Tuberculosis Free Nepal Declaration Initiative Implementation Guideline

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Overview

TB Free Initiative is one of the innovative activities in the National Strategic Plan (2021/22-2025/26). Government of Nepal (GoN) plans to make the Local Governments accountable towards Tuberculosis management and ensure a conducive environment to tackle the foreseen challenges in order to achieve the END TB target by 2050 (<1 TB case/Million population).

‘TB Free’ means the condition of Zero TB or <1 TB case per million population.

Long-term vision: TB Free Nepal

Goal: End TB by FY 2091/92, eliminate TB by FY 2106/07 and Zero catastrophic cost.

Objectives:

1. To provide quality TB services in a sustainable way by mobilizing local resources.
2. To develop ownership and engagement with local partners and stakeholders by maintaining coordination and cooperation between the Federal, Provincial and Local Level Government to end TB.
3. To increase political commitment to end TB along with develop and strengthen patient-friendly health system.

NATIONAL STRATEGIC PLAN TO END TUBERCULOSIS IN NEPAL

Strategies

• Identify and analyze the existing problems in TB services, and make relevant action plans based on their prioritization for ensuring effective services in each ward of local level.
• Secure commitment to implement activities as per the action plan for sustainability of the TB Free Declaration Initiative
• Provide TB identification, diagnosis, prevention, treatment, referral and care and support services free of cost.
• Develop a mechanism between Federation, Province and Local Level for effective implementation of the program.
• Form committees at the local level by ensuring the participation of all stakeholders as required and assign responsibilities.
• Make local level officials, health workers, volunteers, educational institutions, social organizations and government, private and non-governmental organizations responsible towards the program.
• Federal, Provincial and Local Level governments ensure the resources as required for successfully implement the initiative.
• Ensure the commitment from all levels of government for the successful implementation of the program.
• Manage required human resources for quality TB services.
• Keep records as prescribed and ensure regular reporting.

Basis of Declaration

• The details of the population by conducting household survey are kept as per the need and updated from time to time.
• At least one TB laboratory with a dedicated Lab personal operational at each local level for the diagnosis of TB.
• All hospitals, primary health centres, health posts, basic health centres, NGOs and INGOs health clinic operating in the LL should have DOTS centre as per need.
• Proper management is ensured at appropriate treatment center or sub-center for drug resistant TB patients. Referral mechanism is in place if such center and sub-center are not available in the nearest vicinity.
• Every health facility has a TB Focal Person.
• Necessary arrangements are made for infection control and waste management in the diagnostic and treatment centers and sub-centers.
• The minimum physical infrastructure required for diagnosis and treatment centers and sub-centers are available as mentioned in Annex-1.
• Micro-plan for TB-Free Initiative is formulated at each ward of all local levels as prescribed and implemented accordingly.
• Public awareness programs are implemented in the community to eradicate discrimination towards TB disease.
• Active Case Finding Program are conducted on regular basis among the risk group and risk-prone areas.
• The residents of the local level who had gone outside the local level for foreign employment, seasonal employment and had stayed elsewhere for more than four months have undertaken TB test immediately upon return for ensuring TB transmission.
• TB Prevention activities like ensuring 100% BCG vaccination, provision of identifying unvaccinated children and vaccinating them by developing plan by the concerned health facility, and Tuberculosis Preventive Therapy (TPT), are conducted for reducing TB transmission rate.
• The sanctioned posts of human resources should be fulfilled.
• Provision of sputum collection and its transportation have been effectively implemented.
• Supply of medical equipment, reagent and other materials required for conducting the initiative is regular.
• Each year, the local level (palika) identifies TB risk group from the total population and conducts four TB screening camps at the interval of at least three months.
• From among the patients who have come to the healthy facility for receiving services, the risk groups such as PLHIV, malnourished children, people affected with diabetes and chronic diseases are enrolled in sputum test and their X-rays are taken as per the need.
• The reporting and recording of the patients receiving TB services from government, private and non-government health services providers are reported in the prescribed reporting system.
• The evaluation and verification of the TB Free Declaration Initiative is done in two phases.

Phase

Phase 1: The period from the commencement of the program until the end of the second year will be considered as Phase 1. In this phase, the activities of the initiative will be implemented by ensuring all the infrastructures of the Initiative. The activities will be monitored as per the indicators mentioned in Annex-2 attached herewith and
will be verified.

Phase 2: In Phase 2, a protocol describing necessary indicator for carrying out the impact assessment of the TB Free Declaration Initiative will be developed. A micro analysis will be carried out as per the protocol to ensure whether the indicators and standards for the declaration of TB Free status have met. The findings will be verified and the concerned body/agency will be recommended for making the declaration.

The indicators mentioned below will be the main basis for setting up the indicators of impact assessment.

• The treatment success rate of both Drug Sensitive TB (DSTB) and Drug Resistance TB (DRTB) are at least 95% and 85% respectively at local level.
• There is zero TB cases or is less than one active TB case per million population for five consecutive years since the commencement of TB Free Initiative.

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