Stop TB Planning Matrix and Frameworks:
Tool for Global Fund Round 8 TB proposal preparation




   Prepared by the Stop T...
Content
RESOURCES AND REFERENCES.............................................................................................
Stop TB Planning Matrix and Frameworks: Global Fund Round 8 TB proposal preparation, Stop TB Department, World Health Orga...
Stop TB Planning Matrix and Frameworks: Global Fund Round 8 TB proposal preparation, Stop TB Department, World Health Orga...
Stop TB Planning Matrix and Frameworks: Global Fund Round 8 TB proposal preparation, Stop TB Department, World Health Orga...
Stop TB Planning Matrix and Frameworks: Global Fund Round 8 TB proposal preparation, Stop TB Department, World Health Orga...
Stop TB Planning Matrix and Frameworks: Global Fund Round 8 TB proposal preparation, Stop TB Department, World Health Orga...
Stop TB Planning Matrix and Frameworks: Global Fund Round 8 TB proposal preparation, Stop TB Department, World Health Orga...
Stop TB Department, WHO                                                      TB planning matrix - Global Fund Round 8

2. ...
Stop TB Department, WHO                                              TB planning matrix - Global Fund Round 8

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Stop TB Department, WHO                                                       TB planning matrix - Global Fund Round 8
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Stop TB Department, WHO                                                                       TB planning matrix - Global ...
Stop TB Department, WHO                          TB planning matrix - Global Fund Round 8
   (ii)    You can use the “epid...
Stop TB Department, WHO                                 TB planning matrix - Global Fund Round 8
3. Stop TB Planning Matri...
Stop TB Department, WHO                                    TB planning matrix - Global Fund Round 8


3.1.2   SDA 1.2: Imp...
Stop TB Department, WHO                               TB planning matrix - Global Fund Round 8

  "Retooling"
  Retooling ...
Stop TB Department, WHO                                 TB planning matrix - Global Fund Round 8
SDA 1.2 Improving Diagnos...
Stop TB Department, WHO                                 TB planning matrix - Global Fund Round 8
SDA 1.2 Improving Diagnos...
Stop TB Department, WHO                                         TB planning matrix - Global Fund Round 8

    HIV-prevalen...
Stop TB Department, WHO                             TB planning matrix - Global Fund Round 8
3.1.3   SDA 1.3: Patient supp...
Stop TB Department, WHO                                  TB planning matrix - Global Fund Round 8
 SDA 1.3 Patient Support...
Stop TB Department, WHO                                TB planning matrix - Global Fund
  Round 8
  3.1.4    SDA 1.4: Proc...
Stop TB Department, WHO                            TB planning matrix - Global Fund
  Round 8
SDA 1.4 Activities          ...
Stop TB Department, WHO                     TB planning matrix - Global Fund
Round 8




SDA1.4 Procurement and supply man...
Stop TB Department, WHO                           TB planning matrix - Global Fund
Round 8
3.1.5.1 SDA: 1.5.1 Monitoring a...
Stop TB Department, WHO                                TB planning matrix - Global Fund
Round 8
assess trends, although ro...
Stop TB Department, WHO                       TB planning matrix - Global Fund
Round 8

Resources and references
1. Global...
Stop TB Department, WHO                             TB planning matrix - Global Fund
Round 8


3.1.5.2 SDA: 1.5.2 Manageme...
Stop TB Department, WHO                             TB planning matrix - Global Fund
Round 8
− Regular supervisory visits ...
Stop TB Department, WHO                             TB planning matrix - Global Fund
Round 8
 SDA 1.5.2 Management and Sup...
Stop TB Department, WHO                       TB planning matrix - Global Fund
Round 8

Resources & references
Compendium ...
Stop TB Department, WHO                                  TB planning matrix - Global Fund
  Round 8


  3.1.5.3         SD...
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  1. 1. Stop TB Planning Matrix and Frameworks: Tool for Global Fund Round 8 TB proposal preparation Prepared by the Stop TB Department, World Health Organization, Geneva, March 2008 www.who.int/tb/dots/planningframeworks Queries: tbteam@who.int
  2. 2. Content RESOURCES AND REFERENCES..................................................................................................................................................27 RESOURCES & REFERENCES....................................................................................................................................................31 The Stop TB Planning Matrix and Frameworks is one of two Stop TB Planning Tools developed by Stop TB Department, World Health Organization, to guide TB proposal development and TB mid-term strategic planning according to the 6 objectives of the Stop TB Strategy (Objective 1: Pursue High Quality DOTS Expansion and Enhancement; Objective 2: Address TB/HIV, MDR-TB and Other Challenges; Objective 3: Contribute to Health Systems Strengthening; Objective 4: Engage All Care Providers; Objective 5: Empower People with TB and Communities; Objective 6: Enable and Promote Research) and the 20 sub-components of the Stop TB Strategy also called Service Delivery Areas (SDAs). The Matrix lists all Stop TB Strategy objectives, SDAs, and provides a menu of main activities and corresponding indicators. Numbering of SDAs and main activities in the Planning Matrix and Frameworks corresponds exactly to the numbering of the Stop TB Planning and Budgeting Tool, Version 2 in its menu and respective SDA spreadsheet. The Frameworks follow the same structure and give more detail per SDA on activities, indicators and background documents. The Stop TB Planning and Budgeting Tool is another tool to help to cost a TB proposal or a TB mid-term strategic plan, and identify financial gaps. The Stop TB Planning and Budgeting Tool should be used following solid strategic planning and documentation based on the Stop TB Planning Matrix and Frameworks. These Stop TB Planning Tools correspond with the Global Fund documentation i.e.: • Global Fund Monitoring & Evaluation Toolkit Addendum (update for Round 8) • Performance Framework (Attachment A to the proposal form) • Global Fund Budgeting Template (new for Round 8) • Global Fund Enhanced Financial Reporting system Both Stop TB Planning Tools are available on www.who.int/tb/dots/planningframeworks. Any technical queries on the tools can be sent to: tbteam@who.int. This e-mail is supported by the Stop TB Department, World Health Organization, in Geneva and draws on expertise from the entire Stop TB network. 2
  3. 3. Stop TB Planning Matrix and Frameworks: Global Fund Round 8 TB proposal preparation, Stop TB Department, World Health Organization 1. Stop TB Planning Matrix Objectives, Service Delivery Areas (SDAs), activities and main indicators (consistent with the Global Fund Performance Framework and the addendum of the M&E Toolkit updated March 2008) Goal To reduce the global burden of TB by 2015 in line with the Millennium Development Goals and Stop TB Partnership targets Impact/outcome indicators (i) Impact: TB prevalence rate, TB incidence rate, TB mortality rate. (ii) Outcome: Case detection rate, treatment success rate Objectives Stop TB Strategy Components 1-6 below Service Delivery Areas (SDAs) Stop TB Strategy Sub-Components below Activities While some activities could apply to more than one SDA, those activities should only appear once. E.g. staff accounted for under 1.5.3 with possible footnote under other corresponding SDA Indicators By SDA (Stop TB Strategy Sub-Components) Budget Links to the WHO TB planning and budgeting tool are written in underlined blue Stop TB Strategy Menu of activities to be described and budgeted in proposal Objectives and SDAs Menu of Indicators for Performance form (SDAs highlighted in gray are in pull Framework (Numbering corresponding to activities in the Planning and down menu of Performance Framework Budget Tool) and M&E Toolkit) 3
