Thailand Operational Plan Operational Plan To End... · Moreover, findingsfrom a gap assessment conducted as part of a SWOT analysis suggest that there is a problem of unequal benefitsin

Thailand Operational Planto End Tuberculosis 2017-2021

Thailand Operational Plan

to End Tuberculosis 2017-2021

ISBN 978-616-11-3538-6

จดพมพโดย ส�ำนกวณโรคกรมควบคมโรคกระทรวงสำธำรณสข

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Executive SummaryIII

Executive Summary

Background

Tuberculosis(TB)continuestobeanimportantpublichealthprobleminThailand.In2016,

ThailandisclassifiedbytheWorldHealthOrganization(WHO)asoneofthe22countriesintheworld

withthehighestTBburdenwherebyitisexpectedthatthereare120000TBincidencesperyear,

12000casesofwhichwouldresultinmortality.In2015,66179TBcaseswerereported.Moreover,

multidrug-resistantTB(MDR-TB)hasbeenincreasingoverthepast10yearsattherateofapproximately

2200casesperyear.

Despitecontinualeffortsonprevention,structuralshiftsinthepopulationstructure,namely

theagingsocietyandincreasedlabourmobility,haveresultedinahighprevalenceof171/100000

populationasreportedinthenationalTBsurveyin2012.Thesurveyalsosuggeststhatmorethan

halfofTBcasesdonotexhibitanysymptomsordosoonlyminimally.Moreover,TBismoreprevalent

inmaleandfemale,andpresenthigherrisktotheelderlies.

Atthegloballevel,TBremainsthenumberonecauseofdeathamongstinfectiousdiseases

in2014–moreprominentthanAIDS.TheUnitedNations(UN)andtheWorldHealthOrganization

(WHO),throughratificationbymembers,haveidentifiedTBpreventionandcontrolaspartofthe

SustainableDevelopmentGoals(SDGs)andtheEndTBStrategy,withtheaimtoreduceTBincidence

to20and10/100000populationin2020and2025,respectively.

TBincidenceinThailandis1.3timestheglobalrate.Reporteddiagnosisstandsatonly59%

oftheexpectedtotalnumberofcases.Thisreflectspartlyadelayinorlackofaccesstotreatment

thatleadstospreadsinthecommunities.Asaresult,projectionsofTBcasesonlyreduceslowly.To

achievetheSDGsandtheEndTBPlan,ThailandmustdelveinanewdirectionthatcanendTBonce

andforallbeforethesituationworsenstoapointthatstandardtreatmentrendersineffective.

Assessment of Past Strategic Plans

The report from the 5th Joint International MonitoringMission for TB Control (JIMM),

conductedin2013,confirmsthatcomparedtoothercountriesintheregion,Thailandiscurrently

facinganumberofchallenges,namely:

(1)HighmortalityfromTB

(2)Latediagnosis

(3)Duplicationsinthemonitoringandevaluation(M&E)system

(4)Under-reportingfromnon-MoPHsettings

(5)InsufficientcoverageofMDR-TBdetection(In2012,detectionratewasonly28%)

Thailand Operational Plan to End Tuberculosis 2017-2021 IV

(6)DifficultiesinaccessingTBcareformigrantworkers,includingchallengesrelatedtofreedom

ofmovement of peoplewithin the Association of South-East Asian Nations (ASEAN) Economic

Community(AEC),whichcameintoeffecton31December2015andledtoanincreaseinthenumber

ofmigrantsfromneighbouringcountrieswithsignificantlyhigherratesofTBthanThainationals.

Moreover,findingsfromagapassessmentconductedaspartofaSWOTanalysissuggestthat

thereisaproblemofunequalbenefitsintermsofaccesstoTBdiagnosisandtreatmentbetween

the three health insurance schemes, namely, the Universal Coverage Scheme (UCS) under the

NationalHealthSecurityOffice(NHSO),theCivilServantsMedicalBenefitsScheme(CSMBS)andthe

SocialSecurityScheme(SSS).

Thailand Operational Plan to End Tuberculosis 2017 – 2021

ThisThailandOperationalPlan toEndTuberculosis2017–2021hasas goal“to reduce the

incidenceofTBby12.5%peryear,from171/100000populationin2014to88/100000bytheendof2021”.

ToensurethattheOperationalPlanisfullyconsistentwiththeGlobalEndTBPlan,asrecommendedby

WHO,thePlanconsistsoffivestrategiesandtheirassociatedstrategicobjectivesandinterventionsasfollows.

Strategy 1: Expedite TB case finding to ensure full coverage through TB screening

in risk populations

Objectives: Toensurethatall(100%)presumptiveTBcaseshaveaccesstoTBscreening

andearlyTBdiagnosisviamoleculardiagnostics,aswellasstandardadisedTBtreatmentandcare,

andtoascertainaneffectiveTBspreadcontrol.Strategicinterventionsinclude:

1.1 IncreaseaccesstoearlyTBdiagnosisviamoleculardiagnosticsforallpresumptiveTB

cases,namely,elderlies,prisoners,HIV-infectedpersonsandmigrantworkersandensurenational

accesstomoleculardiagnosticscapacity.

1.2 ConductTBcasefindinginkeytargetpopulations,namelychildrenunder5yearsofage

livingwithTBpatients,andHIV-infectedpersonstoensuretreatmentoflatentTBinfection.

1.3 IncreasecoverageofTBcontrolinhealthcarefacilitiesandthecommunities

1.4 SupporttheprivatesectorandcivilsocietytogarnertheirparticipationinTBdiagnosis,

treatmentandcare,aswellaspatientreferral.

Executive SummaryV

Strategy 2: To reduce TB mortality

Objectives:TohalvetheTBmortalityby2021comparedto2015.Strategicinterventions

include:

2.1 Ensure that all TB cases – adult and child – receive full treatment regimenwith

standardisedandhighqualitymedicine

2.2 Expedite efforts to address HIV-associated TB, including joint planning, timely case

finding,TBpreventivetreatment,andanti-retroviraltreatmentforallHIV-associatedTBcases

2.3 Improve the quality of ProgrammaticManagement of Drug-resistant TB (PMDT) and

ensurenationalcoverage

Strategy 3: Enhance human resource capacity on TB prevention, treatment

and control

Objectives:TostrengthentheleadershipandstrategicmanagementcapacityforTBprevention,

treatmentandcontrol.Strategicinterventionsinclude:

3.1 Developaninternet-baseddatasystemtokeepindividualpatientrecords,ensuringdata

linkagestofacilitateconsolidationandutilisationbyserviceproviders,fundingagencies,M&Eagencies

andpolicy-makingbodies

3.2 EnhanceTBhumanresourcequalitytoensurecapabilityandincentive

Strategy 4: Create a system to support a sustainable strategic management

Objectives: Tosustainpoliticalcommitmentbymobilisingresourcestosupportthesystem

forTBprevention,careandcontrol.Strategicinterventionsinclude:

4.1 AppointtheNationalTBPreventionandControlCommitteetoassembleinstitutional

expertiseandskillsonTBprevention,treatmentandcontrolfromallsectorsinvolved

4.2 CoordinatewiththeAIDSandMalariaPlanstoestablishaspecialfundforAIDS,TBand

Malaria(ATM)toensurecontinualfundingpostGlobalFundsupportanddevelopasystemtoprovide

financialsupportforMDR-TBpatientsfromvarioussources–government,privateandcivilsociety

4.3 PromoteappropriateenforcementofTBrelatedlaws

Thailand Operational Plan to End Tuberculosis 2017-2021 VI

Strategy 5: Promote research and innovation on TB prevention, treatment

and control

Objectives:Tointensifyresearchtodirectandoptimiseimplementationandimpact,including

innovationtoimproveprogrammeperformancethatisconsistentwiththelocalsituation.Strategic

interventionsinclude:

5.1 DeveloptheNationalTuberculosisResearchRoadmapwithparticipationfromfunding

agencies,researchinstitutionsandresearchsupportinginstitutions

5.2 PromoteinnovationtofacilitatesystematicTBinterventions

Theaforementionedobjectivesandstrategicinterventionswillbeusedasguidelinestoplan

programmeactivities.Inthisconnection,thetargetforfirst-linedrugtreatmentis108000personsby

2021,equivalentto90%oftheprojectednumberofcases,andincreasingfrom61200personsin2012.

ProjectionsoverthedurationoftheOperationalPlantakeintoconsiderationboththedeclining

trendinTBduetohigherstandardsoflivingandtheincreasingtrendinTBduetoearlydiagnosisin

children,elderliesandpopulationsatriskofwhichmigrantworkersformthelargestproportion.In

thisregard,itisexpectedthat7200migrantworkerswillbediagnosedperyearby2012.Thisnumber

alreadytakesintoconsiderationtheincreaseinnumberofmigrantworkersaftertheAEC.

Itisprojectedthat90%ofreportedMDR-TBcases,equivalentto1900persons,willreceive

treatmentby2021.Meanwhile,2711childrenunder15yearsofageareexpectedtoreceivetreatment

duringthedurationoftheNSP.

Budget

The budget will be prepared in parallel to the operational plan for implementation

during2017–2020.Thebudgetfromtheexistinghealthservicesystemandtheadditionalbudget

willbeconsideredtoenableasignificantprogressonTBcontrolasenvisagedintheOperationalPlan,

forinstance,increasedcoverageofscreeninganddiagnosis,laboratoryimprovement,treatmentofMDR-TB,

patientsupporttoensuretreatmentcollaboration,monitoringofTBcontacts,humanresourcedevelopment

andresearch.Inthisconnection,amulti-sectoralcollaborationiskeyinensuringsuccessfuloutcomes.

ThebudgetframeworkwillbeusedindevelopingtheNSPoperationalplanandcalculatingcostsof

activitiesbyrelevantparties, includingtheNationalHealthSecurityOffice(TBmedicinefundand

laboratorytest),theMinistryofSocialDevelopmentandHumanSecurity(financialsupportforTB

andMDR-TBpatients),MinistryofJusticeincoordinationwiththeMinistryofPublicHealth(TBscreening

andcareforprisoners),andlocaladministrationoffices(communitycare).

Contents

Executive Summary

Introduction

Keyprinciplesandfoundationsonwhichthe

Planisbuilt

Thenationaldevelopmentandhealthcontext

KeycomponentsoftheNationalStrategicPlan

TheprocessofassemblingtheStrategicPlan

Core Plan

Background

Demographic,geographicandsocio-economic

features

Structureandorganizationofthehealthservices

GapAnalysis

The 5thJointInternationalMonitoringMission

Mainrecommendationsofthe5thJIMM

Keyaffectedpopulations

KeynewdirectionsfortheOperationalPlan2017-2021

III

1

1

3

3

4

5

5

7

9

16

17

18

21

The 2017-2021 Plan

Vision

Overallgoalusingnewincidenceversion

Strategy 1: ExpediteTBcasefinding

to ensure full coverage

through TB screening in

riskpopulations

Strategy 2: ToreduceTBmortality

Strategy 3: Enhancehumanresource

capacity on TB preven-

tion,treatmentandcon-

trol

Strategy 4: Createasystemtosup-

port a sustainable strate-

gicmanagement

Strategy 5: Promote research and

innovationonTBpreven-

tion,treatmentandcon-

trolStrategies,objectives,

measures and account-

abilities

23

23

23

23

24

26

27

27

33

33

33

33

34

34

35

35

35

36

36

44

44

44

Monitoring and Evaluation Plan

PurposeofM&EPlan

OverviewofthecurrentM&Esystem

Datacollection,datasourcesand

coordinationbetweensystems

1. Routinerecordingand

reportingmanagedbyBTB

2. Routinecaseregistrationto

NHSOforfinancialpurpose

3. Hospitalinformationsystems

4. Deathcertificate

5. Surveys

6. Theweb-basedTB-CM

M&EPlantomonitorprogressof

the TB epidemic and

implementationofthe

OperationalPlan

Dataverificationandqualityassurance

Supervision

Capacitybuilding

Contents

Introduction1

Introduction

ThisdocumentrepresentsThailand’scomprehensiveplantocontrolTBintheperiod2017

to2021.Itshould,therefore,guidetheactionsnotonlyoftheMinistryofPublicHealth(MoPH),but

alsoalldecision-makers and implementerswithin the government, and in thenongovernmental

sector,bothnationalandinternational,whosedutiesormandatesarerelatedtoTBcontrol.Itshould

alsoserveasprincipalguideforfundingagenciesconsideringinvestmentforTBcontrolinThailand

duringthesameperiod.

Key principles and foundations on which the Plan is built

Global strategy and targets for tuberculosis prevention, care and control af-

ter 2015 InMay2014,TheWorldHealthAssembly,convenedannuallybyWHOattheUNPalaisdes

Nations inGeneva,passedaresolutionapprovingwithfullsupportthenewpost-2015GlobalTB

Strategynamed“TheEndTBStrategy.”TheStrategyhasavisionforaworldfreeofTBandagoal

forendingtheglobalTBepidemic.ItsambitioustargetsaretoreduceTBdeathsby95%andtocut

newcasesby90%between2015and2035,andtoensurethatnofamilyisburdenedwithcata-

strophicexpensesduetoTB.Itsetsinterimmilestonesfor2020(Table1).

