Thailand - Stop TB Partnership

Program management
Administration
Following the reorganization of the Department of Disease Control (DDC), the TB Cluster
was incorporated into the Bureau of AIDS, TB and STIs. The TB Cluster is responsible for
developing and planning TB policies, training health workers, and monitoring TB control
activities countrywide. Reportedly, the reorganization has resulted in blurred lines of authority
and lack of clarity on roles and responsibilities within the new system.
National TB coordinators monitor NTP implementation in Thailand’s four geographical
regions (north, northeast, central, and south) and provincial TB coordinators (PTCs)
operate in each of the country’s 76 provinces. TB staffing levels vary considerably among
provinces. Regional TB centers are integrated into the Regional Office of Disease Prevention
and Control (ODPC) as part of the Bureau of AIDS, TB and STIs and are responsible for
monitoring, training, and supervising TB health workers at the provincial and district levels.
PTCs work closely with district TB coordinators (DTCs). DTCs coordinate TB
control activities, often in collaboration with TB clinics in hospitals. The PTCs, DTCs,
and local health center staff are responsible for implementing the District TB Control
Programme, which provides for quality-controlled TB case detection and treatment services
and coordination of the network of DOTS providers at the subdistrict level. DTCs also evaluate
and report treatment outcomes to the PTC every four months.
TB clinics are based in district, provincial, and regional hospitals. TB diagnosis is
largely conducted by doctors in district and provincial hospitals, which have laboratory testing
and x-ray facilities. TB treatment is provided in district and provincial hospitals as well
as in health centers at the subdistrict level, where village health volunteers coordinate with
local health workers to ensure access to treatment and to monitor treatment adherence.
Many TB experts report that roles and responsibilities within the reformed health
system are not clear and that “everything is up to interpretation.” As a result, all offices of
the ODPC at the regional level oversee TB work according to their own perspectives and priorities.
Under these circumstances, some regional offices decide that TB is not as urgent as
other diseases and consider scaling back TB services an acceptable cost-saving measure. 113
In this environment, TB control officials worry that some districts also appear
to be cutting back their budgets for essential TB services, particularly for monitoring and
evaluation. 114 To ensure that quality services are maintained during this period of transition,
the NTP should ensure sufficient allocation of resources to guarantee coordinated monitoring
and evaluation of TB control services at all levels.
PUBLIC HEALTH WATCH MONITORING REPORTS 55