Global Tuberculosis Control 2010 - Florida Department of Health

A case study from China, which illustrates how strengthening
surveillance can lead to increased notifications
of TB cases and an increase in the CDR, is provided in
. Engagement of all care providers is discussed
in the next section. Strengthening of laboratory capacity
and human resource development are discussed in
and , respectively.
In many countries, one of the best ways to increase case
detection is for NTPs to establish collaboration with the
full range of health-care providers. This is component 4
of the Stop TB Strategy (), and its two subcomponents
are:
involvement of all public, voluntary, corporate and
private providers through Public-Private Mix (PPM)
approaches; and
promotion of the International Standards for Tuberculosis
Care through PPM initiatives.
Efforts to engage all care providers through PPM initiatives,
beyond those which fall under the direct responsibility
of the NTP (termed “non-NTP providers” in this
report), are being introduced and scaled up in many
countries. Unfortunately, demonstrating this progress
is not always possible. First, it requires that systematic
recording and reporting of the source of referral and
place of TB treatment is being done. Second, it requires
that data reported at the local level are aggregated, analysed
and reported at the national level. 1 Often, one or
both conditions are not yet met.
Despite this recording and reporting challenge, substantial
progress in engaging non-NTP care providers
through PPM can be documented for an increasing
number of countries. New and compelling data compiled
from 15 countries (including nine HBCs) in 2010, which
demonstrate the major contribution that PPM can make
to case notifications, are summarized in . In
these 15 countries, the contribution of PPM initiatives
typically ranges from between about one fifth to one
third of total notifications, in the geographical areas in
which PPM has been implemented. This has been accompanied
by maintenance of high rates of treatment success
(data not shown).
As also illustrated in , NTPs have used a variety
of approaches to engage non-NTP care providers,
according to the local context. These include incentivebased
schemes for individual and institutional providers
in India and Myanmar; a web-based system for mandatory
reporting of TB cases by all providers in China
1
WHO recommends that the source of referral and the place of treatment
should be routinely recorded and reported.