03 Mongolia Presentation

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COUNTRY PRESENTATIONCOUNTRY PRESENTATIONMONGOLIAMONGOLIA

Meeting of TB managers and TBMeeting of TB managers and TBlaboratory managers in the WPRlaboratory managers in the WPR

Hangzhou, ChinaHangzhou, China29 June29 June 2 July 20042 July 2004


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Country presentationCountry presentation

PopulationPopulation 2,475,000 (2002)2,475,000 (2002)APGRAPGR 1.3%1.3%

WomenWomen 50.4%50.4%

Reproductive age (15Reproductive age (15--49)49) 56.5%56.5%

Average life expectancy 60.4 (male), 66.1 (female)Average life expectancy 60.4 (male), 66.1 (female)Case notification rateCase notification rate

--New casesNew cases 3772 per 100.0003772 per 100.000 153 (2003)153 (2003)

MDR rateMDR rate

--1% in general population1% in general population--16% in prison population16% in prison population

--No data on MDRNo data on MDR--TB chronic cases category I and IITB chronic cases category I and II

--HIVHIV 4 cases4 cases

**Source:Source: Health sector 2002, Reducing Mortality, Ministry of HealthHealth sector 2002, Reducing Mortality, Ministry of Health

Mongolia, 2003Mongolia, 2003

Annual Statistic Report, National Center for CommuAnnual Statistic Report, National Center for Communicable Diseases, 2003nicable Diseases, 2003


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Country PresentationCountry Presentation

87%87%

(2002)(2002)

86.8%86.8%

(2001)(2001)

Success rateSuccess rate

85%85%85%85%83%83%

(2002)(2002)

83%83%

(2001)(2001)

58%58%

moremore

thanthan

Cure rateCure rate

70%70%70%70%67.5%67.5%67.7%67.7%70%70%DOTS DetectionDOTS Detection

rate new smearrate new smear(+)(+)veve

100%100%100%100%100%100%100%100%100%100%DOTS expansionDOTS expansion

20052005

PlannedPlanned

20042004

PlannedPlanned

20032003

ActualActual

20022002

ActualActual

20052005

OverallOverall

targettarget


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Action Plan 2003Action Plan 2003 --20042004Develop mechanism to ensure effectiveDevelop mechanism to ensure effective

implementation of Global Fund projectimplementation of Global Fund project

1. Approved Accelerating DOTS in Mongolia project, Two year wo1. Approved Accelerating DOTS in Mongolia project, Two year work planrk plan

with budget submitted to the GFATM, Grant Agreementwith budget submitted to the GFATM, Grant Agreementwith PR signedwith PR signed

Accelerating DOTS in Mongolia project implementedAccelerating DOTS in Mongolia project implementedin 9 districts ofin 9 districts of

Ulaanbaatar city and 6 selected provincesUlaanbaatar city and 6 selected provinces

2. Monitoring and Evaluation Plan for two years submitted and ap2. Monitoring and Evaluation Plan for two years submitted and approved byproved bythe Global Fundthe Global Fund

3.3. Organized targeted case detection and treatment activities amongOrganized targeted case detection and treatment activities amongthethe

vulnerable groups. Homeless people receiving free medical care avulnerable groups. Homeless people receiving free medical care at thet theMercy Hospital. New TB section established at the Mercy HospMercy Hospital. New TB section established at the Mercy Hospital whereital where

TB doctors providing consulting to TB patients. International orTB doctors providing consulting to TB patients. International organizationganization

World Vision provide free nutrition and supplement vitaminizatioWorld Vision provide free nutrition and supplement vitaminization ton to

vulnerable TB patient. By the WHO support there was commenced thvulnerable TB patient. By the WHO support there was commenced thee

Study on diagnosis delay of TB patients in Sept 2003. CoverageStudy on diagnosis delay of TB patients in Sept 2003. Coverage size of thesize of thestudy: 4 provinces and 8 districts of Ulaanbaatar. Designed andstudy: 4 provinces and 8 districts of Ulaanbaatar. Designed anddistributeddistributed

500 checklists 160 filled checklist data.500 checklists 160 filled checklist data.


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Action Plan 2003Action Plan 2003 --20042004

Improve quality of DOTS implementation in ruralImprove quality of DOTS implementation in rural

areasareas1. With purpose of improvement the participation of govern1. With purpose of improvement the participation of governors in TB activitiesors in TB activities

there was organized a training among 150 governors frothere was organized a training among 150 governors from 6 selectedm 6 selected

provinces and 9 districts of UB city.provinces and 9 districts of UB city.22.. NTP organizedNTP organized

--Training for 400 family and soum doctors of 15 provinces and diTraining for 400 family and soum doctors of 15 provinces and districtsstricts

supported by the Global Fundsupported by the Global Fund

--Training for 120 doctors from 2 selected provinces supported bTraining for 120 doctors from 2 selected provinces supported by the WHOy the WHO

--Training for 250 volunteers and the health workers on TB treatmTraining for 250 volunteers and the health workers on TB treatment andent and

treatment followtreatment follow--upup

3. Training on supervision and inspection in soum level (3. Training on supervision and inspection in soum level (30 TB coordinators30 TB coordinators

fromfrom

30 TB units)30 TB units)

4. MNTV and Radio broadcasting carried out 13 times4. MNTV and Radio broadcasting carried out 13 times

--Publication, interview by 4 newspapersPublication, interview by 4 newspapers --14times14times