Table 1. Targets of the End TB Strategy

Description

Targets

Milestones SDG End TB

2020 2025 2030 2035

ReductioninnumberofTBdeaths,comparedwith

2015(%)

35 75 90 95

ReductioninTBincidencerate,comparedwith2015(%) 20 50 80 90

TB-affectedfamiliesfacingcatastrophiccostsdueto

TB(%)

0 0 0 0

Toreachthetargets,theStrategybuildsonthreestrategicpillarsunderpinnedbyfourkey

principles.Pillarsincludeagreateremphasisonprevention,patient-centredcare,roleforthecivil

societyinworkingcollaborativelywiththegovernment,andbolderpoliciesincludingcommitment

touniversalhealthcoverageandsocialprotection(Table2).

Thailand Operational Plan to End Tuberculosis 2017-2021 2

Table 2. Pillars of the End TB Strategy

Pillar Key component

1. Integrated,patient-centred

careandprevention

A. EarlydiagnosisofTBincludinguniversaldrugsusceptibilitytesting,

andsystematicscreeningofcontactsandhigh-riskgroups.

B. TreatmentofallpeoplewithTB,includingdrug-resistant,and

patient support.

C. CollaborativeTB/HIVactivities;andmanagementofco-morbidities.

D. Preventivetreatmentofpersonsathighrisk;andvaccination

againstTB.

2. Boldpoliciesandsupport-

ivesystem

A. PoliticalcommitmentwithadequateresourcesforTBcareand

prevention.

B. Engagementofcommunities,civilsocietyorganizations,andall

publicandprivatecareproviders.

C. Universalhealthcoveragepolicyandregulatoryframeworksfor

casenotification,qualityandrationaluseofmedicines,andinfection

control.

D. Socialprotection,povertyalleviationandinterventiontoaddress

socialdeterminantsofTB

3. Intensifiedresearchand

innovation

A. Discovery,developmentandrapiduptakeofnewtools,intervention

andstrategies.

B. Researchtooptimizeimplementationandimpact;andpromote

innovations.

FourkeyprinciplesareusedtoincreaseaccesstoTBtreatmentandcareandlimitthebur-

denontheoveralleconomy(Table3).

Table 3 Principles of the End TB Strategy

Principles Key component

1 Governmentstewardshipandaccountability,withmonitoringandevaluation

2 Buildingastrongcoalitionwithcivilsocietyandcommunities

3 Protectingandpromotinghumanrights,ethicsandequity

4 Adaptationofthestrategyandtargetsatcountrylevel,withglobalcollaboration

TheEndTBStrategycallsnational stakeholders touse it asa framework to guide their

undertakingsand requiresadequatefinancing. It reinforcesa focuswithin thestrategyonserving

populationshighlyvulnerabletoinfectionandpoorhealthcareaccess,suchasmigrants.Thestrategy

alsohighlightstheneedformulti-sectoralparticipationandtheimportanceoftacklingtheproblem

ofMDR-TB.

Introduction3

The national development and health context

The 11thNationalEconomicandSocialDevelopmentPlan,2012-20161,providesthebackgroundtothehealthcontextofthecountryandhasfourmainobjectives: 1) Topromoteafairandpeacefulsociety; 2) ToincreasethepotentialofallThaisbasedonaholisticapproachwithphysical,mental,intellectual,emotional,ethicalandmoraldevelopmentthroughsocialinstitutions; 3) Todevelopanefficientandsustainableeconomybyupgradingproductionandservicesbasedontechnology,innovationandcreativitywitheffectiveregionallinkages,improvingfoodandenergysecurity,upgradingeco-friendlyproductionandconsumptiontowardalow-carbon-society;and 4) Topreservenaturalresourcesandtheenvironmentformaintainingtheecologyandasecurefoundationofdevelopment. The 11thNationalHealthDevelopmentPlan,2012-20162 takes intoaccount theshift indiseaseburden in Thailand and, hence, inpriorities, away fromcommunicablediseases tonon-communicableorlife-stylediseases.It,therefore,aimstostrengthenindividuals’andcommunities’contributionstohealth, incollaborationwiththepublicsector,andto fosterself-reliance in thepromotion of health and the provision of health services. Disaster preparedness is included,especially inthemanagementoffloodsandtheiraftermath.ThePlanseeks formorepro-activehealthsystems,includinginthefieldofdiseasepreventionandcontrol.Itwantstostrengthenhealthsystemswithqualitystandardsandwithadequatehealthpersonnelandappropriatetechnologyatall levels.ThePlan foresees theestablishmentof theNationalHealthServiceDeliveryBoard tobalancetheneedsofpurchasersandprovidersandtoreducethedifferencesbetweenthethreemajorinsuranceschemes.Healthcareformigrantsisincluded,aswellasanimprovedhealthinfor-mation systemand greater emphasis onpublic-privatepartnerships. Research is expected tobecarriedoutonmajornationalhealthissues.

Afterthelaunchofthe11thNationalHealthDevelopmentPlan,ahealthsystemreformwasannouncementwith the goal to decentralise health systemmanagement and administration bydistributingadministrativepowerstothedistricts.

Key components of the National Operational Plan

TheOperationalPlaniscomprisedofthefollowingsections: Introduction ThissectionprovidesthepurposeandunderlyingprinciplesofthePlan.Itoutlinesitsstructureandthecollaborativeprocessthroughwhichitwasdeveloped.ItbrieflydescribesthesocietalandhealthcontextforthePlan.

1 Summaryofthe11thNationalEconomicandSocialDevelopmentPlan(2012-2016).http://www.nesdb.go.th/Portals/0/news/annual_meet/54/book/Executive%20Summary%20of%2011th%20Plan.pdf Accessed on 14December2013

2 BureauofPolicyandStrategy.The11thNationalHealthDevelopmentPlan,2012-2016


Core Plan ThissectionistheheartoftheOperationalPlan,givingthenationalbackgroundinwhichTBcontroloperates,summarizingrecentachievementsoftheNTPandassessingitsstrengths,weaknesses,opportunitiesandthreats. It laysout thegoal,objectivesandstrategic interventions for thenewplanningperiod. M&E Plan ThissectionprovidesdetailsonhowtheOperationalPlanwillbemonitoredandevaluated,withindicatorsandperformancetargetsandhowtheM&Esystemitselfwillberevitalized.

The process of assembling the Operational Plan

FormanyyearstheOperationalPlanhasbenefitedfromthesupportprovidedbyexternalandlocalpartners.Inputswerealsoprovidedbyperiodicprogrammereviews.Themostrecent5th JIMMtookplaceinAugust2013.ItwasorganizedbytheBTB(thecentralunitoftheNTPandpartoftheDDCoftheMoPH).OtherThaiorganizationsthattookpartofthisreviewweretheBangkokMetropolitanAdministration(BMA),KhonKaenUniversity,MahidolUniversity,WalailukUniversity,SirirajHospitaland the Raks-Thai Foundation, National Health SecurityOffice (NHSO).Overall coordinationwasfacilitatedbytheWHOCountryOfficeforThailand.InternationalexpertsfromtheInternationalUnionAgainstTuberculosisandLungDisease(theUnion),FamilyHealthInternational(FHI360),USAID,CDC(ThaiMoPH-USCDCCollaborationaswellasCDC-Atlanta),GlobalInfectiousDiseasesConsultingLtd.(London),andtheGlobalFund;aswellasstafffromWHOHeadquartersandtheRegionalOfficeforSouth-EastAsia.

Followingthis5thJIMM,thenextstepwouldbethepreparationoftheOperationalPlanforthenextprogrammeperiod.AbroadconsultationtookplaceinOctober2013involvingmanyoftheorganizations included in the5th JIMM;peopleaffectedbyTB (including formerTBpatientsandpeoplelivingwithHIVortheirrepresentatives);civilsocietyorganizations(CSOs)andNGOs;andthenationalStopTBPartnership.Follow-upconsultationstookplaceinJanuaryandMarch2014atwhich,inadditiontotheparticipantsofpreviousconsultation,thePrincipalRecipient(PR-DDC)andmorerepresentativesofKAPsattended.In2014and2015,furtherconsultationswereundertakenattheprovinciallevel(3consultations),andtheOperationalPlanwascostedandrevisedduringthisperiodtoensurealignmentwiththeGlobalEndTBStrategy.

ThefirstdraftoftheOperationalPlanwasdevelopedbyDrPaulNunnofGlobalInfectiousDiseasesConsultingLtd.,Headofthe5thHIMM.TheDepartmentofDiseaseControl(DDC)theninvit-edexpertsandstakeholderstorevisethedraft.In2016,DDCissuedanordertoappointtheThailandOperationalPlantoEndTuberculosis2017–20201CommitteetoconsiderthedraftOperationalPlan

foraccuracyandcompletenessbeforesubmittingittotheMinisterandtheCabinetforapproval.

Core Plan5

Core Plan

Background

Demographic, geographic and socio-economic features

Demography

With apopulationof approximately67million, Thailand isoneof themostdeveloped

countriesofSouth-EastAsia(Table4).Thecountryhasarapidlyageingpopulation,ahighandrising

lifeexpectancyandaneedforyounglabour.Themedianageisincreasingrapidlyasfertilitydeclines

whiletheinfantmortalityrate(IMR)isapproachinglevelsofcountriesinWesternEurope.Agrowing

economyandafertilityratebelowreplacementleveliscreatingdemandformigrantlabourwhich

isreadilyavailablefrompoorerneighbouringcountries.In2013,36%ofthepopulationlivedinurban

areas3.AboutasixthoftheentirepopulationresidesinBangkok.

AccordingtotheInstituteofPopulationandSocialResearch,MahidolUniversity,thereare

anestimated4.5millionmigrants,mostlyfromASEANcountries(inparticularMyanmar,Cambodia

andLaos).Outoftheestimation,1.2millionmigrantsareregisteredthroughtheMinistryofLabour.

Unregisteredmigrantshavegenerallyfacedpooraccesstohealthcare.Therearealsoabout150000

refugeeslivingincampsneartheThai-Myanmarborderandapproximately100000statelesspeople

fromethnicminoritygroupsinthenorthandnorth-easternpartsofthecountry.

Table 4. Basic economic, health economic and health indicators4

IndicatorValue Unit Latest data Annual

change5 years ago

Grossnationalincomepercapita 8190 PPPint.$ 2010 +7.62% 6890

Totalhealthspendingasapercent-

ageofGrossdomesticproduct(GDP)

3.9 % 2010 -0.30% 3.5

Percapitahealthspending 179 USD 2010 11.88% 108

Governmenthealthexpenditureas

apercentageoftotalhealthexpen-

diture

75 % 2010 0.40% 72.7

3 Thailand-all health indicators. Available at: http://www.quandl.com/health/thailand-all-health-indicators

(accessedon11September2013).4 Thailand-all health indicators. Available at: http://www.quandl.com/health/thailand-all-health-indicators

(accessedon11September2013).


IndicatorValue Unit Latest data Annual

change5 years ago

Privatehealthexpenditureasaper-

centageoftotalhealthexpenditure

25 % 2010 -0.4% 27.3

Out-of-pocket expenditure as a per-

centageoftotalprivatehealthexpen-

diture

55.8 % 2010 -3.8% 63.7

IMR11 per1000

livebirths

2010 n.a. 26

Adultmortalityrate205 per1000

population

2009 n.a. -

Numberofphysicians2.98 per10000

population

2004 n.a. -

Numberofnursesandmidwives15.2 per10000

population

2004 n.a. -

Economics and health

ThailandisanuppermiddleincomecountrywithaGDPpercapitaofUSD9430in2013,

adjustedforpurchasingpowerparitytoreflectchangesinpricesofgoodsandservices,inflationand

comparativepurchasingpowers.TheGDPpercapitahasbeenincreasingsincethecountry’srapid

recoveryfromthe1997-1999Asianeconomiccrisis.Witha1%unemploymentrate,theeconomyis

shortoflabour.

Lifeexpectancyisontherise5.TheGovernmentcoversthreequartersoftotalhealthex-

penditure,whileprivateexpenditureonhealthisonly25%,ofwhichjustoverhalfisout-of-pocket.

Almostallbirthsareattendedbyskilledhealthpersonnel.Mortalityisdominatedbynon-commu-

nicablediseases,whileAIDSdeathsaccountforoveraquarterofallcommunicablediseasesdeaths.

Physician,nurseandmidwifenumbersarerelativelylowcomparedtootheruppermiddleincome

countries.

Table 4. Basic economic, health economic and health indicators4

4 Thailand-all health indicators. Available at: http://www.quandl.com/health/thailand-all-health-indicators

(accessedon11September2013).5 Healthcarespending.Availableat:http://ucatlas.ucsc.edu/spend.php(accessed12September2013)

Core Plan7

Overview of the national health situation

AlthoughtherehasbeenconsiderableimprovementinthehealthstatusofThaisoverthe

past severaldecades, there is still significant inequitywith theburdenof ill-healthconcentrated

particularlyamongtheruralpoorinthenorthernandnorth-easternprovinces,andtosomeextent

inthesouthernprovinces.

TotalspendingonhealthasaproportionofGDPwas3.9% in2010.Themajorshareof

expenditureisonaccountofnon-communicablediseaseswhichformthebulkofthediseaseburden

inThailand(andhavedonesoforsomeyears).HIV/AIDSistheonlycommunicablediseaseinthe

toptencausesofcombineddeathanddisability6.WithintheMoPHthefocusoncommunicable

diseasesisratherlimited,withresourcesbeingmostlydirectedtowardsemergingdiseases(e.g.new

strainsofinfluenza),dengueandHIV.TheHIVburdenisfairlylarge:nearly450000peopleareliving

withthevirus;andHIV-associatedTBaccountsfor13%ofallTBcasesin2015.Thecasefatalityrate

inHIV-associatedTBhasbeenparticularlyhigh,especiallyinthenorthofthecountry7 .