  4. 4. Stop TB Planning Matrix and Frameworks: Global Fund Round 8 TB proposal preparation, Stop TB Department, World Health Organization SDA 1.1 Political Political commitment activities and budget included in SDA 5.1 # (%) of funds budgeted by the government commitment with on ACSM for TB control out of the total national health increased and Advocacy component of ACSM budget sustained financing • Place TB high on the political agenda, • Foster political will, • Increase and sustain financial and other resources SDA 1.2 Improving 1.2.1 Microscopy laboratories rehabilitation, equipment, Functioning diagnosis laboratory per # diagnosis: supplies for microscopy population covered (e.g. 1 diagnosis Case detection 1.2.2 Culture laboratories rehabilitation, equipment, supplies for laboratory per 80,000 population) through quality- culture assured bacteriology 1.2.3 DST laboratory rehabilitation, equipment, supplies for # (%) of laboratories performing regular drug susceptibility testing (DST) EQA for smear microscopy 1.2.4 Molecular test for DST and diagnosis of smear negative, rehabilitation, equipment, supplies # (%) of laboratories performing regular EQA 1.2.5 Other equipment, X-ray equipment/supplies for culture and DST 1.2.6 Quality assurance programme including External quality assurance (EQA) 1.2.7 Retooling: activities related to retooling process Staff, training and technical assistance included in SDA 1.5.3 on HRD SDA 1.3 Patient support 1.3.1 Situation analysis Percentage (%) of patients receiving 1.3.2 Incentives and enablers provided to the patient (e.g. social incentives or enablers support, food packages, transport vouchers) . Patient charter included in SDA 5.1 on ACSM . Community support included in SDA 5.2 on Community TB care SDA 1.4 Procurement and 1.4.1 First-line drugs for Category I & III patients # (%) of TB management units (BMU) that supply management: 1.4.2 First-line drugs for Category II patients reported a stock out in first and/or second line Drug supply and 1.4.3 First-line drugs for children drugs that resulted in interruption of treatment y DOTS Expansion and Enhancement management system 1.4.4 Buffer stock for first-line drugs during the year out of all TBMUs 1.4.5 Drug management: procurement, storage, distribution Staff, training and technical assistance included in SDA 1.5.3 on HRD SDA M&E: Monitoring 1.5.1.1 Periodic surveys e.g. drug resistance surveillance, TB # (%) of health facilities submitting timely 1.5.1 and Evaluation disease prevalence surveys, surveys of HIV prevalence among reports according to national guidelines system and impact TB patients measurement 1.5.1.2 Routine surveillance including revision of the R&R Prevalence survey performed (y/n) system etc Staff, training and technical assistance included in SDA 1.5.3 DRS performed (y/n) 4
  5. 5. Stop TB Planning Matrix and Frameworks: Global Fund Round 8 TB proposal preparation, Stop TB Department, World Health Organization SDA 2.1 TB-HIV: 2.1.1 Establish TB/HIV mechanisms for collaboration # (%) of TB patients receiving HIV testing Collaborative 2.1.2 Conduct surveillance of HIV prevalence among TB # (%) of HIV positive TB patients who receive TB/HIV activities patients CPT 2.1.3 Decrease the burden of TB in people living with HIV/AIDS • TB screening for people living with AIDS (PLWHA) • Isoniazid Preventive Therapy (IPT) 2.1.4 To decrease the burden of HIV/AIDS in TB patients (including referral to continuum of care) • HIV testing for TB patients • Cotrimoxazole Preventive Therapy (CPT), • Anti-retroviral Treatment (ART) Staff, training and technical assistance included in SDA 1.5.3 on HRD SDA 2.2 MDR-TB: Prevent 2.2.1 Assessment of situation # and % of notified MDR cases and control multi- 2.2.2 Second-line drugs (bacteriologically confirmed) drug-resistant TB 2.2.3 Drugs for adverse events 2.2.4 Default and contact tracing # and % of treatment success rate of MDR 2.2.5 Support GLC initiative cases 2.2.6 Infrastructure upgrade, renovation, construction. Staff, training and technical assistance included in SDA 1.5.3 on HRD; Laboratory support and equipment included in 1.2 diagnosis; DRS included in 1.5.1 M&E SDA High risk groups: 2.3.1.1 Situation analysis to identify high risk groups and # and (%) Smear-positive TB cases identified 2.3.1 Address prisoners, determine the barriers which prevent access to TB control in prisons refugees, TB contacts services TB/HIV, MDR-TB and Other Challenges and other high-risk 2.3.1.2 Coordination with partners ad NGOs # and (%) Treatment success rate of smear- groups and special 2.3.1.3 Transportation Logistic, equipment and supplies positive TB cases identified in prison (or situations including transport for contact home visit other groups)- New smear-positive TB cases 2.3.1.4 Develop adapted strategy . Adaptation and development, that successfully complete their treatment of pro-active and innovative approaches for TB contact among the new smear-positive TB cases investigation, diagnosis and treatment services for refugees and registered during a specified time period in prisoners, other risk groups prison (or other groups) 2.3.1.5 Develop didactic material Development of didactic material to implement the pro-active approaches # TB cases identified among TB contact M&E included in SDA 1.5.1 Incentives and enablers to the patient in SDA1.3.2 # TB contacts screened for TB among high Enablers to community health workers different from enablers risk groups 5
  6. 6. Stop TB Planning Matrix and Frameworks: Global Fund Round 8 TB proposal preparation, Stop TB Department, World Health Organization SDA Cross-cutting HSS • Cross-cutting HSS includes system-wide interventions aimed to See revised HSS indicators for round 8, in the 3.1 (relevant beyond TB address health systems barriers shared by TB control and other M&E toolkit, (WEB-LINK) Cross- control): Actively public health programmes, such as HIV, Malaria and beyond, Objective 3: Contribute to Health Systems Strengthening cutting participate in efforts to which cannot be addressed within the TB programme alone. HSS improve: service • Cross-cutting HSS interventions should be included in section 4B (Sectio delivery; health in one of the disease components n 4B) workforce; information • Such interventions should be planned across the three diseases systems; medical and in collaboration with relevant health systems experts. They products, should be in line with the national strategic plan for HSS where vaccines & technology; such a plan exist. financing; and • HSS interventions do NOT include TB specific activities such as leadership & training of general health staff on TB control, training for TB governance. programme staff, salaries for TB programme staff, TB specific performance incentives, purchase of laboratory supplies and equipment for TB only, which should be included under SDA 1.2, 1.5.2, and 1.5.3. SDA PAL: Share 3.2.1 PAL activities at National level # (%) of facilities with PAL activities, 3.2 innovations that • Assessment/situation analysis strengthen systems, • Guidelines development # (%) of respiratory cases among outpatients including the • Training material development, in health facilities (in NHIS) Practical Approach to • Feasibility test Lung Health (PAL) 3.2.2 PAL activities at sub national levels # of TB suspects identified in the health • Equipment facilities Staff, training and technical assistance included in SDA 1.5.3 on HRD SDA Adapt innovations Retooling on new case definition is included in SDA 1.5.2 on 3.3 from other fields Management and supervision Retooling on new diagnosis tool is included in SDA 1.2 on diagnosis 6