-- Research conferenceResearch conference 2 times2 times

-- Press conference for launch the projectPress conference for launch the project

--Designed, published and distributed IEC materials: posters, leaDesigned, published and distributed IEC materials: posters, leaflets,flets,

stickers (2600 pc)stickers (2600 pc)


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Action Plan 2003Action Plan 2003 --20042004

Strengthen the system to maintain quality ofStrengthen the system to maintain quality of

laboratory serviceslaboratory services

1. Developed new guideline on EQA of smear microscopy in Mongoli1. Developed new guideline on EQA of smear microscopy in Mongolianan

2. 16 Lab. Technicians trained on microscopic examination2. 16 Lab. Technicians trained on microscopic examination

3. Conducted refresher training for 40 lab. Technicians3. Conducted refresher training for 40 lab. Technicians

4. Established new TB laboratory in remote area4. Established new TB laboratory in remote area

5. Supervision visits carried out in 8 district of Ulaanbaa5. Supervision visits carried out in 8 district of Ulaanbaatar and 9tar and 9

aimagaimag


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Access to DOTS for poor and vulnerableAccess to DOTS for poor and vulnerable

populationspopulations

123 vulnerable people (unemployed, homeless TB patient) with123 vulnerable people (unemployed, homeless TB patient) with

improved access to DOTS receiving supplementary food in 9improved access to DOTS receiving supplementary food in 9district of Ulaanbaatardistrict of Ulaanbaatar

40 vulnerable people (unemployed, homeless TB patient) with40 vulnerable people (unemployed, homeless TB patient) with

improved access to DOTS receiving supplementary food in 6improved access to DOTS receiving supplementary food in 6

provincesprovinces


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Activities will be implemented in 2004Activities will be implemented in 2004 --20052005

in address of TB/HIVin address of TB/HIV

2 Quarter 20052 Quarter 2005Conduct workshop on TB diagnosis, treatmentConduct workshop on TB diagnosis, treatment

and prevention for STI doctors from urban areaand prevention for STI doctors from urban area55

3 Quarter 20053 Quarter 2005Conduct peer education on TB/HIV patientConduct peer education on TB/HIV patient

home care and nursing for health workers fromhome care and nursing for health workers fromurban areaurban area

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3 Quarter 20043 Quarter 2004Conducting HIV routine surveillance for newConducting HIV routine surveillance for newserious TB cases in urban areaserious TB cases in urban area

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1 Quarter 20051 Quarter 2005Develop and distribute the guideline on TBDevelop and distribute the guideline on TB

/HIV prevention and diagnosis for patients and/HIV prevention and diagnosis for patients and

health workershealth workers

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2 Quarter 20042 Quarter 2004Active TB and HIV case finding amongActive TB and HIV case finding among

prisoners in detention centerprisoners in detention center22

1 Quarter 20041 Quarter 2004Conduct workshop on HIV/AIDS diagnosis,Conduct workshop on HIV/AIDS diagnosis,

treatment and prevention for TB coordinatorstreatment and prevention for TB coordinatorsof all aimag and district hospitalsof all aimag and district hospitals

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TimingTimingActivitiesActivitiesNoNo


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TB LaboratoryTB Laboratory

Assessment of the implementation of Quality Assurance:Assessment of the implementation of Quality Assurance:-- Developed National Quality Assurance Manual based on theDeveloped National Quality Assurance Manual based on the

recommendation ofrecommendation of

WHO and WPRWHO and WPR

--TB Laboratory NetworkTB Laboratory Network

TB suspectTB suspect

cases send tocases send to

TB laboratoriesTB laboratories00

(Soum hospital, Health(Soum hospital, Health

Center)Center)PeripheralPeripheral

LevelLevel

SmearSmear

microscopymicroscopy

2121

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Aimags TB laboratoryAimags TB laboratory

Districts TB laboratoryDistricts TB laboratory

Prisons TB laboratoryPrisons TB laboratory

IntermediateIntermediate

LevelLevel

EQA and othersEQA and others

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National ReferenceNational Reference

LaboratoryLaboratoryCentralCentral

LevelLevel

DutyDutyQuantityQuantityLaboratoryLaboratoryLevelLevel


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TB LaboratoryTB Laboratory

External Quality AssessmentExternal Quality Assessment

--OnOn--site evaluation of peripheral laboratorysite evaluation of peripheral laboratory

using standard checklistusing standard checklist

--Blinding rechecking ( 923 slides selectedBlinding rechecking ( 923 slides selected

by LQAS , checked 861 (93.3%)by LQAS , checked 861 (93.3%)

false positivity rate 0.9% (8 slides)false positivity rate 0.9% (8 slides)

false negativity rate 1.2% (11 slides)false negativity rate 1.2% (11 slides)


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Current problems in the implementation ofCurrent problems in the implementation of

Quality AssuranceQuality Assurance

Delayed cases registration with the false negativeDelayed cases registration with the false negative

results by EQA in sputum microscopyresults by EQA in sputum microscopy

Lack of laboratory supply and reagents (destroyingLack of laboratory supply and reagents (destroying

smears, broken smear, long storage of smears)smears, broken smear, long storage of smears)

QA Programme in sputum smear microscopy noQA Programme in sputum smear microscopy no

immediately influence in case detection andimmediately influence in case detection anddiagnosis due to the QA unavailable for checking alldiagnosis due to the QA unavailable for checking all

smear (+) cases.smear (+) cases.

03 Mongolia Presentation

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