Report of the Asian National Stop TB Partnership Forum 2016
The Stop TB Partnership Japan
The Asia Stop TB Partnership Forum 2016 was held in Tokyo, Japan, on 14 and 15
March, 2016. Following is the summary report of the presentations and discussions in
the Forum meeting.
Main theme
Community people’s roles in End TB Strategy in Asia
Purposes of the ForumTo bring together the delegates of Stop TB Partnerships (or similar
non-governmental organizations, e.g., Anti-Tuberculosis Association)) of
Asian

countries/

territories,

and

to

discussoverthecurrent

non-governmental efforts against tuberculosis, their perspectives into thenear future, with special emphasis on the roles of women, and possibility ofits strengthening, and collaboration between partnerships across borders,aiming at the earlier achievement of End TB Target in Asia.
Expected Outcomes
１． To enhance people’s awareness of the importance of their ownership for andcommitment with the tuberculosis control activities
２． To

promotetheeffective

collaboration

betweengovernmental

andnon-governmental sectors in the fight against tuberculosis
３． To clarify the problems and challenges of tuberculosis control of each country / area
and to develop action plan addressing them with non-governmental efforts
４． To deepen the understanding of the potentiality of women’s efforts in thecommunity activities
５． To advance cooperation between partners of different countries / territories
Date

14 and 15, March, 2016

Venue
United Nations University, Shibuya, Tokyo (14, March)
Research Institute of Tuberculosis, JATA, Kiyose, Tokyo (15, March)1

Participants
A total of 18 participants representing non-governmental organizations of 8
countries / territories were invited (see Appendix 1). In addition, there were 26
observers from various governmental and non-governmental institutions / groups,
including Ministry of Foreign Affairs and JICA.
Agenda and Results
1. Opening and Introduction of Participants and Staff
Chair:

Dr. Toru Mori (Executive Board Representative, Stop TB PartnershipJapan)

2. Lecture 1: 14 March (United Nations University)
Thema:

Women’s Anti-TB Activities in Japan

Lecturer:

Ms. Takeko Yamashita
Secretary

General,Japanese

Councilofwomen’s

Anti-TB

Associations
Abstract (see Appendix 2)
3. Lecture 2: 14 March (United Nations University)
Thema:

Challenges of Current TB Problem to Today’s Asia

Lecturer:Dr. Nobuyuki Nishikiori
Coordinator, Stop TB and Leprosy Elimination, WPRO, WHO

Abstract (see Appendix 3)
4. Courtesy visit and exchange with Japanese Council of Women’s Anti-TB
Associations members, 14 March (Hotel New Otani, the venue of Annual National
Assembly of the Council)
5. Presentation and discussion of activities of Country / Territory partnerships: 14 and
15 March (Research Institute of TB)
Chair:

Dr. Kosuke Okada (Director, International Cooperation, Japan
Anti-TB Association)(See Appendix 4)
6. Group Discussion 1: 15 March (Research Institute of TB)
Thema :

Challenges to NGO’s activities and women’s roles

Moderator: Dr. Nobukatsu Ishikawa (Director, Research Institute of TB, JATA)
2

(See Appendix 5)
7. Group discussion 2 : 15 March (Research Institute of TB)
Thema:

Fund raising plan in the community activities

Moderator: Ms. Jintana Ngamvitayapong-Yanai (TB-HIV Research Foundation,
Thailand)(See Appendix 6)
8. Adoption of the Forum Statement: 15 March (Research Institute of TB)
Chair:

Dr. Toru Mori (Executive Board Representative, Stop TB PartnershipJapan)(See Appendix 7; Tokyo Statement of Asian National Stop TB Partnership Forum2017)
9. Reception: 15 March (Research Institute of TB)
Special Guest: Mr. Kintaro Shibuya, Mayor of Kiyose City

3

4

Appendix 1
List of Participants
CountryName/Territory

Khloeung Phally
Cambodia

Monyrath Chry
Chharvy Ringsey KEO

Indonesia

Mariani Reksoprodjo
Fitriani Manan
Seungjoon Chang

Korea

Kanghee Kim
Hong Jo Choi
Tha Zin Nwe

MyanmarEi Ei Chaw

Affiliation

Deputy Director of National Center for
Tuberculosis and Leprosy Control (CENAT)
Program manager of Cambodia Anti‐Tuberculosis
Association(CATA)
Cambodia Anti‐Tuberculosis Association(CATA)
Head Quarter/ Executive Secretary of Forum StopTB Partnership Indonesia
Board member of Stop TB Partnership Cimahi City
Executive Director of Stop TB Partnership Korea ,Korean National Tuberculosis Association(KNTA)
Chief of Stop TB Partnership Korea,
Korean National Tuberculosis Association(KNTA)
Korean institute of tuberculosis(KIT)
Chairperson of Myanmar Maternal Welfare
Association(MMWA)
State TB Officer of National Tuberculosis Program,Kachin State, Myitkyinar
Country Representative of Japan‐Nepal Health &Nepal

Ram Sharan Gopali

TB Research Association RIT(JANTRA)／JATA Nepal
OfficeJamuna Panthi
Aurora G. Querri
Philippines
Leonardo G. Parungo Jr

Board member of JANTRA
Deputy Executive Director of RIT/JATA,
Philippines, Inc.(RJPI)
Administrative Officer of RIT/JATA, Philippines,
Inc.(RJPI)
Research Assistant of Tuberculosis MDR

Chih‐Yun Lin

Association(TATA)

TaiwanWei‐Wen Chen

Thailand

Department, Chang‐Hua Hospital/Anti‐TB

Luangjina Sarmwai

Chang‐Hua Hospital MDR TB Department/Anti‐TB
Association(TATA)
Secretary of THRF, Member of the Chiang Rai
Volunteer Ladies against TB/
5

Jintana
Ngamvitayapong‐Yanai

President of TB/HIV Research Foundation (THRF)

6

Appendix 2
Abstract of Lecture 2
Beautiful Health: Introduction of Japanese Women’s Anti-TB Association-

OriginThe 30-year history of the Japanese Women’s Fight against TB –The Association (Officially: Council of Japanese Women’s Anti-TB

Associations) dates back to the foundation of the Women’s Committee of Nagano City
in July 1950, when there was an opportunity for the leaders of the women’s associationof Nagano City to have an audience with Princess Chichibu, who was then the Presidentof the Japan Anti-TB Association (JATA). The Princess inspired them to dedicate
themselves to TB control.
The anti-TB movement of Nagano was further stimulated by a tuberculosis(TB) outbreak that occurred in September of the same year. The TB epidemic broke out
in a primary school of a town of Nagano Prefecture. This incident ignited the women’s
activity to eliminate TB from their community and homes.
This movement developed into an organization covering the entire prefectureof Nagano by 1957, the Nagano council of Women’s Anti-TB Association, as the very
first organization of this kind in Japan.
Development The movement to eliminate TB through the wisdom and efforts ofhousewives has been further expanded. It became increasingly active and has beenmaterialized as the All Japan Housewives’ Convention for Healthy Family, and theLeaders’ Seminar of Women’s Anti-TB Association. A poster for Anti-TB Week adopted
the slogan, “The Housewife is a key person in TB prevention.”
In 1975, the National Women’s Anti-TB Association was established. It wasapproved as a corporate juridical person in 1977 and has become the largest women’s
health organization in Japan. In 1996, the Association celebrated its 20th anniversary.
The Association has come a long way, extending activities all over Japan, responding to
the changing time and situation, as the largest women’s health movement in Japan.
During these several decades, deaths due to TB that used to be feared as a
non-curable illness, have decreased drastically. This may be ascribed to the efforts ofrelated organizations and authorities, as well as the activities of the women’s
Association. To disseminate ideas of TB prevention and its motivation, the Association
7

continues its activities at the grass-roots level, as an organization for protecting people’s
health.
Liaison with JATA

The National Assembly of TB Prevention of JATA has been

held every year since 1949. This assembly discusses what to do in the
non-governmental anti-TB activities and how to address their current challenges. The
Women’s Association supports this assembly and is actively involved in planning andimplementing this event. The National Assembly is also the venue for the Women’s
Association to convene for the Annual Convention Meeting and the Annual Board
Meeting to discuss the future agenda of the Association.
National Seminar

The National Seminar of the Women’s Ant-TB Association

was launched in 1997. The seminar provides the opportunity for learning about TB andother related public health issues and also for exchanging information among members.
Having acquired new knowledge and information in the course, the participants became
more aware of the importance of community activities for communication with thepeople.
Local Leader’s Seminar

Such achievements as these could be reflected in thelocal leaders’ seminar in a total of seven areas of Japan, as bases for local associations’guidelines, which in turn will be a source of their community activities.
Advocacy in Community

The Association actively targets the communication

and advocacy activities on TB prevention not only for the family but for the society ingeneral. Public information media such as leaflets and brochures have been developedin order to disseminate the ideas and knowledge of TB prevention to children and adults.
Regarding actions toward local governments, the Association members pay courtesy
visits to governors/mayors to appeal for strengthening the public TB control services.
Such grass-roots activities of women are significant for disseminating knowledge of TB
and for increasing the awareness of the people, and can also help to fill any gaps ingovernmental services.
Fund Raising The Association has been involved in fund raising as a means oftalking about TB prevention directly to the people. In cooperation with the JATA branchof prefectures, the Association runs the double-barred cross-seal campaign forfund-raising all over Japan during the TB Prevention Week, i.e., during the 4th week of
September. Indeed, the women’s activities provide important support for the
double-barred-cross seal campaign. The double-barred-cross seal campaign was
8initiated in the beginning of the 20th century in Denmark as the Christmas Seal
Campaign and now has now become a symbol of TB prevention worldwide. In Japan,
JATA has devoted itself to this program since 1952 with the support of the government
to promote TB control with the support and cooperation of the general public and in
partnership with foreign countries.
The funds raised by this campaign are an important source for supporting
JATA’s activities. The Women’s Association plays the most vital role in this campaign,
contributing about 30% of the total funds raised. The funds thus raised by this campaign
are spent for the various activities of JATA for the sake of people’s health.
International Cooperation: Study TourAn important area of activity

supported by the fund from the campaign is international cooperation. JATA’s
international cooperation includes its unique grass-roots project that is a long-lasting
program with promoting DOTS as its core. The study-tour is a group tour for themembers of the Association who are involved in fund raising to become more aware of
the TB situation of developing countries. The tour is a good opportunity to understandthe significance of the seal campaign vividly and is a source of energy for future activity.
The program of the study tour was launched in 1994, and since then, we have visited TB
project sites, such as Nepal and Myanmar, and we visited Cambodia in 2006.
The Association’s cooperation has been extended to the national anti-TB
associations of developing countries that are faced with various difficulties in TB
control.
TB control takes a long time to bear fruit and needs a solid organizational basis withfinancial assistance. In this context, the seal campaign can be a great help for people ofdeveloping countries, and it proved surely useful.
Publication“Health Circle”is the official journal of the Association intended totransmit the newest knowledge of tuberculosis and public health in general to the
Association members, and to strengthen the partnership among members. The journal
was first published in 1977 and is now issued three times every year (40,000 copies
each). This communication paper is distributed not only to the Association members,
but also widely to related organizations throughout Japan, such as JATA branches; theMinistry of Health, Labour and Welfare; and Prefectural and Local governments andPublic Health Centers to broadly report the activities of the Women’s Association.
The Way Forward

Thirty years have passed since the foundation of the9Association as a corporate juridical person. Its contribution to TB control in Japan has
been indispensable. However, TB still has not been eliminated. The emergence ofmultidrug-resistant TB, the upsurge of TB among elderly persons and urban youngsters-- -- -- all these issues are complicating the TB problem, and we should address themproperly. Also, we need to address the increasing life-style related illnesses and newly
emerging respiratory diseases.
Globally, over 1.5 million people lose their lives due to TB every year. In order tocontribute to the worldwide fight against TB, the Association joined the Stop TB
Partnership Japan. The Women’s Anti-TB Association is steadily endeavoring to achieve
its purpose. Its current slogan is: health management throughout the life of the people
through promoting control of TB and life-style related illnesses so that people can enjoy
a happy and healthy life. This slogan was adopted in the 58th National Anti-TB
Assembly. Thus, the women are determined to lead the national movement for thepeople to maintain their own health.