  7. 7. Stop TB Planning Matrix and Frameworks: Global Fund Round 8 TB proposal preparation, Stop TB Department, World Health Organization Objective 5: Empower People With TB and communities ProvidersObjective 4: Engage All Care SDA All care providers 4.1.1 PPPM/ISTC activities at National level # (%) of private/public non NTP facilities 4.1/4.2 Public-Public, and 4.1.2 PPM/ISTC activities at sub national levels participating in DOTS activities following the Public-Private Mix Preparation (meetings, printing documents) Demand creation ISTC / out of all planned (PPM) approaches, (Advocacy and communication) including Monitoring and evaluation included in SDA 1.5.1 on M&E # (%) of TB patients registered for treatment International Staff, training and technical assistance included in SDA 1.5.3 in private/public non NTP facilities / out of standards for TB care on HRD all TB patients registered for treatment (ISTC) First-line drugs included in SDA 1.4 on drugs supply Diagnosis supplies included in SDA 1.2 on diagnosis SDA ACSM Advocacy, 5.1.1 General management # (%) of individuals with correct knowledge 5.1 communication and 5.1.2 Advocacy about TB (such as mode of transmission, social mobilization 5.1.3 Communication curability, duration of treatment, etc.) - this and Patients’ Charter 5.1.4 Social mobilization can be measured at the beginning and end of for Tuberculosis Care 5.1.5 Patients' charter the activity through a KAP survey Staff, training and technical assistance included in SDA 1.5.3 on HRD # of Patients’ Charters disseminated SDA Community TB 5.2.1 Policy and piloting # and % of patients managed by the 5.2 Care 5.2.2 Advocacy and communication community throughout treatment 5.2.3 Capacity building 5.2.4 Monitoring and evaluation # and % of new smear positive patients 5.2.5 Incentives to community health workers referred by the community to diagnostic 5.2.6 Ensuring quality of services services All Community TB Care activities not covered under ACSM. Enablers to community health workers different from enablers to patient Staff, training and technical assistance included in SDA 1.5.3 on HRD Monitoring and evaluation included in SDA 1.5.1 on M&E Ensuring quality of services included in SDA 1.5.2 on programme management and supervision Special challenges and operational research included in SDA 6.1 on OR 7
  8. 8. Stop TB Planning Matrix and Frameworks: Global Fund Round 8 TB proposal preparation, Stop TB Department, World Health Organization Objective 6 Enable and Promote Research SDA Operational 6.1.1 Type and costs of studies Presence of operational research agenda (Yes/ 6.1 research Operational research included in Phase 4 trials here, if relevant. No) Staff, training and technical assistance included in SDA 1.5.3 # of operational research studies completed on HRD and results disseminated through global TB M&E system SDA 6.2 Research to develop new diagnostics, drugs and vaccines Not applicable to Global Fund proposals 8
  9. 9. Stop TB Department, WHO TB planning matrix - Global Fund Round 8 2. Goal, targets and indicators of the Stop TB Planning matrix 2.1 Goal Millennium Development Goal, Target and Indicators relevant to TB Millennium Development Goal 6: Combat HIV/AIDS, malaria and other diseases • Target 8: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases • Indicator 23: Prevalence and death rates associated with tuberculosis • Indicator 24: Proportion of tuberculosis cases detected and cured under DOTS 2.2 Targets • At least 70% of people with infectious TB will be diagnosed (under the DOTS strategy), and at least 85% cured. • By 2015: The global burden of TB disease (prevalence and deaths) will be reduced by 50% relative to 1990 levels. (Globally, this means reducing prevalence to 155 per 100,000 and deaths to 14 per 100,000 per year by 2015). 2.3 Impact and Outcome indicators Indicator Target Measurement Reference TB prevalence rate. Estimated Halving of Measured by special JAMA article, number of all active TB cases per prevalence by surveys WHO Global 100,000 population at a given point in 2015, relative to TB Control time 1990 (especially page 54) TB incidence rate. Estimated Measured by special JAMA article, IMPACT number of TB cases occurring per surveys WHO Global year, per 100,000 population (can be TB Control used for specific population subgroups, (especially page e.g. annual incidence of TB 54) in the prison system) TB mortality rate. Estimated Halving of Measured by special JAMA article, number of deaths due to TB (all cases) mortality by surveys WHO Global per year, per 100,000 population 2015, relative to TB Control 1990 (especially page 54) Case detection. New smear positive 70% under DOTS, Quarterly, routine WHO Global TB TB cases detected nationally Health information Control and (diagnosed and reported to the national system PLUS estimates Compendium of health authority), among the new produced by WHO Indicators smear-positive TB cases estimated to occur countrywide each year OUTCOME Treatment success rate. New 85% under DOTS Quarterly, routine WHO Global TB smear positive TB cases that nationally for the Health information Control and successfully complete their treatment cohort of new system. Evaluated by Compendium of among the new smear positive TB smear-positive cohort, ideally for all Indicators cases registered during a specified time patients types of new and re- period. Successful completion entails treatment clinical success with or without cases bacteriological evidence of cure (number and percentage) (TB 3) GOAL 9
  10. 10. Stop TB Department, WHO TB planning matrix - Global Fund Round 8 2.4 Programmatic indicators (M&E toolkit) Examples of Outcome Service Delivery Area Output Indicators indicators SDA 1.0 New smear-positive TB cases that High Quality DOTS * successfully complete their treatment supported by SDAs 1.1 to among the new smear-positive TB 1.5 and a variety of cases registered during a specified time activities. period (number and percentage) New smear positive TB cases detected Case detection rate: SDA 1.2 (diagnosed and reported to the national New smear positive TB Improving diagnosis health authority during each cases detected (diagnosed quarter/year), among the new smear- positive TB cases estimated to occur and reported to the Objective 1: High Quality DOTS countrywide each quarter/year (number national health authority), and percentage)* among the new smear positive TB cases Laboratories performing regular EQA estimated to occur for smear microscopy (number and countrywide each year percentage) (number and percentage) Laboratories performing regular EQA Treatment success rate: for culture and DST (number and New smear-positive TB percentage) cases that successfully SDA 1.3 Patients receiving incentives or Patient support enablers (number and percentage) complete their treatment among the new smear- TB basic management units positive TB cases SDA 1.4 (BMU/district) that reported a stock out registered during a Procurement and supply in first line drugs that resulted in specified time period management (First-line anti- interruption of treatment during the TB drugs) reporting period out of all BMUs (number and percentage) (number and percentage) Health facilities submitting timely SDA 1.5.1 reports according to national M&E guidelines (number and percentage) GOAL 10
  11. 11. Stop TB Department, WHO TB planning matrix - Global Fund Round 8 Registered TB patients who are tested for HIV (during and SDA 2.1 before TB treatment) expressed as a proportion of the total TB/HIV ** number of all registered TB cases(number and percentage)** Objective 2: Address TB/HIV, MDR-TB and Other Challenges HIV positive TB patients who receive at least one dose of co-trimoxazole preventive therapy (CPT) during their TB treatment, expressed as a proportion of the total number of HIV positive TB patients (number and percentage) Notified MDR cases (bacteriologically confirmed) (number and SDA 2.2 percentage) MDR-TB Treatment success rate of MDR cases- Bacteriologically confirmed MDR-TB cases that successfully complete treatment according to programme protocol among all the MDR-TB cases registered on treatment during a specified time period Smear-positive TB cases identified in prisons (number and SDA 2.3.1 percentage) High risk groups Treatment success rate of smear-positive TB cases identified in prison (or other groups)- New smear-positive TB cases that successfully complete their treatment among the new smear- positive TB cases registered during a specified time period in prison (or other groups) (number and percentage) TB cases identified among TB contact (number) TB contacts screened for TB among high risk groups (number) HSSObjective 3: Contribute to Health facilities implementing PAL (number and percentage) SDA 3.2 Practical Approach to Respiratory cases among outpatients in health facilities (in Lung Health (PAL) NHIS) (number and percentage) TB suspects identified in the health facilities (number) ProvidersObjective 4: Engage All Care SDA 4.1/4.2 Private/ Public non-NTP facilities participating in DOTS All care providers activities following the ISTC among all planned (number and (PPM/ISTC) percentage) TB patients registered for treatment in private/public non NTP facilities among all TB patients registered for treatment ((number and percentage) GOAL 11
