The Mexican Model: Health Policy Frame

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2 Contents The Mexican Model Alto TB Mexico Alto TB at state level Implemented strategies Financial protection Assuring detection and cure TB/HIV-AIDS DOTS Network Advocacy, communication and social mobilisation Monitoring and evaluation Impact

3 Contents The Mexican Model Alto TB Mexico Alto TB at state level Implemented strategies Financial protection Assuring detection and cure TB/HIV-AIDS DOTS Network Advocacy, communication and social mobilisation Monitoring and evaluation Impact

4 NATIONAL TUBERCULOSIS PROGRAMME FRAME The Mexican Model: Health Policy Frame National Development Plan National Health Programme Strategies 1. Vincular la salud con el desarrollo económico y social. 2. To Reduce reduce health inequities linked to to poverty 3. Enfrentar los problemas emergentes mediante la definición explícita de prioridades. 4. Desplegar una cruzada por la calidad de los Servicios de Salud. 5. Brindar protección financiera en materia de salud a toda la población. 6. Construir un federalismo cooperativo en materia de salud. 7. Fortalecer el papel rector de la SSA. 8. Avanzar hacia un Modelo Integrado de Atención a la Salud. 9. Ampliar la participación ciudadana y la libertad de elección en el primer nivel de atención. 10. Fortalecer la inversión en recursos humanos, investigación e infraestructura en salud. National Tuberculosis Programme Political Commitment

5 The Mexican Model Humanresourses, Advocacy Communication advocacyand social mobilisation Social mobilisation CurrentSituation Mission Vision Objectives How to decrease the gap? Current situation analysis G o a l s S T R A T E G I E S Proactive case search Timely case detection Cure Population free of TB cases Human Politicalcommitment, development epidemiologicalsurveillance, Supply Evaluation supplies Research

6 The Mexican Model: Legal Frame Federal Constitution Health Law TB expressly mentioned as a priority Seguro Popular (Financial scheme) Coordination/Descentralization Federation (stewardship) States (operation) Mexican Official Regulation for TB prevention and control Ministerial Decree for the establishment of Alto TB Mexico Provides sustainability

7 Contents The Mexican Model Alto TB Mexico Alto TB at state level Implemented strategies Financial protection Assuring detection and cure TB/HIV-AIDS DOTS Network Advocacy, communication and social mobilisation Monitoring and evaluation Impact

8 Contents The Mexican Model Alto TB Mexico Alto TB at state level Implemented strategies Financial protection Assuring detection and cure TB/HIV-AIDS DOTS Network Advocacy, communication and social mobilisation Monitoring and evaluation Impact

9 Alto TB México National Committee President Vice-president Technical Secretariat Ambassador 59 permanent members Subcommittees Clinical TB/ HIV-AIDS DOTs Network Advocacy, communication and social mobilisation Monitoring and evaluation

10 Alto - TB Mexico National Committee Installed on September 7th, 2004 Testified by representatives of 21 countries

11 Alto TB México: Permanent members Federal, state and local governments Medical boards Strategic partners (PAHO,USAID, NGO s) Pharmaceutical industry Private sector physicians Municipalities Network Nurses DOTS Network

12 Alto TB México: Ambassadors Socialization of the fight against TB Act as a link between health authorities and the community

13 Contents The Mexican Model Alto TB Mexico Alto TB at state level Implemented strategies Financial protection Assuring detection and cure TB/HIV-AIDS DOTS Network Advocacy, communication and social mobilisation Monitoring and evaluation Impact

14 Contents The Mexican Model Alto TB Mexico Alto TB at state level Implemented strategies Financial protection Assuring detection and cure TB/HIV-AIDS DOTS Network Advocacy, communication and social mobilisation Monitoring and evaluation Impact

15 Alto TB at state level Installed Ambassador from different disciplines: Olympic medalists, soccer players, marathonists, weight lifters, boxers, cyclists, writers, poets, painters, musicians. Committees at: Aguascalientes Baja California Chihuahua Durango Edo. México Guanajuato Hidalgo Jalisco Nayarit Nuevo León Oaxaca Puebla San Luis Potosí Sinaloa Tlaxcala Veracruz Yucatán Zacatecas