10

Appendix 3
Presentation of Dr Nishikiori“Challenges of Current TB Problem to Today’s Asia”
Regional Framework for Action
on Implementation of the End TB Strategy
in the Western Pacific Region
The Asian National Stop TB Partnership Forum,
14–15 March 2016, Tokyo, JapanDr Nobu Nishikiori, Coordinator
Stop TB and Leprosy Elimination
World Health Organization
Regional Office for the Western PacificWorld Health Organization Regional Office for the Western PacificSurpassing MDGs and other targets
in the Western Pacific Region

MDG6 TB target achieved
REVERSED

43 million
lives saved
between 2000
and 2014

Rate per 100,000 population

TB

47%

Mortality

Incidence

TargetFalling 1.5% per year
(2000-2014).
18% drop since 2000

47% decline since 1990

1990

2000

2014

1990

2000

2014

But huge burden of deaths and suffering remains.
9.6 million people fell ill with TB in 2014, and there were 1.5 million deaths
World Health Organization Regional Office for the Western Pacific

TB burden in the Western Pacific Region

Challenges
1. Many patients unreached2.

Insensitive diagnostics

3. Vulnerable and high-risk groups
4. Only a small fraction of MDR-TB
Estimate number of TB (allforms)

patients diagnosed, yet treatment

1.6 million(85 per 100 000)

capacity insufficient

88 000Estimated number ofdeaths due to TB*(4.8 per 100 000)

Multidrug-resistant TB

71 000HIV-associated TB

31 0005. Limitations in health systems
All estimates are for 2014.
Source: Global TB Report 2015 (WHO)* Excluding death due to TB-HIV co-infection

World Health Organization Regional Office for the Western PacificWorld Health Organization Regional Office for the Western PacificIncreasing difficulty in TB diagnosis

Need for more sensitive diagnostics

All cases identified by prevalence survey
More sensitive diagnogostics
Sm‐ve TB
(culture +ve)
54%

Sm‐ve TB
(culture +ve)
16%

LED Microscopy
10,000/ml
Line-probe assay
10,000/ml

LAMP
50-150/ml

Sm+ve TB
16%

Sm+ve TB
14%

XPERT MTB/Rif
50-150/ml
Liquid culture
10-100/ml

Cases (additionally)
identified
by X‐rayCases identified
by symptom
screening“Smear-negative”

1

10(Data from The Second National TB Prevalence Survey, Cambodia, 2011)

100

1000

“Smear-positive”

10000

1000001M

CFU (colony forming unit ) per ml

World Health Organization Regional Office for the Western PacificWorld Health Organization Regional Office for the Western Pacific

MDR-TB diagnosis, enrolment vs estimatedin the Western Pacific Region

Financial hardship of TB patients and families~ losing a half of annual income ~71,00070,000•

TB patients in low-and middle-income countries faceexpense equivalent to more than 50% of their annual
income.

71 000
MDR-TB
cases
annually

60,00050,000•A half of the costs are incurred before TB treatment•

Patients often have to resort to coping mechanismsthat may be irreversible:

40,000–––

up to 75% of TB patients must take out a loan;
up to 50% sell household items; andup to 66% rely on financial support from relatives.

Number of MDR/RR-TB cases diagnosed andnotified

30,000Distribution of medical expenditures, other expendituresand income loss, before and during TB treatment *20,000Addressing catastrophic patient cost is prerequisite
for further advancing TB control

1,190

o

o

•

Public procurement sufficient for all
notified TB case(Blue bar and line)
Private sector drug sales are almost
equivalent to the notified TB cases(Red bar)

2008

2009

2010

Five times more drugs for initial
treatment relative to drugs for continuous
phase

Reflecting:oooA weak notification system
Incomplete treatment in the private sector
Unnecessary patient costs

500 000

2012

2013

External funds

2014

Enrolled

Estimated

Rich countries

Investment
Private sector drug sales*

600 000

2011

World Health Organization Regional Office for the Western Pacific

700 000
Drug procumenet/sales volume(equivalent to a number of pa ents could be treated)

o

8,850

3,773

TB drugs in the private sector market
Growing evidence on a hugeprivate sector drug market

10,263

6,412
2,057

0

World Health Organization Regional Office for the Western Pacific•

Only 12%enrolled

13,437
8,725

10,000•National
Programmes

Procurement by Na onal TB
Programme
TB cases no fied (1‐year
offset)••••Provincial/District
Programmes

Large external funds
Delivery of proven interventions
Quick & measurable health gain
Help poor countries get out of the vicious cycle temporal large investment justified

400 000

Interventions
Services

300 000

Health Centres

Consequences• Fixed unilateral aid flow, power imbalance and donor
fatigue• Too much focus on performance in narrow agenda,
less on process and the net social benefit• Inequitable distribution of services within the healthsystem200 000

100 000

0
2007

2008

2009

2010

2011

* Private sales was translated as a number of patients could have been initiated intensive phase of treatment
with 4 fixed-dose combination tablets.
(Islam, T. Tisocki, K. et al. Public Health Action 3, 337–341 (2013).)World Health Organization Regional Office for the Western Pacific

Health outcomes
Health development model in the MDG era

Global commitment to End TB
Moving from halting TB to ending TB by 2030

The End TB Strategy

SDG 3.3 “End the epidemics of AIDS, tuberculosis, malaria andneglected tropical Diseases”

Draft Regional Framework for Action

World Health Organization Regional Office for the Western Pacific

Health development modelin the context of Sustainable Development
Universal Health Coverage
Health system capacity• Quality & safety• Efficiency• Equity• Accountability• Sustainability and resilience

Funds
Revenue

Governance
For Health(Resources forhealth)Health policies,
system & services
Efficient and coherent service
deliverySustainable
development andgrowthHealthgovernanceVision:A world free of TB
Health outcomes

Non‐health sector
policies & actions

Disease control in the SDG era• Disease control efforts:—should support system building—should be supported by bold
systems• System efficiency, equity andsustainability• Strong governance• Multisectoral engagement

Projected acceleration of TB incidence decline to target
levelsCurrent global trend: ‐2%/year

Optimize current tools,
pursue universal healthcoverage and social
protection

Average‐10%/yearby 2025

Introduce new tools: a vaccine, a
new prophylaxis & treatment
regimen, a PoC test

GLOBAL TB
PROGRAMME

Vision, goal, targets, milestones‐5%/year
Average‐17%/year

Zero TB deaths,
Zero TB disease, and Zero
TB suffering

Goal:
End the Global TB
epidemic

The End TB Strategy:

3 pillars and 4 principles

Regional Framework for Action
on Implementation of the End TB Strategy
Purpose• Facilitate the adaptation and implementation of the
End TB Strategy
Structure and contents• Follow the same three-pillar structurewith 7 components• Each component composed of:– Strategy– Regional situation– Proposed actions•

Region specific issues:

Regional Framework for Action
Pillar 1: Integrated, people-centredcare and prevention

Pillar 2: Bold policies and supportive
systems

1. Treatment and care for all TB
patients

1. Governance and stewardship••••• MDR-TB• TB among children• High-risk populations (enhancing contact
investigation)• TB/HIV• Co-morbidities

2. Engagement of public and private
providers
3. Addressing social determinants andsocial protection

2. TB laboratory networks
3. Latent TB infection and BCG
vaccination
Regional Framework for
the End TB Strategy– High risk groups, opportunities for social protection, urban TB
control, co-morbidity management

NSP and TB control financing
UHC policy and TB control
Drug regulatory systems
Disease notification and surveillance systems

Pillar 3: Research– Enhancing TB research capacity

Endorsed by Member States in 66th RCM in Oct 2015
World Health Organization Regional Office for the Western PacificWorld Health Organization Regional Office for the Western PacificParadigm shift in TB control

Attributes highlighted and elaborated• Paradigm shift in TB control• Apply health system strategies and concepts• Covering the whole epidemiological spectrum

Elimination ofcatastrophic costs /Harmonization with UHC
schemes

Gradual expansion toadditional services(e.g. radiography)
Free diagnosis anddrugs(in‐kind provision)

Supportive
supervision andcommunity‐based
support• People-centred care

Patient‐centred care

Examples:• “free diagnosis & treatment”
 UHC & social protection• DOT  Patient-centred care

Supervised
drug intake

World Health Organization Regional Office for the Western Pacific

Key areas elaborated

World Health Organization Regional Office for the Western Pacific

Changes in TB incidence between 1994-2013• People centered care  Principle• Social protection floor– ILO Recommendation R202

• Social determinants– HiAP & Urban TB control

500
200

HKG

100

MAC
SGP

JPN

NZL
AUS

100

1000

10000
Estimated incidence (n umber)World Health Organization Regional Office for the Western Pacific

CHN

KOR
MYS

50

BRN

20

– WPRO’s policy framework on sustainable financing
for priority health programmes

Estimated incidene rate (per 100 000)– Link with ageing societies• TB care financing in the context of UHC

PHL
VNM

10

• Co-morbidity management

KHM
LAO
MNG PNG

5– WPRO/SEARO 2007 Policy Document

1000001000000
Estimates from Global TB Database

World Health Organization Regional Office for the Western PacificEvolution of the TB control components
along with an epidemiological spectrum
High burden

Low incidence

Pre-elimination

Three tiers of actions

Elimination

Spectrum of TB epidemiology
High burden

Pillar 1. Quality TB services
e.g. Basic / resource constraint 

Low incidence

Pre-elimination

Comprehensive / fully satisfy the standards of caree.g. Contact investigation: Facility-based  home-based  active epi. investigation
e.g. LTBI: PLHIV/Childhood contacts Progressive actions towards elimination

Expansion to other high risk groups

Pillar 2. Bold support systems (vertical/top-down  sustainable & integrated)
e.g. Surveillance: Basic system 

Universally applicable actions for all settings

Electronic / case-based system
Link with lab. info system  gene/molecular surveillancee.g. Social protection: enablers  income compensation  comprehensive health-welfare link

Setting specific considerations (e.g. Pacific islands, urban areas)* Only selected components are shown for the illustrative purpose.
World Health Organization Regional Office for the Western PacificWorld Health Organization Regional Office for the Western Pacific

TB control asa global public good for healthA vision beyond DOT:
People-centred health care

• Public goods—e.g. safe drinking water, clean air, etc.
• TB control has been regarded as a classic example of“a public good for health”– TB control in one setting will benefit everybody– Collective (global/regional) TB control is impacted by the level of control
achieved in the worst national TB program(the weak link characteristics)• This principle is a key for continued advocacy for sustainablepublic financing as well as cross-country collaboration• Health care that is organized aroundpatients, families and communities

Action domains• Responding holistic needs ofpatients, rather than the needs ofprogrammes or systems

2. Competent and responsive healthworkers– Medical, psychological, social, andfinancial– Strong service coordination

1. Informed and empowered patients,
families and communities

3. Efficient and humane health careorganizations
4. Supportive health systems

Smith R., Beaglehole R., Woodward D., Drager N. (ed.) Global Public Goods for
Health: health economics and public health perspectives.
World Health Organization Regional Office for the Western PacificWorld Health Organization Regional Office for the Western PacificPeople-centred TB care

Summary

Engagement &Partnership

Community
FamilyRisk group
BCG & LTBI

SocialdeterminantsSocial protection
Patient

Infected and become sick

Treatment and careCommunity
healthworkers
Health careorganizations

Laboratory network

Community
healthworkers

HealthWorkers

Health system
capacity• Substantial achievement in TB control globally• Remaining and emerging challenges– TB among high-risk and vulnerable populations– Scaling up response to drug-resistant TB– Building sustainable TB control system while contributing to the overall
health system strengthening efforts• The End TB Strategy and its Regional Framework opened up
new era of TB control– From a vertical programme to “an essential health system competency”– People-centeredness as a core principle– All countries to be aligned and cooperate for regional/global TB control

Treatment and care for all

Governance and stewardshipWorld Health Organization Regional Office for the Western PacificWorld Health Organization Regional Office for the Western PacificThank you!

