Fullscreen

  • Overview of PIP

    Content

    The State Programme Implementation Plan (PIPs) for health and family welfare services under National Health Mission (NHM) funding spell out the strategies to be deployed, budgetary requirements and aimed health outcomes.

    PIPs are the most crucial documents in NHM through which the states/ Union Territories (UTs), identify and quantify the targets required for programme implementation for the proposed year.

    PIPs are prepared by states annually as a document which is then finalised in the National Programme Coordination Committee (NPCC) meeting for administrative approval.

    On finalisation of the budget in the NPCC meeting, it becomes an official document available in the Ministry's site for general viewing.

     

    Importance of PIP

    • Its a plan according to which the different activities are carried out and performance of each activity can be monitored against it.
    • Approval of PIP implies that states/districts can carry out the activities mentioned in the plan.
    • It is the indicator of the total budget requirement of the state for carrying out the programme activities

     

    PIP Preparation Process under NHM

    A bottom-up approach is followed for preparing the State PIP wherein the inputs are taken from blocks, cities, Community Health Centre (CHC)/ Peripheral Health Centre (PHC), and village level to prepare a DHAP. These DHAPs are then consolidated to prepare a State PIP.

     

    Budget Heads

    A total of 18 different budget heads comprises the PIP. These include:

    1. Service Delivery – Facility-based

    10. Review, Research, Surveillance & Surveys

    2. Service Delivery – Community-based

    11. Information, Education. Communication (IEC)/ Behaviour Change Communication (BCC)

    3. Community Interventions

    12. Printing

    4. Untied Funds

    13. Quality Assurance

    5. Infrastructure

    14. Drug Warehousing & Logistics

    6. Procurement

    15. Public Private Partnership (PPP)

    7. Referral Transport

    16. Programme Management

    8. Service Delivery – Human Resource

    17. IT Initiatives for strengthening service delivery

    9. Training & Capacity Building

    18. Innovations

    Each budget annexure is linked to the budget summary sheet and the corresponding budget abstracts.

    National Tuberculosis Elimination Programme (NTEP) is one of the many National Health Programmes that have come under the umbrella of the NHM. NTEP is now a flagship component of NHM and provides technical and managerial leadership to anti-tuberculosis activities in the country. NHM, in turn, is responsible for making funds available to carry NTEP related activities. The budget heads of NTEP may differ from other programmes. Hence, after the activities to achieve TB-elimination based on the Detect-Treat-Prevent Build strategies under National Strategic Plan (NSP) for TB Elimination 2017-2025 are planned, they have been aligned with the Financial Management Report (FMR) codes of NHM. This facilitates district, state, and central NHM to consolidate the individual PIPs for necessary approvals.

     

    Resources

     

    Assessment

    Question​

    Answer 1​

    Answer 2​

    Answer 3​

    Answer 4​

    Correct answer​

    Correct explanation​

    Page id​

    Part of Pre-test​

    Part of Post-test​

    Budget heads of NTEP and other programmes under NHM are same.

    True

    False

     

     

    2

    The budget heads of NTEP may differ from other programmes.

     

    Yes

    Yes

  • Identifying and mapping the target population for ACF campaign

    Content

    A targeted approach is considered as an appropriate public health response to identify the hidden cases of TB in the communities. In this regard the National TB Elimination Programme (NTEP) expects that 110,000 per million vulnerable population (11%) should be mapped for community-based screening and >90% of the mapped target vulnerable population should be screened for symptoms of TB.

    Mapping of target population from the identified vulnerable population helps the programme to screen out the persons into: 1) those who are at high risk of progression to active TB disease; 2) those who are eligible for TB preventive treatment 3) Enhance the cost-effectiveness of the programme

    Following are various methods for identifying and mapping the target population from the vulnerable population:

    • Tuberculosis symptom screening

    • Sputum testing

    • Chest X-ray

    Various modalities used to conduct mapping of target population from the identified vulnerable population under the ACF campaign are:

    a) House-to-house TB symptom interviews through community volunteers

    • Relatively minimal costs

    • Needs community awareness session as a pre requisite before conducting ACF

    • May be affected by self and perceived stigma

    • Community volunteers may require monetary/ no monetary incentives.

    b) Door-to-door Sputum collection / sputum drop-off clinics

    • Has the potential for higher yield of TB cases

    • Involvement of Trained TB staff is required for appropriate collection of sputum

    • The sputum has to be non-contaminated in order to avoid compromising the results.

    c) Conducting Camps in prisons, migrant localities, old age homes and other such institutional settings

    • Accessible to the population who are at high risk but otherwise have limited access to TB testing services

    • Essential to detect TB early and stop the spread of infection in such institutional settings.

    • Requires skilled TB staff in such settings

    d) Mobile vans equipped with X-ray units and Truenat machines

    • Feasible yet resource-intensive modality

    • Requires skilled staff to handle the testing

    • Requires resources - electricity, internet, computer/ tablet etc.

     

    713

    Resource 

    Assessment

     

    Question    

    Answer 1    

    Answer 2    

    Answer 3    

    Answer 4    

    Correct answer    

    Correct explanation    

    Page id    

    Part of Pre-test    

    Part of Post-test    

    What proportion of mapped target vulnerable population is recommended by NTEP to be screened for symptoms of TB?

    >25%

    >40%

    >60%

    >90%

    4

    NTEP recommends >90% of the mapped target vulnerable population should be screened for symptoms of TB.