16 Contents The Mexican Model Alto TB Mexico Alto TB at state level Implemented strategies Financial protection Assuring detection and cure TB/HIV-AIDS DOTS Network Advocacy, communication and social mobilisation Monitoring and evaluation Impact

17 Contents The Mexican Model Alto TB Mexico Alto TB at state level Implemented strategies Financial protection Assuring detection and cure TB/HIV-AIDS DOTS Network Advocacy, communication and social mobilisation Monitoring and evaluation Impact

18 Financial Protection: Seguro Popular Persons affected by TB are protected by Seguro Popular Financial protection shared by their family Follow-up with National Health Card System Integrated health care services: prevention and treatment Laboratory services guaranteed

19 Contents The Mexican Model Alto TB Mexico Alto TB at state level Implemented strategies Financial protection Assuring detection and cure TB/HIV-AIDS DOTS Network Advocacy, communication and social mobilisation Monitoring and evaluation Impact

20 Contents The Mexican Model Alto TB Mexico Alto TB at state level Implemented strategies Financial protection Assuring detection and cure TB/HIV-AIDS DOTS Network Advocacy, communication and social mobilisation Monitoring and evaluation Impact

21 Infrastructure Strategic alliance with USAID Infrastructure reinforcement nationwide Equipment to support laboratory, epidemiologic surveillance, information processing, training and evaluation activities 32 state surveillance systems 1,500 Bk and 32 culture laboratories 6 MDR Labs

22 Screening & Diagnostic outreach Mobile laboratories designed for distant locations Coverage 3 893,656 Population screened 6,720 TB cases 112

23 New Blister Intensive Phase Strategic alliance with the pharmaceutical industry Four- drug mix, just one tablet Sustainment Phase Reduces default, failure and drug resistance 40% reduction drugs price By % treatment coverage

24 Mobile DOT Reduce treatment default ratio from 18% to 0%

25 Binational TB Card Strategic alliance with US Government TB prevention and control binational activities Ensures continued treatment for migrants Guarantees patient s reference and case follow-up Two toll free lines

26 Contents The Mexican Model Alto TB Mexico Alto TB at state level Implemented strategies Financial protection Assuring detection and cure TB/HIV-AIDS DOTS Network Advocacy, communication and social mobilisation Monitoring and evaluation Impact

27 Contents The Mexican Model Alto TB Mexico Alto TB at state level Implemented strategies Financial protection Assuring detection and cure TB/HIV-AIDS DOTS Network Advocacy, communication and social mobilisation Monitoring and evaluation Impact

28 TB-HIV/AIDS Coordination between National Programmes Leadership integration and joint operative planning Binomial epidemiological surveillance TB/HIV-AIDS treatment in prisons First Latin-american TB/HIV-AIDS meeting in Oaxaca on november 2005 with NGOs collaboration

29 Contents The Mexican Model Alto TB Mexico Alto TB at state level Implemented strategies Financial protection Assuring detection and cure TB/HIV-AIDS DOTS Network Advocacy, communication and social mobilisation Monitoring and evaluation Impact

30 Contents The Mexican Model Alto TB Mexico Alto TB at state level Implemented strategies Financial protection Assuring detection and cure TB/HIV-AIDS DOTS Network Advocacy, communication and social mobilisation Monitoring and evaluation Impact

31 Strategic alliances: Nurses DOTs Network Non-medicalized programme Nurses viewed as leaders Support White Flag strategy Proactive case search in risk groups Collaboration in social mobilisation Deliver nutritional aid to persons affected with TB

32 Strategic alliances: National Association of Private Practice Physicians and Hospitals Training events Web page availability of TB materials Active participation in the development of national TB guidelines

33 Strategic alliances: Academic Institutions Agreement Ministry of Health/UNAM 5 sessions broadcasted live, once a week Broadcasted by Internet and Channel 22 (national coverage) Assignments and feedback through live chat Final assessment via Internet Diploma with curricular value 151,040 individuals trained

34 Contents The Mexican Model Alto TB Mexico Alto TB at state level Implemented strategies Financial protection Assuring detection and cure TB/HIV-AIDS DOTS Network Advocacy, communication and social mobilisation Monitoring and evaluation Impact

35 Contents The Mexican Model Alto TB Mexico Alto TB at state level Implemented strategies Financial protection Assuring detection and cure TB/HIV-AIDS DOTS Network Advocacy, communication and social mobilisation Monitoring and evaluation Impact