World Health Organization Regional Office for the Western PacificAppeendix 4
Counntry Presentations
1. E
Epidemiologgical Data (Cited from WHO: Gloobal TB Rep
port 2015, a nd others)

12

13

14

15

16

17

Presentation and discussion ofactivities of partnerships

Cambodia Anti-TB Association
Cambodia

About CATA (1)1. Background:
Cambodia Anti-Tuberculosis Association(CATA), a
local NGO established in 2003, as a TB professional
association of individual and institution committed tocontribute to the fight against TB in Cambodia.
2. Vision:
Make Cambodia free from TB and Lung Disease.

About CATA (2)Asian National Stop TB Partnership Forum"Community people’s roles in End TB
Strategy in Asia”
United Nation University, Tokyo, Japan
14 and 15 March, 2016
Dr. Khloeung Phally
Mr. Chry Monyrath

3. Mission
Coordinate and advocate for TB free Cambodia and ensuresocial and community enabling environment through: Promoting the institution and the individual to involve in
Stop/End TB strategy
 Information sharing, research and capacity building Promoting the quality of effective prevention, early detection
and treatment of Tuberculosis and Lung disease Strengthening the effective enforcement of relevant laws,
policies and guidelines.

TB Burden in Cambodia• Cambodia is still one of the 22 HBC with TB in theworld• Incidence rate of TB all forms in 2014 is 390/100,000*.
• Prevalence rate of TB all forms in 2014 is668/100,000*.
• Prevalence rate of Sm+ for age 15 and over in 2011 is272/100,000.
• Death rate 58/100,000*

About CATA (3)4. GoalStrengthening the coverage and quality of TB services
by increasing commitment of the institution and theindividual and promoting the social and community
environment.

* Global report 20151

Current Projects
Project NameCoverage Area

Public-Private Mix-DOT in
Factory (work place)
Active Case Finding
among Elderly and other
Vulnerable Communities

14 Factories, Phnom Penh
12 Operational Districts in 8
Provinces.

TB Control in Factory (2)2. Current Methods:• Trained peers to conduct peer contact activities.
• Conduct follow up (FU) meetings with peers• Refer suspected TB case from factory to public healthcenter• Implement DOT in factories ( work place)

TB Control in Factory (3)3. Results:• 14 garment factories were implemented.
• 11,553 workers were contacted by peer educators( 11 months ).
• 12 sessions of FU were conducted• 108 TB suspects referred to HC (11mths).
• 10 TB cases registered (5s+, 4s- and 1EP) for
treatment by DOT in factory (11 months).

TB Control in Factory (1)1. Background:• Factories, the poor ventilated settings where thousandsof workers work and share room air are at high risk for
TB• Patients with TB symptoms may receive symptomatic
treatment at the factories as factory clinics support only
primary health care, leading to diagnostic delay.
• Untreated, some one with chronic TB may face being
dismissed from employment due to frequent
absenteeism , and bring additional hardship to thevulnerable family.

TB Control in Factory (4)4. Cases notified by TB types/years
EP
BKBK+

25

5
20

6

15

12

7
10

5

1
0

5

2
2

9

6

4
4

4

5

3

3

9

9

3
3

7

7

5

0

2007 2008 2009 2010 2011 2012 2013 2014

2

TB Control in Factory (5)Active Case Finding (2)5. Lesson Learnt:• Lack of awareness raising activity, the discrimination
among workers might be not reduced leading to lessnumber of referral• Limited budget for FU meeting with Peers is the causeof less peers’ activity.
• TB patients can work regularly during the course oftreatment( in the exception of 1st month therapy ofsmear positive cases).
• In congregated settings, one case treated can prevent
hundreds of co-workers from TB

2. Methods:• Active case finding using mobile teams equipped with a chest xray (CXR) and Xpert machine in 12 Operational Districts.
• 1 to 2 weeks before field operation, each health centre wasvisited for one day by the team:- Volunteers performed door to door symptom screening
prior to CXR screening day.
- TB suspects with a positive CXR were then tested by
Xpert MTB/RIF assay- TB cases were registered and put on treatment• Elderly were primarily targeted.
• Project yield and TB notification data were analysed to assess
impact on treatment initiation.

Active Case Finding (3)3. Results (1):Year 1 (2014)
Indicators

Achieved
Target%Annual Planned
TargetAchieved
Target%1) #of people screened

113735

68846

61%

57810

56996

99%

(2) #of TB suspects

21840

11995

55%

16830

16043

95%

(3) #of people tested by TB X
ray.

18055

11650

65%

15810

12147

77%

(4) #of TB suspects tested byGene Xperts.

3276

2520

77%

3478

2084

60%

(5) #of people confirmed as SS+/B+ (yield SS+/B+)

663

397

60%

557

334

60%

(6) #of people confirmed as TB
all forms (yield all forms)

1243

1064

86%

1265

1094

86%

Active Case Finding (1)Active Case Finding (4)1. Backgrounds:

3. Results (2):

•

•
•
•
•

TB burden in Cambodia has decreased by > 50% by
end 2015 compared to 1990 data.
• Cambodia still one of the highest TB prevalence in theworld- Prevalence all form : 668 cases/100,000 population- Prevalence survey in 2011, TB burden in elderly is≥3time higher than the general population.
- Prevalence/Notification ratio in >55 years = 1.5• Hypothesis: poor access to TB diagnosis and treatment

Year 2 (2015)

Annual Planned
Target12 operational districts visited.
193 health facilities visited.
23,797 individuals screened by CXR.
4,604 (19.0%) individuals were tested using the Xpert
MTB/RIF assay,• Resulting in the detection of 731 (16%) MTB-positive
patients.
• Total cases : 2158 (MTB positive + others)3Active Case Finding (4)3. Results (3):New bacteriologically-positive notifications
increased +119.2% for all ages and +262.7% for those ≥55 years
during the ACF quarters compared to trend expected notifications.
Changes in new Bac+ and All Forms of TB treatment initiation and reporting in 4 Operational Districts of Year 1
Trend
ActualExpected
Additional
Additional
Patients Detected Intervention
Intervention
Notifications(Project Yield)
Quarter
Notifications
Quarterto Yield Ratio
Notifications
Notifications
New Bac+, All Ages
319
399
182
217 (+119.2%)
68.00%
Ang Roka
58
24
34 (+141.7%)
97.10%
35
Battambong
68
115
56
59 (+105.4%)
86.80%
110
Kong Pisey
105
45
60 (+133.3%)
54.50%
106
Sampovmeas
121
57
64 (+112.3%)
60.40%
243
67
176 (+262.7%)
76.20%New Bac+, ≥55 Years
231
Ang Roka
34
8
26 (+325.0%)
89.70%
29
Battambong
62
61
13
48 (+369.2%)
66.70%
Kong Pisey
68
71
24
47 (+195.8%)
69.10%
62
Sampovmeas
77
22
55 (+250.0%)88.70%
1,232
653
579 (+88.7%)
73.10%All Forms of TB, All Ages
893
Ang Roka152
68
84 (+122.4%)
69.40%
98
Battambong
445
196
249 (+126.6%)
85.20%
230
Kong Pisey
318
344
245
99 (+40.3%)
77.00%
247
Sampovmeas291
143
148 (+103.6%)
57.90%

Active Case Finding (6)4. Lesson Learnt (2):• The conditions to replicate and expand the successful
strategy are:
– The combination of the team 1 and team 2 to work
together for:• Increasing the number screened by CXR,
• Saving fuel needed to supply 2 generators that
operated separately.
• Minimizing interruption of the operation due to unsafe
power supply.
– Procure a set of new CR machine to avoid interruption
due to Prima console system error or broken.

Active Case Finding (4)Active Case Finding (7)3. Results (4):NTP notifications in intervention period compared to

4. Lesson Learnt (3):• The strategy used is likely appropriate for ACF but there aresome constraints factors as following:– Road conditions are bad due to rainy season, causing
difficulty to reach the HCs, leading to implementation timeis short.
– Elderly need to look after their grandchildren at home andsometime cannot come to HCs.
• The project screens/tests a lot of patients per day for a long
period of time, so it may cause to damage the material. To
avoid that and ensure the project run smoothly, CATA seeksfund to buy new equipment especially CR and X-ray
machine for security.

expected notifications based on 3 year trend:New Bac+ notifications
were +54.0% and +109.2% higher than expected for all ages and ≥55
years respectively.
New Bacteriologically‐positive TB Notifications by Age Group400
350

TB Patients Treated

300
250
200
150
100
50
0

TB Patients Treated, All Ages

Pre‐Intervention Trend

TB Patients Treated, ≥55 Years

Trend Expected TB Patients Treated

Active Case Finding (5)4. Lesson Learnt (1):• The factors contributing to the success are the involvementfrom stakeholders and the trust to the project for its newtechnology, and quick diagnosis.
• The conditions for success to be continued are:1)
proper maintenance of all equipment to avoid being broken
during implementation,2) well calculation and implementation of project’s resources
supplied and demand3) continue providing transport cost to the poor and those
who live far away from HCs, and;4)
The use of communication skills and incentive provided toall stakeholders for better involvement is still key factors for
success.

Active Case Finding (8)5. Conclusion:• ACF using mobile teams was able to increase access
to TB diagnosis, especially the elderly people.
• Compare to baseline data, the intervention can detectand treat many patients who previously missed routine
TB services.
• We recommend to consider targeted ACF interventionsin other settings where access to diagnosis andtreatment is limited.

4

5

29/04/2016...Indonesia...

Presentation and discussion ofactivities of partnerships

Indonesia is the biggest archipelago in the worldthat consist of 17,000 islands.
It also comprises administratively of :
 34 Provinces-416 districts and 98 cities-7,094

Forum Stop TB Partnership Indonesia

subdistrics-8,412 hamlets and 74,093 villages

Indonesia...Indonesia...

presented during“THE ASIAN NATIONAL
STOP TB PARTNERSHIP FORUM”,
14 and 15 March 2016,
Tokyo, Japan
prepared by:

Drg Mariani Reksoprodjo & Dr Fitriani Manan

Indonesia

Area : 1,913,578.68
Population :254,826,034

Current result :Stop TB Partnership is only available in :
 1 city in west java province 1 city and 2 districts in east java province 4 districts in south Sulawesi Province
Based on those data, it is significantly obviousthat “our homeworks” remain so many toaccomplish.

Systematic Presentation

1. Name and Legal Corporate Status
2. Short History
3. Relationship with Other Organizations
4. Members:

Membership, Current Members

1

29/04/2016...Systematic ...

5. Purposes
6. Activities
7.

Current Challenges... History...

Name and Legal Corporate Status

Name:

FORUM STOP TB PARTNERSHIPINDONESIA (FSTPI)

Status:Meanwhile, it remains temporarily as a Forum.
Chairman of FSTPI is attempting to make the
FSTPI a legal organization and formallyregistered to the Ministry of Legal and Human
Rights, Republic of Indonesia•

Address of Secretariat:

Phone / Fax:
Website:Twitter:
Facebook:

Jalan Sultan Iskandar Muda No. 66A
Kebayoran Lama Utara
Jakarta Selatan
DKI Jakarta, Indonesia+62 21 739 74 94
www.stoptbindonesia.org@StopTBIndonesia
StopTBIndonesia• 3 -4 March 2014:

Host for The 2nd Forum of National Stop TB
Partnership in South-East Asia, West
Pacific and East Mediterranian Region
This meeting was attended by 13
out of 14 invited countries(Myanmar regretted to come) and they
were:

Short History••

30 May 2013:

October 2013:

FSTPI was officially established andlaunched in Jakarta.
This is a partnership groupconsisting of diverse organizations
and individuals who have similarcommitment in dealing with TB
problems... History...



SEA:

India, Bangladesh, Thailand
Nepal and Indonesia



WP:

China, Philippines, Cambodia,
Vietnam, South-Korea and JapanEM:

Pakistan and Afghanistan

Operational Guideline on FSTPI was
published2

29/04/2016

5.

MEMBERSHIP,
CURRENT NUMBER

6.

