Summary of the Tuberculosis Programme
Programme: Scaling up Tuberculosis Control in Romania by focusing on poor and vulnerable populations
Background: Despite important efforts done during last years, TB continues to represent an important public health issue in Romania. Even the epidemiological data show a slightly decreasing of the TB case notification rate, from 142 cases registered among 100.000 population during 2002, to 118 TB cases registered among 100.000 population during 2006, TB infection continues to be largely spread among the general population.
The decreasing of the TB case notification rate was possible due to a high case detection rate (over 90% for all TB cases) and a success rate over 80% of registered cases (82% for the 2004 year cohort).
However, Romania stands as the 42nd in rank from a total of 211 countries that provide data regarding TB to the World Health Organization (WHO). Within the European Region of WHO Romania stands as the 2nd in rank regarding TB case notification rate; only Kazakhstan has a higher TB case notification rate.
Starting with 1997, the most effective strategy for TB control recommended by WHO, the DOTS strategy, was implemented in Romania.
By this moment due to the political commitment of the Romanian government that ensured diagnosis and treatment free of charge for all TB patients, with a sustained and continuous support of WHO and with an important funding from the Global Fund within the 2nd Round it has been registered important progress in TB control activities implementation. Among them we mention: DOTS Strategy available for 100% of the population, development of 2 Centers for MDR- TB diagnosis and treatment, elaboration of 5 practical guidelines for TB control, development of an electronic system for recording and reporting TB cases, development of an efficient system for monitoring and evaluation of NTP implementation, strengthening the laboratory network of bacteriological laboratories, integration of TB control activities from the penitentiaries within the TB network.
Further on, in order to obtain the most effective TB control we need to focus the efforts on certain interventions on vulnerable groups: homeless children and youngsters, prisoners, population from remote/ poor areas, MDR- TB patients and to develop some innovative activities as well.
Goals and objectives:
The goal of the programme is to increase the efforts for TB Control activities, by introducing innovative activities, and continuing the proven effective activities in order to decrease the TB burden in Romania.
The following objectives are followed:
- To ensure high quality TB diagnosis and patient centered health care through public- private partnership development in TB control field;
- To protect the poor and vulnerable groups for TB through specific health education and interventions in order to ensure compliance to TB treatment;
- To scale- up MDR- TB Control through DOTS- Plus implementation;
- To strengthen the management capacity of the National TB Control Programme (NTP) to coordinate at national and local level the TB Control activities through health systems strengthening;
- To develop the involvement of the communities and to increase the political commitment for TB control;
- To ensure efficient and effective implementation of the Global Fund Grant.
Strategies:
- Elaboration of needs assessment studies of TB patients and their family members for resources mobilization at community level for TB control activities, in order to develop the ACSM strategy (from "Advocacy-Communication and Social Mobilization");
- Elaboration of KAP studies (from "Knowledge-Attitudes-Practices") related to TB control for certain vulnerable groups (homeless children and youngsters, prisoners), analysis of all previous studies performed in Romania in this field by this moment in order to elaborate the national strategy for health education in TB control and to establish the most effective interventions for behavior change communication;
- Elaboration of a meta-analysis study on the current roles and responsibilities of public and private sector in TB control activities in order to develop the public- private partnership and to ensure the patient centered health care of the TB patients;
- Outreach activities at vulnerable groups' level, at health care providers level that face difficulties in TB control activities implementation;
- Social assessment and ensure psychological and social support for homeless children and youngsters and their family members;
- Psychological assessment and counseling to ensure compliance to TB treatment of homeless children/youngsters;
- Development of training materials, curricula for training of different categories of social care providers, health care providers, for management and coordination of TB control activities;
- Development of distance learning in TB control field, targeting different staff categories: specialized medical staff, primary health care providers and even prisoners and penitentiary staff;
- Organization of workshops, working group meetings with representatives of organization and institutions having responsibilities in TB Control activities field in order to obtain consensus on guidelines, strategies and working protocols;
- Development of human resources capacity through training of trainers, development of their abilities to plan, monitor and evaluate the interventions in TB control field;
- Information- Education- Communication activities at different levels (general population, TB patients, vulnerable groups, medical staff, mass- media), using different instruments (educational films, printed materials, promotional materials, press layouts, media events, newsletters, etc) on different occasions: World TB Day, outreach activities, procurement of electronic devices for TB Dispensaries for educational films dissemination, caravans in remote communities, etc.;
- Elaboration and implementation of PAL strategy;
- Development of Operational Research in TB Control in Romania.