  12. 12. Stop TB Department, WHO TB planning matrix - Global Fund Round 8 ResearchObjective 6 Enable and Promote Objective 5: Empower People With TB and communities SDA 5.1 Individuals with correct knowledge about TB (such as mode of ACSM transmission, curability, duration of treatment, etc.) - this can be measured at the beginning and end of the activity through a KAP survey (percentage) SDA 5.2 Patients managed by the community throughout treatment Community TB care (number and percentage) New smear positive patients referred by the community to diagnostic services (number and percentage) SDA 6.1 Operational research Operational research studies completed and results disseminated through global TB M&E system (number) *High quality DOTS is supported by several SDAs (1.1 to 1.5) and a variety of activities. It is assessed through Treatment success rate and case detection rate outcome indicators and should be reported quarterly as well as annually. ** See HIV/TB indicators in the HIV section for comprehensive HIV/TB core set of indicators Suggestions for Global Fund proposal writing: (i) Use the indicators proposed in the Global Fund Performance Framework of the proposal form and the Global Fund M&E toolkit (taken from the Compendium of TB indicators). Impact,/outcome correspond to the goal level while programmatic indicators correspond to the service delivery areas (SDA) level. GOAL 12
  13. 13. Stop TB Department, WHO TB planning matrix - Global Fund Round 8 (ii) You can use the “epidemiology” sheet in the TB planning & budgeting tool for calculating the number of TB patients to be detected and treated (based on projection of incidence over the planning period). GOAL 13
  14. 14. Stop TB Department, WHO TB planning matrix - Global Fund Round 8 3. Stop TB Planning Matrix and Frameworks: Global Fund Round 8 TB proposal preparation 3.1 Stop TB Strategy Objective 1: Pursue high quality DOTS expansion and enhancement 3.1.1 Service Delivery Area (SDA) 1.1: Political commitment Stop TB strategy Indicators Activities to be budgeted subcomponent and SDAs 1.1 Political Advocacy component of ACSM # (%) of funds disbursed by commitment with (Excludes CSM accounted under the government for TB increased and 5.1) control out of the total sustained financing activities to place TB high on the national health budget Advocacy component political agenda, foster political of ACSM will, increase and sustain financial and other resources Political commitment is the first component of the DOTS strategy as it is a precondition for realising the full implementation and expansion of the DOTS strategy at local, country, regional and global levels. Suggestions for GLOBAL FUND proposal writing: (i) Political commitment is most often obtained and strengthened through advocacy activities and therefore is linked to ACSM. (ii) Please refer to ACSM section 5.1 for detailed activities and indicators SDA1.1 Political Commitment 14
  15. 15. Stop TB Department, WHO TB planning matrix - Global Fund Round 8 3.1.2 SDA 1.2: Improving diagnosis To pursue high-quality DOTS expansion and enhancement through improved case detection and quality-assured bacteriology. Stop TB strategy Sub component/ Indicators Activities to be budgeted Service Delivery Area (SDA) SDA Improving 1.2.1 Microscopy laboratories: Renovation, Functioning diagnosis 1.2 diagnosis: equipment, supplies for microscopy laboratory per # population Case 1.2.2 Culture laboratories: Renovation, covered (e.g. 1 diagnosis detection equipment, supplies for culture laboratory per 80,000 through 1.2.3 DST laboratory: Renovation, equipment, population) quality- supplies for drug susceptibility testing (DST) assured 1.2.4 Molecular test for DST and diagnosis of # (%) of laboratories bacteriology smear negative: Renovation, equipment, performing regular EQA supplies for smear microscopy 1.2.5 Other equipment, X-ray equipment/supplies # (%) of laboratories 1.2.6 Quality assurance programme including performing regular EQA external quality assurance (EQA) for culture and DST 1.2.7 Retooling: activities related to retooling process Staff, training and technical assistance included in SDA 1.5.3 on HRD Diagnostic services will be coordinated with the administrative, epidemiological and clinical units of the NTP and will be integrated in general health services. They will be developed concurrently with the other disease components in order to achieve high technical performance and coverage. Radiological services (in high HIV setting) and laboratory network functions will be integrated with the regular operations of NTP. This will ensure quality assurance for smear microscopy, culture and DST; development of training curricula; establishment of good laboratory practices and standard operating procedures; establishment/ strengthen culture and drug susceptibility capacity; and developing operational research capacity in various diagnostic areas. Chest radiography is an important investigation to assist the diagnosis of TB in patients with smear negative pulmonary TB. Particularly in HIV prevalent settings it has to be provided for patients at the earliest time possible to expedite the diagnosis. This calls for the expansion of quality radiography services, including establishing quality assurance system with increase and training of human resources. SDA1.2 Improving diagnosis 15
  16. 16. Stop TB Department, WHO TB planning matrix - Global Fund Round 8 "Retooling" Retooling is the process of introduction, adoption and implementation of new and improved diagnostics, medicines, and vaccines with the goal of maximizing their widespread use while minimizing delays. To be successful, the retooling process involves the participation of a wide range of stakeholders at the global and country levels, the consideration of a number of key components, including a country's assessment on its capacity to adopt and implement new technologies. As part of the retooling approach, WHO recommends the use of liquid medium and the rapid species identification in middle- and low-income countries to address increasing needs for culture and drug susceptibility testing (DST). Since liquid systems will be implemented as a step wise approach, and be integrated into a country's specific comprehensive plan for laboratory capacity strengthening, the following key issues should be addressed : 1. appropriate bio safety level; 2. detailed customer plan describing guarantees and commitments of the manufacturer; 3. appropriate training of staff; 4. maintenance of infrastructure and equipment in laboratories; 5. quick transportation of samples from the peripheral to the culture laboratory; 6. rapid communication of results. A checklist of key actions for the introduction of liquid systems for culture and DST at global and country level has been developed by the retooling task force. It includes policy development, registration, introduction and financing, preparation phase, training of laboratory technicians, quantification of needs and procurement, distribution, quality assurance and monitoring and evaluation. SDAs and activities should be mutually exclusive. To avoid duplicate laboratory activities, attention should be made to SDA 1.5.2 on Programme management and supervision; SDA 1.5.3 on human resources; SDA 2.1 on TB/HIV; SDA 2.2 on MDRTB management; and SDA 2.3 on special groups. SDA 1.2 Improving Diagnosis Activities Links with budget tool 1.2.1 Microscopy laboratories 1.2 Improving diagnosis & lab • Renovation items list 1.2.1 Microscopy laboratories • Equipment, including fluorescent microscopy 1.5.3.1 HRD staff • Supplies for microscopy 1.5.3.2 HRD TA • Transportation of samples to laboratories 1.5.3.3 HRD Training (1.5.3.3.2 Training for diagnosis) 1.2.2 Culture laboratories 1.2 Improving diagnosis & lab • Renovation items list • Equipment 1.2.2 Culture laboratories 1.5.3.1 HRD staff • Supplies for culture 1.5.3.2 HRD TA SDA1.2 Improving diagnosis 16
