COUNTRY PRESENTATION MONGOLIA

Meeting of TB managers and TB laboratory managers in the WPR Hangzhou, China 29 June 2 July 2004

Country presentation
Population 2,475,000 (2002) APGR 1.3% Women 50.4% Reproductive age (15-49) 56.5% Average life expectancy 60.4 (male), 66.1 (female) Case notification rate - New cases 3772 per 100.000 153 (2003) MDR rate - 1% in general population - 16% in prison population - No data on MDR-TB chronic cases category I and II - HIV 4 cases
*Source: Health sector 2002, Reducing Mortality, Ministry of Health Mongolia, 2003 Annual Statistic Report, National Center for Communicable Diseases, 2003

Country Presentation
2005 Overall target
DOTS expansion 100%

2002 Actual
100%

2003 Actual
100%

2004 Planned
100%

2005 Planned
100%

DOTS Detection rate new smear (+)ve Cure rate

70%

67.7%

67.5%

70%

70%

58% more than

83% (2001) 86.8% (2001)

83% (2002) 87% (2002)

85%

85%

Success rate

Action Plan 2003 - 2004

Develop mechanism to ensure effective implementation of Global Fund project
1. Approved Accelerating DOTS in Mongolia project, Two year work plan with budget submitted to the GFATM, Grant Agreement with PR signed Accelerating DOTS in Mongolia project implemented in 9 districts of Ulaanbaatar city and 6 selected provinces 2. Monitoring and Evaluation Plan for two years submitted and approved by the Global Fund 3. Organized targeted case detection and treatment activities among the vulnerable groups. Homeless people receiving free medical care at the Mercy Hospital. New TB section established at the Mercy Hospital where TB doctors providing consulting to TB patients. International organization World Vision provide free nutrition and supplement vitaminization to vulnerable TB patient. By the WHO support there was commenced the Study on diagnosis delay of TB patients in Sept 2003. Coverage size of the study: 4 provinces and 8 districts of Ulaanbaatar. Designed and distributed 500 checklists 160 filled checklist data. 4

Action Plan 2003 - 2004

Improve quality of DOTS implementation in rural areas
1. With purpose of improvement the participation of governors in TB activities there was organized a training among 150 governors from 6 selected provinces and 9 districts of UB city. 2. NTP organized - Training for 400 family and soum doctors of 15 provinces and districts supported by the Global Fund - Training for 120 doctors from 2 selected provinces supported by the WHO - Training for 250 volunteers and the health workers on TB treatment and treatment follow-up 3. Training on supervision and inspection in soum level (30 TB coordinators from 30 TB units) 4. MNTV and Radio broadcasting carried out 13 times - Publication, interview by 4 newspapers -14times - Research conference 2 times - Press conference for launch the project - Designed, published and distributed IEC materials: posters, leaflets, stickers (2600 pc)

Action Plan 2003 - 2004

Strengthen the system to maintain quality of laboratory services
1. Developed new guideline on EQA of smear microscopy in Mongolian 2. 16 Lab. Technicians trained on microscopic examination 3. Conducted refresher training for 40 lab. Technicians 4. Established new TB laboratory in remote area 5. Supervision visits carried out in 8 district of Ulaanbaatar and 9 aimag

Access to DOTS for poor and vulnerable populations

123 vulnerable people (unemployed, homeless TB patient) with improved access to DOTS receiving supplementary food in 9 district of Ulaanbaatar 40 vulnerable people (unemployed, homeless TB patient) with improved access to DOTS receiving supplementary food in 6 provinces

Activities will be implemented in 2004 - 2005 in address of TB/HIV

No
1

Activities
Conduct workshop on HIV/AIDS diagnosis, treatment and prevention for TB coordinators of all aimag and district hospitals Active TB and HIV case finding among prisoners in detention center Conducting HIV routine surveillance for new serious TB cases in urban area Develop and distribute the guideline on TB /HIV prevention and diagnosis for patients and health workers

Timing
1 Quarter 2004

2 3 4

2 Quarter 2004 3 Quarter 2004 1 Quarter 2005

5 6

Conduct workshop on TB diagnosis, treatment 2 Quarter 2005 and prevention for STI doctors from urban area Conduct peer education on TB/HIV patient 3 Quarter 2005 home care and nursing for health workers from urban area
8

TB Laboratory
Assessment of the implementation of Quality Assurance: - Developed National Quality Assurance Manual based on the recommendation of WHO and WPR - TB Laboratory Network
Level Central Level Laboratory National Reference Laboratory Quantity 1 Duty EQA and others

Intermediate Level

Aimags TB laboratory Districts TB laboratory Prisons TB laboratory (Soum hospital, Health Center)

21 8 1

Smear microscopy

Peripheral Level

TB suspect cases send to TB laboratories

9

TB Laboratory

External Quality Assessment - On-site evaluation of peripheral laboratory using standard checklist - Blinding rechecking ( 923 slides selected by LQAS , checked 861 (93.3%) false positivity rate 0.9% (8 slides) false negativity rate 1.2% (11 slides)
10

Current problems in the implementation of Quality Assurance

Delayed cases registration with the false negative results by EQA in sputum microscopy Lack of laboratory supply and reagents (destroying smears, broken smear, long storage of smears) QA Programme in sputum smear microscopy no immediately influence in case detection and diagnosis due to the QA unavailable for checking all smear (+) cases.

11