Therearemultiplehealthcareproviders.Theprivatesectorislargeandnotfullyregulated.

Migrantsandprisonersarechallenginggroupswhenitcomestoprovidinghealthservices.Boththese

groupsareparticularlyvulnerabletoTB.

Therapidageingofthepopulationalsopresentssignificantproblemsbothintherangeof

diseaseselderlypeopleareproneto,andintheprovisionofsuitablehealthservices.Withrespect

toTBdisease,theincidenceishigherintheelderliescomparedtootheragegroups.Assuch,the

shiftingpopulationstructuretowardsanagingsocietymayresultinhigherTBincidencesinThailand.

Structure and organization of the health services

Administratively,Thailandisdividedinto13OfficesofRegionalHealthInspectorswhichare

furtherdividedintoprovinces,districts,sub-districtsandvillages.EachregionhasaDepartmentof

DiseasePreventionandControlandahealthregion.Attheprovinciallevel,thereisaProvincialHealth

OfficeorPHOineachprovincewhileBangkokhastheBangkokMetropolitanAdministrationwhichis

independentandhasitsowngovernancestructure.ProvincesoutsideBangkokaredividedinto878

districts.

Thereisathree-tier(province,districtandsub-district)publichealthdeliverysystemwitha

goodhealth infrastructuredowntothevillagelevel.Provincialhospitalshave400to2000beds;

6 WHO.WorldHealthOrganizationCountryOffice:Thailand’scountrycooperationstrategy.7 CausesofmortalityamongtuberculosisandHIVco-infectedpatientsinChiangRai,NorthernThailand.Kantipong

P,MurakamiK,MoolphateS,AungMN,YamadaN.inHIVAIDS(Auckl).2012;4:159-68.doi:10.2147/HIV.S33535.

Epub4Oct2012


districthospitalshave30to120bedsand2to9doctors,andhealthpromotionhospitalsatthe

villagesub-districtlevelhave3to6nursesandotherhealthworkers.WithintheMoPH,about10

departmentstouchonTB,with22separateagencies.

AmajorfeatureofthehealthsysteminThailandisthelinkwiththreeinsuranceschemes,

whichcover99%oftheThaipopulation8.MostimportantistheUniversalCoverageScheme(UCS),

establishedin2001andrunthroughtheNationalHealthSecurityOffice(NHSO).Theothersarethe

CivilServantsMedicalBenefitsScheme(CSMBS)andtheSocialSecurityScheme(SSS),whichgoback

tothe1980sand1990s,respectively.However,theseinsurancepackagesarenotharmonized,lead-

ingtosomeinequity–aproblemthatisrecognizedandbeingaddressed.TheCSMBSandUCSare

financedbygeneraltaxationwhereastheSSSisfinancedbyapayrolltaxwithatripartitecontribution

sharedbyemployer,employeeandthegovernment,with1.5%ofthesalaryaspremium.These

schemescoverthecostsofbasiccareforalmostallthepopulation,andhavenearlyeliminatedthe

riskofcatastrophichealthexpenditureforfamilies.

Inadecentralizedhealthsystem,wheremoreandmoredecision-makingisdevolvedtothe

provinces,theroleofnationalagenciesisbeingredirectedtonorm-setting,policyguidanceandad-

vocacy.Managementatthecentrallevelhaslimitedauthoritytoissueinstructionstoprovincialand

districtmanagementinotherdepartmentsandreliesonnegotiations.Meanwhile,healthinsurance

agenciespaytheprovidersdirectlyusingaservice-basedapproach, therefore,hospitals focuson

reportingtotheagenciesforreimbursement.

TheemphasisofreportingtoNHSOisonreimbursementforagreedperformanceindicators

ratherthanclinicalissuesandoutcomes.Thereisnosystemtoensurethecollectionandmainte-

nanceofaccurateandcompletedataonclinicalissuesandtreatmentoutcomesthatcanbeutilised

byDDC.

8 NewresearchshowssuccessofThailand’suniversalhealthcarescheme.Availableat:http://asiancorrespondent.

com/106809/new-research-continues-to-demonstrate-the-success-of-thailands-universal-coverage-healthcare-

scheme(accessed02October2013)

Core Plan9

Gap Analysis SWOTanalysisofthemajorprogrammecomponents,unitofanalysisisNTP

Area of TB care and prevention

Strengths Weaknesses Opportunities Threats

Case finding 1.Provenimpact

on the epidemic

ofTBwith

declines in

estimated

incidence,

prevalenceand

mortality.

2.Establishmentof

aforumforall

stakeholders

fromthepublic,

private,academic

andmilitary/

police hospitals

to discuss TB

issuesandagree

onwaysforward

3.Comprehensive

policiesofTB

controlagreed

andenforced

andnew

guidelinesfor

adult TB care

andprevention

in place.

1.Slowerthan

expectedfallin

newcase

findings

2.Onlysome

providersare

activelyengaged

in TB control.

3.Public-private

and public-pub-

lic sector coordi-

nation is limited.

Mostteaching,

privateand

militaryhospitals

do not report

cases.

4.Highnumberof

TB inpatients.

1.Healthinsurance

withstate

financedhealth

insurance

schemescovering

almost the

entire population

2.Presenceof

privateand

public hospitals

ofinternational

standard.

Hospital

accreditationby

independent

agency.

3.Mappingof

collaboration

andsupportfor

NGOsandCSOs

toprovide

community

support and

followup

services

1.Decentralisation

and health

reformmay

result in a loss

offocusonTB.

Localhealth

authoritiesmay

ormaynot

prioritise TB.

2.Diseaseoutbreaks

suchasSARS

anddenguecan

leadtolackof

focusonTBas

thesamestaff

areinvolved.




Treatment 1.AssessmentofstandardsforTBservicedelivery

2.CommunityhealthvolunteershaveshowneffectivenessinprovidingDOTforTBcases.

3.Automated,centralizedprocurementofpharmaceuticals throughtheGovernmentPharmaceuticalOrganization.

4.Nostock-outsofdrugsduringthepast decade.

1.UrbanTBcontrol,particularlyinBangkok.Thereis limited engagementofcivilsociety.

2.Delaysin updatingthe

newguidelineswhileDOTisnotwellacceptedandnotroutinelypractised.DOTbyfamilymember or communityhealthvolunteerpractisedinmanysettingswithlimited or no involvementofhealthcarestaff.

3. Treatment successforthe2013cohortbelowtheglobaltargetof85%.

1.Focusonnon- communicable

diseases opens opportunities to address co-mor-bidities(e.g.TBand diabetes mellitus or cancer).

2.ProgressinBMAincasefindingandtreatment.

3.ThecontextofuniversalaccessprovidesanopportunitytoreviseTBaimsandoperations,makingitmoreefficient.

1.Focusonnon-communica-ble diseases mayleadtoalossofinterestandfocusonTB.

2.Increasednon-communica-ble diseases (such as diabetes mellitus)maylead to

increased TB incidence and casefatality.

4.InadequatestaffcapacityattheBTBtosuperviseclinical and public health performanceofprovincialandregionalstaff.Aformalhumanresourcedevel-opmentplanforalllevelsisneeded.

Core Plan11



MDR-TB 1.The2012

drug-resistance

surveydidnot

showevidence

ofasignificant

increaseof

MDR-TBover

time.

2.Five-yearplan

formanaging

MDR-TBdrafted.

3.Managementof

MDR-TBtreatment

rolled out to

100sitesfrom

2009onwards.

4.Nostock-outof

drugsatNHSO.

5.Drugstotreat

adverseeffects

areavailable

andcoveredby

NHSO.

1.Capacityfor

diagnosingdrug

resistance is

under-utilized.

2.Only<30%of

estimatedMDR-TB

casesamongthe

notifiedcases

(TB07)are

identified,and

approx.10%are

treated and

reported.

3.Managementof

extensively

drug-resistant

tuberculosis

(XDR-TB)is

insufficient.In

addition,

standardsof

procedurefor

eachlevelto

respond to

XDR-TBarenot

available.

4.Confusionabout

rightsofnon-

citizensin

receivingMDR-

TB treatment.

1.Privatehospitals

areinvolvedin

thediagnosis

MDR-TBand

could collaborate

withthepublic

sector.

2.Thecurrent

debate around

healthcarefor

migrantscould

helpmake

MDR-TBtreat-

mentavailable

formigrants.

3.Increasing

availabilityof

XpertMTB/RIF

machines should

facilitateearly

and rapid

diagnosisof

MDR-TB.

1.Iftreatmentof

MDR-TBcases

remainsatlow

levels,XDR-TB

willlikely

increase.




TB/HIV 1.TB/HIV collaboration is

progressing:ahighproportion(72%in2012)ofTB patients is testedforHIV;themajorityofco-infectedpatients are under dual treatment(62%onARTand77%onCPT).

2.Infectioncontrolin healthcare facilitieswellmanaged.

1. Increase in numbersofpatients not receivingorexperiencedelaysinreceivingARTandCPT,andincrease in mortality

2.IPTnotroutinelyprovidedtopeoplelivingwithHIV(PLWA).

3.Challengesincoordination betweenNTPandNACPatcentral and regionallevelswithlimitedjointplanning.

4.TBandHIVplansnotwellaligned.

1.EarlyidentificationofHIVandearlyadditionofARTandCPTtoanti-TB treatment wouldhelpreducemortality

2.OperationsunderthesupportofGlobalFundleadto increased coordinationofTBandAIDSplans

3.StrongevidenceofpositiveimpactofIPTforPLWA(includingthoseonART)isavailable.

4.Capacitytoconduct

researchonIPTeffectivenessunderthenewHIVguidelinesforPLWAwithCD4<500

cells/mm3

1.ContentmentwithsuccessonHIV/AIDScontrol

2.Areasof increased

MDR-HIValsoreflectMDR-TB

Core Plan13



Vulnerable populations

(elderly, prison-ers, migrants and

children)

1.GoodlinkagesestablishedwithMinistryofJusticeforincreasingeffortsto control TB amongprisoners.

2.Excellentqualityofpaediatriccareavailable.PaediatricInfectiousDiseaseSocietyinterested in increased collaboration to address

childhood TB.3.Significant

amountsofcarealreadyprovidedtomigrants.

4.Ampleevidencethat TB rates are veryhighinpeopleabove

65years

1.IncidenceofTBamongprisonersissignificantlyhigherthaninthegeneralpopulation.

2.OnlyaminorfractionofTBcases are reported in children,

suggestingsignificantunder-reporting.ManagementofchildhoodTB,includingcontacttracingisofteninadequate.Paediatricdrugformulationsgenerallyunavailable.

3.Limited information

about TB in theelderly.

1.Currentdebateaboutprovisionofhealthservicesformigrants,andpolicymovementtowards

establishingcare,atleastformigrantworkersandtheirfamilies.

2.SeveralNGOsand international partnersworkingonmigrantandcross-border issueshavestrongrelation-shipswithcommunities in border areas

andmigrantcommunities.

3.TheASEANfreeeconomic area willprovideanopportunitytoadvocateforgoodaccesstocare and

support to migrants.

1.IfTBintheelderlyisunaddressed it willseriouslyundermine effortstoreducethe TB burden in thecountry.

2.TBinprisonsislikelyactingasamajoramplifica-tionsystemforTBinthewholepopulation.

3.UnaddressedTBinmigrantswilllikelyincreasetransmission amongcitizens.




4.Thaiuniversitiesarewell

positioned to carryout

operational research to elucidate and resolvebarrierstocareforvulnerablepopulations.

5.CollaborationwithMaternalandChildHealthandtheExpand-edProgrammeonImmunizationcouldcatalyseTBdiagnosisinchildren.

Laboratory strengthening

1. The National referencelabora-tory(NRL)andSupra-national ReferenceLaboratoryundertheBTBallowopportunities

forfrequentinteraction and cooperation.

1.Laboratorysupervisionisinsufficientandstaffareuncertainabout their

roles and responsibilities

2.Theprocessofexternalqualityassessment needsrevision

3.Laboratorycapacityformolecular diagnosticsfortimelydiagnosisneeds to be improved.

4.TheroleofXpertMTB/RIFisnotclear,resultinginunder-useofmachines.

1.Significantopportunities areofferedbythenew

diagnostictechnologies.

2.AccreditationoflaboratoriesforTBofferspossi-bilityofincreas-ingquality.

1.Failuretoinvestinadequateequipmentandtrainingwillhavenegativeconse-quencesontheTB epidemic.

2.Excessivecustoms duties onnewmolecu-lardiagnostictests.

Core Plan15



Surveillance, Monitoring and

Evaluation

1.Worldclassdatasystems(includ-ingNHSO)andexcellentinformationtechnologyinfrastructure.

1.Fragmented,inefficientandparallel report-ingsystems.Paper-basedsystemprovidingaggregateddataonlytothecentrallevelarestill in place in most areas.

2.Vitalregistrationisnotyetadequateforaccurate TB deathreporting.