  17. 17. Stop TB Department, WHO TB planning matrix - Global Fund Round 8 SDA 1.2 Improving Diagnosis Activities Links with budget tool • Transportation of samples to laboratories 1.5.3.3 HRD Training (1.5.3.3.2 Training for diagnosis) 1.2.3 DST laboratory 1.2 Improving diagnosis & lab • Renovation items list • Equipment 1.2.3 DST laboratory 1.5.3.1 HRD staff • Supplies for drug susceptibility testing (DST) 1.5.3.2 HRD_TA • Transportation of samples to laboratories 1.5.3.3 HRD_Training (1.5.3.3.2 Training for diagnosis) 1.2.4 Molecular test for DST and diagnosis of smear negative 1.2 Improving diagnosis & lab • Renovation items list • Equipment 1.2.4 Molecular tests 1.5.3.1 HRD staff • Supplies 1.5.3.2 HRD_TA • Transportation of samples to laboratories 1.5.3.3 HRD_Training • Develop national guidelines including new case definition (1.5.3.3.2 Training for and accelerated diagnosis algorithms to expedite the diagnosis) diagnosis of smear negative pulmonary and extra pulmonary TB 1.2.5 Other equipment, X-ray 1.2 Improving diagnosis & lab • Equipment items list • Supplies 1.2.5 Other equipment, X-ray • Training of health workers (clinical officers and nurses) on CXR 1.5.3.1 HRD staff reading 1.5.3.2 HRD_TA 1.5.3.3 HRD_Training (1.5.3.3.2 Training for diagnosis) 1.2.6 Quality assurance programme including External Quality 1.2 Improving diagnosis & lab Assurance (EQA) items list Establish quality assurance programme for smear, culture, DST, X- 1.2.6 Quality assurance ray etc programme • Develop/implement supervision scheme and rechecking/panel 1.5.2 Management and testing scheme supervision • Develop training materials 1.5.3.1 HRD staff • Organize workshop on supervision checklist and 1.5.3.2 HRD_TA rechecking/panel testing scheme 1.5.3.3 HRD_Training • Recruit technical and supervisory staff for all levels of (1.5.3.3.2 Training for diagnostic services to carry out supervision and rechecking diagnosis) • Provide transportation for supervision and rechecking • Develop scheme for proficiency testing between a NRL and a Supranational Reference Laboratory (SRL) SDA1.2 Improving diagnosis 17
  18. 18. Stop TB Department, WHO TB planning matrix - Global Fund Round 8 SDA 1.2 Improving Diagnosis Activities Links with budget tool 1.2.7 Retooling: activities related to retooling process 1.2.7 Retooling process • Plan development for introduction, financing, and monitoring 1.5.3.1 HRD staff and evaluation of new/improved diagnostic 1.5.3.2 HRD TA technologies/strategies 1.5.3.3 HRD Training • Technical consultative meeting for implementation - preparation (1.5.3.3.2 Training for phase diagnosis) • Recruitment List of Annexes: Annex 1: Assessment to ascertain whether a number of microscopy centres in the country is adequate Annex 2: Design materials, equipment of the peripheral and national reference laboratory Annex 3: Design plan of the peripheral microscopy centre Annex 4: Design plan of the national reference laboratory Annex 5: Equipment for the peripheral laboratory (with cost estimates) Annex 6: Equipment for the national reference laboratory (with cost estimates) Annex 7: Equipment and supplies requirements for microscopy Annex 8: Equipment and supplies requirements for culture laboratory Annex 9: EQA Supervision/on-site evaluation (microscopy) Annex 9A: EQA Supervision checklist (microscopy) Annex 10: EQA Process planning and implementation steps (microscopy) Annex 11: EQA Resource requirement checklist (microscopy) Annex 12: Quality control for culture Annex 13: EQA for drug susceptibility testing Annex 14: Staffing requirements for the national reference laboratory References: http://www.who.int/tb/publications/en/  Laboratory Services in Tuberculosis Control; (WHO/TB/98.258) - Part I Organization and Management - Part II Microscopy - Part III Culture  The Public Health Service National Tuberculosis Reference Laboratory and the National Laboratory Network. International Union Against Tuberculosis and Lung Disease, 1998  External Quality Assessment for AFB Smear Microscopy APHL, CDC, IUATLD, KNCV, RIT and WHO, 2003  Guidelines for Surveillance of Drug Resistance in Tuberculosis (WHO/TB/2003.320)  Improving the diagnosis and treatment of smear-negative pulmonary and extrapulmonary tuberculosis among adults and adolescents. Recommendations for SDA1.2 Improving diagnosis 18
  19. 19. Stop TB Department, WHO TB planning matrix - Global Fund Round 8 HIV-prevalent and resource-constrained settings (WHO/HTM /TB/2007.376 & WH References related to retooling: New Technologies for TB Control: a framework for their adoption, introduction and implementation. WHO/HTM/STB/2007.40 http://www.stoptb.org/retooling/publications.asp This document identifies key issues that need to be addressed to accelerate the adoption and implementation of new and improved technologies. It provides guidance on what actions are needed when improved existing and/or new medicines, diagnostics and vaccines become available. The document is primarily intended to support NTPs, national immunization programmes and clinical laboratory and diagnostic services. It is also meant to inform Stop TB Partnership constituents, including advocacy and community-based organizations, donors, intergovernmental agencies, new product developers, national policy and decision makers, and academic and technical partners. The framework identifies challenges to retooling and proposes key steps for facilitating appropriate and timely adoption and implementation. It also provides an overview of technical and operational considerations for retooling at global and national levels. Checklist of key actions for introduction of the Liquid Media Culture and Drug Susceptibility Testing (DST) http://www.stoptb.org/retooling/publications.asp This document describes key actions related to global policy development, country policy development, registration of the liquid media system, planning of introduction and financing, preparation phase, training of laboratory technicians, quantification of needs and procurement, distribution, quality assurance and monitoring evaluation. Engaging stakeholder engagement plan http://www.stoptb.org/retooling/publications.asp The primary purpose of this document is to provide guidance to managers of national TB control programmes, national immunization programmes, and clinical laboratory and diagnostic services on identifying stakeholders and engaging them as contributors and beneficiaries in TB-control retooling. It also aims to inform members of the Stop TB Partnership, including advocacy and community-based organizations, donors, intergovernmental agencies, new product developers, national policy- and decision-makers, and academic and technical partners. The document also provides simple tools for preparing a stakeholder engagement plan, and a list of suggested reading on the topic. Retooling advocacy package http://www.stoptb.org/retooling/media.asp The package includes an Executive summary, FAQs, a comprehensive overview of the retooling process and a postcard. All those documents have been included in an CD and are available in English, Arabic, Chinese, French, Spanish and Russian. The CD contains also the electronic version of the retooling framework (New technologies for TB Control: a framework for their adoption, introduction and implementation) in English. SDA1.2 Improving diagnosis 19
