HERD - NEPAL

Development of a desk guide to assist TB case management in Nepal

Nepal adopted DOTS strategy as national policy for TB control in 1995. By 2001 DOTS was implemented in all 75 districts of the country. NTP training modules, manuals and guidelines were prepared during 1996-1998. The NTP manual which covers aspects of TB control including the policy, organisation, laboratory tests, diagnosis, treatment, management and supervision were issued in 1996/97. Similarly, a clinical manual was developed by NTP with support from Nuffield in 1998 and revised in Feb 2006. Basic and refresher training are provided to different cadre of health workers by using different training modules. Since then some new policies and strategies have been adopted by NTP and they recently held an international review, and completed operational research projects supported by the NCIHD have made some policy recommendations. Considering these recent changes, NTP Nepal and its stakeholders have realised the need to have a comprehensive revision of existing documents stating all aspects of TB case management to be used under the NTP by all service providers. It is also considered useful for Nepal NTP to adopt the comprehensive TB deskguide developed by Nuffield Centre which included appropriate revisions taking the local context into account, and proved to be beneficial and useful in other countries.

This pilot study aims to strengthen the Nepal TB Control programme by reviewing and revising the training modules, TB manuals and adopting TB desk-guide to improve the quality of TB care in Nepal. The project intends to bring the new developments into policy and practices by revising existing NTP materials with locally tested best practices. This creates an opportunity to accommodate all operational research (OR) findings into policy and practices, most of these OR were supported by the Nuffield Centre and COMDIS projects. The revision will address the following areas: option of public private mix (PPM) approaches, TB and HIV/AIDS program collaboration, treatment regimens recommended by Stop TB and the International Standards of TB Care (ISTC) and training modules and TB manuals. It will also incorporate the knowledge gained from research into policy and practice including TB related stigma and discrimination, management of tuberculosis suspects, delay in diagnosis and treatment of TB and TB services for the migrant population in urban areas of Nepal.

The new guidelines and tools will be tested and revised based on the findings of cohort studies in selected districts. This pilot project will be conducted in collaboration with the NTP, SAARC TB and HIV Centre, and other stakeholders (NGOs and private sector). Consultative meetings and discussions will be held to adopt TB desk guide and revision process. Final products will be used widespread under the Nepal NTP. It is expected that this will enhance the overall program performance. Individual health workers will be able to deliver proper care to patients and improve their performance. Similarly, patients will benefit directly and indirectly by obtaining good quality of care. The findings will be communicated at national and international levels.