Involvement of NGO & PPS in RNTCP under revised schemes.

Dr.Khalid.U.K. LRS INSTITUTE OF TB & RESPIRATORY DISEASES SRI AUROBINDO MARG, NEW DELHI

NEED FOR INVOLVEMENT

Easy access to patients.
First point of contact.

PPs/Private Hospitals / Private Nursing Homes are more in No.

Higher success rates with involvement .

AIM
Strengthen TB control by Private Practitioners and Non-Governmental

Organizations
R.N.T.C.P.

involvement

in

OBJECTIVES
To review the progress in involvement of NGO/PP in RNTCP since the formulation of schemes and share experiences.

To review the present NGO/PP schemes,

identify constraints and suggest improvements. To recommended new schemes to improve the collaborations with other sectors in all aspects of RNTCP implimentation

SCHEMES FOR COLLABORATION With NGO & PPs

Scheme 1 Scheme 2 Scheme 3 Scheme 4 Scheme 5 Scheme 6 Scheme 7 Scheme 8 Scheme 9 Scheme 10 : : : : : : : : : : ACSM Scheme SC Scheme Transport scheme DMC Scheme LT Scheme Culture and DST scheme Adherence scheme Slum Scheme TU Model Scheme TB-HIV Scheme

Scheme - 1
ACSM Scheme: TB advocacy, communication and social mobilization. Mobilization of local political commitment and resources for TB. Improved case detection and treatment adherence. Empower people and communities affected by TB.

Reduced stigma and discrimination against persons and families affected by TB.
Area with population varies from 0.5 1 million or greater.

Eligibility
2-3 years experience in social mobilization and grass root level activities.

Scheme 1 Cont
Grand in - Aid
1.5 lacs per million population per years Prorata population covers. Role of NGO ACSM activities in consultation with DHS.

Role of RNTCP (DTO/STO)

Help in identification of pockets which needs attention. Illustration Community meeting of at least 50 people @ Rs. 300 x 4 meetings x 12 months = Rs. 14400/-

Scheme 1 Cont
School activities Rs. 1000/- per activity x 12 months = Rs. 12000/ Sensitization meetings for PRIs/SHGs/Religious head @ Rs. 500 per meeting x 12 months = Rs. 6000/ Patient provider meetings atleast two in a month @ Rs. 200 per meeting x 4 meetings per month x 12 months = Rs. 9600/-. Information materials to be used= Rs. 33,000 per anum. Other innovative activies = Rs. 25,000/ Travel and mobility cost = Rs. 50,000/TOTAL Rs. 1.5 lac per anum per million population.

Scheme 2
SC SCHEME: Sputum collection centre/s

Sputum collections in diagnosis and during follow up as per RNTCP guideline. Sputum transportation to the nearest DMC

Eligibility
Any institution in under served area with convenient access at appropriate time to the population served. Role of NGO Collect diagnostic and follow-up sputum specimen as per RNTCP guideline .

Scheme 2
Ensure accurate recording and reporting.

Cont.

Ensure adherence to guideline on sputum collection.

Ensure the mechanism for transportation of sputum specimen.

Role of RNTCP (DTO/STO) Help in identification of under served area. Help in sputum microscopy at DMC in timely transmission of results Training of concerned staff and provision of sputum cup.

Grand in - Aid
Facility cost Rs. 3000 per month, Service cost Rs. 2000 per month. TOTAL Rs. 60,000 per anum per sputum collection centre.

Scheme 3
Transport Scheme: Sputum pick-Up and Transport Service Accessibility under served population

Eligibility
Capacity to transport sputum specimens as per RNTCP guidelines. Role of NGO Coordinate with assigned sputum collection centers and DMCs. Transport samples to DMC periodically.

Convey results in dispatch list and forms to sputum collection centers.

Maintain travel log-book.

Scheme 3 Cont..
Role of RNTCP (DTO/STO)

Planning and allocation of sputum collection scheme, transportation in collaboration with DMC, MO and external partners.
Training of concerned staff and provision of materials. Ensuring quality microscopy and timely result transmission.

Grand in Aid
Rs. 24,000 per anum (for maximum of 20 visits per month)

Scheme 4
DMC Scheme: Designated Microscopy and Microscopy cum Treatment Centre (A & B) A. Designated microscopy and treatment centre Free of cost Anti-TB medications and Microscopy.
Eligibility NGO registered under society act. Minimum three years experience in relevant field. Availability of infrastructure, equipments and staffs.

Role of NGO
Serve as a DMC and DOT centre free of charge. Serve as a referral of non area patients after diagnosis.

Scheme 4 Cont
Role of RNTCP (DTO) Provide training and technical guidelines. Perform laboratory quality control.

Grand in Aid
Annual grant in aid of Rs. 1.5lacs.