  20. 20. Stop TB Department, WHO TB planning matrix - Global Fund Round 8 3.1.3 SDA 1.3: Patient support Stop TB strategy Sub component/ Indicators Activities to be budgeted Service Delivery Area (SDA) SDA Patient support 1.3.1 Situation analysis Percentage (%) of 1.3 1.3.2 Incentives and enablers patients receiving provided to the patient (e.g. social incentives or enablers support, food packages, transport vouchers) Patient charter included in SDA 5.1 on ACSM Community support included in SDA 5.2 on Community TB care Experiences in different countries show that providing TB diagnosis and treatment free of charge still leaves many patients, and their families, faced with different direct and opportunity costs in terms of access to health services and treatment. Such costs can influence patients’ behaviour, and have a negative effect on diagnostic delay, case detection and treatment adherence. Populations particularly vulnerable to the direct and opportunity costs vary depending on the country, and can include poor rural and marginalized urban populations, migrants, ex-prisoners, etc. In some settings, carefully designed provision of incentives and/or enablers to vulnerable populations has yielded improved tuberculosis treatment outcomes. Performance-based financial or material incentives (i.e. incentives and enablers linked to, for example, regular health centre attendance and/or treatment adherence) such as food, transport vouchers, money, material goods or similar may be effective at reducing the cost of treatment for the vulnerable groups. Consulting with such vulnerable groups to understand what obstacles they face and what incentives/enablers may contribute to better design of patient support scheme. Implementation of patient support activities will require careful thinking in order to ensure impact and sustainability. Issues to keep in mind include: communication about the availability of incentives/enablers to the vulnerable population(s), monitoring impact of such activities, and ensuring regular and timely rollout of incentives/enablers. Dangers of offering incentives and enablers should be carefully considered – please see further reading below. SDAs and activities should be mutually exclusive. Activities in this SDA should exclude activities in SDA 2.3 on special groups, Patients’ Charter promotion (SDA 5.3), and patient support activities within community involvement activities (SDA 5.2). 20 SDA1.3 Patient Support
  21. 21. Stop TB Department, WHO TB planning matrix - Global Fund Round 8 SDA 1.3 Patient Support Activities Link with budget tool 1.3.1 Situation analysis • Conduct situation analysis 1.3.1 Situation analysis • Meetings with vulnerable groups in order to assess their needs analysis and jointly plan support (all meetings with different targeted groups) • Production/development of strategic plan 1.3.2 Incentives and enablers provided to the patients (e.g. 1.3.2 Incentives and social support, food packages, transport vouchers) enablers Organize awareness-raising activities for targeted vulnerable 5.1 ACSM/Communication populations informing them about availability of incentives/enablers and eligibility criteria FURTHER READING: Advocacy, Communication, and Social Mobilization (ACSM) for Tuberculosis Control: a handbook for country programmes. WHO/HTM/STB/2007.45. World Health Organization, 2007. Beith A, Eichler R, Weil. Performance-Based incentives for health: a way to improve tuberculosis detection and treatment completion? Center for Global Development Working Paper # 122, 2007. (http://www.cgdev.org/content/publications/detail/13544/) Community involvement in tuberculosis care and prevention: towards partnerships for health. Stop TB/WHO, 2008. Engaging all heath care providers in TB control: Guidance on implementing public- private mix approaches, Stop TB/WHO, 2006. Lönnroth K, Uplekar M, Blanc L. Hard gains through soft contracts: productive engagement of private providers in TB control. Bulletin of the World Health Organization, 2006, 84:876-83. Macq J, Torfoss T, Getahun H. Patient empowerment in tuberculosis control : reflecting on past documented experiences. Tropical Medicine and International Health, 2007, 12:873-85. Mangura, BT, Passannante MR, Reichman LB. An incentive in tuberculosis preventive therapy for an inner city population. International Journal of Tuberculosis and Lung Diseases, 1997, 1:576-78. Patients’ Charter for Tuberculosis Care. Viols-Laval, World Care Council, 2006 (http://www.worldcarecouncil.org/index.php? nSection=1&module=default&content=34, accessed 30 November 2007). Sagbakken M, Frich JC, Bjune G. Barriers and enablers in the management of tuberculosis treatment in Addis Ababa, Ethiopia: a qualitative study. BMC Public Health, 2008, 8:11. 21 SDA1.3 Patient Support
  22. 22. Stop TB Department, WHO TB planning matrix - Global Fund Round 8 3.1.4 SDA 1.4: Procurement and supply management of 1st line drugs Stop TB strategy Indicators Sub component/ Service Activities to be budgeted Delivery Area (SDA) SDA Procurement and 1.4.1 First-line drugs for Category I # (%) of TB management units 1.4 supply & III patients (TBMU) that reported a stock management: Drug 1.4.2 First-line drugs for Category II out in first and/or second line supply and patients drugs that resulted in management system 1.4.3 First-line drugs for children interruption of treatment 1.4.4 Buffer stock for first-line drugs during the year out of all 1.4.5 Drug management: procurement, TBMUs storage, distribution Six basic elements of pharmaceutical management include: 1. Policy and legal framework (national drug laws including registration) 2. Selection (includes products used and treatment regimens) 3. Procurement (includes quantification of needs) 4. Distribution (includes receipt of shipment into country) 5. Use (includes compliance/adherence by prescriber and patient) 6. Management support (includes management information system, quality assurance, human resource needs, basic and in-service training and monitoring and supervision) The Procurement and Supply Management (PSM) plan could be initiated at this stage of proposal development and include:  Description of the pharmaceutical management system using the six basic elements  Identify the gaps (weaknesses, things that are lacking) within each of the six elements in the pharmaceutical management system  Description of how to use the Global Fund resources to overcome the gaps SDAs and activities should be mutually exclusive. To avoid duplicate activities careful attention should be given to check drug management and supplies is not yet be included in SDA 1.5.2 on Programme management and supervision activities, in SDA 1.5.3 on human resources, in SDA 2.1 on TB/HIV; SDA 2.2 on MDR-TB management; in SDA 2.3 on high risk groups, or in SDA 4.1 on PPM SDA 1.4 Activities Link with budget tool 1.4.1 First-line drugs for Category I & III patients 1.4.1 First-line drugs for Category I & III patients 1.4.2 First-line drugs for Category II patients 1.4.2 First-line drugs for Category II patients 1.4.3 First-line drugs for children 1.4.3 First-line drugs for children SDA1.4 Procurement and supply management 1st line drugs 22
  23. 23. Stop TB Department, WHO TB planning matrix - Global Fund Round 8 SDA 1.4 Activities Link with budget tool 1.4.4 Buffer stock for first-line drugs 1.4.4 Buffer stock for first- • Provide and maintain adequate buffer stock at central, line drugs intermediate and peripheral (if required) levels 1.4.5 Drug management: procurement, storage, distribution 1.4.5 Drug management: • Drug procurement procurement, storage, o Quality control distribution o Preshipment inpection 1.5.3.1 HRD staff o Transport FOB and CIF 1.5.3.2 HRD_TA o Insurances 1.5.3.3 HRD_Training • Drug storage o Storage costs at national ,intermediate, peripheral levels • Drug distribution o Costs of distributing drugs to intermediate level o Costs of distributing drugs to peripheral level • Equip all levels in storage capacity, rehabilitation facilities • Recruitment of staff (pharmacist, assistants, store keepers) • Develop instructions/manual on TB drug procurement (estimation, order, importation, stock etc), TB drug storage, distribution and DMIS • Train staff on best procurement practices for local and international purchases and how to request drugs and supplies from international organizations like GDF-GLC, • Train staffs at all levels on drug management including order, storage, inventory, DMIS. • Establish appropriate delivery schedules and modes of transportation • Equip central level/peripheral level with appropriate modes of transportation • Develop computer-based or manual-based DMIS • Participate in the international training for drug management, GF implementation, regional meeting. Resource material: 1. Guide to writing the Procurement and Supply Management Plan http://www.theglobalfund.org/en/about/procurement/. 2 .Managing Pharmaceuticals and Commodities for Tuberculosis http://www.msh.org/what_MSH_does/tb/medicines.html 3. Direct procurement of TB drugs through GDF http://www.stoptb.org/gdf/drugsupply/direct_procurement_process.asp SDA1.4 Procurement and supply management 1st line drugs 23
