Ram Sharan Gopali (MPH)
Executive Director

Basic Facts of Nepal
Nepal is a landlocked country located in the WHO
Asian region at the edge of the Himalaya
between India and the Peoples Republic of China
Area

147,181
Sq. kmRegion

5Zone

14

District75

Treatment Centre

1140

Sub-treatment

2907

MicroscopeCentre554

Gene-Xpert
Center22

MDR Centre

13

Scenario:2015• Major Public Health Problem• Priority 1 Programme of the Government
Population
 Incidence rate (all TB cases) Prevalence rate (all TB cases) Mortality rate
20/100,000
 TB patients co-infected with HIV
 Proportion of MDR-TB: 27 million: 163 /100,000: 241/ 100,000:

 New cases
 Previously treated cases: 2.2%: 16%



: 2.4%

Who we are…………?
JANTRA is a non-profitable, public service
oriented non-government organization
JANTRA is affiliated with Research Instituteof Tuberculosis/Japan Anti-Tuberculosis
AssociationJANTRA is a member of Nepal TB ControlNetwork

Mission
To franchise in the prevention/control ofTuberculosis, Public Health and Social
Development issues in Nepal.
Areas of Intervention;
 Policy and Advocacy at alllevel Community SystemStrengthening (CSS) Knowledge Management
 Partnership andnetworking(Nationally &Internationally)

Our Steps for………..
• To enhance collaboration between TB patients,NGO’s/CSO’s, Research Institutions,Universities, Government line agencies• To care and support for those who are infected

and affected by TB, for the purpose ofcontrolling and caring all forms of TB (TB, DR,TB/HIV)• To reduce stigma and discrimination relatedwith TB and its co-infection• To improve community health throughinnovative models up to grassroots level byknowing the local contexts

Current ProjectsUrbanTB
Control

TB
REACH
Wave 4

Post
DisasterRecovery
ProjectRIT/JATA

UNOPS/Stop TB
Partnership

UNOPS/StopTBPartnership1. Quality DOTS services is provided for TBpatients
 Innovative DOTS and Sputum

examination (8:00 AM-4/5 PM) Referral, cross-referral and counter

referral from community andprivate sectors

 Operational partnership withpartners and CSO’s

 Capacity building of key

stakeholders (Health care providers
public and private), volunteers,
local administrative authorities

82. Community engagement and theirrole
 Active case finding door to door visit byvolunteers
 monthly meeting for TB
volunteers
 School health program Volunteer Trust Fund
 Referral and cross referral ofpresumptive cases Tracing of loss to follow up TBpatients
 Organize advocacy and social
mobilization
93. Net-working and Social Protection
 Communication and social

mobilization activities for factory
workers and vulnerable groups
 Strengthening coordination &collaboration with partners andsynergy Tangible & intangible support for TB

patients who are in need
 Initiation of TB patients club
 Empowerment of TB patients
 Enhanced understanding on Patient

Character among service
stakeholders and service providers

10

4. Strengthening Urban TB control
 Organizing regular meetingwith stakeholders and partners
 Carrying-out joint supportive
supervision with concerned
stakeholders and immediate
feedback mechanism
 Establishment of Volunteers
Trust fund Support for poor TB patients
who are not eligible in publicsocial protection scheme Logistic management support

11

DOTS service & SPUTUM EXAMINATION(2014/2015)274300

214

250

200

150

110

89

100

50015

Case finding
2067/68 (2010/11)

2068/69 (2011/12)

2070/71 (2013/14)

2071/72 (2014/15)

2069/70 (2012/13)

300

241
238

250

254

201
200

150100500110102947984

7966

655946231411 9 10

2 0 2 1 1

1 3 0 0 0293232
2315221610 10 1237251818

6232

Trend of Treatment Success Rate
100%
90%

17%

9%

15%

19%

80%
70%
60%
50%

Success

FailureDiedDefault

TONR

40%
30%20%10%0%2067/68 (2010/11)

2068/69 (2011/12)

2069/70 (2012/13)

2070/71 (2013/14)

Hotline Consultation
Consultation from Hotline telephone
140

123
120

103
100807866

60

40

200071/072

MaleFemale072/073

Key Q & A of hotline consultation

 Sign and Symptoms ofTuberculosis
 Location of DOTS
Centre Venue of MicroscopicCamps Information aboutdaily DOTS andassurance oftreatment
 Minor side effects
 Clinic opening time

Hotline Consultation

Systematic Screening of target
populations & microscopy camps
 Community-Based;- TB screening/presumptive TB
identification/examination/treatment
enrollment and contact investigation- Awareness raising PPM- Strengthen cross referral mechanism- Refer TB suspects to microscopic campand other laboratories- Collaboration with private laboratory
 Meaningful involvement and mobilizationof health workers (Public and Private andvolunteers)Case finding framework

TB REACH (WAVE 4) Achievement
From July 16, 2014 to November 15,
1100002015

112341

10000090000

MaleFemale

Total

80000
70000
60000

56816
55525

50000
40000
30000

24086

20000
12244
11842

10000

20123
941810705

0
Screening

Presumptive

TB Microscopy

216

208

134 82

129 79Dignosis

Treatment

Post Disaster Recovery Project

Thematic Program Thrust-

Early TB Case finding
Target Beneficiaries-

Internally Displaced Peopleof Kathmandu valley andSindhupalchok district

InterventionooooooMapping of IDP s Camps
Capacity building of Volunteers andkey stakeholders
Presumptive TB Case identification
Sputum sample collection, sputumtransportation & Test by Gene Xpert
Chest Camp
Treatment enrollment and follow upPost Disaster Recovery TB ProgramSep 2015- 20 jan 2016
5730

6000

MaleFemale

Total

5000

3462

4000

3000

2268

2000

1000

221 240

461

143

17

1130

Screening ofIDPs

Gene-Xpert Test

Bac Positive

Treatment
enrollment

14Lesson Learnt …………..


Support from NTP:
 leads to sound implementation ofthe planned activities

Proper Orientation & consistentfollow-up:
 To continue engagement ofstakeholders (sample transportationfrom community to MicroscopyCentre)

Intensive Advocacy Programme:
 More partners are interested tocollaborate (local CBOs showstheir interest for thecollaboration)•

Lesson Learnt………


Highly enthusiastic andcommitted volunteer; Leads to productive andsustainable
programme inthe communityEstablishment of Patients club; Leads to effective contact
tracing and peer education in
the communityConsistent IEC/BCC
Programme:
 To change service seeking
behavior

Supportive Supervision & Result basedmonitoring Result based M&E anddiscussion with NTC

 Regular follow-up andmonitoring from the RHD
and respective project
districts

 Project review andassessment from the TB
REACH & RIT/JATA

Issues to be address;
ooooooSustainability and ownership
Compatibility of TB Program inline with
Sustainable Development Goal.
Factor affecting TB Treatment and its
success; co-morbidity for instancediabetes, malnutrition etc
Funding gap
Logistic, documentation and monitoring.
Research and development ; TB andGender, PPM, Community Engagement,
UHC

Acknowledgements
 National Tuberculosis Centre Research Institute of Tuberculosis/JATA UNOPS/Stop TB Partnership Global Affairs, Canada World Health Organization
 Regional Health Directorate Office District (Public) Health Offices Urban Health Clinics
 Health care Providers (Public & Private) Female Community Health Volunteers

 TB Patients and Family members

Thank you