1.Amajoroppor-tunityexiststoremoveduplica-tion in the TB M&Esystemandmakeitmuchmoreefficientbycreationofaweb-based,case-based system.

2.Aweb-basedsystemwouldfacilitatetheinvolvementoftheprivatesector in TB case reporting.

3.Focusedtrainingcould increase thereportingofunder-reported groupssuchaschildren and hospitalstaff

1.IfBTB’sanalyti-calcapacitytohandle the increased amountsofdataisnotincreased,itwillcreateabottleneck.


The 5th Joint International Monitoring Mission

The 5thJIMMtookplaceinAugust2013,bringingtogetherexternalexpertsandnationalstafftoreviewtheperformanceofTBcareandpreventionactivitiesindifferentsettings.Thereviewteamprioritisedtheirmainconcernsintothefollowingconclusions:

1. Low case notifications Private,university,militaryandsomeMoPHhospitalsrarelyreportTBcases.InBangkok,forexample,only21of97hospitalsreportalltheircasestotheBTB.Theextentofthisnationalunderreporting isunknownbutlikelytobesignificant.This isespeciallythecase inchildren,theelderlyandthosewithMDR-TB,wherereportedratesarewellbelowestimatedrates.AmongthereasonsforthislowreportingarethattheprivatesectorispassivelyengagedinpartnershipwiththeNTP.Thoughcasenotificationforcertaindiseases (includingTB), ismandatorybylaw,this law isneitherobservednorenforcedforTB.Thepriorityforcomplyingwithrecordingandreportingnationwideistosatisfytheinsuranceschemesratherthanthediseasecontrolbureaus.ForBangkokspecifically,themajorityofhospitalsareprivatehospitalsandthosethatdonotcomeundertheBMA;thus,TBnotificationislow.

2. Inefficient reporting and surveillance systems CurrentsystemsforregisteringandfollowingcasesaretimeconsuminganddonotexploittheexistingopportunitiesofferedbytheinformationtechnologyinfrastructureinThailand.PotentialsynergiesofsharingdatawiththeNHSOhavealsonotbeenexploited.Thailandis,therefore,currentlyaddressingTBwithoutaclearunderstandingofthesizeoftheproblemortheimpactofitspolicies.ThecountryisatriskoffailingtorecognizerapidchangesintheTBepidemic,e.g.outbreaksofMDR-orXDR-TBwhilethereiscapacitytomanageboth.

3. Urgent need for improvement of treatment outcomes Nationally,thetreatmentsuccessratewas82%in2012amongthenotifiednewThaismear-positivecases,whichisbelowtheglobaltargetof85%.Itislargelyduetothelackoffollowupbyprivatehospitals.Awiderrangeofsupportapproaches isneededforpatient-centredcare.Thisshouldbeprovidedbyexpandingexistingpublicservicestoincludeoutreachservicesfordiffi-cult-to-reachpatients, throughcollaborationwithothercareproviders,suchasnongovernmentalagencies.

4. Provision of suitable care for all migrants in need Themajorityofmigrantsareundocumented.TheyareconcentratedinborderareasaswellasinandaroundBangkok.Theyarereluctanttoseekcareatthehospital.Forthosewithaccesstocare,theyarelesslikelytocompletethetreatment.WhentheAECcomesintoforce,thefreemovementofpeoplewilllikelyincreaseimmigration.Demandforhealthylabour,respectforhumanrightsandprotectingpublichealthallsuggestthataccesstotreatmentshouldbefacilitatedforall

migrants,regardlessofdocumentationstatus.

Core Plan17

Insummary,underreportingdoesnotnecessarilymeanthatcasesgountreated,especially

sincetheadventofnear-universalhealthcoverage.Similarly,whilecasenotificationdatainmany

provinces shouldnotbe regardedasaccurateor reliable, itdoesnotmean that theunderlying

epidemiologyofTBisworsening. Infact,detailedanalysisofthedataavailablesuggeststhatthe

burdenofTBisfalling.Meanwhile,incompletereportingandirregularavailabilitysurveillancedata

generallyreflectsinadequacyofthedatasystemtoefficientlycaterforTBcontrol.

Nonetheless,the5thJIMMattributedthedeclineinTBburdentowidespreadandeffective

coverageofhealthinsurance,whichcoversthecostofdiagnosis,treatmentandmuchofthecare

forallformsofTB.Catastrophicexpendituresasaresultofillnesshasbeensignificantlyreduced.

This situation has important implications for the futuremanagement of TB in Thailand, and for

Thailand’s partners in TB control.

Main recommendations of the 5th JIMM

1. TheMoPHshouldaddressthegapsinnotificationwiththegoaloffindingallTBcases.

GreaterpriorityshouldbeaccordedtoTBcontrol.TheMinistryshouldtaketheleadinstrengthening/

establishingaPPMapproachthroughahigh-levelconferenceearlyin2014.Thiseventshouldinclude

stafffromtheMoPHandBMA,leadersofprivate,militaryandteachinghospitals,internationaland

bilateralpartners(suchasWHOandUSAID).Thenotificationsystemneedstobestrengthenedin

ordertoachievemandatoryreportingtotheBTBofallcasesfromallinstitutionsthattreatTB.The

qualityofdiagnosisneedstobeimprovedbyusingthenewrapiddiagnostictestsasthefirst-linetest

throughoutthecountryby2016.Investmentsshouldbemadeinqualityassurance.AllTBlaboratories

should be accredited. TheMoPH and BMA should also discuss (re-)establishing clear regulatory

controlovernon-BMAfacilitieswithrespecttoTBreportingandcasemanagement.

2. Aunified,nationwidecase-based,web-basedelectronicrecordingandreportingsystem

shouldbesetupthatcaptureallcasesinallfacilities.Suchasystemshouldbelinkedwiththedata

collectionsystemoftheNHSO.Acarefultransitionfromthecurrentsystemshouldbeplanned.

3. Toensuremaximumtreatmentsuccess,acampaigntargetingbothpatientsandhealth

staffshouldbeorganizedtoimprovetreatmentoutcomesbasedonDOT.Careneedstobemore

patient-centred,withprovisionofenablerstopoorpatients,propermanagementofco-morbidities

andaclearernotionoftherolesandresponsibilitiesofpatientsandproviders.ResourcesforDOT

should inparticular focusonhigher-riskpatients (HIV, theelderly, uninsured,marginalized, etc.).

Qualityofcareshouldbemonitored.InBangkok,theBMAshouldtakeresponsibilityforsettingupa

monitoringunitandoutreachservicethatfollowsupcasesusingDOTproviders/peereducatorsand

supportsprivatepractitionerstofollowtheirpatients.

4. Toprovidesuitablecareforallmigrantsinneed,theMoPHshouldpromotetheprinciple

thattosafeguardthehealthofallpeopleinThailand,TBcareshouldalsobeofferedtomigrants,


regardlessoftheirstatus.Accesstocareshouldbeextendedamongnon-Thaisbypromotingactive

TBcase-finding,migrant-sensitiveTBhealthservicedeliveryandcoordinatedapproacheswithinternational

andlocalNGOsandCBOs.Local initiativesshouldbeexpandedtoestablishcross-borderreferral

mechanisms,e.g.betweenMaeSotandMyawaddy(Myanmar).TheMoPHshouldfurtherexplore

innovativefinancingapproachestoensuremigrants’universalhealthcoverage,includingtheremoval

offinancialbarrierstoTBcare.

5. AsThailandisundergoingatransitiontoanindustrializedeconomywithuniversalhealth

coverage,theBTBshouldkeeppacewiththesechangestoavoidbecomingcost-ineffectiveinan

environmentwhereTBdiagnosis, treatmentandcareare increasinglyundertaken inhospitaland

reimbursedbythehealthinsuranceagencies.Adebateshouldbestartedonthefuturestrategyof

NTP.TheMoPHneedstoexpandtheBTB’sanalytical,financialandmanagementcapacity,whilealso

strengtheningitstechnicalcapacity.

Key affected populations

Therearespecificvulnerablepopulations,notablymigrants,displacedandstatelesspeople,

prisoners,people residing indetentioncentresandPLWA.Thereareabout1.1million registered

migrantswhileitisestimatedthat2to3millionmigrantsareunregistered.Registeredmigrantshave

accesstotheThaipublichealth-caresystemthrougheitherthe(compulsory)migranthealthinsurance

scheme,withanannualpremiumofTHB1300plusTHB600forenrolmentandmedicalchecks;or

throughtheSSSforthoseemployedintheformalsector.However,lessthanhalfofthoseeligible

haveenrolled ineither scheme.During the secondhalfof 2013,health insurancecoveragewas

extendedtoallmigrants,regardlessofageorregistrationstatus,butwithincreasedpremiumcostto

themigrants.

Theuninsured,ofwhommigrantsarethegreatmajority,havelimitedaccesstoTBcare.This

problemislikelytoexpandwiththecreationoftheAEC.Whileeconomicallybeneficial,theexpected

influxofmigrantsmaypotentialleadtoaggravationofcommunicablediseasecontrol.Migrantscoming

into contact with health services struggle with financial, language, cultural and legal issues.

Consequently,theyfinditdifficulttoadheretotreatmentforthefulldurationofthecourse.Fearof

losingemploymentalsonegativelyaffectstreatmentcompletion.AdditionaldemandsforTBservices

aregeneratedbythosewhocrosstheborder,primarilyfromMyanmar,specificallytoseekhealth

careinThailandwherethehealthinfrastructureiswelldeveloped.

Thailandhasalargeprisonpopulation.WhilemanyThaiprisonershaveaccesstohealth

insurance,somearereluctanttorevealtheir13digitidentificationcode.Prisonshousealargenumber

ofcurrentandformerdrug-addictedpeoplewithdisproportionateHIVandTBprevalences.Thereare

strongeffortstoaddressTBinprisonsbytheNTP.Thailand’sprisons,however,arebuilttohouse

Core Plan19

about105000prisoners;whileon1December2015theyhousedcloseto300000inmates.Thereis

thushugeovercrowdingfavouringTBtransmission.Over4%ofprisonerswithTBhaveMDR-TB,which

istwicethenationalrate.

HIVinfectionisconcentrated,withanestimatedprevalenceinexcessof1%ofthe15-49

yearoldpopulation,inotherwordsthereareabout450000PLWA.Nationalrecordindicatesthat

13%ofTBcasesareinfectedwithHIV,whichisacauseofimmunityimpairmentandleadstoincreased

riskofTB.InThailand,thereisevidencetosuggestthatTBincidenceriseswithagewithanotable

increaseinpeopleover65yearsofagecomparedtootheragegroups.AsurveyofnationalTBprevalence

in 2012 – 2013with sample size of 67 000 people finds that 44%of 142 smear-positive cases

representspeopleover60yearsofage,reflectingtheincreaseinelderpopulationinThailandduring

thelastdecade(Figure2).ThisimpliesthatTBintheelderlieshasbecomeamajorcomponentof

TBinfection.

TheabovementionedsurveyalsofindsthatTBistwicemorecommoninmalethanfemale

and57%ofTBcasesareconcentratedinthenorth-easternregion.Anotherkeyfindingisthat60%

ofTBcasesdonotexhibitsymptomsordosobelowthecriteriaforTBsuspects.Hence,thecriteria

mustberevisedtobecomemoresensitive/responsivenesssothatdiagnosiscanbeperformedfor

thisgroup.Alternatively,achestx-Raymaybeusedasthemainscreeningmethod.

Figure 2. Rapid demographic changes over two decades in Thailand. Each pyramid represents

the distribution of the population by age and sex (Source:UNPopulationDivision2013)


Datafromthenationalregistryindicatesthatthereishighprevalenceinthenorth-eastern

regionofThailand.However,per100000population,allprovinceswithhighprevalencecanbefound

inallregions(Figure3).Thus,operationalplanshouldtakeintoconsiderationsocio-geographical

differencesbetweenareastoensureappropriatenessforlocalcontexts.

9 BenjakulS,TermsirikulchaiL,HsiaJ,KengganpanichM,PuckcharernH,TouchchaiC,LohtongmongkolA,AndesL,

AsmaS.Currentmanufacturedcigarettesmokingandroll-your-owncigarettesmokinginThailand:findingsfrom

the2009GlobalAdultTobaccoSurvey.BMCPublicHealth.2013Mar27;13:277.doi:10.1186/1471-2458-13-277.

Figure 3. Map of TB prevalence (median) / 100 000 population, by province

ItiswellknownthatsmokingisariskfactorofTB.Smokingismorecommonamongmen

(46%)thanwomen(3%)9.TobaccosmokingisaknownriskfactorforTB.Considerationshould,therefore,

begiventocollaborationofTBcontrolandanti-smokingefforts.

Thepercentageof childhoodcasesoutof all cases reported is less thanexpected for a

middle-incomecountry(5%-15%ofallTBcasesareexpectedbasedonobservationsfromcountries

withwell-functioningTBsurveillancesystems).Thisindicatesaproblemofunder-diagnosis,under-reporting

ofdiagnosedcasesorboth.Asperthe5thJIMMreportunder-reportingofdiagnosedcasesislikelyto

bethemainproblem,sinceThailand’shealthsystemshowsahighperformance inacontextof

Median TB prevalence (2010 - 2014) Registered TB cases in 2014

Core Plan21

universalaccesstohealthcareandalowunder-5mortalitywhileunder-reportingwasobservedin

severalinstitutions,includingtheBMA.Theextentoftheunder-reportingisdifficulttodetermine;it

wasestimatedtobeatleast33%butcouldbeover45%.