  24. 24. Stop TB Department, WHO TB planning matrix - Global Fund Round 8 SDA1.4 Procurement and supply management 1st line drugs 24
  25. 25. Stop TB Department, WHO TB planning matrix - Global Fund Round 8 3.1.5.1 SDA: 1.5.1 Monitoring and evaluation system, and impact measurement Stop TB strategy Indicators Sub component/ Service Activities to be budgeted Delivery Area (SDA) SDA M&E: Monitoring 1.5.1.1 Periodic surveys # (%) of health facilities 1.5.1 and Evaluation e.g. drug resistance submitting timely reports system and impact surveillance, TB disease according to national guidelines measurement prevalence surveys, surveys of HIV prevalence Prevalence survey performed among TB patients (y/n) 1.5.1.2 Routine surveillance including • DRS performed (y/n) revision of the R&R system etc Staff, training and technical assistance included in SDA 1.5.3 on HRD To implement reliable monitoring and evaluation system and impact measurement in order to: • Ensure routine recording and reporting are used to monitor closely the implementation of TB control activities, to identify problems and to suggest solutions. • Ensure TB control is adequately financed, and that budgeting, financing and expenditure are properly monitored. • Assess the impact of TB control activities (including those funded by the Global Fund) on the burden of TB, in particular with reference to the millennium development goals. Routinely collected data, combined in some cases with special surveys (e.g. population-based prevalence of disease surveys) can be used to assess the burden of TB disease in a given country, trends in the burden, and the impact of TB control on that burden. Reporting of financial indicators is needed. Where staff working in health-care facilities work on diseases other than TB in addition to TB, any training in, for example, use of computers or basic data analysis, will contribute to the quality of the work done by those staff on other diseases. There is also the potential to pool resources such as computers. As appropriate for given country, the following broad areas of activities might be proposed for funding by the Global Fund: − Strengthening or updating existing recording and reporting system − Improve analysis of routinely collected data − Special surveys/studies, including operational research Vital registration data (deaths), and other health or economic indicators. Population- based (as opposed to programme-based) surveys of prevalence of infection, of disease, or of mortality may be appropriate to help assess the burden of TB. Where no baseline survey exists for comparison, a second survey will generally be needed to SDA1.5.1 M&E 25
  26. 26. Stop TB Department, WHO TB planning matrix - Global Fund Round 8 assess trends, although routinely collected data (e.g. case notifications, average age of TB cases) can be used, if of consistently high quality. Cost-effectiveness studies help inform decisions about how best to spend limited funds, and (where an intervention is shown to be cost-effective) to strengthen the case for increased funding for certain interventions. In some cases these might be listed under other SDAs (e.g. PPM DOTS, community-based DOTS, Operational research ) SDA 1.5.1 M&E Links with budget tool 1.5.1.1 Periodic surveys e.g. drug resistance surveillance, TB 1.5.1.1 Periodic disease prevalence surveys, surveys of HIV prevalence among surveys TB patients • Equip central/regional level for data entry/analysis 1.5.3.1 HRD staff (computers, internet access) 1.5.3.2 HRD_TA 1.5.3.3 • Technical assistance for writing protocols, preparing and HRD_Training conducting surveys, data entry/analysis (epidemiologist) (on SDA 1.5.3.2) • Recruit staff central/regional level for writing protocols, Link also with 1.2 preparing and conducting surveys, data entry/analysis improved diagnosis (epidemiologist) for lab equipment, CXR, and 1.5.2 • Procurement of additional equipment for the survey (e.g. Management and for DRS and/or prevalence survey: upgrading laboratory, supervision for infrastructure equipment, consumables, for prevalence transportation (e.g survey: purchase of x-ray machines, films, reagents, cars cars for prevalence for field operations) survey teams) • Plan and budget field operations (plan operational costs of field teams for data/specimen collection, including transportation costs, process, analysis, quality control of data and specimen etc) • Technical assistance for preparation, monitoring, mentoring, review of data, analysis of results, publications (on SDA 1.5.3.2) • Training of survey teams • Meetings to plan logistics of survey • Meetings with experts to analyse, review results • Costs of publication of results 1.5.1.2 Routine surveillance including revision of the R&R 1.5.1.2 Routine system etc surveillance • Review of data management system: consultative meeting with NTP staff and experts in M&E 1.5.3.1 HRD staff • Training of health staff at Sub-national level (e.g. district) 1.5.3.2 HRD_TA to use the system 1.5.3.3 • Development of recording and reporting forms HRD_Training • Purchase, adaptation or development of software/web system for data management • Train in use of software • Recruit staff for data management and analysis, data entry at central/regional level • Technical assistance SDA1.5.1 M&E 26
  27. 27. Stop TB Department, WHO TB planning matrix - Global Fund Round 8 Resources and references 1. Global tuberculosis control: surveillance, planning, financing. WHO report 2006. Geneva, World Health Organization (WHO/HTM/TB/2006.362). www.who.int/tb/publications/global_report 2. Monitoring and Evaluation Toolkit: HIV/AIDS, Tuberculosis, and Malaria. www.theglobalfund.org/en/apply/call6/documents/ 3. Compendium of indicators for monitoring and evaluating national tuberculosis programs. Geneva, World Health Organization (WHO/HTM/TB/2004.344). www.who.int/tb/publications/2004/en/ 4. Online workshop on TB epidemiology and surveillance: www.who.int/tb/surveillanceworkshop/ 5. Revised TB Recording and Reporting forms http://www.who.int/tb/publications/recording_and_reporting_draft/en/index.html SDA1.5.1 M&E 27
  28. 28. Stop TB Department, WHO TB planning matrix - Global Fund Round 8 3.1.5.2 SDA: 1.5.2 Management and Supervision Stop TB strategy Sub component/ Indicators Activities to be budgeted Service Delivery Area (SDA) SDA Management 1.5.2.1 Recruitment processes # (%) of supervisory visits 1.5.2 and 1.5.2.2 National staff meetings performed with Supervision 1.5.2.3 Staff meetings at intermediate documented feedback and peripheral level reports / out of planned 1.5.2.4 Development, production and visits during a specified distribution of guidelines (including period retooling for new case definition) 1.5.2.5 Supervision from national level Use of supervision 1.5.2.6 Supervision from Intermediate checklist (y/n) level 1.5.2.7 Supervision from peripheral level 1.5.2.8 Strengthening supervision 1.5.2.9 Transportation 1.5.2.10 Office space, supplies and equipment at national level 1.5.2.11 Office space, supplies and equipment at sub-national level 1.5.2.12 Infrastructure, new and renovation Staff, training and technical assistance included in SDA 1.5.3 on HRD Supervision is an integral part of support to all key elements of the Stop TB Strategy. It is an extension of training as well as a systematic process for increasing the efficiency of health workers, regional and district level programme managers (coordinators) by developing their knowledge, perfecting their skills, improving their attitudes towards their work, and increasing their motivation. Subsequently, well motivated and skilled health workers care better for their patients and ultimately contribute towards improving the performance of the programme. As appropriate for given country, the following broad areas of activities might be proposed for funding by the Global Fund: − Development of the supervisory check lists for different areas of work (DOTS implementation, laboratory diagnosis, implementation of MDR-TB treatment, implementation of TB/HIV collaborative activities, PPM, community care, etc.). As much as possible, unified check lists should be developed, incorporating activities necessary for specific areas of work (for example a check list of the reference laboratory supervision should take into account smear microscopy activities for basic DOTS as well culture for MDR-TB and TB/HIV and DST for MDR-TB component). − Regular supervisory visits from the National level to regions or provinces and selected districts and selected peripheral health facilities (health centres). SDA1.5.2 Programme Management and Supervision 28