Government Group• Ministry of Health• Coordinating Ministry of Human
Development and Culture• Ministry of Legal and Human Rights• Ministry of Defense• Ministry of Manpower andTransmigration• Centre of Health of National Army
• Centre of Medical and Health of Police
Department

2. State Owned and Private Companies Group• BPJS (Universal Health Coverage) of
Manpower• BPJS (Universal Health Coverage) ofHealth• Indonesian Entrepreneurs Association
3. Development Partners Group• WHO Indonesia• USAID• DFAT• KNCV• FHI 360
4.

Health Service Group• Indonesian Hospital Association• Indonesian Primary HealthCare Facilities and Clinics
Association

Based on the List of FSTPI members at central level,
there are 54 members that consist of:1.

Professional Organizations• Indonesian Medical Doctor Association• Indonesian Internist Association• Indonesian Lung Doctor Association• Indonesian Pediatric Association• Indonesian Public Health Educators
Association• Indonesian National Nurses Association• Indonesian Pharmacists Association• Indonesian Midwives Association• Indonesian Blood Transfusion Technician
Association• Indonesian Medical Laboratory Technology
Expert Association• Gunung Sahari Clinical Laboratory
7.

Academician Group• Faculty of Public Health, University of Indonesia

8.

University Students Group• Asian Medical Students Association (AMSA Indonesia)• Centre for Indonesian Medical Students Activities(CIMSA)• Students Executive Board of Facultiy of Public Health,
University of Indonesia

PURPOSES The main goal is to contribute in supporting thegovernment on TB control

 The Forum is expected to be able to assist in
overcoming the burden of national TB problem.

 In TB control, it will be difficult to do it if each groupexercises it without good cooperation and coordination,
as it can lead to the less optimal result.

CSO Group• 9 CBO• 7 FBO3

29/04/2016

Activities
1. Quarterly plenary meeting
2. Facilitated meeting for developing national strategicplan on TB

3. Facilitated PHO/DHO/CSO to establish the forum StopTB Partnership

4. Upload any news related TB / FSTPI into website
5. Share information to all of members (from Union, WHO,
Global Stop TB Partnership)

4. Only around 30% of hospitals that have conducted Hospital
DOTS Linkage.
5. Very limited budget allocated for TB Control from central andlocal governments.
6. Inappropriate TB facilities
7. Lack of understanding of community on TB...Activities...

6. Will Establish 5 working group in the forum :• Public communication• Advocacy• Community• Health service• Resource Mobilization

1. High Incident Rate and Prevalence Rate in Indonesia(based on the result of survey of 2013-2014)• Incidence Rate: 403 / 100,000 population• Prevalence Rate: 660 / 100,000 population
Total Population in Indonesia:+ 250 million

2. TB-related Issues:• The quality of DOTS should be improved• TB – MDR• TB-HIV• TB-DM• TB-with bad smoking habit
3. a.
b.

Recording and Reporting System for private
physician are notyet formulated
ISTC is not yet fully functioning4

29/04/2016

52016-04-29

Presentation and discussion of activitiesof partnerships<History of Korean TB situation>

Stop TB Partnership Korea
Korea(Kim and Yim, 2015)

Name and legal corporate status

INTRODUCTION OF
STOP TB PARTNERSHIP KOREA• Name : STOP-TB Partnership Korea(STBK)• Legal corporate Status : None
- Secretariat of STBK was installed under Korean National
TB Association in 2009

Hongjo Choi, MD. PhD(KNTA, KIT)

Short history

Table of Contents<Progress>
2008. 3 : Announcement of establishment / operation plan of the STOP-TB Partnership

1. Name and legal corporate status

KOREA by the Ministry of Health and Welfare and Korean Center for Disease Control

2. Short history

2009. 6 : Establishment of the STBK's Secretariat under Korean National Tuberculosis

3. Relationship with other organizations

2010. 3 : Formal registration as the national cooperation partner of WHO Stop TB

4. Members: Membership, Current number
5. Purposes
6. Activities
7. Current challenges

Association
Partnership2010. 12 : STBK inaugurated with 19 partners(Chairperson : Sook Mi Son, , Member of National Assembly)

2012. 11 : Hold 1st forum of national to stop western pacific & south-east asia regions
2015. 9 : Appointment 2nd chairperson, Myung Yeon Kim, Member of National Assembly2016. 3 : 44 organizations and almost 60,000 individual partner take part in1

2016-04-29

Members: Membership, Current number

Relationship with other organizations<STBK Organization Chart>
Government

STBK
Cooperation
Committee

국회의원

국회의원

국회의원

국회의원

김광림

김명연

김무성

문정림

국회의원

국회의원

국회의원

국회의원

이자스민

김용익

유기준

이만우

국회의원

국회의원

나경원

신상진

STBK
Advisory Committee(Working Group)

National
Assembly

Academic &Expert Group

Civil Societies

KOREA

Anti -TB
Organizations& Hospitals

Business GroupInternational
Organizations
PublicRelationship with other organizations<Business Implementation System>

Purposes• TB prevention education and support for the vulnerable,
particularly, migrants and homeless people• Development and promotion of tuberculosis elimination
projects among underdeveloped countries and exchange
programs for global & National STOP-TB Partnership• Establishment of cooperative system to raise social
awareness and participation into the domestic and global
plan to stop TB.

Members: Membership, Current number

Activities<Advocacy>

Secretariat(4 staff)

Cooperation Committee(44 representativesof partner organizations)

STBK
Advisory Committee(36 expert s & person in
charge of partner organizations)

TV Documentary production for
Improving TB AwarenessA commemorative eventon the “World TB day”

2

2016-04-29

Activities<Advocacy>

Policy forum to support
efficient TB patient care

<Pilot programs to support homeless TB patients>

Monthly webzine publicationand e-mail service

Activities<Advocacy>

Appoint the representatives of 12
national communities as foreign
TB honorary ambassador

Activities<Education>

Production of various IEC materials

Health lecture for TB high risk groupsuch as the immigrants, homeless

Activities<Support for The Vulnerable population>

Providing free TB X-ray
screening joint with TB related
partners during multicultural
festival for the immigrants

Providing treatment expense
for MDR-TB Patients

STOP-TB Camp for youth

Activities<International Cooperation>

Project for Korea-Mongolia Anti-TB
Collaboration in Ulaanbaatar

1st forum of national to stop TB western
pacific & south-east Asia regions

3

2016-04-29

Current challenges• Development and vitalization of various tuberculosis eradication
activities joint with partners to support NTP• Improvement of sustainability STOP-TB Partnership Korea
through developing unique fundraising method besides
government aid• Participating in active international tuberculosis eradication
movement through the reinforcement of global cooperation
capability by developing specific cooperation project andreinforcing link with other national partnership44/29/2016

This presentation includes;

Presentation and discussion ofactivities of partnerships

 Brief information about MMCWA
 MMCWA’s participation in community based TB care activities

Self-reliance Approach

MYANMAR MATERNAL AND
CHILD WELFARE ASSOCIATION
Myanmar4

Target areas
Methodology
 Achievements
Project Approach- CBTBC Project in collaboration with
National TB Program(NTP) and Global Fund(Round-9)
Target areas
Methodology
Achievements and challenges

Profile of MMCWA
Myanmar Maternal and Child Welfare
Association
Established since 30th April 1991
(according to law No: 21/90 – November 9th, 1990)
Non-profit Voluntary Organization
5

5

Mission Statement

Acitvities on Prevention and Control Measures of TB
byMYANMAR MATERNAL AND CHILD WELFARE ASSOCIATIONThe Myanmar Maternal and Child Welfare
Association is a voluntary organization dedicatedto serve the Myanmar Society in promoting thehealth and well-being of mothers and children

14-15th Mach,2016
Tokyo, Japan

with the aim to improve the quality of life of the

Daw Thazin Nwe
President
MMCWA

people.
661

4/29/2016

Objective
To carry out activities related to development ofhealth, education, economic and social aspects ofbeneficiaries with priority to the grassroots level
residing in wards and villages.

Health Activities

10

7

Provision of Community based health care services

MMCWA Organizational Structure
Central Council

Central Executive Committee

Health Education

Programme for Congenital DefectPrevention and Control ofCommunicable diseases

Eye Care Activities

Programme for Chronic
Non-communicable diseases

State and Regional, NPT Council Area Supervisory Committees(15)Safe motherhood programmeDistrict Supervisory Committees(72)8Members of MMCWA- > 12millions

Programme for Traditional
Medicine

Immuization programme

Capacity Building Programme

11

Prevention and control of communicable diseases(HIV/AIDS, Malaria, TB, Leprosy, other infectious d/s..)

MMCWA activities in line with its objectives

Health Education- IEC dissemination- Mass Media- Community health talks- Outreach round table talks
 Early Case Detection
 Referral Support for care and treatment

1. Health Activities
2. Educational Activities
3. Economic Activities
4. Social Activities

9

Anti Tobacco activities

Nutrition Progamme
Township Associations ( 330 )Branch Associations (Wards/Villages) (22063)

Environmental Health

9

12

2

4/29/2016

Formal Education◌ၤ

Educational Activities

Stationary Support to needy students

School Enrollment Week-Community
Mobilization

13

Educational activities

Non-formal Education

1. Early Childhood Development Centre (ECCD)
2. Participation in mobilization for School enrollment
week
3. Stationeries, Uniforms and Financial Assistance forFormal Education
4. Adult Literacy
5. Evening classes

3-R Classes
14

17

Early Childhood Care and Development (ECCD)
Activities
Establishing holistic development

Continuous Learning Initiative
for Adult Literacy

Libraries – 12873 numbers
Community learning Centre – 3260 numbers

from transition period of the children
Creating opportunities for income
generation for mothers
Provision of parenting education
Pre-school Teacher training
In 2014,
Number of Pre-school - 730
Children (male) - 12349(female) - 15317
Number of Day Nursery 39
Children (male) ( female) -

574
738

Provided Books to Libraries

34/29/2016

Economic Activities

19

Social Activities

22

Income Generation Programme
1.
2.
3.
4.

Provision of vocational training courses(VCT) on sewing, knitting,cooking etc.
Micro-credit small loan scheme
Financial assistance for small household farming, agriculture andsmall scale home industries
Finding Job Opportunities

Social activities
 Elderly Care Program ( Home based care services for physical & psychosocial

well-being) Bringing social support to orphanages and vulnerable group
 Maxillofacial correction to promote self esteemed for cleft children
 Promoting and assisting civic duty and cultural heritage for future generation
 Risk management and rapid response in time of disaster20

23

Micro-credit small loan scheme

MMCWA participation in Elderly Care Activities
Approaches
1.

Training on Embroidering
Tapestry

Self reliance Approach-by MMCWA (Central)/State & Regional /Township
MCWA supervisory committees

2. Project Approach(MMCWA+DSW)(MMCWA Funding)Training on Basic Computer
Skills4

4/29/2016

II. Home-based care for elderly projectMMCWA+ Dept; of Social Welfare

Collaborating Agencies of MMCWA
Government sector
1. Ministry of Health

Total -35 townships

2. Ministry of Education
3. Ministry of Social Welfare

Amayapuya
2007

Chauk

TatkoneYaynanchaungLeiwayAyarwaddey Region
26 townships

Tanphyuzayat

4. Ministry of Internal Affairs
2010

Dawbon2011

Malamyaing
Myeik

International
1.WHO
2.UNICEF
3. IPPF
4.UNFPA
5.UNAIDS
6.JOICFP28
7.GGA

MMCWA Community Based TB Care Activities

Conducting Home Based
Medical Care

Provision of eye care for elderly
29

Participation in relief matters at the effected area of disasters

Approaches
1.