B. Designated Microscopy centre only.

Free microscopy Eligibility Availability of infrastructure, equipments and staffs. Maintain records and reporting as per RNTCP policy. In first year positive and negative ratio 1:2 and after one year 1:1.2.

Scheme 4 Cont
Role of PPs Sputum microscopy free of cost. Preserve slides for quality assurance by STLS. Maintain record and submit the report as per RNTCP policy. Role of DHS Provide training and technical guidelines. Perform laboratory quality control. Provide reagents, laboratory forms and registers.

provide binocular microscope if needed and available.

Grand in Aid
Rs. 25 per slide.

Scheme 5
LT Scheme: Strengthening RNTCP diagnostic services STLS under guidance of DTO supervise lab technician.

Eligibility
Registered NGO with capacity and commitment to provide sustained support for at least 3 years.

Role of NGO
Recruitment of lab technicians via a competitive mechanism. Maintenance of person on payroll and regular salary payments. Deployment of person to work at identified DMC. Supervision and monitoring of LT performance. Resource mobilization by NGO if this activity is funded by them.

Scheme 5 Cont.
Role of RNTCP (DTO/STO) Joint planning with NGO for identification of underserved area for DMC. Coordination with NGO and health society to ensure timely payment.

To ensure that LT is trained as per RNTCP guideline.

To ensure that RNTCP, EQA protocol is implemented. Supervision and monitoring of LT performance. Grant-In-Aid Contractual LT salaries + 5% overhead and recruitment cost reimbursement = one month salary.

Scheme 6
Culture and DST Scheme: Providing quality assured culture and drug susceptibility testing services.

Well functioning mycobacterium laboratories in NGO for sputum/specimen mycobacterium C & DST activities.

Eligibility

Applicant laboratory should have infrastructure, equipment and staff for sputum culture and DST activities.
Laboratories should accreditated by RNTCP accreditation mechanism. The annual proficiency testing with RNTCP, NRL as per RNTCP guidelines. Sputum C & DST free of charge to all RNTCP patients.

Scheme 6 Cont.
Responsibilities of NGO/Private facilities Adequate infrastructure, equipment, consumables and staff for lab. Keep records and submit reports as per RNTCP guidelines. Coordinate with NRL and STO for EQA of lab regularly. Responsibilities of STO Coordinate with NGO, DTO and NRL for service provision, training, supervision and quality assurance. Ensure timely payment to laboratories on six monthly basis. Regular report to be sent to CTD and state level DOT Plus committee.

Scheme 6 Cont.
Grant-in-aid Rs. 2000 per specimen for sputum/smear, culture, species identification and DST for four first line anti-TB drugs. Rs 400 per specimen for sputum/smear, culture and species identification. Payment will be based on pre-decided number of MDR suspect as per RNTCP, DOT Plus implementation plans.

Scheme 7
Adherence Scheme: Promoting treatment adherence.

NGOs and PPs play major role for free DOTS and patients adherence during treatment.

Eligibility

NGO must be registered under society registration act (1860) and should have a minimum of one year experience in health field.
NGO must have necessary infrastructure and agree to provide services in at least one TU. PPs should be trained in RNTCP modular training.

Scheme 7 Cont.
Role of NGO A. DOT Services

Identify, trained and supervise volunteers for DOTS.

Assessable and acceptable to patients. Free DOTS to patients as per RNTCP policy. Maintain record as per RNTCP policy. Ensure the collection of follow-up sputum specimen. Manage and refer for side effects at right time. facilitate payment of honorarium to community DOT provider. Referred or transferred patients may be taken care.

Scheme 7 Cont.
B. Awareness generation Conduct IEC activities for treatment adherence like community and patient provider meeting. Create awareness and linking patients to welfare scheme. C. Counseling services for patients and families

Counseling services to includes emotional support, symptoms, disease, treatment duration, treatment adherence, side effects and referral.
Services and referral for substance abuse. Retrieval efforts for interrupter.

Scheme 7 Cont.
D. Additional services Transportation of patients wise boxes and treatment card from PHI to DOTS centre and vice versa. maintain records of such transfers. Role of Private Providers

Ensure home address verification and counseling of patients and their family.
DOTS and sputum microscopy as per RNTCP policy.

INH prophylaxis as per RNTCP policy.

Patients retrieval mechanism as per RNTCP policy. Recording and reporting as per RNTCP guidelines.

Scheme 7 Cont.
Role of DHS
Coordinate the identification of partners NGOs and PPs. Provide training for DOT providers.

Provide literature for training and orientation.

Provide free anti-TB drug and sputum container. Provide records as required. Supports default retrieval for PPs. Provide honorarium as per RNTCP norms to DOT provider.

Grant-in-aid (NGOs)
NGOs supervising DOT services Rs. 40,000 per lac population per anum, prorata for population served.

