The Comprehensive and Quality of Directly Observed Treatment (DOTS)/ Addressing TB control in War Affected, Post conflict Areas and Other Challenges

Introduction

The Six TB educational booklets

Sudan carries 15% of the TB burden in the Eastern Mediterranean Region with an estimated incidence of 60 new smear positive and 119 for all forms of TB per 100 thousand population with only 6,518 and 19,331 cases detected respectively translating into a case notification rates of 21% and 53% below the global target. Sudan has experienced chronic and more recent conflicts affecting the TB program service. DOTS 100% coverage was achieved in 2000 and in 2008 the new Stop TB strategy was adopted and widely implemented such as PPM expansion, ACSM, and others (NTP Annual Report 2011). However, the impact of these activities on the TB burden has not yet been assessed particularly in areas that are affected by the civil war and conflicts in Darfur and the Eastern parts of the country. Treatment success rate of 70.6% (below 85% target) was achieved among new smear positive cases detected in 2011 and defaulter rate has increased to 12% as a result of secession between North and South in states like White Nile and South Kordofan that served as transit returnee zone.

The overall goal of the SSF_TB/HSS Project is to drastically reduce the TB burden in Sudan, particularly among poor and vulnerable populations in line with the 2015 MDGs and the Stop TB Partnership targets. The project aims to decrease the burden of TB through reducing mortality, morbidity and transmission of the disease until the disease no longer poses a threat to public health in Sudan. It also aims to reduce human suffering and the social and economic burden which families and communities have to bear as a consequence. The project aims to scale up and strengthen quality DOTs including creating access to war-affected and post conflict regions; strengthen partnership including PPM and engagement of health care providers; prevent and control MDR-TB, and address TB contact management; as well as raise awareness and participation of communities and politicians, including the creation of positive perceptions toward TB prevention, treatment efficacy and adherence, in addition to reducing stigmatizing attitudes the burden of TB/HIV in Patients and PLWHA.

In order to meet these needs, UNDP launched The Comprehensiveness and Quality of Directly Observed Treatment (DOTS) Project in January 2007 with the support of The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM).

In addition to the Addressing Tuberculosis control in war affected, post conflict areas and other challenges Project was launched for the period 2010-2015, which was later combined with the previous grant under the Single Stream of Funding.

Project Objectives

Addressing TB control in War Affected, Post conflict Areas and Other Challenges
  • Reduce the burden of TB through reducing mortality, morbidity and transmission of the disease until TB no longer poses a threat to public health in Sudan.
  • Reduce human suffering and the social and economic burden families and communities have to bear as a consequence.
  • Drastically reduce the TB burden in Sudan, particularly among poor and vulnerable populations in line with the 2015 MDG and the Stop TB Partnership targets.
  • Scale up and strengthen quality DOTs including creating access to war-affected and post conflict regions.
  • Strengthen partnerships including PPM and engagement of health care providers.
  • Prevent and control MDR-TB, and address TB contact management.
  • Raise awareness and participation of communities and politicians, including the creation of positive perceptions toward TB prevention, treatment efficacy and adherence, and reduce stigmatizing attitudes.
  • Reduce the burden of TB/HIV in patients and PLWHA .

Snapshots of the project's major achievements



a. Tuberculosis • TB treatment was provided to 19,831 TB cases. • The project detected 6, 518 new smear positive TB cases. • 70.6% of reported new smear positive TB cases were successfully treated. • 254 TB cases were diagnosed as MDR-TB cases and put on treatment. • 190,589 condoms were distributed to TB patients. • Almost 2, 827 people trained on TB management, contact tracing and management, PPM, DOTS links and health communication skills. • 27 TBMUs were newly established in Darfur’s’ states. • 54 DOTs were newly established in Darfur’s’ states.  b. Health System Strengthening • A health system strengthening project implementation mechanism was created within the Ministry of Health and the CCM, including establishing a HSS sub-CCM committee • Site assessment and design work for rehabilitation of the Academies of health Sciences finalized; and civil work is on-going to be realized by June 2013. • Equipments’ to upgrade 5 rural hospitals, 25 health centers, 15 laboratories & 5 health academies were procured & handed over to MOH. • 293 health management personnel from 114 localities trained in decision-making, teamwork, effective meetings, and health planning and district health management • 25 participants from states and federal level trained on M&E of the health system, out of which 5 staff was nominated to participate in external advance training on M&E will be conducted in Liverpool University. • 42 health managers from states and localities trained in health economics/financing. • A framework for community based health insurance (CNHI) has been designed. • 5 fellowships in health economics & health care management were awarded in collaboration with the national health insurance fund & university of Chulalongkorn, Bangkok, Thailand. • 20 health mangers from states & localities were enrolled in health economics/financing 4 week in country short course in collaboration with the national health insurance fund & university of Chulalongkorn, Bangkok, Thailand. • A new implementation strategy was developed in light of the changes in the implementation arrangement for phase II.  Coverage of Activities Initially during 2007 it was in the 15 northern states and 6 southern states but in 2009 it became only in the northern states Currently All 17 Northern States of Sudan are covered  Global Fund Programme Management Unit UNDP is a key partner to the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria (GFATM) and is the UN agency assuming the role of Principal Recipient of GFATM grants in Sudan. As the Principal Recipient of 5 ongoing grants (2005-2016) amounting to more than USD 400 million, UNDP is managing the largest fund portfolio in the Arab region. UNDP‘s management role consists of implementing grants, ensuring financial accountability, and training of a variety of national and international counterparts on programme management and financial accountability. In its role as Principal Recipient, UNDP ensures quality financial management, timely procurement of supplies and service delivery as well as efficient monitoring and evaluation of grant implementation activities.  To ensure the proper management of all the grants, the Global Fund Programme Unit is divided into eight sections- four sections managing the specific grants, a Monitoring and Evaluation section to assess progress made, a Finance section as well as a Procurement section and a Supply Chain section.