Self reliance Approach-by MMCWA (Central)/State & Regional / Township
MCWA supervisory committees

2. Project Approach(MMCWA+NTP)(Global Fund Round-9 Funding)Donation for Flooded Townships in
Kalay and Tamu

Preparation Dignity Kits for Disaster-riskareas at MMCWA HQs

27

5

4/29/2016

Community based TB Care (MMCWA+NTP+GF)(Townships - 69 townships)

MMCWA Self reliance TB Care Activities Target- 15 States and Regions(330 townships)

 Methodology

2011
2012-2015- 37 townships- 69 townships

 Dissemination Health Talks on prevention of TB

Mandalay Region (26 /s) Referral of presumptive TB cases

Naypyitaw (3 t/s)

 MMCWA volunteers’ participation on DOTs

Bago Region (27 t/s)

programme

Yangon Region (1 t/s)
Kayin State (2 t/s)

Mon State (10 t/s)

34

31

MMCWA Self reliance TB Care Activities(Cont;)
120000100000
80000
60000
40000
20000
0

Health Education
Referral cases
DOTs Supervision2010 2011 2012 2013 2014 2015
Health Education 71328 96425 72847 55928 48881 43286
Referral cases
36923 38034 43271 26783 20723 19846
DOTs Supervision 48144 32473 30292 18999 12237 11860

32

35

Activities(1) Central Training of trainers on Community TB Care (Naypyitaw)(x 2 days) (1 volunteer/tsp)(2) Township Multiplier Training for Community volunteer on DOTS(x 2 days) (30 volunteer/tsp)(3) TB case finding and/or treatment activities at community level(4) Community education session(5) Half yearly evaluation meeting for community volunteer at
respective township level
33

36

6

4/29/2016

(6) Central Annual Evaluation Meeting at MMCWA HQ(Yearly)(7) Refresher Training for community volunteers at
MMCWA HQ
(once in 3 year)

Supervision(1) Supervision from Central to State/Regional level- One visit per year to the respective State/Regions(2) Supervision from Districts to Townships level- One visit per year to the respective townships
37

40

Indicators
3500
3000
2500
2000
1500
1000
500
0
No. of community volunteer
trainedNo. TB suspected cases
referred by community
volunteers
No. of TB patients detected
and put on treatment
No. of health talks
conducted at community
lavel
38

2011

2012

2013

2014

2015

1147

2139

2190

2070

2069

2357

531

2255

3177

2921

282

298

344

589

615

1606

1468

2251

2905

3126

41

MMCWA contribution to National TB Program(NTP)39

7

4/29/2016

Strengths

Supervision from Central to Mon State

1

MMCWA Volunteers reach to the gross-root level2

Volunteers are enthusiastic and energetic in finding new cases andreferral3

MCWA Volunteers participate in Home-based Care for providing DOTS

4

Community participation are active;- Interested in Health Talks on TB preventive and control measures

1

Supervision from District to township level reports are not receiving
regularly.

2

Attrition within the ToT volunteers

Challenges

3

Reporting system sometimes weak, not received in time.

4

Need patient support and transportation fees for patients

43

Supervision from Central to Mandalay
RegionVolunteerism
Performing an act of kindness , freely giving of talent, time,effort for the simple fulfillment of community expectations.

44

Training of Trainers(ToT) Refresher Training

45

48

Thank You48

8

2016/4/29

Scenario:2015

Presentation and discussion ofactivities of partnerships• Major Public Health Problem• Priority 1 Programme of the Government
Population
Incidence rate (all TB cases) Prevalence rate (all TB cases) Mortality rate

: 27 million: 163 /100,000: 241/ 100,000: 20/100,000Japan-Nepal Health & TB Research Association



TB patients co-infected with HIV
Proportion of MDR-TB: 2.4% New cases
 Previously treated cases

Nepal: 2.2%: 16%

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

Ram Sharan Gopali (MPH)
Executive Director

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

147,181 Sq.
km

Mission
To franchise in the prevention/control of Tuberculosis,
Public Health and Social Development issues in Nepal.
Areas of Intervention;
 Policy and Advocacy at all level

Region5

 Community System

Zone

14

District75

Strengthening (CSS) Knowledge Management
 Partnership and networking(Nationally & Internationally)

Treatment Centre

1140

Sub-treatment

2907

Microscope Centre

554

Gene-Xpert Center

22

MDR Centre

13

MDR Sub-Cen.

71

1

2016/4/29

Our Steps for………..

2. Community engagement and their role

• To enhance collaboration between TB patients,

NGO’s/CSO’s, Research Institutions, Universities,
Government line agencies

 Active case finding door to door visit by volunteers
 monthly meeting for TB• To care and support for those who are infected andaffected by TB, for the purpose of controlling and caring all
forms of TB (TB, DR, TB/HIV)• To reduce stigma and discrimination related with TB and its

co-infection

volunteers
 School health program Volunteer Trust Fund
 Referral and cross referral ofpresumptive cases Tracing of loss to follow up TB• To improve community health through innovative models up

to grassroots level by knowing the local contexts

patients
 Organize advocacy and social

mobilization

10

Current Projects

3. Net-working and Social Protection
 Communication and social mobilization

activities for factory workers andvulnerable groups
 Strengthening coordination &collaboration with partners and synergy

Urban TB
Control
RIT/JATA

TB
REACH
Wave 4
UNOPS/Stop
TB Partnership Tangible & intangible support for TB

Post Disaster
Recovery
Projectpatients who are in need
 Initiation of TB patients club
 Empowerment of TB patients

UNOPS/Stop
TB
Partnership Enhanced understanding on Patient

Character among service stakeholders
and service providers

11

1. Quality DOTS services is provided for TB patients

4. Strengthening Urban TB control

 Innovative DOTS and Sputum

 Organizing regular meeting withexamination (8:00 AM-4/5 PM)

stakeholders and partners
 Carrying-out joint supportive Referral, cross-referral and countersupervision with concerned
stakeholders and immediate feedback
mechanism
 Establishment of Volunteers Trust fund Support for poor TB patients who are
not eligible in public social protection
scheme Logistic management support

referral from community and private
sectors
 Operational partnership with partners

and CSO’s Capacity building of key stakeholders(Health care providers public andprivate), volunteers, local administrative
authorities

9

12

2

2016/4/29

DOTS service & SPUTUM EXAMINATION

Hotline Consultation(2014/2015)

Consultation from Hotline telephone
274

300

140

123

214

250

120

103

200
100
150

110

89

78

80

100

66

15

50

60

0

40

PBC

PCD

EP

Total

Sputumexamination

200

071/072072/073
Male

FemaleCase finding
Key Q & A of hotline consultation
2067/68 (2010/11)

2068/69 (2011/12)

2070/71 (2013/14)

2071/72 (2014/15)

2069/70 (2012/13)

 Sign and Symptoms ofTuberculosis

300

 Location of DOTS Centre

254
241238250232

 Venue of Microscopic

201
200

Camps
 Information about daily

150

94

100

DOTS and assurance oftreatment Minor side effects
 Clinic opening time

110
102
79 84

79
66

50

59

65

46
14 11

29 32 3223
9 10

2 0 2 1 1

37
23

15

10

1 3 0 0 0

16

25

22
10

12

18 18
6

0

Systematic Screening of target populations &microscopy camps

Trend of Treatment Success Rate
100%
90%

17%

9%

15%

19%

 Community-Based;- TB screening/presumptive TB
identification/examination/treatment enrollment
and contact investigation

80%
70%

- Awareness raising

60%
50%

Hotline Consultation

Success

FailureDied

Default

TO

NR

 PPM

- Strengthen cross referral mechanism

40%- Refer TB suspects to microscopic camp andother laboratories

30%- Collaboration with private laboratory

20%



10%

Meaningful involvement and mobilization of healthworkers (Public and Private and volunteers)

0%2067/68 (2010/11)

2068/69 (2011/12)

2069/70 (2012/13)

2070/71 (2013/14)

3

2016/4/29

Case finding framework

Intervention
Mapping of IDP s Camps
Capacity building of Volunteers andkey stakeholdersooPresumptive TB Case identification
Sputum sample collection, sputumtransportation & Test by Gene XpertooChest Camp
Treatment enrollment and follow upoo

TB REACH (WAVE 4) Achievement
From July 16, 2014 to November 15, 2015
110000

Post Disaster Recovery TB Program

112341

Sep 2015- 20 jan 2016

10000090000

Male

Female

Total

5730

6000

Male

80000

60000

Female

Total

5000

70000
5552556816

4000

50000

3462

3000

2268

40000
2000

30000

24086

20000
1184212244

10000

20123

1000

Screening

Presumptive

TB Microscopy

Post Disaster Recovery Project82

Dignosis129

Screening of IDPs

79

Target Beneficiaries-

Internally Displaced Peopleof Kathmandu valley andSindhupalchok district

461
14

Gene-Xpert Test

3

Bac Positive

17

11

3

14

Treatment enrollment

Treatment

Lesson Learnt …………..


Support from NTP:
 leads to sound implementation of theplanned activities



Proper Orientation & consistent followup:
 To continue engagement of stakeholders

Thematic Program Thrust-

Early TB Case finding

240

0

134

0

221

208

216

9418 10705(sample transportation from community to
Microscopy Centre)•

Intensive Advocacy Programme:

 More partners are interested tocollaborate (local CBOs shows theirinterest for the collaboration)

4

2016/4/29

Lesson Learnt………

Acknowledgements
 National Tuberculosis Centre Research Institute of Tuberculosis/JATA

Highly enthusiastic and committed
volunteer; Leads to productive and sustainable
programme in the community

 UNOPS/Stop TB Partnership Global Affairs, Canada World Health Organization
 Regional Health Directorate OfficeEstablishment of Patients club; Leads to effective contact tracing
and peer education in the community
Consistent IEC/BCC Programme:
 To change service seeking behavior

 District (Public) Health Offices Urban Health Clinics
 Health care Providers (Public & Private) Female Community Health Volunteers
 TB Patients and Family members

Supportive Supervision & Result based
monitoring Result based M&E and discussion

with NTC
 Regular follow-up and monitoringThank youfrom the RHD and respective
project districts
 Project review and assessment

from the TB REACH &RIT/JATA

Issues to be address;
o
o
o

o
o
o

Sustainability and ownership
Compatibility of TB Program inline with
Sustainable Development Goal.
Factor affecting TB Treatment and its success;co-morbidity for instance- diabetes, malnutrition
etc
Funding gap
Logistic, documentation and monitoring.
Research and development ; TB and Gender,
PPM, Community Engagement, UHC

54/29/2016

RIT/JATA Philippines, Inc.

Presentation and discussion ofactivities of partnerships• Local-based NGO• Established in 2008

TB/HIV Research Foundation
Thailand• 7 staff

Accreditation/Membership
RIT/ JATA Philippines, Inc.
Activities and Accomplishments• Securities and Exchange Commission• Philippine Council for NGO Certification

STOP TB Partnership Forum – Asia
March 14-15, 2016

• NTP – Technical Working Group

About us….
JATA
(Japan)Research Institute of Tuberculosis /Japan Anti-Tuberculosis Association
Philippines, Inc.
(RIT/ JATA Philippines, Inc.)JATA HQ

RIT

Hospital

47 Officebranches

Overseas
OfficeExtension office

PHILIPPINESCAMBODIAZAMBIA1

4/29/2016

PhilPACT Strategies
Vision:• Strategy 5: Address MDR-TB, TB/HIV and theneeds of vulnerable populations

TB- Free Philippines
Mission:To contribute to the NTP of the Philippines intheir goal of ensuring that quality TB services areavailable, accessible and affordable for all TB
patients.

• Strategy 6: Regulate and make available quality TB
diagnostic tests and drugs• Strategy 7: Certify and accredit TB care providers• Strategy 8: Secure adequate funding and improve
allocation and efficiency of fundutilization.

