The main objective of this component is to assist in implementing priority activities that improve infection control measures in TB facilities and improve prevention, diagnosis, and treatment for multi-drug resistant (MDR) TB cases.
Key program efforts to improve TB prevention and treatment
The Resident TB Advisor provides day-to-day operations support to the National Tuberculosis Program (NTP) to implement the National TB Plan for 2010-12 and WHO Green Light Committee (GLC) recommendations. This implementation support will build capacity within the NTP and increase NTP’s accountability to the MOH and donors for successful implementation of its plans. Based on Abt’s experience in the region, a few critical activities to focus on with NTP include:
- Strengthening the Existing Directly Observed Treatment, Short-course (DOTS) Strategy
- Build Capacity in MDR TB Diagnosis and Treatment.
- Utilizing Quality Improvement Processes to Implement TB Clinical Practice Guidelines (CPGs)
- Strengthening the TB Monitoring & Evaluation (M&E) System
- Institutionalizing Continuous medical Education (CME) on TB and MDR TB.
Refine Provider Payment System for TB Services
WHO and SHA have initiated discussions on refining the provider payment system for TB services. HS-STAR collaborates closely in continuing these discussions. Objectives of a new provider payment system include matching payment to the BBP entitling the population to TB services; improved allocation of TB resources; increased efficiency and effectiveness of TB service provision; increased payments for MDR TB (and other, more complicated TB cases); and introduction of incentives to rationalize the vertical delivery structure for TB services, improve integration into PHC, and improve treatment outcomes.
HS-STAR ex- TB advisor Subroto Mukherjee studying an X-ray record
The project works with WHO and SHA to develop a new provider payment system for TB services, which would include innovative features to create incentives to improve case finding and diagnosis, and the completion of both the intensive and continuation phases of Directly Observed Treatment Strategy (DOTS) treatment. The project will propose to the GOAM for adopting a “Global Budget” approach for financing the TB hospitals or TB departments in general hospitals for completion of the intensive phase of DOTS treatment. The Global Budget would be based on the number and severity of cases projected by the TB M&E and surveillance system and a cost accounting exercise.
Support MOH to strengthen TB infection control practices
HS-STAR works with the MOH, NTP, WHO, other TB partners, and facility managers to assess and plan for the improvement of Infection Control (IC) standards and practices in line with WHO guidelines. These efforts will significantly contribute to protecting against nosocomial TB infection of patients and TB infection among health workers. HS-STAR provides guidance to develop an IC assessment tool and help conduct IC assessments in facilities providing TB services. The project will provide engineering expertise and appraisals through STTA for the Global Fund and the World Bank proposed renovations of TB facilities related to infection prevention and control. Armenian public health and medical students can be engaged to help conduct assessments, after receiving training and instruction on personal infection control. The assessments will result in concrete recommendations that NTP and each facility may implement to improve IC in three dimensions: administrative, environmental, and personal protection measures. HS-STAR will share findings and recommendations on engineering appraisals with GOAM and donors as they plan investments to upgrade the physical infrastructure of TB facilities.