Tuberculosis

  • TB treatment was provided to 19,831 TB cases.
  • The project detected 6, 518 new smear positive TB cases.
  • 70.6% of reported new smear positive TB cases were successfully treated.
  • 254 TB cases were diagnosed as MDR-TB cases and put on treatment.
  • 190,589 condoms were distributed to TB patients.
  • Almost 2, 827 people trained on TB management, contact tracing and management, PPM, DOTS links and health communication skills.
  • 27 TBMUs were newly established in Darfur’s’ states.
  • 54 DOTs were newly established in Darfur’s’ states.
  •  

Health System Strengthening

  • A health system strengthening project implementation mechanism was created within the Ministry of Health and the CCM, including establishing a HSS sub-CCM committee.
  • Site assessment and design work for rehabilitation of the Academies of health Sciences finalized; and civil work is on-going to be realized by June 2013.
  • Equipments’ to upgrade 5 rural hospitals, 25 health centers, 15 laboratories & 5 health academies were procured & handed over to MOH.
  • 293 health management personnel from 114 localities trained in decision-making, teamwork, effective meetings, and health planning and district health management.
  • 25 participants from states and federal level trained on M&E of the health system, out of which 5 staff was nominated to participate in external advance training on M&E will be conducted in Liverpool University.
  • 42 health managers from states and localities trained in health economics/financing.
  • A framework for community based health insurance (CNHI) has been designed.
  • 5 fellowships in health economics & health care management were awarded in collaboration with the national health insurance fund & university of Chulalongkorn, Bangkok, Thailand.
  • 20 health mangers from states & localities were enrolled in health economics/financing 4 week in country short course in collaboration with the national health insurance fund & university of Chulalongkorn, Bangkok, Thailand.
  • A new implementation strategy was developed in light of the changes in the implementation arrangement for phase II.

Global Fund Programme Management Unit
UNDP is a key partner to the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria (GFATM) and is the UN agency assuming the role of Principal Recipient of GFATM grants in Sudan. As the Principal Recipient of 5 ongoing grants (2005-2016) amounting to more than USD 400 million, UNDP is managing the largest fund portfolio in the Arab region. UNDP‘s management role consists of implementing grants, ensuring financial accountability, and training of a variety of national and international counterparts on programme management and financial accountability. In its role as Principal Recipient, UNDP ensures quality financial management, timely procurement of supplies and service delivery as well as efficient monitoring and evaluation of grant implementation activities.

To ensure the proper management of all the grants, the Global Fund Programme Unit is divided into eight sections- four sections managing the specific grants, a Monitoring and Evaluation section to assess progress made, a Finance section as well as a Procurement section and a Supply Chain section.

Finance

GFATM TB R5
$15,140,468
  TB R8
$3,886,314
Phase 1 SSF-TB/HSS   $19,851,519.02
Phase 2 SSF-TB/HSS   $25,416,185.98

TB Grants and Duration

TB R5 from Jan 2007 to December 2011 and TB R8 from March 2010 to February 28th 2015.
The two grants were consolidated in July 2010 into the Single stream of funding (SSF-TB) extending from July 2010 to February 2015.

Delivery

TB R5 $11,684,917
TB R8 $3,886,314
SSF-TB/HSS Phase 1 $15,587,385.09

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