Objective:
To improve the access of the community to quality
DOTS implementation by strengthening the linkage
between GOs and NGOs/private organizations

THE TUBERCULOSIS PROJECT IN SOCIO-ECONOMICALLY URBAN AREAS IN
METRO MANILA, THE PHILIPPINES
2008- June 2011
Funded by : Ministry of Foreign Affairs

PhilPACT Strategies• Strategy 1: Localize implementation of TB Control• Strategy 2: Monitor health system performance• Strategy 3: Engage both public and private TB careproviders

TB CONTROL AND PREVENTION PROJECT IN SOCIO-ECONOMICALLYUNPRIVILEGED AREAS IN METRO MANILA, THE PHILIPPINES
2011- June 15, 2014
Funded by : Japan International Cooperation Agency• Strategy 4: Promote and strengthen positive
behavior of communities2

4/29/2016

Project Sites

Engagement of NGOs
Canossa
POPULATION
2013

Sto De Tondo Charity Clinic

405, 125

Urban poor
population

193, 746(47.8%)

Land Area

5.64 sq km

Population
density(sq. Km2)

71,831

German Doctors

10 Health Centers
2 NGO DOTS Facilities
14 NGO Referring Facilities

PAOFISaint Luigi Orione

POPULATION

2013

700

120, 633

NGO DOTS’ Contribution‐ Tondo,
2007 ‐ 2012600

Urban poor
population

108, 063(90%)

LAND AREA

3.21 sq km

Population
density(sq. Km2)

37,580

500

LGU

400

NGO
300
District I‐ Tondo, Manila
200

100

3 Health Centers
3 NGO DOTS Facilities
1 Referring Facility

0

2007

2008

2009

2010

2011

2012

LGU

407

374

406

449

464

512

NGO

146

152

169

155

157

133

District I‐ Tondo, Manila

553

526

575

604

621

645

NGO DOTS’ Contribution ‐Payatas
250

200

Interventions

150

LGU
100

NGO
Payatas, Quezon City

50

0

2007

2008

2009

2010

LGU

85

75

109

117

101

125

NGO

45

46

90

92

2011
107

2012
105

Payatas, Quezon City

130

121

199

209

208

230

3

4/29/2016

Capacity Building
Basic TB DOTS Training

Infection Control Training

Orientation of CHV on Basic
STI HIV and AIDS Education

CHV Assembly

Appreciation Course for CXR
Basic DSSM Training for Medical Technologist

Network and Linkage (ACSM Activities)
Interpersonal Communication and Counselling

Orientation of CHV in NTP Program

Development of Recording Forms
Basic DSSM Training for Lab Assistants

Monitoring Tool4

4/29/2016

CHVs’ Contribution to DOTS Facility‐
Tondo, 2010‐2012

Development of Policies/Guidelines

2000
1800
1600
1400

DOTS
FacilityNGO
Referring

1200
1000
800
600
400
200
0

2010
1014
43

DOTS Facility
NGO Referring

2011
1599
28

2012
1846
42

CHVs’ Contribution to DOTS Facility –Payatas, 2010‐2012
1000
900
800
700
600
500
400
300
200
100
0

DOTS Facility
NGO
Referring

DOTS Facility
NGO Referring

2010
454
6

2011
898
22

Operational Researches Conducted• Effectiveness of Training Course on Quality
Assurance of Chest Radiography• Health Care Seeking Behavior of Pulmonary TB
Patients• Research on Tuberculosis Diagnostic
Committee (TBDC)

2012
846
16

Monitoring and Evaluation Visits

Accomplishment in the two project sites• Engagement of NGOs (combined in both sites):
oNumber of NGOs from 3 (2008) to 5 (2010)
oNumber of NGO referring facilities: 4 (2008) to 15 (2012)• Percent contribution (combined in both sites) :oPercent contribution of NGO DOTS to TB Cases ranged
from 27. 9 % to 41.6 % (2007 to 2012)
oPercent community contribution to TB Cases ranged
from 2.1 % to 3.3 % (2010 to 2012).

5

4/29/2016

Project Areas
TECHNICAL ASSISTANCE SERVICES TO CAPACITATECOMMUNITY BASED ORGANIZATIONS (CBOs) AS RURALHEALTH UNITS ( RHUs) PARTNERS IN TUBERCULOSIS CONTROL
January 15, 2015 – April 30 2016
Funded by : Philippine Business for Social
Progress/Innovations on Multi‐Sectoral Partnership toAchieve Control of TB (PBSP/IMPACT)

RIT/ JATA (RJPI)Technical Assistance(Initial)

PBSP‐IMPACT
Establish Network /linkage with
RHO/PHO/MHO/
RHUs/ CBOs

Recording andReportingCriteria for Project site selection• Low TB performance ( LGU ) because of low
utilization of DOTS services by the target clients

Capacitybuilding

Training

Province of Bulacan

Joint Monitoringand Evaluation(PHO/MHO/RHU/BHS)

Project Goal
• To increase the case detection rates and to
improve or maintain Cure Rates in the six
municipalities of Bulacan.

– Low awareness of the TB disease– Stigma– Distance and cost in going to the facility– Lack of public involvement• Strong political support• Presence of CBOs

Roles of CBOs
• Identify and refer presumptive TB to Rural
Health Units (RHUs)• Provide TB education• Supervise TB treatment of patients64/29/2016

Challenges
Roles of CBOs
• Encourage contacts of TB cases undergo TB
screening at health centers• Follow‐up presumptive TB (who were not able
to access RHUs) and interrupters of treatment• Health financing: reduce financial burden amongclients• Health Resources for Health: deployment of support
systems and enabling environment; keep the
motivation of Community Health Volunteers• Essential medical products and technologies:
Balanced diagnostic and treatment supplies

Contribution of CBOs to the 6municipalities of Bulacan

Municipalities
RHU
Accomplishment1130

No. of TB All Forms
CBO% contribution by
Accomplishment
CBO to RHU
83
7%

Challenges• Service delivery: Patient‐ centered approach
care; improvement of access to quality TB
services• Lack of funding support to continue ourcommunity‐based TB activities

Challenges• Leadership and Governance– Continuity of adherence to policies (municipal
ordinance) and make necessary amendments ifneeded;– Continuity of supportive supervision among
NGOs.

• Health Information system– Utilization of data to inform policy change

Future Directions• TB and Universal Health Care
• TB and Tobacco• TB and Diabetes (?)• Promote gender equality (?)

7

4/29/2016。

8

2016/4/29

Presentation and discussion ofactivities of partnerships

Chang-Hua TB Care Association
TaiwanWei-Wen, Chen (Sally)
Griffith University, Queensland, Australia
Master of Gerontology Nursing 2003-2005
 Chang-Hua TB Care Association
Member 2014 -present
 Chang-Hua Hospital, Ministry of Health andWelfare, Changhua, Taiwan
Secretary and research assistant, MDR TB
Department 2014 - present

Geographic Position

Chang-Hua TB Care Association
TaiwanPresented by
Wei-Wen Chen
(Sally)Chih Yun, Lin (Vicky)
Fu Jen Catholic University, New Taipei City,
Taiwan Department of Life Sciences 2001-2005
 Chang-Hua TB Care Association
Supervisor 2012 -present
 Chang-Hua Hospital, Ministry of Health andWelfare, Chang-hua, Taiwan 2008-present你好 =こんにちは=
HelloGeographic Position• Capital: Taipei•The total area of
Taiwan :36,193 km2(13,974 sq mi)• Population: 23 million

1

2016/4/29

Geographic Position

First meeting in 2009

Chang-Hua county
Area: 1,074 km²
Population: 1.3 millions

History

The first non-governmental and non-profit making
voluntary organization established in Chang-Hua County
in March 2009 by Dr. Yi-Wen Huang (MD, Chief ofPulmonary and Critical Care Unit, Chang-Hua Hospital,
Deputy commander of Central region communicable
Disease Control Medical Network) with a view to raisingpublic awareness against Tuberculosis (TB) and adopting
preventive and curative measures towards the control ofthe diseases.

Present Director 2015~
Name: Pei-Chun, Kuo
RN, Master of Health Care Administration,
Central Taiwan University of Science andTechnology
 Clinical Registered nurse since 1997
 Supervisor of Nursing Department , Chang-Hua
Hospital since 2012~nowThe First Director 2009-2014
Name: Yi-Wen, Huang
MD, Kaohsiung Medical University 1975-1982
 Deputy commander of central region communicable control
medical network, CDC, Ministry and welfare since 2013-now
 Chief of Pulmonary and Critical Care Unit, Chang-Hua
Hospital since 2010~now Chief of Emergency Department, Chang-Hua Hospital since
2008~now
 Chief of Tuberculosis Department, Chang-Hua Hospital
since 2007~now Chief of Central Region MDR-TB team, since 2004~nowMembership
We pursue our mission in part through an open
membership policy, any individual involved andinterested in the objectives of the Association
may apply for membership The Executive Committee shall decide as to theacceptance or not of any application andsimilarly decide into which category theapplicant shall be placed.
22016/4/29

TB epidemics in Taiwan

Membership

TB Incidence by County, 1990-2013

For individuals: more than 20 years old
and working in health care settings at
Chang-Hua county or people living in
Chang-Hua county
 For organizations: any associations orgroups who agree objectives of the
Association
 For sponsorships : people or groups who
agree objectives of the Association


New Taipei City
Taipei City
Keelung City
Taoyuan County
Hsinchu County
Hsinchu City

Yilan County

Miaoli City
Taichung City
Changhua County
Nantou County(per 105)

Hualien County

Yunlin County
Chiayi County
Chiayi City
Tainan City

Taitung County

Kaohsiung City

16

Pingtung County

TB Case Number and Incidence, 2005-2013

Membership
76 members
 Clinical staffs from hospital setting 、
community setting and DOTS.
 TB cases who completed treatments

new caseage‐adjusted incidence
incidencecase number

cases perpopulation

10
5

The case number and age‐adjusted incidence in 2013 declined with a rate of 30.0% and43.4% compared with 2005.
17

Aim/Purpose

TB incidence rate in Chang-Hua2009 -2014

Support disadvantage and special groups
to complete TB treatment thus reduce thechance to progress to MDR-TB
 We are a collaborative network of policy
makers, health workers, researchers,
people affected by TB and advocates.

80



70
60
50
40
30
20
10
0

2009

2010

2011

2012

2013

2014

Chang-Hua

67.6

61.4

59.8

58.7

53.93

53.96

TW

57.8

57.2

54.5

53

49.4

47.36

3

2016/4/29

Mission

Assist with disadvantage and special groups(eg.
homeless, HIV, drug abused, psychiatrics, alcoholics, people living
alone) who has suffering with TB (MDR & pre XDRTB) : improve their lives through financial
support, education, and encouragement.

MissionFundraising for patients who is at low
economical status or unqualified toretrieve governmental support, increase
patients’ motivations and adherence tocomplete treatment.
 The undertaking of the Research andInvestigation on subjects concerning
tuberculosis.
 Import & monitor new TB drugMissionHome visits by clinical staff or volunteers
 Strengthening clinical education forclinical TB staff
Activities
Regular medical allowance or foodsubsidies Provide toiletries for homeless cases

Fundraising42016/4/29

Challenges
Chang-Hua county is mainly rely on
urban agricultures- Lack of TB information and knowledge- Unable to recognized TB symptoms- TB = Sin
 Delay hospitalization
 Short of funding5

&KLDQJ5DL3URYLQFH

Presentationanddiscussionof
activitiesofpartnerships

TB/HIV ResearchFoundation
Thailand,Q– +,9SUHYDOHQFH
LQPLOLWDU\FRQVFULSWZDV

2500

RIT-TB/HIV Research
Project

TB/HIV Research
Foundation (THRF)

2000
1500

HIV
epidemic

1000




500

Registered Non-profit Non-government organization in Thailand # 222/2545
http://www.tbhivfoundation.org/index.php

0

HIV positive

HIV negative

HIV unknown35(6(17$7,21
 $ERXW7%+,95HVHDUFK)RXQGDWLRQ 7+5)

THRF-HISTORY ( 1 )• 1992, a group of Thai and Japanese doctoral students carriedout their multi-disciplinary dissertation research on TB and
HIV/AIDS (THRF Founding members)

2. Highlight NGO’s Role: The Volunteer Ladies$JDLQVW7%• Epidemiology• Clinical and public health• Social sciences

THRF-HISTORY ( 2 )• 1995 The Research Institute of Tuberculosis, Japan AntiTuberculosis Association (RIT/JATA) set up “TB/HIV Research Project”• 2002 TB/HIV Research Foundation” (THRF) was officially

PARTNERS
RS

registered as a non-profit, non-government organization

THRF BOARD MEMBERS (NON-PAID)• President Jintana Ngamvithayapong-Yanai, B.N. (Hons.), M.A., Ph.D.
• Vice President Pathom Sawanpanyalert, M.D. (Hons.), Dr.PH.
Pacharee Kantipong, M.D.