36 Social mobilisation Municipality Community Health Municipal Committe Diagnosis Information Sanitary improvement Projects Social acknowledge and incentives Health Local Committees Health education, social participation and communication to involve community in the adoption of healthy life styles and needs assessment

37 Social Mobilisation: Essential chain I DU L P PC TS JJ RPJ 52 ENF EPIJ Links in the fight against TB MU A E IE RE EPI RENZ LES AE PS DSS

38 Social Mobilisation: Community Assemblies Integration of community leaders Health diagnosis Analysis of available resources Definition of responsibilities Promotion/involvement for timely case detection

39 Social mobilisation: Community-based events Organization of prevention and health promotion events: parades and rallies against TB Community involvement in the design and use of communication materials

40 Communication: Materials Different spaces, different subjects, different messages Signs, comics, leaflets, public address megaphone system messages, posters, radio messages, wall painting, post stamps, promotional articles In spanish and indigenous languages Broad distribution Japu ali we rosówasa kili nataka nima, simea mujé japu oná nirú owiruami, li mi nema echi owiruami japu ona mi nayulú

41 Social Mobilisation: White Flag Community co-responsibility and fight against stigma Required criteria to raise the White Flag 80% of the population is duly informed about TB (is contagious but curable and treatment is free of charge) Proactive participation in case detection 100% DOT coverage

42 Social Mobilisation: White Flag 308,228 community health promoters 40% of them in indigenous areas Flags have been raised in 2,112 communities in 712 municipalities

43 Contents The Mexican Model Alto TB Mexico Alto TB at state level Implemented strategies Financial protection Assuring detection and cure TB/HIV-AIDS DOTS Network Advocacy, communication and social mobilisation Monitoring and evaluation Impact

44 Contents The Mexican Model Alto TB Mexico Alto TB at state level Implemented strategies Financial protection Assuring detection and cure TB/HIV-AIDS DOTS Network Advocacy, communication and social mobilisation Monitoring and evaluation Impact

45 Evaluation Scheme Federal Alto TB México Committee State Local Health services Operative teams More than 11,000 health teams

46 Evaluation: Walking towards excellence Indicators Case-detection coverage Timely diagnosis Cure rate Adequate follow-up Laboratories productivity Measures effectiveness of activities implemented Reflects velocity of change Identifies critical points

47 Evaluation: Walking Towards Excellence Performance Index Nayarit Aguascalientes Colima Tlaxcala Guerrero Durango Coahuila Tamaulipas Guanajuato Distrito Federal Hidalgo Jalisco Zacatecas México Tabasco Veracruz Sonora Quintana Roo Yucatán Puebla Querétaro Sinaloa Chihuahua Michoacán San Luis Potosí Campeche Morelos Baja California Sur Oaxaca Baja California Chiapas Nuevo León Nacional % 20% 40% 60% 80% 100% Sobresaliente (80.0 a < 100%) Satisfactorio (60.0 a <80.0%) Mínimo (40.0 a <60.0%) Precario (<40.0%) Outstanding Rank

48 Evaluation: Recognizing Achievement Based on Walking towards excellence Categories recognized: Programme leaders Epidemiologists Laboratorists Nurses Health promoters Awards are diplomas, training courses and participation in national and international TB meetings

49 Evaluation: Public Accountability Annual report presented at World TB Day celebration

50 Contents The Mexican Model Alto TB Mexico Alto TB at state level Implemented strategies Financial protection Assuring detection and cure TB/HIV-AIDS DOTS Network Advocacy, communication and social mobilisation Monitoring and evaluation Impact

51 Contents The Mexican Model Alto TB Mexico Alto TB at state level Implemented strategies Financial protection Assuring detection and cure TB/HIV-AIDS DOTS Network Advocacy, communication and social mobilisation Monitoring and evaluation Impact

52 Impact: DOTs Coverage % Priority municipalities Years

53 Impact: Budget Direct expenses Year Millions (USD) Blister and Green Light Committee Seguro Popular

54 Impact: Morbidity and mortality Morbidity % 14 R A T E * Bk required to detect one case: % Mortality

55 Impact: Patients cured and treatment default rate Cured 60 % Years Default

56 Our commitment Mexico free of tuberculosis