Scheme 7 Cont.
For DOTS
Cat I and II patients: Rs. 250 per cure or treatment completed patients

Cat IV Patients: Rs. 2,500 (1000 for IP + 1500 for CP) per cure or treatment completed.
Grant-in-aid (PPs)

PPs providing DOT

Rs. 400 per successfully treated including initial home visit and default retrieval.

Rs. 250 per successfully treated only and Rs. 150 for Initial home verification and default retrieval by NGO
Cat IV Patients: Rs. 2,500 (1000 for IP + 1500 for CP) per cure or treatment completed.

Scheme 8
Slum Scheme: Improving TB control in urban slums

Intensive focus on slum dwellers under this scheme.

Eligibility NGOs/community based organization/self help group/private practitioners in capacity and commitment to provide supports for at least three years. Role of NGO/Collaborating partner IEC activity and service awareness in slums population. Diagnostic process, treatment initiation, treatment adherence, migration and default prevention. Collect contact details and other information of migration.

Scheme 8 Cont
Conduct address verification for patients. Address special needs like drug and alcohol abuse. Link and facilitate welfare scheme. Facilitate sputum collection and transportation to DMCs. Provide DOTS as per RNTCP guidelines. Patients retrieval and informed RNTCP staff about patient not retrieved. Facilitate referral and transfer of impending migration of patients.

Role of RNTCP (DTO/STO)

Training of NGO and service providers. Provide sputum cups, IEC materials and printed materials.

Scheme 8 Cont
Supervise, monitor and evaluate NGO activities and patients care. Provide honorarium for individual provider as per RNTCP norms. Grant-in-aid (PPs) PPs providing DOT

Rs. 50,000 per 20,000 population per anum (pro-rata for slum population size).For facility cost, remuneration, sputum transportation costs and administrative cost

Scheme 9
Tuberculosis Unit Model
In a area where government infrastructure not sufficient for effective RNTCP implementation.

NGO currently working in health field in the same area.

Role of NGOs Microscopy, DOTS, defaulter retrieval, recording , registration , supervision, recording and quarterly reporting to DTO. Memorandum of understanding sign every two years. Role of DHS Provide technical orientation , guidance and supervision. TB register, Lab register, Treatment card , I card, Lab from & other formats. Anti TB drugs, Antibiotics, Microscopes, Lab consumables, Two wheeler (If required).

Scheme 9 Cont
Grant-in-aid
Startup activities (one- time only)

Item

Amount (in Rs)

Civil works for up gradation of microscopy centers (up to 1,50,000 Rs.30,000 per microscopy centre)
Funds for training of multi-purpose workers and other staff (MO) Funds for training of multi-purpose supervisors and related staff.

40,000 10,000

Sub-total available for one- time assistance.

2,00,000

Scheme 9 Cont
Annual Grant-in-Aid
Personnel (NGO to ensure full-time , mobile staff to serve as senior Treatment Supervisor and Senior Tuberculosis Laboratory Supervisor. Amount (in Rs) 1,80,000

Honoraria for directly observed treatment (@ Rs 250/ patient with an assumption that 25% patients will be with the community volunteers) General Support (to cover all administrative and technical costs of running the programmed, including ensuring the presence of an MO of the TB Unit, book keeping , getting the account audited annually by a chartered accountant, POL and maintenance of vehicles, phone calls, faxes, photocopying, accounting expenses, etc.)
Amount available for annual assistance.

50,000

3,00,000

5,30,000

Scheme 9 Cont
Eligibility Under societies registration act. Minimum three yeas experience in health care Infrastructure, Staff.

Annually account audited and report Submission till 15th June each year to DHS.

Scheme 10
TB-HIV Scheme: Delivering TB-HIV interventions to high HIV risk groups
Targeted intervention programme for vulnerable population like commercial sex workers, truck drivers, eunuchs etc. NGO currently working in health field in the same area. Eligibility NGOs under taking NACP in targeted population and catering to minimum of one thousand of such population. or NGOs running a NACP accreditated/funded community care centers for HIV, with atleast 20 beds. NGOs already providing HIV care to high risk group. NGOs being offered RNTCP scheme should willing to under take delivery of comprehensive TB care.

Scheme 10 Cont.
Role of NGO/Collaborating partner Intensify TB case findings by TB symptom screening through out reach workers and client attending NGOs clinics Patients friendly approach for diagnosis and categorization . Under take address verification before treatment initiaion. Treatment provision. Treatment adherence, smooth transfer, monitoring, supervision and recording. Monthly meeting with DTO. Out reach activities like ACSM to high risk group.

Scheme 10 Cont.
Role of RNTCP (DTO/STO) Training of NGO and service providers.

Provide sputum cups, IEC materials , Treatment card , I card etc.

Provide honorarium for individual DOT provider as per RNTCP norms.

Grant-in-aid
Rs. 1,20,000 per NGO per 1000 target population, increased prorata for target population.

Thank You