SR Coordination Meeting

Marie Adelaide Leprosy Centre

23rd,July,2016 Islamabad

Global Fund – New Funding

Model (NFM)

Implementation of Public

Private Mix InterventionsProject Duration: July,2015-Dec,2017

NFM-GOALS AND OBJECTIVE

Goals:

The New Funding Model (NFM) grant will contribute to achieve the goal of the national strategy to control TB in Pakistan, which is to reduce by 50% the prevalence of TB by 2025 in comparison to 2011.

Objective:

To increase the number of notified TB cases from 298,981 in 2013 to at least 420,000 by 2020 while maintaining the treatment success rate at 91%.

NFM OVERVIEW

New Funding

Model (NFM)

Start date Jul 01, 2015

End date December 31, 2017

Program

Coverage

Punjab: 27 Districts

Sindh: 16 Districts

KP: 15 Districts

Balochistan: 09 Districts

AJK: 04 Districts

GB: 03 Districts

And Islamabad

Implementing

Partners (Sub-

Recipients)

ACD, ASD, BCF, PLYC, SPO,

MALC and MC-PIU

S. No. Name of DistrictsNew/

Existing

1 Bagh Existing

2 Kotli New

3 Mirpur Existing

4 Bhimber Existing

5 Diamer Existing

6 Gilgit Existing

7 Skardu Existing

8 Chitral Existing

MALC Districts

Activities Targets

Number of notified cases of all forms of TB -

bacteriologically confirmed plus clinically diagnosed, new

and relapses

2,241

Number of notified cases of bacteriologically confirmed TB,

new and relapses1,125

Percentage of bacteriologically confirmed TB cases

successfully treated (cured plus completed treatment)

among the bacteriologically confirmed TB cases registered

during a specified period

671

Proposed Targets for MALC

Activities Targets

Number of Doctors from private health facilities received

Basic training on TB DOTS as per National Guidelines128

Number of Doctors from private health facilities received

Refresher training on TB DOTS as per National

Guidelines

221

Number of Paramedics from private health facilities

received Basic training on TB DOTS as per National

Guidelines

128

Number of Paramedics from private health facilities

received Refresher training on TB DOTS as per National

Guidelines

221

Proposed Targets for MALC

Activities Targets

Number of Lab Technicians from private health facilities

received Basic training on TB DOTS as per National

Guidelines

21

Number of Lab Technicians from private health facilities

received Refresher training on TB DOTS as per National

Guidelines

29

Number of chest camps conducted 79

Number of community events conducted 79

Number of meetings with area notables held 79

Proposed Targets for MALC

NFM OVERVIEW-MAJOR ACTIVITIES

• Training for GPs, Paramedics, Lab technicians

• Community Events(Community Gathering, Meeting with notables,

Chest Camps)

• Community Awareness

• Recording and Reporting

• Monitoring and Evaluation

• Coordination with PTP and District Health Officials.

P1 P2 P3 P4

DistrictTarget

(Jul-Sep)

Total Achieved in 3rd Quarter

Target (Oct-Dec)

Total Achieved in 4th Quarter

Target (Jan-Mar)

Total Achieved in

Jan

Total Achieved in

Feb

Total Achieved in Mar

Target (Apr-Jun)

Total Achieved in Apr

Total Achieved in May

Total Achieved in June

Total Targets till

Feb Cumulative

Targets Achieved

Till Jan Cumulative

%

Bagh 14 25 14 27 14 14 12 14 15 12 21 16 57 141 247%

Kotli 49 0 49 1 49 1 5 5 50 7 11 17 197 47 24%

Mirpur 25 10 25 36 25 7 23 12 26 12 15 15 101 130 129%

Bhimber 28 8 28 34 28 1 16 18 29 13 17 10 113 117 104%

Diamer 15 2 15 12 15 3 26 41 15 7 7 5 60 103 172%

Gilgit 8 6 8 10 8 7 4 6 7 5 9 6 31 53 171%

Skardu 18 6 18 19 18 4 12 17 18 8 11 6 72 83 115%

Chitral 15 0 15 6 15 4 4 9 13 6 13 7 58 49 84%

Total 172 57 172 145 172 41 102 122 173 70 104 82 689 723 105%

Comparison B/w Targets And Achievements

DistrictTarget(Jul

-Sep)

Total cases

achievedin 1st

Quarter

%Target (Oct-Dec)

Total casesachieved

in 2nd Quarter

%Target (Jan-Mar)

Total cases

achievedIn 3rd

Quarter 2016

%Target (Apr-Jun)

Total cases

achievedin 4th

Quarter 2016

%

Bagh 14 25 179% 14 27 193% 14 40 286% 15 49 327%

Kotli 49 0 0% 49 1 2% 49 11 22% 50 35 70%

Mirpur 25 10 40% 25 36 144% 25 42 168% 26 42 162%

Bhimber 28 8 29% 28 34 121% 28 35 125% 29 40 138%

Diamer 15 2 13% 15 12 80% 15 70 467% 15 19 127%

Gilgit 8 6 75% 8 10 125% 8 17 213% 7 20 286%

Skardu 18 6 33% 18 19 106% 18 33 183% 18 25 139%

Chitral 15 0 0% 15 6 40% 15 17 113% 13 26 200%

Total 172 57 33% 172 145 84% 172 265 154% 173 256 148%

Targets & Achievements – All Cases (For P1,P2,P3 and P4)