Intheabsenceofadequateinfectioncontrolprocedures,healthcareworkersareathigher

riskofTB.TrendsinTBincidenceamonghealthcareworkersinSaraburihospital(Region2)showan

averageTBincidenceof206per100000person-yearsover2003/2010comparedtoanestimatedTB

incidenceof 145per100000person-years in the general adultpopulation. Similar resultswere

observedinhospitalsinBangkokandelsewhere.

Diabeticsarereportedtocomprise6.9%ofthepopulationover15yearsofage10.Therisk

ofTB isabouttwotothreetimesgreateramongdiabetics11.Thisarearequiresmoreoperational

researchandpolicydevelopmenttowardscollaborativeactivities.

Key new directions for Thailand Operational Plan to End Tuberculosis

2017-2021

1. Therapidandmoresensitivediagnosistechnologieswillbefocusedtoreducediagnostic

delaysandprovideachanceforstartingtreatmentearlierandmaythuspreventdeaths.Thesenew

testsareespeciallyusefulfordiagnosingMDR-TBaswellasdiagnosingTBinPLWAandotherhigh-risk

groupsforTBandothergroupswithdifficultyindiagnosissuchaschildren,presumptiveTBpatients

withsmearnegativeandelderly.

2. Patient-centredapproachwillbepromotedtoimprovethetreatmentoutcome.Mechanism

toprovidepsycho-socialsupportandfinancialsupportwillbestrengthened.TBcasemanagerwill

beintroducedtotailorcaretothepatients.Inaddition,causesofpooroutcomeswillrequirespecific

investigation,andremedialactionswillneedtobetakeninatimelyfashion.Outreachservicemodels

thatprovideDOTespeciallyforthoseathigherriskofnon-compliance(particularlyinBangkokand

othercapitaldistricts)willbedeployed.

3. Leadershipandmanagementcapacityofprogramstaffandclinicalstaffatalllevelswill

behighlighted.ThemajorstrengthofNTPstructureisthatTBofficersareofficiallyappointedand

theyactivelyperformtheirrole.However,highturn-overratesofTBstafflimittheeffectiveimplementation.

Human resourcedevelopment, therefore,becomes key. The typesof staffwill alsoneed tobe

tailoredinordertobooststaff’scapacityforanalyticalworkonepidemiologicalprogramdataand

policydevelopment.Staffdevelopmentwillalsoneedtofocusonliaisingmorecloselywithother

programmessuchascommodityprocurementandmanagement,HIV/AIDSprogram,policydevelopment

formigranthealthcare,theHospitalAccreditationAgency,andhumanresourcedevelopmentaswell

10 11thNationalHealthDevelopmentPlan.11 WHO.Collaborativeframeworkforcareandcontroloftuberculosisanddiabetes(WHO/HTM/TB/2011.15)


aswiththehealthinsuranceschemes.Inaddition,capacitybuildingforTBstaffandmotivationare

necessarytoimprovingstaff’sperformance.

4. ArenewedefforttoengageallprovidersinTBcarewillbestartedthroughanexpanded

setofpublic-privateandpublic-publicapproachesinordertoaddressthechallengesoffragmentation

ofTBcontrolandstandardcareaswellasTBsurveillance.Thisisespeciallyimportantforthelarge

private,militaryandteachinghospitalsthattreatsignificantnumbersofpatientswithoutnotifying

them.TheMoPHwillengagewithNGOsandlocaladministrationorganizationsthatprovidesocial

andhealthservices,especiallythosethatworkwiththemigrantsliving inThailandthroughlocal

practicestandardsorcross-bordermigrantsthroughInternationalHealthRegulations2005.

5. InformationtechnologywillbeusedtoimproveTBsurveillancesystem.Differentoptions

are available. These include the linkage of TB surveillancewith existing health data of hospital

administrationaswellasaunifiedweb-based,case-basedTBelectronicrecordingandreportingsystem.

Linkagewithlaboratoryandpharmaceuticaldatasystemswillhelpkeeprecordsuptodate,reduce

dataentryburdenandduplicationofefforts.

6. Sustainedpoliticalcommitmentwithadequateresourcesandeffectivemanagementfor

TBpreventioncareandcontrolwillbestrengthened.Thisincludessocialprotectionbyproviding

financialsupporttopatientswithM/XDR–TBtoalleviateeconomicandsocialproblemsforpatients

inallhealthinsuranceschemes.Moreover,asacountrywitharegionalrole,policiestoaddressTB

problemalongtheborderareneeded.Keyconsiderationsincludetreatmentandcare,followupand

treatmentcontinuityandinformationsharingbetweenborder-healthcarefacilities.

7. AnationalTBresearchplanwillbedevelopedtorespondtothecountry’sneedsthrough

collaborationwithresearchinstitutionstoensurethatallresearch-relatedactivitieswillbebeneficial

andimpactful.Innovationsforimprovingprogramperformancewillbepromotedinwaysthatare

consistentwithlocalsituations.

The 2017-2021 Plan23

The 2017-2021 Plan

Vision

ThevisionoftheOperationalPlanisa“ThailandfreeofTB”

Overall goal using new incidence version

TheoverallgoalistoreduceTBincidenceby12.5%peryear,from171per100000to88per

100000,between2017and2021

Overall Goal Indicator Target Means of measurement

Reductionin

Incidence

Incidence in the

generalpopulation

88/100000by2021 Incidenceassessmentusingmodellingand

surveillancesystemasaproxymeasurement,

etc.

Operational objectives and strategic interventions12

Strategy 1: Expedite TB case finding to ensure full coverage through TB screening in

risk populations

Objectives :Toensurethatall(100%)presumptiveTBcaseshaveaccesstoTBscreeningandearly

TBdiagnosisviamoleculardiagnostics,aswellas standardadisedTB treatmentandcare,and to

ascertainaneffectiveTBspreadcontrol.Strategicinterventionsinclude:

1.1 IncreaseaccesstoearlyTBdiagnosisviamoleculardiagnostics forallpresumptiveTB

cases,namely,elderlies,prisoners,PLWAandmigrantworkersandensurenationalaccesstomolecular

diagnosticscapacity.

Whilesupportingroutinediagnosisbysputumsmear,theOperationalPlancallsforincreased

throughputofculturebybothsolidandliquidmediuminexistinglaboratories,withanadditional

investmentinmoleculardiagnosticsasapprovedbytheWHO.

1.2 ConductTBcasefindinginkeytargetpopulations,namelychildrenunder5yearsofage

livingwithTBpatients,andHIV-infectedpersonstoensuretreatmentoflatentTBinfection.

1.3 IncreasecoverageofTBcontrolinhealthcarefacilitiesandthecommunities,andpromote

assessmentofhealthcarefacilitiestogetherwithprogrammaticmeasures(sputumbooths,surgical

masks forpatients to reduce thespreadof infectiousdropletsandpersonalprotection tools for

12 Abriefdescriptionoftheactivitiesineachstrategicinterventionisgivenhere.IntheBudgetsectiontheseare

dividedintonumberedspecificactivitiesandsub-activities


hospitalstaff).PromoteTBpreventionactivitiestopreventinfectioninfamiliesandcommunities,for

example,knowledgesharingwithpatientsandfamilymemberstoraiseawarenessontheimportance

ofinfectionpreventioninresidences,communityareas,publictransports,schoolsandworkplaces.

Accountabilitywillbedevolvedtocommunity-basedfacilities.

1.4 SupporttheprivatesectorandcivilsocietytogarnertheirparticipationinTBdiagnosis,

treatmentandcare,aswellaspatientreferral.

1.4.1 Increaseprivate sector and civil societyparticipationbydevelopingoperational

guidelinestostrengthenjointrolesandresponsibilities

1.4.2 Providetrainingandcommunicationtoensureunderstandingandconfidenceofall

healthcareproviders

1.4.3 Strengthen TB operations in large cities by forging collaboration between local

stakeholders

Strategy 2: To reduce TB mortality

Objectives:TohalvetheTBmortalityby2021comparedto2015.Strategicinterventionsinclude: 2.1 Ensure that all TB cases – adult and child – receive full treatment regimen withstandardisedandhighqualitymedicine 2.1.1 Supportpatientsandprovidetreatmentandcareusingapatient-centredapproach 2.1.2 AppointTBcasemanagerstoprovideorcoordinatesupportthatalignswiththepatient’sneedstofacilitatetreatmentcompletion 2.1.3 ProvideconsultingservicetoTBpatientsthatistailoredforeachspecificcasetofostertreatmentcollaboration.Theservicewillhelpidentifyissuesrelatingtotreatmentadherence,treatmentsideeffects,TBinfectioncontrolandmoralandsocialsupport. 2.1.4 Promote DOT by public health officers, civil society organisation staff, villagevolunteersormigrantworkervolunteers,andusemobilephonesascommunicationdevicesforpatientsandtrainers.VDOobservationisanothermethodtoobservemedicationintake. 2.1.5 PromotecapacitybuildingonDOTforpatientstoensureadherence. 2.1.6 DevelopacoordinationmechanismwiththeMinistryofLabouronlawenforcementtoenablepatients–Thaiandnon-Thai–totakesickleaveorbecompensatedincaseofdismissal 2.1.7 Promotesocialandhumanrightsmeasurestopreventstigmatisationanddiscrimination 2.1.8 StrengthenTBoperationsinchildrenbysteppingupthemonitoringofcontactsinorder to increase case findings, utilising standard diagnosis, providing fixed dose and palatableformulationforchildren,andprescribingTBpreventivemedicinetochildrenunder5yearsofageaccordingtothecountry’sguidelines. 2.1.9 Conductdeathcaseconferencetoidentifycausesofdeathandcollectinformationthatwill serve as reference in developing knowledge on treatment and care for severe cases,

therebypreventingdeath

The 2017-2021 Plan25

2.2 ExpediteeffortstoaddressHIV-associatedTB,includingjointplanning,timelycasefinding,

TBpreventivetreatment,andanti-retroviraltreatmentforallHIV-associatedTBcases

2.2.1 Developandutiliseacoordinationmechanismatthenationalandsub-national

levelse.g.regionalandprovincial,tointegrateeffortsfromplanningtomonitoring

2.2.2 ReduceTBburdeninPLWAbystrengtheningcasefindings,infectioncontrol,and

providingIsoniazidPreventiveTherapy(IPT)for6–36months

2.2.3 ReduceHIVburdeninTBpatientsbyprovidingdiagnosis,Co-trimoxazolePreventive

Therapy(CPT)andARTtoallregardlessofCD4levels

2.2.4 EnsuretreatmentoflatentTBinfectionaccordingtotheguidelinesdevelopedby

theNationalTBandAIDSplans,includingthosefromNHSO

2.3 Improve the quality of ProgrammaticManagement of Drug-resistant TB (PMDT) and

ensurenationalcoverage

2.3.1 ConductscreeninginMDR-TBriskpopulations,includingre-treatmentcasesfrom

treatmentfailure,re-treatmentcasesfromdiscontinueddosage,repeatedinfectionorirresponsiveness

ofsputumsmearresultaftertwomonthsoftreatment,MDR-TBcontacts,PLWA,prisonersandthe

elderlies–allofwhomshouldbediagnosedwithmoleculardiagnostics

2.3.2 ProvideuniversalaccesstoDSTamongriskgroupstoensurethatMDR-TBpatients

arediagnosedforbothfirst-andsecond-linedrugresistances,usingmoleculardiagnostics

2.3.3 Providesecond-linedrugsforallidentifiedMDR-TBcases,alongwithcounselling

andpatientsupportassessment.Treatmentwillbeambulatorywithcommunity-basedDOTandcare

aswellascasemanagementsupportthroughamulti-disciplinaryteam.Inparticular,MDR-TBpatients’

injectionandmedicationmustbeundertheobservationofapublichealthofficeratleastoncea

day.Hospitalizationwillremainanoptionforaminorityofpatientswithcomplications

2.3.4 ImprovetheITsystemandcounsellingservicechannels(fromnationalTBexperts)

forpatientswithcomplications

2.3.5 Improvethelaboratoryinformationsystemtoenablereal-timereportingsothat

treatmentcanbeginpromptly

2.3.6 Supportoutbreakdetectionandmitigation

2.3.7 Supportsupervisionforpatientstostrengthentreatmentcollaborationandreduce

sideeffects

2.3.8 EnsurethatpractiseinPMDTadherestotherecommendedprinciplesreflectedin

internationalandnationalguidelines

2.3.9 Introduce new drugs and shorterMDR-TB regimens under operational research

settingsandestablishasystemforactivepharmacovigilance

2.3.10 EnsurecoordinationbetweentheMinistryofPublicHealthandtheMinistryof

SocialDevelopmentandHumanSecurityindevelopingpoliciesandbudgetonfinancialassistance


forMDR-TBpatientsduetolongtreatmentduration(atleast20months),severesymptoms,inability

toworkandlossofincome.Thus,financialassistancewouldhelpencouragetreatmentadherence.

2.3.11 Promotepalliativeandend-of-lifecaresforallTBpatientswhomcannotbetreat-

edwithTBdrugs.Arrangefortreatmentofrespiratoryandothersymptomssuchasdietandpsycho-

logicalwellbeing,aswellasinfectionprevention.

