guidelines Major challenges • Still high prevalence, incidence and death • Resources to maintain huge services(1314 health DOTS facilities),and expanding specific services and new tools( childhood TB, PPM-DOTS, TB-IC, Xpert…) • Big reliance on external aid ( >75 % on donors) • More ambitious targets, 2016-2020 and years beyond National TB Strategy/Policies •Timeframe: 2014-2020 •Targets: annual average reduction of 6.5 % prevalence, 5.5% death and 4% incidence •Alignment with WHO End TB strategy? •Alignment with National Health Sector Plan •Budgeted: 25-30 USD million per year •Funding sources : - 2015-2017 :GF: ~27%,Govt: 20%,USAID: amount ? - 2018-2020: GF?,Govt: 25%,USAID: amount ? Laboratory strengthening • LED:Total Microscopy centers in 2014 = 215 (LED Microscope= 29 and Conventional Microscope = 186) • Xpert: 20 in routine services and 8 inn ACF •Quality assurance: SOP for EQA exists - Participation rate = 97% , Agreement rate = 98.6% (2013) - False positive rate = 2.8% , False negative rate = 1.2%( 2013) - Acceptable performance = 89% in 2013 •Laboratory information management system: Paper based report and quarterly basis •TA partners-,GLI , RIT, US-CDC (Atlanta, USA), WHO, MSF (Antwerp, Belgium) Reach the unreached •Intensive case finding: among elderly, diabetics, prison inmates •TB screening policy and practice: - revising policy, -ACF and childhood TB •Contact investigation: improve diagnosis and coverage •TB-HIV: improve referral and diagnosis procedures( more Xpert MTB/RIF,…) •Child-TB: improve diagnosis and coverage Surveillance • Quality of surveillance system: sufficient & acceptable( JPR 2012) •New case definition roll out: introduced nation wide since early 2014 •e-R&R: planned to start in 2016/2017 •Analysis and usage of data at national and subnational levels - national level: good - suib-national level: limited •Current situation: PMDT -11 treatment sites with 57 isolated rooms - 20 Xpert machines - MDR-TB cases increased from 31 in 2010 to 121 in 2013 •Plan vs universal coverage -Treatment sites:11/18 ( 18 by 2020) -Xpet: 20/82 (82 by 2018) -Target cases: increase around 10% per year from 2014 to 2020 •Barriers: missing suspects during diagnosis process for DS TB and referral system of samples of MDR-TB suspects •Priority actions: improve diagnostic procedures and referral system Bold policies and supportive systems •TB care financing and social protection - big financial gap 2015-2020 (govt~ 25-30%) - social protection is under discussion between NTP and partners including MoH (TB NSP2014-2020) •Strengthening notification mechanism: - improve paper-based and planned for ereporting •Drug regulations - re-enforcing circular on banning on sale and import of anti-TB drugs and sero-logical test for TB Patient centred care: involvement of patients and civil society •Community mobilization activities community DOTS: 577 HCs out of total 1090 HCs •CBO involvement and their role : In C-DOTS, ACF, TB/HIV •Involvement of patient groups in TB control So far not much, mainly in country consultation and little in C- DOTS •Forms of social support to TB patients - transportation costs for DS and DR TB and food enablers for all MDR -TB