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Action PlanAction PlanPrepared by :Prepared by :
Ismat Ara KhusheedIsmat Ara Khusheed
Deputy Director,PTP SindhDeputy Director,PTP Sindh At JAPAN 2006At JAPAN 2006
GENERAL FEATURESGENERAL FEATURES Name; city district Government ,KarachiName; city district Government ,KarachiArea ;3527sq.kmArea ;3527sq.kmPopulation Density;2795 per sq kmPopulation Density;2795 per sq kmAverage housr hold size ; 7Average housr hold size ; 7Literacy rate ;60%Literacy rate ;60%Nos of town ;18Nos of town ;18Nos of diagnostic centre ;55Nos of diagnostic centre ;55Nos of treatment centres ;111Nos of treatment centres ;111Average public transport fare ;Rs.10 one wayAverage public transport fare ;Rs.10 one wayAverage time travel ;45 minutes one way by public Average time travel ;45 minutes one way by public
transport.transport.Large no of migrants who have flocked to karachi in Large no of migrants who have flocked to karachi in
search of opportunities.search of opportunities.
Back GroundBack Ground Karachi is the largest city of Pakistan and the capital of Karachi is the largest city of Pakistan and the capital of
its southern province of Pakistan karachi is divided in to its southern province of Pakistan karachi is divided in to 18 towns every town is supervised by town health 18 towns every town is supervised by town health officer.officer.
Mega city is administered by city district Govt. Of Mega city is administered by city district Govt. Of karachi (CDGK).which has an elected city council each karachi (CDGK).which has an elected city council each town has its own council and Nazim.town has its own council and Nazim.
Mega city like karachi pose a great challenge to Mega city like karachi pose a great challenge to community –based urban DOT strategy the public community –based urban DOT strategy the public sector cannot achieve the target of detecting all new TB sector cannot achieve the target of detecting all new TB cases hence PTP is in need of building partnership to cases hence PTP is in need of building partnership to bridge the gaps between public and private sectors bridge the gaps between public and private sectors prevailing in the urban DOTS.prevailing in the urban DOTS.
OrganogramOrganogram
Secretary Health
DG Health
Director TB Control Program
Deputy Director Hyderabad
Deputy Director Karachi
Deputy Director Sukkur
Deputy Director Larkana
Technical Support from NTP
4 NPOs and 1 Sociologist
DEFAULT RATEDEFAULT RATE
14%16% 15%
17%
13% 14% 14%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
Q1, 03 Q2, 03 Q3, 03 Q4, 03 Q1, 04 Q2,2004
Q3,2004
%
OUT COMEOUT COME
Dots coverage 2003 100%Dots coverage 2003 100%
New case detection sspos 52%New case detection sspos 52%
Case detection of all type 63%Case detection of all type 63%
Smear conversion 82%Smear conversion 82%
Success rate 86%Success rate 86%
Default rate 14%Default rate 14%
BeneficiariesBeneficiaries ImplementingImplementing
Agencies.Agencies.
Decision Decision makers.makers.
Funding Funding agenciesagencies
PotentialPotential
Opponents.Opponents.
PatientPatient EDOEDO
THOTHO
BHU. RHCBHU. RHC
Teaching Teaching HospitalHospital
Ministry ofMinistry of
HealthHealth
National National tuberculosistuberculosis
MohMoh
PtpPtp
GFATMGFATM
GeneralGeneral
practionerpractioner
CommunityCommunity
peoplepeople
Partner agenciesPartner agencies
FIEDELISFIEDELIS
CIDACIDA
WHOWHO
NationalNational
TuberculosisTuberculosis
programprogram
CIDACIDA
WHOWHO
FIEDELISFIEDELIS
PrivatePrivate
HospitalHospital
quakquak
EDO.EDO. NGONGO
TB AssociationTB Association
GfatmGfatm
Provisional Provisional
TubrtculosisTubrtculosis
programprogram
QuackQuack
hakeemshakeems
Traditional Traditional healershealers
Stakeholders AnalysisStakeholders Analysis
High defaulter rate
Poor compliance to Treatment of TB
patients
Weak linkage bet. Diagnostic
& treatment centers For case-holding activities
Il-Legal migrant of TBPt at karachi city
No proper home address
Difficulties to tress them
Poor co- ordinationAmong facilities
Pt develop drug resistantProblem Analysis
Poor compliance to Treatment of TB patients
Side EffectsLack of knowledge
Of TB patient
IN Sufficient Health education
HW has lack of knowledge
Very busy
Stop taking medicine
Lack of training
No funds
Too many responsibilities
Go to the alternative treatment
Problem Analysis
Poor capacity of health workers
Low defaulter rate
good compliance to Treatment of TB
patients
Good linkageSystem bet. Diagnostic
& treatment centersFor case-holding activities
Less migrant of TBPt at karachi city
permanent home address
Easy to trace them
Good co- ordinationAmong facilities
Pt not develop drug resistantObjective Analysis
Good compliance to Treatment of TB patients
Side Effects decreasedSufficient knowledge
Of TB patient
Sufficient Health education
HW has enough knowledge
HW have time
Continue taking medicine
Adequate training
Funds are available
Adequate responsibilities
Objective Analysis
Stop alternative treatment
improved capacity Of health workers
Sufficient Sufficient
HE to PT.HE to PT.