Strategy 3: Enhance human resource capacity on TB prevention, treatment and control

Objectives: To strengthen the leadership and strategicmanagement capacity for TBprevention,

treatmentandcontrol.Strategicinterventionsinclude:

3.1 Developaninternet-baseddatasystemtokeepindividualpatientrecords,ensuringdata

linkagestofacilitateconsolidationandutilisationbyserviceproviders,fundingagencies,M&Eagencies

andpolicy-makingbodies

3.1.1 Conductmonitoringandevaluation,usingacase-baseddatasystemthatprovides

linkagebetweenTBandAIDSrecordsofhospitals,NHSOandDDC,aswellas linkagewithdeath

certificatedatasystemtoimprovetheaccuracydeathnotifications

3.1.2 Supportcaseinvestigationbygeneticsequencingtodetermineclusterofinfections

3.1.3 Manageandsuperviseprogrammebyorganisingregularstaffmeetingsatalllevels

(e.g.quarterlyprogrammereviewmeetings)andformulatingproductionofguidelines(e.g.forthenew

electronicrecordingandreportingsystem).Italsoincludessupervisoryvisits(fromthenationaltothe

regionallevel,fromtheregionaltotheprovinciallevel,fromtheprovincialtothedistrictleveland

fromthedistricthealthofficetothehealthfacilities)andinformation/education/communication(IEC)

activities.

3.2 EnhanceTBhumanresourcequalitytoensurecapabilityandincentive

3.2.1 Formulate strategicplans forhuman resources anddevelopa staff information

databasewhichcanbeusedtocalculatejobrequirements,trainingneedsandTBpersonnelbudgetneeds.

3.2.2 PreparemanualandcurriculumonTBstafftrainingforallmulti-disciplinesandlevels

3.2.3 DevelopanE-learningsystemtoequipTBstaffwithup-to-dateknowledgeand

conducttrainingsthatpromotecontinuouslearning(continuingeducationcredit)bycollaborating

withaccreditinginstitutions

3.2.4 DevelopanincentivesystemforTBstaff

The 2017-2021 Plan27

Strategy 4: Create a system to support a sustainable strategic management

Objectives:TosustainpoliticalcommitmentbymobilisingresourcestosupportthesystemforTB

prevention,careandcontrol.Strategicinterventionsinclude:

4.1 Appoint theNationalTBPreventionandControlCommitteetoassemble institutional

expertiseandskillsonTBprevention,treatmentandcontrolfromallsectorsinvolved

4.2 CoordinatewiththeAIDSandMalariaPlanstoestablishaspecialfundforAIDS,TBand

Malaria(ATM)toensurecontinualfundingpostGlobalFundsupportanddevelopasystemtoprovide

financialsupportforMDR-TBpatientsfromvarioussources–government,privateandcivilsociety

4.2.1 Formulateguidelinesontheestablishmentofaspecial fundthroughsharingof

experiencesandlessonslearnedfromsuccesscases

4.2.2 ReducecatastrophiccostsforTBpatientsandtheirfamiliesasaresultofvarious

expendituresincurred,includingdirectcostsoftreatment,particularlyforuninsuredorinadequately

insuredpersons(mismatchofrightsandtypesoffacilities)andothercostsnotcoveredbytheinsurance

policy,and indirectcostse.g. transport, food, lossof incomeanddebtaccumulation.Afinancial

supportprogrammewillbeestablished,forinstance,withsupportfromNHSOorothersources,to

compensateforlossofincome.Acatastrophiccostsurveytounderstandthecurrentsituationwill

beimplementedandutilisedforpolicydevelopment.

4.2.3 Coordinatewithconcernedagenciese.g.MinistryofSocialDevelopmentandHuman

Securityandlocaladministrationofficestocreateanetworktoprovidesocialandeconomicsupport

forTBpatients,MDR-TBpatientsandtheirfamilies.Coordinatepoliciestoinitiateawelfareprogramme

tocareforTBpatientsandtheirfamiliestoensuregoodqualityoflife.

4.3 PromoteappropriateenforcementofTBrelatedlaws

4.3.1 Createamechanismtoenforcelawsandregulations,particularlyonTBcasereporting

4.3.2 UtilisetheCommunicableDiseaseActB.E.2015inareaswithTBorMDR-TBinfection

Strategy 5: Promote research and innovation on TB prevention, treatment and control

Objectives: Tointensifyresearchtodirectandoptimiseimplementationandimpact,includinginnovation

toimproveprogrammeperformancethatisconsistentwiththelocalsituation.Strategicinterventions

include:

5.1 DeveloptheNationalTuberculosisResearchRoadmapwithparticipationfromfunding

agencies,researchinstitutionsandresearchsupportinginstitutions

5.2 PromoteinnovationtofacilitatesystematicTBinterventions


Strategies, objectives, measures and accountabilities

StrategiesObjectivesMeasures

Accountabilities

Strategy 1

Objectives

1.1

1.2

1.3

1.4

Expedite TB case finding to ensure full coverage

through TB screening in risk populations

Toensurethatall(100%)presumptiveTBcaseshaveaccess

to TB screening and early TB diagnosis viamolecular

diagnostics,aswellasstandardadisedTBtreatmentandcare.

Increase access to early TB diagnosis via molecular

diagnosticsforallpresumptiveTBcases,namely,elderlies,

prisoners,HIV-infectedpersonsandmigrantworkersand

ensurenationalaccesstomoleculardiagnosticscapacity.

ConductTBcasefindinginkeytargetpopulations,namely

childrenunder5yearsofagelivingwithTBpatients,and

HIV-infected persons to ensure treatment of latent TB

infection.

IncreasecoverageofTBcontrolinhealthcarefacilitiesand

the communities

Supporttheprivatesectorandcivilsocietytogarnertheir

participationinTBdiagnosis,treatmentandcare,aswellas

patientreferral.

MinistryofPublicHealth

NationalHealthSecurity

Office

Ministry of Education

(universityhospitals)

MinistryofDefense(Royal

Tha i A rmy Med i ca l

Department, Royal Thai

NavyMedicalDepartment,

Royal Thai Air Force

MedicalDepartment)

RoyalThaiPolice(Police

Hospital)

Bangkok Metropolitan

Administration (hospitals

underBMA)

Privatehospitals/clinics

Local administrat ion

officesandthecivilsociety

The 2017-2021 Plan29


Accountabilities

Strategy 2

Objectives

2.1

2.2

2.3

To reduce TB mortality

TohalvetheTBmortalityby2021comparedto2015

EnsurethatallTBcases–adultandchild–receivefull

treatment regimenwith standardised and high quality

medicine

Expediteefforts toaddressHIV-associatedTB, including

jointplanning,timelycasefinding,TBpreventivetreatment,

andanti-retroviraltreatmentforallHIV-associatedTBcases

Improve the quality of ProgrammaticManagement of

Drug-resistantTB(PMDT)andensurenationalcoverage



Office

Ministry of Education

(universityhospitals)

MinistryofDefense(Royal

Tha i A rmy Med i ca l

Department, Royal Thai

NavyMedicalDepartment,

Royal Thai Air Force

MedicalDepartment)

RoyalThaiPolice(Police

Hospital)

Bangkok Metropolitan

Administration (hospitals

underBMA)

Privatehospitals/clinics

Strategy 3

Objectives

3.1

3.2

Enhance human resource capacity on TB prevention,

treatment and control

Tostrengthentheleadershipandstrategicmanagement

capacityforTBprevention,treatmentandcontrol.Strategic

interventionsinclude:

Developaninternet-baseddatasystemtokeepindividual

patient records, ensuring data linkages to facilitate

consolidationandutilisationbyserviceproviders,funding

agencies,M&Eagenciesandpolicy-makingbodies

EnhanceTBhumanresourcequalitytoensurecapability

andincentive


MinistryofEducation



Accountabilities

Strategy 4

Objectives

4.1

4.2

4.3

Create a system to support a sustainable strategic

management

Tosustainpoliticalcommitmentbymobilisingresources

tosupportthesystemforTBprevention,careandcontrol.

Strategicinterventionsinclude:

AppointtheNationalTBPreventionandControlCommittee

to assemble institutional expertise and skills on TB

prevention,treatmentandcontrolfromallsectorsinvolved

CoordinatewiththeAIDSandMalariaPlanstoestablisha

special fund for AIDS, TB andMalaria (ATM) to ensure

continualfundingpostGlobalFundsupportanddevelop

asystemtoprovidefinancialsupportforMDR-TBpatients

fromvarioussources–government,privateandcivilsociety

PromoteappropriateenforcementofTBrelatedlaws



Office

MinistryofDefense

MinistryofForeignAffairs

MinistryofSocialDevel-

opment and Human

Security

MinistryofInterior

MinistryofEducation

MinistryofLabour

MinistryofJustice

ThaiRedCross

NationalHealthCommis-

sionOffice

SocialSecurityOffice

National Economic and

Social Development

Board

BureauofBudget

WHO Thailand Country

Office

Tuberculosis Eradication

AssociationLungsDisease

CivilSociety

The 2017-2021 Plan31


Accountabilities

Strategy 5

Objectives

5.1

5.2

Promote research and innovation on TB prevention,

treatment and control

Tointensifyresearchtodirectandoptimiseimplementation

andimpact,includinginnovationtoimproveprogramme

performance that is consistentwith the local situation.

Strategicinterventionsinclude:

DeveloptheNationalTuberculosisResearchRoadmapwith

participationfromfundingagencies,researchinstitutions

andresearchsupportinginstitutions

PromoteinnovationtofacilitatesystematicTBinterventions


MinistryofEducation

NationalResearchCouncil

ofThailand

Privatesector

Fundingagencies

Researchsupportinginsti-

tutions

Nat ional Innovat ion

Agency

Monitoring and Evaluation Plan33

Monitoring and Evaluation Plan

Purpose of M&E Plan

TheCorePlanoftheOperationalPlanlaysouttheoverallgoalfor2017-2021–toreducethe

prevalenceofTBfrom171/100000populationin2014to88/100000bytheendof2021–and

describesfiveobjectives,togetherwiththestrategicinterventionswhicharedesignedtoachievethe

overallgoal.Theactivitiesandsub-activitiesaresetoutintheoperationalplanandbudget.

ThisM&EPlanhastwomainparts.Thepurposeofthefirstpartistodescribehow,usingthe

M&Esystem, impactonaddressingtheTBepidemic inThailandwillbechartedupuntil2021. It

willalsomonitorprogressinachievingplannedoutcomes,outputs,processesandinputs.Relevant

indicatorsaredescribedandannualtargetsgiven.Inthesecondpart,theM&EPlanwilladdressthe

strengths andweaknesses of the currentM&E system. The plan should enable theNational TB

PreventionandControlCommitteetocheckprogressofTBworksinaregularfashion,decidewhether

milestonesaremetorcorrectiveactionneedstobetaken.

Overview of the current M&E system

Although,thereareanumberofdatasourcescollectingTBinformation,currentM&Esystem

inThailandmainlydependsontheroutinereportingsystemresponsiblebyTBBureau.

Data collection, data sources and coordination between systems

TBdataformonitoringandevaluationareavailablefromthefollowingsources:

1. RoutinecasenotificationstotheBTBcompiledinanationaldatabaseofquarterlyaggregated

counts(BTBininchargeofdatacompilationandmanagement);

2. RoutineTBcaseregistrationstotheNHSOforfinancialpurpose–dataareavailableina

nationaldatabaseofaggregatedcasecounts.Forpartsof thecountry, acase-baseddatabase is

available;

3. HospitalInformationSystemse.g.HosXPorHosOSareabletouseforTBcasefinding

reports;

4. TBdeaths(HIV-negative)fromdeathcertificates(BureauofPolicyandStrategyorBPS)–

dataarecase-basedandsubmittedbytheMinistryofInterior(MoI);

5. NationalsurveysofTBprevalencewereconductedin1962,1977,1991,and2012.National

surveysofMDR-TBwerealsoimplementedin1997–1998,2001–2002,2006–2007and2012–2013.

6. In2016,aweb-basedTBClinicManagement(TBCM)willbelaunched,anditisprojected

tocoveracountrywidewithinthreeyears.


1. Routine recording and reporting managed by BTB

TBsurveillancemanagedbytheBTBisbasedonelectronic.BTBdevelopedanon-lineweb

applicationatwww.tbthailand.org/dataforTBclinicstaffofalltreatmentunitstoenterthesummary

dataintothestandardformsavailableonthewebsite.Registrationforusernameandpasswordis

requiredforTBclinicstaffandTBcoordinatorsofalllevelstoaccesstothedatabase.Toreducethe

duplicationindataentryandanyerrors,alllevelscanseethefigures,whenTBclinicstaffentersthe

data.TBcoordinatorsoftheProvincialHealthOfficeandtheOfficeofDiseasePreventionandControl

areabletodothedataqualitycheck.AprogrammeratTBBureauisresponsibleforwebsitemanagement.

Althoughalltreatmentunitsareavailableforthedataentry,privatehospitalsoruniversi-

tyhospitalsbarelyparticipateinthissystem.Pleasenotethatthroughoutthecountrythereare999

publicand316privatehospitals13 .