• Members

Petchawan Pungrassami, M.D.,Ph.D.
Supalert Nedsuwan, M.D., M.P.H.

• Treasurer• Secretary

Surakameth Mahasirimongkol, M.D., M.Sc.,Ph.D.
Oranuch Nampaisan, B.Sc. (Statistic),
M.Sc.(Biostatistics))XQGLQJ3ROLF\• 1RIXQGLQJIURPWREDFFRDQGDOFRKROUHODWHG
EXVLQHVV• 5HVHDUFKZLWKSKDUPDFHXWLFDOFRPSDQ\LVD
VXEMHFWRIERDUGFOHDUDQFH• 3KDUPDFHXWLFDOFRPSDQ\FDQGRQDWHPRQH\
WRFKDULW\ EXW12FRPSDQ\ORJR

Piyanoot Chatchawarat, B. Econ., M.Ed.,(Admin.)Sarmwai Luangjina, B.A.

14 Fulltime paid staff

VisionMission

S TB, HIV and other diseases of poverty,
Stopw
with the people for the people

Involving and collaborating with local, national,
international research and academic institutes,
popolicy makers, NGOs, private sectors, civilsosocieties and vulnerable populations (with thepepeople) to reduce the burden on the people
af
affected by tuberculosis, HIV/AIDS and otherdiseases of poverty (for the people) by meansof epidemiology, bio-medical, social science,
operational and participatory action research.

WHAT WE DO ?

• Improvement of diagnosis by using urine test of detecting DNA
fragment of Mycobacterium tuberculosis (RIT/JATA)• Impact of isoniazid preventive therapy on TB morbidity andmortality: A cohort study of people living with HIV (JATA)• Pharmacogenomic study of anti-tuberculosis side effects(MOPH/NIH and U.of Tokyo)• Identification of blood transcriptional signature of active:K\UHVHDUFKDQGFKDULW\"• 0RVW7%SDWLHQWVDUHSRRU• 3RYHUW\FDXVHWUHDWPHQWLQWHUUXSWLRQDQG
ORVVIROORZXS• 5HVHDUFKVWDIIDUHQRWULFKtuberculosis in Thai population (MOPH/NIH and U.of Tokyo)• Ensuring treatment adherence through "CARE"CAR (Connection,:HZHUHYHU\VLFNDQGZHFRXOGQRWJRWRZRUN:HIHHOVREDGWKDWRXUVRQ \HDUV OHIWWKHVFKRRODQGHDUQHGLQFRPHE\ER[LQJDQGODERUZRUN:HGRQRWKDYHPRQH\WRJRWRWKHKRVSLWDO)LUVWO\ZHPXVWKDYHIRRGVWRIHHG
WKHZKROHIDPLO\Affordable Reminder,
Affordable,
Reminder and Enabling) Box” (Grand(G
Challenge
Canada)• Evaluation of Rapid TB Culture and Drug Susceptibility Test

through AutoMODS (Automated Microscopic Observation Drug
Susceptibility) (Global Fund and National Innovation
Association)• Interventions for reducing sodium intake among patients withhypertension (Thailand Health Promotion Foundation)• Workshops on TB in risk groups (JATA-seal funding)• Training for community volunteers and prisoner volunteers about TB• Member, Global Fund Thailand Country Coordinating Mechanism
CCM• Member, TB Laboratory Expert Committee, MOPH
• Technical collaboration with local NGOs, NTP/MOPH and National
Health Insurance• Field practicum in statistics and global health for students fromuniversities in Thailand and School of Public Health University ofAlberta, Canada

3KRWRDQGVWRU\FUHGLW 6DUPZDL/XDQJMLQD 

• 2007: established a TB patient-fund(Center for Sharing) to support very
poor TB patients for transportation andliving expenses. (initial 3,000 US$ fundfrom StopTB Partnership, Geneva)• 2009: THRF and JATA established

Volunteer Ladies Against TB to sustain
the patient-fund and to support TB care

:KRDUH9ROXQWHHU/DGLHV$JDLQVW7%"• PDMRULW\DUH&KLDQJ5DL RULJLQVDJH!\UVJRRGVRFLRHFRQRPLFVWDWXV• DFWLYHLQVHYHUDOYROXQWHHUDFWLYLWLHVQRWRQO\7%
DFWLYLWLHVCHALLENGES• Recruiting and maintaining qualified medical
research and admin staff with good English
command in Chiang Rai• Limited international research funding due tobeing “high middle income country”• Sustaining charity activities without budget for staff
running charity activities

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7KH&KLDQJ5DL/DGLHV9ROXQWHHUV$JDLQVW7%“Eradicating TB with women’s
hands and heart “)XQGUDLVLQJIRU“Center for Sharing”
3DFNLQJGDLO\7%GUXJVWRHDVHPHGLFDWLRQVisit to patients’ home  VXSSRUWLQJIRRGVDQGVKDULQJSV\FKRORJLFDOVXSSRUW

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GDWDDVRI'HF  )XQGUDLVLQJWRVXSSRUW7%SDWLHQWIXQGLQJ,ZDVYHU\VLFNDQGWKRXJKWWKDW,ZDVJRLQJWRGLH
7KDQNVWRWKHYROXQWHHUVEULQJLQJPHEDFNWRWKHKRVSLWDODQGFRPSOHWH7%WUHDWPHQW$IWHUP\7%ZDVFXUHG,ZDVSUHJQDQWDQGGHOLYHUHGDEDE\,DPVR
KDSS\

•

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• 7RWDOSDWLHQWVUHFHLYHGILQDQFLDOVXSSRUWWRHQKDQFHWUHDWPHQWFRPSOHWLRQ 7KDLKLOOWULEH PLQRULWLHV0\DQPDUPLJUDQWV

2. Assisting the hospital’s pharmacists in packing
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SDWLHQWVHQFRXQWHULQJVWLJPDDQGVRFLDOLVRODWLRQ• SDWLHQWVZHUHYLVLWHG 7KDLKLOOWULEH PLQRULWLHV0\DQPDUPLJUDQWV • $OOFRPSOHWHGWUHDWPHQWH[FHSWGLHG 7%+,9 EXWGLHG
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1(;767(35HVHDUFKWRHQKDQFH“Bold Policy”• +RZ VRFLDO SURWHFWLRQLQWHUYHQWLRQVKHOS(QGLQJ7%DQGFRQWULEXWHWRVRFLDODQG
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Appendix 5Group Discussion 1: 15 March 2016 (10:15 – 11:45)
Topic: Challenges of NGO to End TB and role of women
Moderator:

Nobukatsu Ishikawa

Rapporteur: Jintana Ngamvithayapong-Yanai

The moderator started the discussion by showing a list of roles of NGOs/CSOs to cover for
End TB, as following:

hard to reach groups/poor patientscare/support to catastrophic costSocial protection (e.g., Stigma, discrimination)

Universal health coverage (UHC)

Use of community health volunteersEngage TB

Social linkage

local authorities



Advocacy voice for the voicelessCommunity empowerment

Communicate/coordinate stakeholder

Conducting researchand Non-TB sectors

The moderator then requested each NGO to write a top three challenges in three pieces ofpost-it note paper. One piece for one challenge which they think are challenges for NGO to
End TB.

All NGOs posted their lists on a big board. Later, the moderator createdcategories based on the lists presented in the Table 1. Table 2 presents challenges
classified by NGO/country as discussed in the country presentations and in the document
for End TB.

Table 1: The top-three free listing of perceived challenges to NGOs/CSOs to end TB

Categories of Challenges (Number)

List of challenge (country)

Challenges related to community - How to maintain and keep volunteers
health volunteers (5)actives?
(Indonesia, Thailand)- Need of resource and incentives forvolunteers (Indonesia, Myanmar, Philippines)
19

- Case findings still low in remote area andvolunteers can do more (Cambodia)
Challenges related to funding (4)- Budget sustainability (Korea)-

Limitedresources, funding (Cambodia,

Nepal, Philippines)
Challenges related to support to TB patients and poor patients (4)Addressing

inequality

inTB

patient(Philippines)- Advocacy voice for vulnerable people(Thailand)- Need of nutrition support to patients(Myanmar)- Patient confidentiality (Taiwan)

Challenges related to patients and -Need to increase TB awareness amongcommunity awareness about TB (3)community people (Taiwan, Thailand,
Myanmar)

Challenges related to stakeholders - Lack of consensus between government and(3)

NGO (Korea)- Satisfaction for donors or satisfaction ofpatients? (Korea)- High expectations from stakeholders (Nepal)

Challenges related to professional care providers (2)Difficultyin

implementing

International

Standard of TB care among the providers(Indonesia)- Less capacity in conducting research anddevelopment (Nepal)

Other (1)-Migration (Cambodia)

Table 2: Challenges of NGO to End TB classified by country

Organization, Country

Challenges of NGO to End TB

Stop TB Partnership, - Budget sustainability
Korea- Lack of consensus between government and NGO- Satisfaction for donors or satisfaction of patients?

Chang-Hua Hospital / - Awareness of TB among community and society
TATA, Taiwan- Stigma and discrimination- Confidentiality of patient side, Privacy
20

Stop

TB

Partnership - Difficulty keeping the volunteers active

Indonesia- Need resources to support the volunteers- Difficulty implementing International Standard of TB careamong the providers

THRF, Thailand- TB awareness among general people- Advocacy voice for vulnerable people- Sustainability of volunteers

JANTRA, Nepal- Limited resources- Less capacity in research and development- High expectations from stakeholders

CATA, Cambodia- Limited fund
- Case finding is still low- migration

MMWA, Myanmar- To increase community awareness by providing more IE&C
materials and community health talk
- Funding for nutrition and transportation support for patients- Volunteer incentive is not enough for the targeted 330
townships for providing psycho-social support to complete
treatment

RIT/JATA, Philippines- Provision of incentive- Funding support- Addressing patients’ inequality

The challenges related to “funding” was not included in this discussion session because theafternoon session will specifically discussed about fundraising. The group members shared
their experiences and participated in discussion of the following issues:
1. Challenges related to community health volunteers
Turnover rate of the volunteers is common in most countries because of lack of incentives,lack of recognitions by community people, particularly recognition from people with highsocial and economic status. The following strategies may motivate volunteers to stay longer
and increase volunteers’ dignity or recognitions:
1.1 Provision of incentives including- special right to access free health service,- organize periodic meetings and let the volunteer to report their performance- organize “exchange visit” so that the volunteers open their eyes to expose to other21

sites- organize training to increase TB knowledge- provide transportation fee, award ceremony for outstanding volunteers
1.2 To enhance dignity, the volunteers should be selected by community people
Despite provision of these incentives and motivation, several participants felt the turnoverrate of the volunteer is still high and require additional interventions. JUNTRA Nepal
proposed “Trust fund” as an intervention motivating volunteers to actively work with dignity.

2. Enhancing TB awarenessParticipants shared their opinion on enhancing TB awareness as followings:-

Means and message to convey TB information to people living in remote area
should be cultural sensitive.

-

TB patients and their family should be involved in providing TB education to thecommunity-

It is important to repeat TB education to every level-

Enhancing the role of peer group (TB patients group)

The moderator concluded summarizing the sessions that the roles and challenges ofNGOs/CSOs are diverse and varies according to the country and organization, but key
common issues such as community and patient oriented approach were discussed andshared, and this kind of sharing is a most useful to promote the spirit of stop TB partnership.
For that, documentation of the success stories is important. A term of human dignity wasraised particularly for community health volunteers’ motivation, but the concept could apply
to all aspect of the work by NGOs/CSOs.