Cases Detected in 1st Quarter 2015

25

0

10

8

2

6 6

00

5

10

15

20

25

30

Bagh Kotli Mirpur Bhimber Diamer Gilgit Skardu Chitral

1st Quarter

1st Quarter

Cases Detected in 2nd Quarter 2015

27

1

3634

1210

19

6

0

5

10

15

20

25

30

35

40

Bagh Kotli Mirpur Bhimber Diamer Gilgit Skardu Chitral

2nd Quarter

2nd Quarter

40

11

42

35

70

17

33

17

0

10

20

30

40

50

60

70

80

Bagh Kotli Mirpur Bhimber Diamer Gilgit Skardu Chitral

3rd Quarter

P1 2016

Cases Detected in 3rd Quarter 2016

Cases Detected in 4th Quarter 2016

49

35

42 40

19 2025 26

0

10

20

30

40

50

60

Bagh Kotli Mirpur Bhimber Diamer Gilgit Skardu Chitral

4th Quarter

P2 2016

0

10

20

30

40

50

60

70

80

Bagh Kotli Mirpur Bhimber Diamer Gilgit Skardu Chitral

Comparison of P1, P2, P3 and P4

P1 P2 P3 P4

Breakup of cases detected during P2

2015

84

15 5

0

13

4

1628

1

2 1

1

23

10

3

2

4

74

0

0

5

27

34

6

14

10

1

36

19

0

10

20

30

40

50

60

70

80

Bagh Bhimber Chitral Diamer Gilgit Kotli Mirpur Skardu

Total cases

Extra pulmonary

pulmonary/Clinically diagnosed

Bacteriologically +ve

Breakup of cases detected during P3

2016

40

11

42 35

70

1733

17

26

9

2626

0

2

15

0

11

0

12

73

7

14

12

3

2

4

2

67

8

4

5

0

20

40

60

80

100

120

140

160

bagh kotli Mirpur Bhimber Diamer Gilgit Skardu Chitral

Total Pulmonary/Clinically Diagnosed B+ve Extra Pulmonary

4935 42 40

19 20 25 26

41

33 23 31

0 0

9 3

7

115 9

5 7

1415

1

1

4 0

14 13

2 8

0

20

40

60

80

100

120

bagh kotli Mirpur Bhimber Diamer Gilgit Skardu Chitral

Total Pulmonary/Clinically Diagnosed B+ve Extra Pulmonary

Breakup of cases detected during

2016

S.no DistrictsTotal Targets till

Mar (Cumulative)Total Achievements till March

(Cumulative)No. of B+ve Cases

(Cumulative)%

1 Bagh 42 92 26 62%

2 Kotli 147 12 0 0%

3 Mirpur 75 88 24 32%

4 Bhimber 84 77 14 17%

5 Diamer 45 84 8 18%

6 Gilgit 24 33 16 67%

7 Skardu 54 58 20 37%

8 Chitral 45 23 13 29%

Total 516 467 121 23%

% Of B+ve Cases against the Target (Cumulative)

S.No. District Reasons for under

performance

Activities Timeline Responsible Update

1 Bagh 02 labs yet to start working

Provision of microscopes/nonconsumable items (interim arrangement by SR)

First week of April

NTP /PRRC & PM

2 Bhimber O1 lab yet to start working

Provision of microscopes/nonconsumable items (interim arrangement by SR)

First week of April

NTP/PRRC & PM

3 Chitral 02 labs yet to start working

Provision of microscopes/nonconsumable items (interim arrangement by SR)

First week of April

NTP /PRRC & PM

4 Kotli 03 labs yet to start working

Provision of microscopes/nonconsumable items (interim arrangement by SR)

First week of April

NTP /PMRC & PM

5 Mirpur All GPs are not reporting

Increase number of monitoring visits to non-reporting GPs

Revised monitoring plan from April

RC

6. Gilgit All GPs are not reporting

Increase number of monitoring visits to non-reporting GPs

Immediate/P4

RC

7. Diamer All GPs are not reporting

Increase number of monitoring visits to non-reporting GPs

Immediate/P4

RC

8. Skardu O1 lab yet to start working

Provision of microscopes/nonconsumable itemsIncrease number of monitoring visits

Immediate/P4

NTP/PMRC & PMs

Way Forward

Current Practices Improved Strategy

General Monitoring More specific task oriented monitoring of DFS, meeting with GPs, visiting labs and Patients follow up for better compliance and ensure contact tracing

Generic reporting Quality report with issues identified and solution suggested with follow up

Less number of visits by Project manager More frequent visits to the targeted districts with clear objectives

Quality Monitoring

IndicatorTarget for

P1Achieved %

Target For P2

Achieved %Target For

P3Achieved %

Doctors Training 49 0 0% 48 8 17% 58 72 124%

Paramedics Training 49 0 0% 48 8 17% 58 88 152%

Refresher Training 0 0 0% 0 0 % 71 0 0%

Lab Tech Training 9 0 0% 4 0 0% 8 6 75%

Chest Camp 7 0 0% 8 6 75% 8 20 250%

Community Event 7 0 0% 8 6 75% 8 22 275%

Meeting with Notable

7 0 0% 8 6 75% 8 20 250%

Targets & Achievements - Trainings & Activities for P1,P2 & P3

Districts Total Targetstill P3

Achieved Targets

% Backlog

Bagh 42 92 219% NilKotli 147 12 8% 135

Mirpur 75 88 117% NilBhimber 84 77 92% 7Diamer 45 84 186% NilGilgit 24 33 137% Nil

Skardu 54 58 107% NilChitral 45 23 51% 22

516 467 91%

Target/Achievement till P3 & Backlog

Challenges to address:

• Timely submission of supporting documents (Readable, duly verified)

• Detection of new cases

• Contact Screening

• Active case finding in hyper endemic areas

• Efforts to increase B+ve cases

• Training of required Human Resource

Thank you