2. Routine case registration to NHSO for financial purpose

TheNHSOdevelopedacomprehensivecase-baseddiseasemanagementinformationsystem

forTB.Anti-TBdrugsandreimbursementtoserviceprovidersconcerningpatientsundertheUCS,

whichcoversabout70%ofthepopulation,isthemainobjectiveoftheinformationsystem.ItsTB

informationsystem,however,providesmuchmoreinformationthanneededtomonitorUCS-related

financialflows.Itallowsthemonitoringoftreatmentoutcomesandactivecasefinding,forexample,

inadditiontodetailsofmedicalservicesprovidedtoeachpatient.

TheNHSOTBdatabasealsoincludesdataonpatientsnotonUCS(UCSstatusisconfirmed

byrecordlinkagewithamasterdatabaseofUCS-affiliatedpeople,usingthe13-digitnationalIDnumber

asasingleidentifier).In2012,53000TBcaseswereregisteredand42000(79%)wereontheUCS.

Thechoiceislefttotheserviceprovidertoenterdatafornon-UCScases.ApaymentofTHB10is

providedforeachenteredrecord,regardlessofwhethertherecordreferstoapatientonUCSornot.

Dataonculture,DSTandMDR-TBareentereddirectlyonlinefromlaboratoriesorhospitals

usinganon-linewebapplicationcalledDMIS-TBwhichislinkedtotheNHSOTBdatabase.

ThereisadesiretoputinplaceanautomaticproceduretoextracttheTBdatarightfrom

eachHospitalInformationSystems(HIS)inordertominimizedataentryrequirements.

TheNHSOrequiresreportingoftreatmentoutcomesbyhospitals,thus,itisabletoprepare

reportsonnationaltreatmentoutcomes.ThissystemisnotsharedwiththeBTB.

The NHSOmaintains a similar parallel information system for a few other diseases,

includingHIV/AIDS,renaldeficiencyrequiringhaemodialysis,orchronicobstructivepulmonarydisease.

13 http://en.wikipedia.org/wiki/List_of_hospitals_in_Thailand


3. Hospital information systems

EachhospitalmaintainsaHIS,andthesearenotstandardizedacrosshospitals.Theypartly

allowthemonitoringandsupervisionofTBcases.However,dataisnotusedforgeneratingprovincial

ornationalreports.ThislimitationistheunderlyingreasonforrelianceonBTBdatabase.

AnimportantadvantageofHISsisthatTBcasesarereportedaswitnessedbyhospital

staffandcanbereadilyusedbyrelevantpersonnel.ITstaffareavailabletoassistwithsystemusage

anddataexports.

4. Death certificates

VitalstatisticsarecollectedbytheMoIthroughdeathcertificates,whichareforwardedto

theBPSoftheMoPH.Ateamoffivestaffroutinelychecksdataqualityandonestaffencodescauses

of death forwell over 400 000 death certificates per year. The data can be queried through a

password-protectedwebinterfacetogeneratereports.Differentstrategieshavebeenusedtoimprove

dataquality,involvinghospitaldoctors,thenhealthcentresandlastlyofficersfromtheMoI,trained

bytheBPS.Thishasledtoavariablestateofimplementationacrossprovinces.

HospitaldataareautomaticallyextractedfromHISs.Communitydeathsareinvestigated

byMoIofficers,whointerviewrelativesandfillindeathcertificates.TheMoIwillcoverallprovinces

in2014.

Bylaw,deathcertificatesmustbecompletedbeforeabodyiscrematedorburied,but

thislawisnotalwaysenforced.

Dataqualityissuesincludeincompletecoverageofcausesofdeathandalargenumberof

ill-definedcauses.MiscodingbetweenHIVandTBcausesofdeathisalsoarecognizedproblembut

thefrequencyisnotwellquantified.Thelastlargescaledataqualityauditoncausesofdeathwas

conductedin1999in16provincesandshowedthatonly29%ofcauseswerecorrectlyattributed.

Randomsamplingnowtakesplaceeveryyearinabouttenhospitals,coveringaround2000deaths.

Thereiscurrentlynomechanismforauditingcausesofdeathreportedatcommunitylevel.

5. Surveys

Anationalprevalencesurveymeetinginternationalstandardswasconductedin2012-2013,

samplingseparatelythepopulationinthe76provincesandinBangkok.Thethirdandfourthnational

drugresistancesurveyswereconductedin2006and2012,respectively.

ThefifthnationalsurveyrevealedusefulinsightsonchangesinTBepidemiology.Forinstance,

smear-positiveTBcaseswithunclearsymptomsmadeupalmost1/3ofallcasesandTBprevalence

washigheramongtheelderlies.However,surveylimitationincludedlowparticipationrateofBangkok

residents,availabilityofquantitative(sizeofdiseaseburden)ratherthanqualitativedata(qualityof

care),lackofdataontheproportionsofHIVinfections–informationthatisalreadypresentinexisting

reportingsystem.


6. The web-based TB-CM

Itisexpectedthatin2016,thisweb-basedTB-CMwillbecomeasinglenationalonline

web-basedandcase-basedreal-timereportingsystemforTB.Thedataentryisperformedathospital

level.ThenthedatacheckscanbedonebycoordinatorsattheProvincialHealthOfficeandthe

OfficeofDiseasePreventionandControl.Thedata-interchangemechanismtolinkwiththeNHSO

willbeestablishedsothatnorecordneedstobeenteredtwiceatthehospitallevel.

M&E Plan to monitor progress of the TB epidemic and implementation

of the Operational Plan

Indicators TheMonitoringFrameworkfollowsthelogicalapproachofmonitoringinputs,processesand

outputs,throughtoassessingthecoverageofTBservicesandtheimpacttheyprovide(Figure7).

ThemajorindicatorsformonitoringtheplananditsimpactarelistedintheM&EFramework

(Table5).TheindicatorscloselyfollowtheobjectivesandstrategicinterventionsfromtheCorePlan,

usingthesamenumberingsystem.

Figure 7. Logical indicator sequence

Monitoring programmatic performance

Input

Inputindicators

Processindicators

Outputindicators

Outcomeindicators

Impactindicators

Process Output Outcome Impact

Coverage and health impact

- HR- medicines & vaccines- Lab and medical photography tools & apparatus- Operational budget

- HR development- Health services- Active surveillance on drug safety- Infection control in health facilities and communities- Supervision and M&E

- No. of trained HR- No. of vaccines provided- No. of health services (lab test, diagnosis, medical photography)

- No. of detected and treated cases- No. of detected and treated cases (latent infection)- Treatment outcomes

- Incidences- % MDR-TB


Tabl

e 5:

Nat

iona

l M&

E Fr

amew

ork

No.

Indi

cato

rBa

slin

ePe

rfor

man

ce t

arge

tDa

ta s

ourc

e &

fre

quen

cyIn

dica

tor

type

Year

Valu

e20

1720

1820

1920

2020

21

Ove

rall

goal

– R

educ

tion

in T

B in

cide

nce

TBin

ciden

cera

te(p

er1

000

00p

opul

ation)

2014

171

150

131

115

100

88Gl

obalT

Bre

port,

surveilla

nce

system

Impa

ct

Stra

tegy

1: E

xped

ite T

B ca

se fi

ndin

g to

ens

ure

full

cove

rage

thr

ough

TB

scre

enin

g in

risk

pop

ulat

ions

To e

nsur

e th

at a

ll (1

00%

) pre

sum

ptiv

e TB

cas

es h

ave

acce

ss to

TB

scre

enin

g an

d ea

rly T

B di

agno

sis v

ia m

olec

ular

dia

gnos

tics,

as w

ell a

s st

anda

rdad

ised

TB t

reat

men

t an

d ca

re.

%T

Bca

sefind

ing(all

type

s)20

1459

8082

.585

87.5

90Gl

obalT

Bre

port,

surveilla

nce

system

Out

com

e

1.1

Incr

ease

acc

ess

to e

arly

TB

diag

nosis

via

mol

ecul

ar d

iagn

ostic

s fo

r all

pres

umpt

ive

TB c

ases

, nam

ely,

eld

erlie

s, pr

isone

rs, H

IV-in

fect

ed p

erso

ns

and

mig

rant

wor

kers

and

ens

ure

natio

nal a

cces

s to

mol

ecul

ar d

iagn

ostic

s ca

paci

ty.

1.1.

1Pr

opor

tion

ofcon

tact

sincon

firm

edT

Bpa

-

tient

’sh

ouse

hold

rece

ivingx-Ra

ysc

reen

ing(%

)

2014

NA30

4050

6070

TBsur

veillan

cesys

tem

(Web

-bas

edT

BCM)

Out

put

1.1.2

Prop

ortio

nof

spu

tum

sm

earsla

borato

ries

achiev

ingac

cept

able

per

form

ance

on

exte

rnal

quality

asses

smen

t(EQ

A-LQ

AS)(

%)(

Onl

ysm

ear)

(False

pos

itive

/False

neg

ative)

2014

6790

9090

9090

NRL

(BTB

)per

form

ance

repo

rt

Out

put

1.1.

3Pr

opor

tion

ofe

xistin

glabo

rato

ryro

utinel

y

perfo

rmingDS

Tan

dac

hiev

ingac

cept

able

perfo

rman

ceo

nex

tern

alq

ualit

yas

sessm

ent(

at

leas

t95%

14)

agre

emen

tfor

Rifa

mpicin

and

Isoniaz

idw

ithth

ere

sults

ofN

RL)(

%)

2014

35

(7/

20)

85

(20/ 23)

90 (21/ 23)

9510

010

0NR

L(B

TB)p

erfo

rman

ce

repo

rt

Out

put

14จ

ะพจำ

รณำต

อไปโ

ดยระ

ดบนโ

ยบำย

แหงช

ำต


No.

Indi

cato

rBa

slin

ePe

rfor

man

ce t

arge

tDa

ta s

ourc

e &

fre

quen

cyIn

dica

tor

type

Year

Valu

e20

1720

1820

1920

2020

21

1.2

Cond

uct

TB c

ase

findi

ng in

key

tar

get

popu

latio

ns, n

amel

y ch

ildre

n un

der 5

yea

rs o

f ag

e liv

ing

with

TB

patie

nts,

and

HIV-

infe

cted

per

sons

to

ensu

re t

reat

men

t of

late

nt T

B in

fect

ion.

1.2.1

Prop

ortio

nof

child

ren

(und

erfive

yea

rs)w

ho

are

cont

actso

fbac

terio

logic

ally-con

firm

edT

B

patie

ntsan

dre

ceivingtre

atm

enta

ccor

ding

to

the

TBTre

atm

entG

uide

lines

forC

hild

ren

(%)

2014

NA50

6070

8090

TBsur

veillan

cesys

tem

(Web

-bas

edT

BCM)

Out

put

1.2.2

Prop

ortio

nof

PLW

Awho

are

pre

sum

ptive

late

nt

TBcas

esacc

ording

toth

eHI

VTrea

tmen

tand

Prev

entio

nGu

idel

ines

,rec

eiving

trea

tmen

tfor

late

ntT

B(%

)

NA10

2030

4050

TBsur

veillan

cesys

tem

(Web

-bas

edT

BCM)

Out

put

1.3

Incr

ease

cov

erag

e of

TB

cont

rol i

n he

alth

care

fac

ilitie

s an

d th

e co

mm

uniti

es

1.3.

1Pr

opor

tion

ofta

rget

hos

pita

lsm

eetsth

ecrite

ria

ofT

Binfe

ction

cont

rola

ndsta

ffus

epe

rson

al

prot

ectio

nto

ols(%

)

2014

NA90

9090

9090

Survey

Out

put

1.3.2

Num

bero

fTB

inh

ealth

care

wor

kers/gen

eral

popu

latio

n

2014

1.2

--

11

Survey

Out

put

Supp

ort

the

priv

ate

sect

or a

nd c

ivil

soci

ety

to g

arne

r the

ir pa

rtic

ipat

ion

in T

B di

agno

sis, t

reat

men

t an

d ca

re, a

s w

ell a

s pa

tient

refe

rral

.

1.4.1

Prop

ortio

nof

TB

case

sre

porte

dto

the

BTB

by

Non–

MoP

Hca

rep

rovide

rs(%

)

2014

NA20

4060

8010

0TB

sur

veillan

cesys

tem

(Web

-bas

edT

BCM)

Out

put


No.

Indi

cato

rBa

slin

ePe

rfor

man

ce t

arge

tDa

ta s

ourc

e &

fre

quen

cyIn

dica

tor

type

Year

Valu

e20

1720

1820

1920

2020

21

Stra

tegy

2: T

o re

duce

TB

mor

talit

y

To h

alve

the

TB

mor

talit

y by

202

1 co

mpa

red

to 2

015.