22

Appendix 6

Session 2: 15 March 2016 (13:00 – 14:30)
Topic: Fundraising for the community activities
Moderator:

Jintana Ngamvithayapong-Yanai

Rapporteur: Ram Sharan Gopali

The moderator started the session by showing a short video clip on “Japan hosts‘Touch-a-boob’ fundraising event” https://www.youtube.com/watch?v=pUi-FIfzHIw This is
the second most viewed video clip in the YouTube for a searching keyword of “fundraising”.
The video shows how Japanese Foundation for AIDS Prevention (a Japanese NGO) raised
US$50,000 within 24 hours with the objectives to raise HIV awareness in Japan and raisefund to support HIV prevention, treatment and care. Several Japanese porn queens
voluntarily contributed to this fund raising. The participants discussed how they felt andwhether or not this fundraising methodology can be applied in their countries. All participants
reported this fundraising method cannot be applied because it is against law and culture in
their respective countries.
Following this introductory video, the moderator presented topics for the discussion.
All participants agreed with the topics. Results from the discussion are summarized asfollows: Current community TB activities requiring fund include:
1. Activities directly related to patient supports include; supporting patients’transportation, providing foods to complete TB treatment, and home visit
2. Activities related to community volunteers include; support for meetings, training
and allowance for volunteers
3. International community TB activities

Table 1:

Current funding sources of the participants’ NGOs

Organization, Country

Funding sources

Stop TB Partnership, The operational cost is funded by the government of Korea
Korea

and programmatic budgets are from several funding sources
such as Koica, Korean Anti-TB Association

Chang-Hua Hospital / For TATA, 80% of funding are from the president, Christmas
TATA, Taiwan

seal. As for Chang Hua, funding are from membership,
donation of members, pharmaceutical companies

Stop

TB

Partnership Entire fund is from the Chairperson (owner of oil company)
23

Indonesia
THRF, Thailand

Research funding for research activities For charity, mostly
come from the volunteer ladies’ fundraising

JANTRA, Nepal

For

regularfunding

is

from

RIT/JATA.

For

project

implementations are from Global Fund, Stop TB partnership,
TBREACH
CATA, Cambodia

JATA, USAID, TBREACH

MMWA, Myanmar

For regular fund are from membership fee, properties (renting
lands/building), running pre-school. For project are fromseveral sources such as UNICEF

RIT/JATA, Philippines

JATA, MOFA, JICA, USAID

Participants learnt that MMWA has 12 million members and each member pay about 0.2
US$ for life-long membership and they receive a pin and a certificate to be a member.

Table 2:Fund raising methods of NGOs participating in the meeting

Organization, Country

Methods of fund raising

Stop TB Partnership, - Developing proposal for funding
Korea- Putting donation box in department store, post office andbank (obtained very small amount)

Chang-Hua Hospital / - Annual donation by people (Taiwanese people like
TATA, Taiwan

donation)- Donation from pharmaceutical companies (cash andmedicine) -selling

Stop

TB

Christmas seals

Partnership - Organizing charity events such as cultural night, sport

Indonesia

competition to high income people

THRF, Thailand- Developing proposal for research funding- For charity: The volunteer ladies raise the fund by
self-donation, organizing gala dinner, donation from othersources

JANTRA, Nepal- Developing proposal for funding

CATA, Cambodia- Organizing field visit for Japan Women Anti-TB Association- Developing proposal for funding

MMWA, Myanmar- Donation from donors- Selling calendar and magazine

RIT/JATA, Philippines- Developing proposal for funding

24

Funding from tobacco, alcohol and pharmaceutical companies
All participants recognized tobacco and alcohol as risk factors for TB. Therefore, theirorganizations do not accept funding from tobacco and alcohol related business. Particularly,
Stop TB partnership Indonesia’s mission also includes stop tobacco. Cambodia
implemented TB prevention project in tobacco factory but does not receive funding from thecompany. As for funding from pharmaceutical companies, participants from Korea, Taiwan
and Thailand reported that they accepted donation with conditions. For examples, thepharmaceutical companies can donate money to support TB activities as if they are an
individual donor. Therefore, the company’s logo must not appear in the product or the
events funded by the pharmaceutical companies. JUNTRA, CATA and RIT/JATA Philippines
have never been approached by pharmaceutical company. In addition to pharmaceuticalbusiness, Myanmar MMWA also reject funding from some baby products such as baby
talcum, milk or baby food. The senior participants from RIT shared the information thatpharmaceutical companies are also members of Stop TB Partnership Japan. Accepting
funding from this business sector should be considered based on the conditions and context
of funding proposal.
The moderator closed the session by concluding that funding is important for running NGO
and implementing community activities. The discussion shows that integrity to accept or toraise funding is priority for all participants.

25

Appendix 7

Tokyo Statement on Community Engagement in End TB Strategy
Asian National Stop TB Partnership Forum 2016
The Asian National Stop TB Partnership Forum 2016 was held on March
14-15, in Tokyo, Japan, with the participation of a total of 18 delegates from
8 Asian countries / territories (Cambodia, Indonesia, Korea, Myanmar,
Nepal, Philippines, Taiwan, and Thailand). These participants represented
the non-governmental organizations (NGO) and other civil society
organizations (CSO) engaged in tuberculosis control.
The missions of the Forum were;-

To enhance people’s awareness of the importance of their ownership forand commitment to tuberculosis control activities,-

To promote the effective collaboration between governmental andnon-governmental sectors in the fight against tuberculosis, with specialreference to the potentiality of women’s roles,-

To clarify the problems and challenges of tuberculosis control of eachtarget area or community to be addressed in their action plans, and-To advance cooperation between partners of different groups beyond
country borders.

During the two-day meeting the participants shared their experiences andviews of their groups, as well as those of the Women’s anti-TB Associationand Western Pacific Region of WHO, and had discussions over the ways toenhance respective groups’ activities in the perspective of End TB Strategy.
Following are the summary findings of presentations, discussions, andproposals from the forum, as agreed upon by all the participants.
Background: Paradigm shift in the fight against tuberculosis
Along with the paradigm shift from the Millennium Development
Goals to Sustainable Development Goals, the global TB program has turned
to End TB Strategy as endorsed in 2014. In this strategy, tuberculosis is
recognized more clearly than ever as a socio-economic challenge, not merely
as a medical issue, to which more engagement of communities, or
non-governmental organizations, is badly needed, as claimed throughout thepillars of the strategy. Specifically, integrated, patient-centered TB care and26

prevention is claimed as the fundamental element in Pillar 1. This is alsostressed in the Regional Framework developed by WPRO, adapting the End
TB Strategy to its regions.
Roles of NGOs in End TB Strategies: Missions, Opportunities, and Challenges
In country presentations and group discussions, the following four points
were highlighted as important roles of NGOs / CSOs, each with special
emphasis as supplemented in numbers 1, 2, …. . Although the roles andchallenges of NGOs/CSOs are diverse and variable according to the countries
and organizations, the key issues such as community and patient-oriented
approach were common, and this sharing was felt as most critical inpromoting the spirit of the stop TB partnership.

1) Cooperation with the government in implementing NTP
1. Supporting TB case detection through urging symptomatic subjects, or
TB suspects, to visit health facilities.
2. Encouraging patients to take medications regularly.
3. Increasing the awareness and knowledge of TB among community people
on various occasions to reduce the stigma, discrimination andsuperstition, and to take proper action against illnesses.

2) Social support of patients and families
1. Supporting, educating, and empowering patients and their family facing
financial barriers through forging UHC.
2. Providing patients with food, transport, housing, etc., as important areasof patient support.

3) Advocacy
1. Advocating voices of patients and vulnerable people.
2. Increasing awareness of TB among the community.
3. Creating patients’ groups, so that they have a stronger voice for claiming
better service and protection, and also enhancing community awarenessof TB.
4. Creating peer support groups with high capacity to support vulnerable
groups (e.g., the very poor, women, children, HIV-infected or elderly
persons, etc.).
5. Advocating research for TB control, especially operational researches
27and researches involving community activities.
6. Engage other areas of the society/community with TB, such as education,
agriculture and MCH, etc..
7. Empower health activists and volunteers o set up networks at grass-root
level involving other community members

4) Women’s roles and potentials
1. Gender equity should be addressed in TB care, including access to healthservices and knowledge of TB.
2. Women’s potential in community activities should be fully recognized.
Fund raising issues
Many groups suffer from inadequate budgets, but few of them use
specific schemes of their own for fund raising, e.g., Christmas-seal campaign,
Calendar sales, donation box (in shops, etc.), and charity events, in addition
to donations from individuals (group members and others) and companies.
Other funding sources include government programs, the Global
Fund, WHO, Union, Stop TB Partnership, UNICEF, other bilateral plans(e.g., JATA, USAID, TBREACH), and charitable foundations.
Apart from the inadequacy of funds, possible concern may exist forreceiving donations from pharmaceutical industries (in some countries, also
other health-related businesses), to say nothing of donations from tobaccoand alcohol industries.
Challenges
1. The high turn-over rate of volunteers is common, possibly due toinadequate incentives and lack of community recognition, or volunteers’
dignity.
2. Incentives for volunteers may include privileged free access to healthservices, periodic meetings for reporting volunteers’ activities,
opportunities of training and exchange with other groups, awarding foroutstanding performance, and provision of travel allowances.
3. Addressing patient’s confidentiality or privacy.
4. In some cases, consensus between government and NGOs is not enough,and some care providers have difficulty in implementing International
Standards of TB Care.
5. Low capacity of research activities, when NGO’s operational research is28

expected as very significant, especially in UHC and social protection
schemes.
6. Documentation of success stories of community activities may be
important in sharing recognition of bases of TB control such as UHC andpatient-centered care.
Forum slogan
The forum decided to adopt a following slogan to be shared by member organizations asa priority message of activities.
-

Women are creators of community health through family health.

Acknowledgement
The Forum acknowledges the contribution and efforts of the following individuals andorganizations that made the meeting possible and successful. The Forum also expresses
deep thanks to the observers for their kind interest in the meeting.
Participants[Organization] Cambodia: National Center for TB and Leprosy control (CENAT), Cambodia
Anti‐Tuberculosis Association (CATA). Indonesia: Headquarthers of Forum Stop TB PartnershipIndonesia and Stop TB Partnership Cimahi City, Korea: Korean National Tuberculosis Association(KNTA), Stop TB Partnership Korea, Myanmar: Myanmar Maternal Welfare Association (MMWA),
National Tuberculosis Program, Kachin State, Nepal: Japan‐Nepal Health & TB Research Association(JANTRA), Philippines: RIT/JATA, Philippines Inc. (RJPI), Taiwan: Taiwan Anti‐TB Association (TATA),
National Chang‐Hua Hospital MDR TB Department, Thailand: TB/HIV Research Foundation (THRF),
Chiang Rai Volunteer Ladies against TB[Member] Cambodia: Khloeung Phally, Monyrath Chry, Chharvy Ringsey Keo, Indonesia: Mariani
Reksoprodjo, Fitriani Manan, Korea: Seungjoon Chang, Kanghee Kim, Hong Jo Choi, Myanmar: Tha
Zin Nwｅ, Ei Ei Chaw, Nepal: Ram Sharan Gopali, Jamuna Panthi, Philippines: Aurora G Querri,
Leonardo G. Parungo Jr, Taiwan: Chih‐Yun Lin, Wei‐Wen Chen, Thailand: Sarmwai Luangjina, Jintana
Ngamvitayapong‐Yanai

Staff[Organization] Stop TB Partnership Japan, Japan Anti‐Tuberculosis Association (JATA), ResearchInstitute of Tuberculosis, JATA, Council of Japanese Women’s Anti‐Tuberculosis Associations,Western Pacific Regional Office of World Health Organization
29

[Member] Ram Sharan Gopali, Makiko Goto, Yumi Ishikane, Nobukatsu Ishikawa, Shoji Kudo, Ayako
Miyamoto, Toru Mori, Nobuyuki Nishikiori, Jintana Ngamvitayapong‐Yanai Kosuke Okada, Kintaro
Shibuya, Noriko Shirasu, Noriyo Shimoya, Keiji Tanaka, Tomoko Tsuji, Takeko Yamashita

30

JAPAN

Asian National Stop TB Partnership Forum 2016
Date： 14-15, March, 2016
Venue １：1F HALL United Nations University,
Venue ２：Hotel New Otani
Venue ３：Research Institute of Tuberculosis (RIT)討 論