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Tuberculosis

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Tuberculosis (TB) is one of the top 10 causes of death worldwide. In 2016, 10.4 million people fell ill with TB, and 1.7 million died from the disease. Over 95% of TB deaths occurred in low- and middle-income countries. Pakistan ranks 5th among the top seven high TB burden countries of world which bear 64% of world TB burden.

Greenstars’ Contribution in TB case Notification:

In Pakistan, each minute a healthy individual develop TB disease and after every 12 minutes a person dies with TB disease despite the fact that free TB diagnostics and treatment is available at all public and selected private health facilities all across Pakistan. As per national estimates, 31% of the incident (new and relapse) TB patients are missed from diagnosis/diagnosed but could not start treatment, and /or could not get standardized management under DOTS strategy and remain source of disease spread in community Greenstars’ Contribution in TB case Notification
DIAGNOSIS

HISTORY

Round 3 GFATM

Donor: Global Fund
Theme: PPM DOTS
Timeline: 2005-08
Implementation Zone: 5 metropolitan cities (Lahore, Karachi, Rawalpindi, Quetta, Peshawar)

GSM started its work in TB back in 2005 with “Active Case Detection” strategy in metro cities of the country under the Round 3 Grant. This active case TB detection strategy proved to be a success.

Key Successes
  • 1. GSM detected and managed around 35000 cases of TB by working within community and reaching doorstep of TB patients.
  • 2. Capacity building of 1080 doctors and 49 lab technicians on standard TB treatment in five metropolitan cities of Pakistan.
  • 3. The estimated cost /case detected was around $85.00
  • 4. 90% treatment success.

Round 8 GFATM

Donor: Global Fund
Theme: TB Drug Management and TBDMIS
Timeline: 2009-14
Implementation Zone: Nationwide with 3 implementing partners

Greenstar started Round 8 in 2009 with the goal to reduce morbidity and mortality due to TB in Pakistan and health system strengthening by bridging the gap for TB treatment through pursuing high quality DOTS expansion, and enhancing the capacity of health providers all across Pakistan with support from three Sub Recipients.

Key Successes
  • 1. Development of Drug Management Information System (DMIS).
  • 2. Capacity building of public health facility staff on DMIS all across Pakistan.
  • 3. Drug management training curriculum design and implementation.
  • 4. Drug management trainings all over Pakistan.
  • 5. Case detection.

Round 9 GFATM

Donor: Global Fund
Theme: PPM DOTS
Timeline: 2010-15
Implementation Zone: 22 districts including 5 metropolitan (Lahore, Karachi, Rawalpindi, Quetta, Peshawar)

GSM entered in Round - 9 Grant in 2010 with the vision of “Improving Access to Quality DOTS” i-e implementation of DOTS through PPM and have achieved great outcome with intense dedication across 22 major districts of Pakistan

Key Successes
  • 1. Functional 800 outlets 106 labs
  • 2. Active case detection
    • a. Phase 1 = 10353 new SS+ve
    • b. Phase 2 = 6963 all types

PTP - KPK / Kfw / EPOS

Donor: KfW / EPOS
Theme: Active Case Detection/PPM
Timeline: 2015
Implementation Zone: 6 districts of KP

Key Successes
  • 1. Conducted around 2000 community awareness and engagement sessions
  • 2. Conducted 228 free chest camps for detection of missed TB cases through doorstep screening of TB presumptives

New Funding Model NFM GFATM Grant

Donor: Global Fund
Theme: PPM DOTS
Timeline: 2015-2017
Implementation Zone: 13 districts including metros

DOTS implementation at private health provider (doctor) with provision of free diagnosis and treatment to patients, referral of TB symptomatic from informal providers including pharmacies, community awareness and mobilization events followed by outreach chest camps were the key strategies of NFM Grant

Key Successes
  • 1. Greenstar has successfully completed NFM grant (2015 – 2017) with Global Fund under umbrella of National Program by detecting 51,234 TB cases i-e 102% achievement against the assigned task.

Partners/Donor

Community Perception

  • Doctors’ opinion
  • Patients’ experience
  • Patient treatment supporters’ view
  • Pharmacists’ perspective

Success Story

ACHIEVEMENTS

  1. Collaborating with TB Control Program since 2005
  2. Detected/registered and treated 127,000+ TB patients with treatment success rate of 91%.
  3. Successfully implemented GFATM Round 3, Round 8, Round 9 and New Funding Model projects
  4. Since inception trained around 15,000 health care providers on National TB Guidelines (DOTS Strategy)
  5. Pioneer of Public Private Mix TB interventions through implementation of effective GP Model
  6. Awarded ‘A’ ranking by Global Fund for GFATM Round 8
  7. Developed National TB Drug Management Information System (DMIS) and Ware House Management Information System (WMS) for National TB Control Program (NTP).
  8. Collaborating network of 1300+ providers treating TB patients and 120+ collaborating laboratories for TB case detection and management
  9. In NFM Grant (2015 – 2017) with Global Fund, Greenstar TB Project achieved yet another landmark by registering 51,234 cases (the largest contribution by any private organization). Here GSM is working as Sub recipient (SR) to NTP in 13 highly populated cities of Pakistan; Karachi, Sukkur, Hyderabad, Bahawalpur, Rahim Yar Khan, Muzaffargarh, Bahawalnagar, Lahore, Faisalabad, Sheikhupura, Gujrat, Rawalpindi and Peshawar.

SUCCESS STORY

Greenstar has successfully completed NFM grant under umbrella of National Program by detecting 51,234 TB cases i-e 102% achievement against the assigned task. In addition, Greenstar has conducted more than 4,600 community events including meeting with community influential and Community Gathering meetings, where 122,300 community members were sensitized, mobilized and given awareness about TB disease. GSM also screened 116000 patients and detected around 4000 patients through chest camps who otherwise might not get a chance to get the required treatment and might remain a source of disease transmission among community.

UPCOMINGS

  • Greenstar entering into a new grant (2018-20) with Global Fund for TB Control in Pakistan
  • Sky is the limit - Committed to touch the new horizons
  • Chasing a challenging task of detecting 80,000 TB Cases in 3 years (2018-2020)

  • 1. Expended Geographical coverage to 20 districts across Pakistan, entering Baluchistan and FATA
  • 2. Challenging task of notifying 80,000 missed TB cases, conducting 5400 community events and screening 570,000 presumptive for TB disease.
  • 3. Greenstar will work with network of around 1700 trained doctors and around 165 private laboratories.
  • 4. Management of childhood TB, referral linkages with informal sector and pharmacy engagement for referral of TB presumptive to the DOTS trained facility are initiatives taken to reach and treat missed TB cases