TBm

orta

lityinth

ege

neralp

opul

ation

(per

100

000

pop

ulat

ion)

2014

109

87

65

Annu

alG

loba

lTB

Repo

rt

and

natio

nal T

B

surveilla

nce

system

Impa

ct

2.1

Ensu

re t

hat

all T

B ca

ses

– ad

ult

and

child

– re

ceiv

e fu

ll tr

eatm

ent

regi

men

with

sta

ndar

dise

d an

d hi

gh q

ualit

y m

edic

ine

2.1.1

Trea

tmen

tsuc

cessra

tefo

rnew

and

re-in

fect

ed

TBcas

esu

singfirst-line

dru

gtre

atm

ent

2013

8185

8687

8890

TBsur

veillan

cesys

tem

(Web

-bas

edT

BCM)

Out

com

e

2.1.2

Prop

ortio

nof

TB

case

sre

ceivingco

mpl

ete

treat

men

treg

imen

(inc

luding

DOT)

und

erth

e

care

ofc

ase

man

ager

s(%

)

2556

NA50

6070

8090

Rese

arch

and

asse

ssm

ent

Out

put

2.2

Expe

dite

eff

orts

to

addr

ess

HIV-

asso

ciat

ed T

B, in

clud

ing

join

t pl

anni

ng, t

imel

y ca

se fi

ndin

g, T

B pr

even

tive

trea

tmen

t, an

d an

ti-re

trov

iral t

reat

-

men

t fo

r all

HIV-

asso

ciat

ed T

B ca

ses

2.2.1

Prop

ortio

nof

all

TBcas

esw

ithH

IVte

stre

sult

reco

rded

inT

Bre

giste

r(%

)

2014

7175

8085

9095

TBsur

veillan

cesys

tem

(Web

-bas

edT

BCM)

Out

put

2.2.2

Prop

ortio

nof

HIV-assoc

iate

dTB

cas

esre

ceiving

CPT

(%)

2014

6475

8085

9090

TBsur

veillan

cesys

tem

(Web

-bas

edT

BCM)

Out

put

2.2.3

Prop

ortio

nof

HIV-assoc

iate

dTB

cas

esre

ceiving

ART

(%)

2014

6975

8085

9090

TBsur

veillan

cesys

tem

(Web

-bas

edT

BCM)

Out

put


No.

Indi

cato

rBa

slin

ePe

rfor

man

ce t

arge

tDa

ta s

ourc

e &

fre

quen

cyIn

dica

tor

type

Year

Valu

e20

1720

1820

1920

2020

21

2.3

Impr

ove

the

qual

ity o

f Pr

ogra

mm

atic

Man

agem

ent

of D

rug-

resis

tant

TB

(PM

DT) a

nd e

nsur

e na

tiona

l cov

erag

e

2.3.1

Prop

ortio

nof

bac

terio

logica

llyc

onfir

med

&

prev

ious

lyt

reat

edc

ases

,re

ceiving

DST

resu

lts

cond

ucted

bym

olec

ulard

iagno

sticso

rcon

vent

iona

l

phen

otyp

icm

etho

d(%

)

2014

3850

6070

8090

TBsur

veillan

cesys

tem

(Web

-bas

edT

BCM)

Out

put

2.3.2

Prop

ortio

nof

new

cas

es,re

ceiving

DST

resu

lts

cond

ucted

bym

olec

ulard

iagno

sticso

rcon

vent

iona

l

phen

otyp

icm

etho

d(%

)

2014

2430

4050

6070

TBsur

veillan

cesys

tem

(Web

-bas

edT

BCM)

Out

put

2.3.3

Case

det

ectio

nrate

ofM

DR-T

B(%

)20

1423

(506

/

2,20

0)

5060

7080

90TB

sur

veillan

cesys

tem

(Web

-bas

edT

BCM)

Out

put

2.3.4

Prop

ortio

nof

MDR

-TB

case

sun

dergoing

trea

t-

men

t(%

)

2014

71(3

03/

428)

9595

9595

95TB

sur

veillan

cesys

tem

(Web

-bas

edT

BCM)

Out

put

2.3.5

Cove

rage

ofn

ewd

rugpr

ovisi

onin

pre

sum

ptive

MDR

-TB

case

s(%

)

2014

NA90

9090

9090

Minut

eso

fthe

mee

tings

ofth

ena

tiona

lexp

ert

com

mitt

eeo

nMDR

-TB

Out

put


No.

Indi

cato

rBa

slin

ePe

rfor

man

ce t

arge

tDa

ta s

ourc

e &

fre

quen

cyIn

dica

tor

type

Year

Valu

e20

1720

1820

1920

2020

21

Stra

tegy

3: E

nhan

ce h

uman

reso

urce

cap

acity

on

TB p

reve

ntio

n, t

reat

men

t an

d co

ntro

l

To s

tren

gthe

n th

e le

ader

ship

and

str

ateg

ic m

anag

emen

t ca

paci

ty f

or T

B pr

even

tion,

tre

atm

ent

and

cont

rol

3.1

Deve

lop

an in

tern

et-b

ased

dat

a sy

stem

to

keep

indi

vidu

al p

atie

nt re

cord

s, en

surin

g da

ta li

nkag

es t

o fa

cilit

ate

cons

olid

atio

n an

d ut

ilisa

tion

by

serv

ice

prov

ider

s, fu

ndin

g ag

enci

es, M

&E

agen

cies

and

pol

icy-

mak

ing

bodi

es

3.1.

1Pr

opor

tion

ofT

Btre

atm

entu

nitsre

porti

ngfo

r

MoP

Hse

tting

s,no

tinc

luding

spe

cialis

edh

ealth

units

(%)

2014

9090

9595

100

100

TBsur

veillan

cesys

tem

(Web

-bas

edT

BCM)

Out

put

3.1.2

Prop

ortio

nof

TB

treat

men

tunitsre

porti

ngfo

r

non-

MoP

Hse

tting

s,no

tinc

luding

spe

cialis

ed

health

units(%

)

2014

21

(138

/652

)

4050

6070

80TB

sur

veillan

cesys

tem

(Web

-bas

edT

BCM)

Out

put

3.1.

3M&E

and

sur

veillan

cesys

tem

asses

sed

follo

w-

ingth

eW

HOche

cklis

t

2013

Yes

Yes

Yes

Yes

Yes

Yes

Survey

and

sel

f-asses

s-

men

t,te

chnica

lly

supp

orte

dby

WHO

Proc

ess

3.2

Enha

nce

TB h

uman

reso

urce

qua

lity

to e

nsur

e ca

pabi

lity

and

ince

ntiv

e

3.2.1

Availabilit

yof

acom

preh

ensiv

estrate

gicp

lan

forH

RD

2015

NANo

Yes

Yes

Yes

Yes

TBsta

ffda

taba

sePr

oces

s

3.2.2

Num

bero

ftrained

sta

ffon

TB

stan

dard

cou

rses

20

15NA

800

800

800

800

800

TBsta

fftra

iningre

port

Proc

ess


No.

Indi

cato

rBa

slin

ePe

rfor

man

ce t

arge

tDa

ta s

ourc

e &

fre

quen

cyIn

dica

tor

type

Year

Valu

e20

1720

1820

1920

2020

21

Stra

tegy

4: C

reat

e a

syst

em t

o su

ppor

t a

sust

aina

ble

stra

tegi

c m

anag

emen

t

To s

usta

in p

oliti

cal c

omm

itmen

t by

mob

ilisin

g re

sour

ces

to s

uppo

rt t

he s

yste

m f

or T

B pr

even

tion,

car

e an

d co

ntro

l.

4.1

Appo

int

the

Natio

nal T

B Pr

even

tion

and

Cont

rol C

omm

ittee

to

asse

mbl

e in

stitu

tiona

l exp

ertis

e an

d sk

ills

on T

B pr

even

tion,

tre

atm

ent

and

cont

rol f

rom

all

sect

ors

invo

lved

4.1.1

Num

bero

fminut

eso

fthe

mee

tings

oft

he

Natio

nalT

BPr

even

tion

and

Cont

rolC

omm

ittee

2015

NA2

22

22

Minut

eso

fthe

mee

tings

(BTB

)

Proc

ess

4.2

Coor

dina

te w

ith t

he A

IDS

and

Mal

aria

Pla

ns t

o es

tabl

ish a

spe

cial

fun

d fo

r AID

S, T

B an

d M

alar

ia (A

TM) t

o en

sure

con

tinua

l fun

ding

pos

t

Glob

al F

und

supp

ort

and

deve

lop

a sy

stem

to

prov

ide

finan

cial

sup

port

for

MDR

-TB

patie

nts

from

var

ious

sou

rces

– g

over

nmen

t, pr

ivat

e an

d ci

vil

soci

ety

4.2.1

Availabilit

yof

aspe

cialf

und

forA

TM20

15No

NoYe

sYe

sYe

sYe

sGl

obalF

und

prog

ress

repo

rt

Proc

ess

4.2.2

Asy

stem

top

rovide

fina

ncials

uppo

rtfo

r

MDR

-TB

patie

ntsfro

mvarious

sou

rces

–gov

ern-

men

t,pr

ivat

ean

dciv

ilso

ciety

2015

NoYe

sYe

sYe

sYe

sYe

sMinist

ryo

fSoc

ialD

evel

-

opm

enta

ndH

uman

Secu

rity

Proc

ess

4.2.3

Num

bero

fTB

patie

ntsre

ceivingm

onth

ly

allo

wan

ce

2015

NA4

050

7510

012

5So

cialw

elfare

prog

ressre

port

(BTB

)

Out

put

4.2.4

Prop

ortio

nho

useh

olds

facin

gca

tastro

phic

costs

asare

sult

ofT

Btre

atm

ent

2015

NA-

-0

-0

Rese

arch

repo

rtOut

put

4.3

Prom

ote

appr

opria

te e

nfor

cem

ent

of T

B re

late

d la

ws

4.3.1

Num

bero

fpro

vinc

esth

atu

tilise

the

Com

mun

i-

cabl

eDi

seas

eAc

tB.E.2

015

forT

Bop

erat

ions

2015

NA5

1015

2025

Survey

Out

put


No.

Indi

cato

rBa

slin

ePe

rfor

man

ce t

arge

tDa

ta s

ourc

e &

fre

quen

cyIn

dica

tor

type

Year

Valu

e20

1720

1820

1920

2020

21

Stra

tegy

5: P

rom

ote

rese

arch

and

inno

vatio

n on

TB

prev

entio

n, t

reat

men

t an

d co

ntro

l

To in

tens

ify re

sear

ch to

dire

ct a

nd o

ptim

ise im

plem

enta

tion

and

impa

ct, i

nclu

ding

inno

vatio

n to

impr

ove

prog

ram

me

perf

orm

ance

that

is c

onsis

tent

with

the

loca

l situ

atio

n.

5.1

Deve

lop

the

Natio

nal T

uber

culo

sis R

esea

rch

Road

map

with

par

ticip

atio

n fr

om f

undi

ng a

genc

ies,

rese

arch

inst

itutio

ns a

nd re

sear

ch s

uppo

rtin

g

inst

itutio

ns

5.1.

1De

velo

pmen

toft

heN

ationa

lTub

ercu

losis

Rese

arch

Roa

dmap

with

partic

ipat

ion

from

fund

ingag

encie

s,re

search

institu

tions

and

rese

arch

sup

porti

ngin

stitu

tions

2015

NoYe

sYe

sYe

sYe

sYe

sDD

COut

put

5.2

Prom

ote

inno

vatio

n to

fac

ilita

te s

yste

mat

ic T

B in

terv

entio

ns

5.2.1

Prop

ortio

nof

bud

getf

orre

search

stu

dies

(%)

2014

3

(604,9

08/

19,69

4,609

)

44

68

10Gl

obalT

Bre

port

Inpu

t

5.2.2

Num

bero

fTB

inno

vatio

ns(IT

&m

anag

emen

t)20

15NA

24

68

10Su

rvey

Out

put


Data verification and quality assurance

Dataverificationandqualityassurancewillbecarriedoutthroughvariousprocesses:

1. RoutineDataQualityAssessment (RDQA)toolswillbeusedtomeasureperiodicdata

qualityoftheM&EandtheroutinesupervisionbytheNTPandpartners.TBsupervisorscanalso

conductRDQAproceduresinanothersitethantheirusualsupervisionarea.M&Estaffwillbetrained

inconductingRDQAtostrengthendatamanagementandreportinginordertoproducequalitydata.

2. Inaddition,follow-upverificationswillbeconductedatintermediatelevels(provinces)

andattheBTB,wheredataentrieswillbe“cross-checked”foraccuracyandreliability.

3. On-sitedataverificationprocessesinrandomlyselectedprovinceswillbecarriedoutto

assessthequalityofdataandthereportingsystemsatdifferentlevels.

Supervision

SupervisionisanintegralpartofsupporttothekeyelementsofTBcontrol,andisahigh

priorityamongthecoreactivitiestobecarriedoutduringthelifespanoftheM&EPlan:tomonitor

NTPactivities,checkthedatacollectionmethodology,assessqualityofdata,buildcapacityand

providefeedbacktotheperipheralunits.Supervisionshallbeconductedasfollows:

•FromtheBTBtoeachregionandselectedprovinces,annually

•Fromtheregiontotheprovinces,quarterly

•Fromtheprovincetothedistrictandselectedhealthfacilities,annually

•Fromthedistricttothehealthfacilitiesandcommunityactivities–ongoing

Capacity building

StrengtheningtheOperationalPlantoallowittoaddresstheexpecteddemandsinthenear

future,especiallyintermsofdesignandinstallationoftheweb-basedsurveillancesystem,increased

dataanalysis,policydevelopment,etc.requiresconsiderationofthestaffingneeds.

On-goingtrainingwillberequiredofstaffatalllevels–bothworkingexclusivelyorpartly

onTB–ontheroutinecurrentactivitiesaswellasthenewactivitiestobeconductedoverthe

planned period.

Inaddition,relevantstaffmayparticipateinstudytours,conferencesandtrainingworkshops

overseas(basedonneeds).

Documents

Thailand Operational Plan Operational Plan To End... · Moreover, findingsfrom a gap assessment conducted as part of a SWOT analysis suggest that there is a problem of unequal benefitsin