  29. 29. Stop TB Department, WHO TB planning matrix - Global Fund Round 8 − Regular supervisory visits from the region or province level to all districts and selected peripheral health centres/health posts. − Regular supervisory visits from the Districts level to all health centres/health posts. − Regular meetings held to discuss achieved results, encountered problems, planning, etc. These meeting should happen at all levels with an appropriate frequency. For example the national meetings could be held every 6 months and should invite regional TB coordinators; regional meetings could be held once quarterly and should involve District TB coordinators, etc. SDA 1.5.2 Management and Supervision Activities Link to budget tool 1.5.2.1 Recruitment processes 1.5.2.1 Recruitment Assess human resource needs for management and supervision processes 1.5.2.2 National staff meetings 1.5.2.2 National • National meeting for regional/provincial coordinators staff meetings o Book the venue o Arrange travel of participants o Book hotel for participants 1.5.2.3 Staff meetings at intermediate and peripheral level 1.5.2.3 Staff • Regional, province and district level for programme meetings at intermediate and coordinators (e.g.: regional/provincial meetings for peripheral level district coordinators) o Book the venue o Arrange travel of participants o Book hotel for participants (if required) 1.5.2.4 Development, production and distribution of guidelines 1.5.2.4 (including retooling for new case definition) Development, • Workshops – consultations for guidelines development production and distribution of o Arrange travel of participants guidelines o Book hotel for participants (including retooling o External technical assistance (if required) for new case definition) 1.5.2.5 Supervision from national level 1.5.2.5 Supervision • Prepare all documents to ensure continuity of activity from national level (copies of previous visits, problems encountered during past visits, recommendations given, any feed-back or follow up, etc.) • Conduct supervision visits (transport cost and per diem x number of visits x number of days per visit x number of persons travelling) • Prepare a report - which should be left in the supervised facility, and a copy should be taken back to the supervisor's place of work 1.5.2.6 Supervision from Intermediate level 1.5.2.6 Supervision SDA1.5.2 Programme Management and Supervision 29
  30. 30. Stop TB Department, WHO TB planning matrix - Global Fund Round 8 SDA 1.5.2 Management and Supervision Activities Link to budget tool • Prepare all documents to ensure continuity of activity from Intermediate level (copies of previous visits, problems encountered during past visits, recommendations given, any feed-back or follow up, etc.) • Conduct supervision visits (transport cost and per diem x number of visits x number of days per visit x number of persons travelling) • Prepare a report - which should be left in the supervised facility, and a copy should be taken back to the supervisor's place of work 1.5.2.7 Supervision from peripheral level 1.5.2.7 Supervision • Prepare all documents to ensure continuity of activity from peripheral level (copies of previous visits, problems encountered during past visits, recommendations given, any feed-back or follow up, etc.) • Conduct supervision visits (transport cost and per diem x number of visits x number of days per visit x number of persons travelling) • Prepare a report - which should be left in the supervised facility, and a copy should be taken back to the supervisor's place of work 1.5.2.8 Strengthening supervision 1.5.2.8 • Contracting with third parties to strengthen supervision Strengthening supervision 1.5.2.9 Transportation 1.5.2.9 • Purchase new and replacement vehicles (4WD, cars, Transportation motorbikes, boats) for national, regional and district level • Maintain all vehicles at all levels • Buy fuel for existing 4WD, cars, motorbikes, boats 1.5.2.10 Office space, supplies and equipment at national level 1.5.2.10 Office • Annual rent of office space space, supplies and equipment at • Purchase office equipment national level • Maintenance cost of office equipment (%cost) 1.5.2.11 Office space, supplies and equipment at sub-national level 1.5.2.11 Office • Annual rent of office space space, supplies and equipment at sub- • Purchase office equipment (e.g. computer(s), national level photocopier, printer, mobile phones, stationery, audio visual equipment, internet access) • Maintenance cost of office equipment (%cost) 1.5.2.12 Infrastructure, new and renovation 1.5.2.12 • Upgrade/renovate medical stores, wards, other Infrastructure, new and renovation (including security measures) • Construction of medical stores, wards, other SDA1.5.2 Programme Management and Supervision 30
  31. 31. Stop TB Department, WHO TB planning matrix - Global Fund Round 8 Resources & references Compendium of indicators for monitoring and evaluating national tuberculosis programs. Geneva, World Health Organization (WHO/HTM/TB/2004.344). www.who.int/tb/publications/2004/en/ Budgeting tool SDA1.5.2 Programme Management and Supervision 31
  32. 32. Stop TB Department, WHO TB planning matrix - Global Fund Round 8 3.1.5.3 SDA: 1.5.3 Human Resources Development Stop TB strategy Sub component/ Indicators Activities to be budgeted Service Delivery Area (SDA) SDA Human 1.5.3.1 HRD Staff: # (%) of health facilities 1.5.3 Resources 1.5.3.1.1 National level with at least one health Developmen 1.5.3.1.2 Intermediate level worker trained on TB out t (HRD) 1.5.3.1.3 Peripheral level of all staff 1.5.3.2 HRD Technical Assistance # (%) of posts filled 1.5.3.2.1 International assessment missions according to HRD plan (external technical assistance) 1.5.3.2.2 Country-based staff 1.5.3.3 HRD Training 1.5.3.3.1 Training for patient care, programme management and M&E 1.5.3.3.2 Training for diagnosis 1.5.3.3.3 Training for TB/HIV 1.5.3.3.4 Training for MDR-TB 1.5.3.3.5 Training for PAL 1.5.3.3.6 Training for PPM/ISTC 1.5.3.3.7 Training for community involvement 1.5.3.3.8 Training for civil society-ACSM 1.5.3.3.9 International training /meetings 1.5.3.3.10 Coordination with other programmes and departments 1.5.3.3.11 Other training/meetings 1.5.3.3.12 Other aspects of HRD − To ensure there is enough staff (clinical and managerial) available at all levels to implement the plan without the detriment to other areas of work of the NTP. − To ensure all staff involved in the programme (at all service levels and public or private) are competent (have the required knowledge and skills) and motivated to implement it. Human Resources for Health (HRH) constitute all those persons who make each individual and public health interventions happen. Without sufficient, adequately trained, motivated, skilled and readily available (well distributed) and supported human resources it will not be possible to achieve global TB control targets and the Millennium Development Goals (MDGs). In addition it often limits the capacity of countries to absorb resources from donor agencies. HR development has been seen as synonymous with training. Donors, technical and other partners have put the emphasis on the organization of training courses and on the numbers of trained staff to the detriment of the quality of training and the formulation of SDA1.5.3 Human Resources 32

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