Good Linkage Good Linkage system system approachapproach
Economic Economic development development approachapproach
H.E AND economic H.E AND economic development approach.development approach.
Costs BenefitCosts Benefit 55 44 33 44
SustainabilitySustainability 33 33 33 55
FeasibilityFeasibility 44 44 22 55
Available Available resources.resources.
44 33 33 33
1616 1414 1111 1717
Project SelectionProject Selection
Project selectionProject selection Provisional tuberculosis programme Provisional tuberculosis programme
should emphasize on effective case should emphasize on effective case holding mechanism through health holding mechanism through health education and capacity building of health education and capacity building of health workers.workers.
PDMPDM Project NameProject Name:: effective case holding mechanism effective case holding mechanism
through healtteducation and referral syatem.through healtteducation and referral syatem.
Target area:Target area: slums of six towns of Karachi city.slums of six towns of Karachi city.
Target group:Target group: The target population in slums and The target population in slums and katchi abadies of six towns ,of karachi iskatchi abadies of six towns ,of karachi is approximately 3 millionapproximately 3 million
Duration;Duration; 1-7-2006 TO 31-6-20091-7-2006 TO 31-6-2009 Date;Date; 23-2-2006. 23-2-2006.
Narrative Narrative SummarySummary
O. V. IndicatorsO. V. Indicators Means of Means of VariationVariation
Important Important AssumptionsAssumptions
Overall Goal:Overall Goal:To reduce the To reduce the mortality and mortality and morbidity due to morbidity due to tuberculosis in tuberculosis in Karachi.Karachi.
The mortality The mortality and morbidity is and morbidity is reduced by 10% reduced by 10% by 2009 in 6 by 2009 in 6 towns in Karachi.towns in Karachi.
Health management Health management and information and information system. system.
Sindh health Sindh health department department continues to continues to include PTP as one include PTP as one of the priority of the priority programmes.programmes.
Project purposeProject purpose;;
To reduce the To reduce the default rate in default rate in
KarachiKarachi. .
The default rate The default rate has reduced by has reduced by half by the year half by the year 2009. 2009.
Quarterly reports,Quarterly reports,
Annual reports.Annual reports. The population in The population in the slum areas in 6 the slum areas in 6 towns in Karachi towns in Karachi do not increase do not increase drastically.drastically.
OUTPUTS.OUTPUTS.
1. Sufficient H.E is 1. Sufficient H.E is provided to TB provided to TB patients and patients and community.community.
1- TB patient s 1- TB patient s knowledge on TB knowledge on TB is increased by is increased by 30% by the year 30% by the year 2007.2007.
-Project survey.-Project survey.
-Project records on -Project records on trainings conducted.trainings conducted.
-Monthly reports,-Monthly reports,
Minutes of meeting.Minutes of meeting.
TB register. TB register.
The TB situation of The TB situation of migrant population migrant population do not become do not become worsen.worsen.
2. Capacity of 2. Capacity of health workers is health workers is improved through improved through training.training.
3- Good linkage 3- Good linkage between between diagnostic & diagnostic & treatment centers treatment centers established for established for effective case effective case holding activities. holding activities.
2-. 50% of LHW 2-. 50% of LHW have completed have completed TB training by TB training by 2007.2007.
3- Number of 3- Number of diagnostic centers diagnostic centers that have monthly that have monthly meeting with meeting with treatment centers treatment centers increase by 80% increase by 80% in 2008.in 2008.
4- Number of 4- Number of properly transfer properly transfer out cases out cases increase by 50% increase by 50%
in 2008.in 2008.
ACTIVITIES:ACTIVITIES:
1-1Conduct base-line 1-1Conduct base-line survey to identify causes of survey to identify causes of defaulter cases. defaulter cases.
1-2. Interview & 1-2. Interview & questionnaire to TB patients questionnaire to TB patients & families to identify their & families to identify their knowledge on TB.knowledge on TB.
1-3Conduct advocacy 1-3Conduct advocacy meetings with stakeholders.meetings with stakeholders.
1-4. IEC materials 1-4. IEC materials developed & distributed.developed & distributed.
2- Develop supervisory 2- Develop supervisory guidelines.guidelines.
2-3 Conduct workshop with 2-3 Conduct workshop with HWs.HWs.
2-4 Conduct one day 2-4 Conduct one day seminar every month.seminar every month.
2-5 Trainings conducted.2-5 Trainings conducted.
3- Directory furnished.3- Directory furnished.
3-1 Monthly meeting with 3-1 Monthly meeting with
DC & TC.DC & TC.
InputsInputs
Personnel:Personnel: long term expert, long term expert, project leader, project co-project leader, project co-ordinator.ordinator.
Short term experts as Short term experts as required.required.
Equipment:Equipment: vehicle, vehicle, maintenance parts, POL maintenance parts, POL and spare parts.and spare parts.
Training material and IEC Training material and IEC materials.materials.
Funding of workshops and Funding of workshops and meetings.meetings.
Training facilityTraining facility
Local cost.Local cost.
Facilities like DHDCofficeFacilities like DHDCoffice
Trained workers continue to Trained workers continue to work for their facilities.work for their facilities.
Pre-conditionsPre-conditions
The NTP and CIDA support The NTP and CIDA support the project. the project.