        

       Yes

     Yes

     

    What are the various modalities used to conduct mapping of target population from the identified vulnerable population under the ACF campaign?

     

    		 House-to-house TB symptom interviews through community volunteers

    Door-to-door Sputum collection / sputum drop-off clinics

    		 Conducting Camps in prisons, migrant localities, old age homes and other such institutional settings All of the above 4 Mapping of target population from the identified vulnerable population helps the programme to screen out the persons into: 1) those who are at high risk of progression to active TB disease; 2) those who are eligible for TB preventive treatment 3) Enhance the cost-effectiveness of the programme   Yes Yes

     

     

  • Planning Process at TU level

    Content

    Strategic planning is a fundamental component in the management of a TB programme and is a key instrument in efficiently implementing the policies for TB prevention, care & control and elimination in the country. Therefore planning the programmatic activities is crucial not only at the national level but also at the level of a Tuberculosis Unit (TU) which is setup almost at the lowest point of hierarchy and is the closest to patient’s reach.

     

    The plan for conducting activities at the TU level should be formulated with focus on the achievement of key programmatic indicators that are monitored under the four pillars of the End TB strategy mentioned in the national strategic plan 2017-2025.

    Pillars of End TB strategy

    Key Focus Areas

    Key Problem Areas

    Potential Solutions

    Detect

    Laboratory and diagnostic services, case finding in high-risk population, private sector engagement

    Lack of awareness regarding TB leading to delay in treatment initiation

    Non-achievement of projected case detection rate

    Poor management of partnership with private sector

    Inadequate funding / improper management of funding

    - Plan Information, Education, Communication (IEC) activities involving Accredited Social Health Activists (ASHA), Mahila Arogya Samithi, TB champions etc to improve awareness on TB symptoms and testing at the community level

    - Plan and advocate incorporation of private sector engagement approaches in the Programme Implementation Plan (PIP) budget.

    Plan combined activities and review meetings  with Public Private Mix (PPM) coordinators and the Private Provider Support Agency (PPSA) [where available] and establish clarity on the performance expectations.

    Treat

    Initiation of appropriate TB treatment regimen for all diagnosed patients and sustaining them on treatment until successful completion, provide patient-centred services along with social support.

    High Treatment interruption and Lost to follow up rate

    Success rate

    Delay in treatment initiation due to non-availability of pre treatment evaluations at the rural level

    Co-morbidities and Adverse Drug Reactions (ADRs)

    - Plan home visit sessions for patients and their family members (upon consent) to assess the psycho-social aspects that could impact treatment adherence and provide regular counselling whenever required.

    - Regularly review if all Ni-kshay related entries for the TU has been updated by the concerned staff.

    - Implement a robust mechanism at TU level to triage as per severity and address/ refer patients  with ADR and co-morbidities.

    Prevent

    Prevent the emergence of TB in susceptible populations through scaling up Air-borne Infection Control (AIC) measures at health care facilities; treatment for Latent TB Infection (LTBI) for the contacts of people with confirmed TB, address the social determinants of TB through intersectoral approach

    Poor AIC in health care settings

    Non achievement of LTBI diagnosis and initiation of TB preventive treatment

    Social determinant affecting TB treatment uptake and adherence 

    - Plan patient movement in the out-patient setting so as to avoid over crowding

    - Avoid mixing up infective TB patients (eg: patients not initiated on treatment yet, patients lost to follow up etc) with others in the setting.

    - Ensure Personal Protective Equipment (PPE) is used by the personnel handling critical aspects such as sputum collection, sample handling etc. in the health facility.

    Display IEC related to cough etiquette in the health facility on most visible walls.

    - Conduct regular screening of all new patient contacts for LTBI and plan counselling and initiation of TB preventive treatment.

    Build

    Setting up of infrastructure and Human Resources (HR) for TB control and elimination, establishment of programme surveillance units to build and strengthen enabling policies.

    Inadequate HR capacities

    Poor infrastructure management

    - Plan to fill up all vacant sanctioned posts.

    - Plan capacity building activities for the TU staff on bio-medical and psycho-social aspects.

     

    Under direct overall supervision of the District TB Officer (DTO), the Medical Officer-Tuberculosis Control (MO-TC) is responsible for planning all these activities at the TU level with assistance from Senior Treatment Supervisor (STS) and Senior TB Laboratory Supervisor (STLS).

     

    Resource

    National strategic plan for tuberculosis: 2017-25 elimination by 2025

    TRAINING MODULES (5-9) FOR PROGRAMME MANAGERS & MEDICAL OFFICERS, Central TB Division, MoHFW, India 

    Assessment

    Question    

    Answer 1    

    Answer 2    

    Answer 3    

    Answer 4    

    Correct answer    

    Correct explanation    

    Page id    

    Part of Pre-test    

    Part of Post-test    

    Medical Officer -Tuberculosis Control (MO-TC) is responsible for planning all the activities at the TU level.

    True

    False

    		    

    1

    Under direct overall supervision of the District TB Officer (DTO), the Medical Officer-Tuberculosis Control (MO-TC) is responsible for planning all these activities at the TU level with assistance from Senior Treatment Supervisor (STS) and Senior TB Laboratory Supervisor (STLS).

        

       Yes

     Yes

  • ACSM activities at different levels

    Content

    Advocacy, Communication and Social Mobilization (ACSM) activities must place the individual at the centre and bring in the family, community and society to bring about sustained changes in TB perceptions and behaviours. ACSM activities must target these 4 groups accordingly:

     

    1. Individual: Specific interventions that ensure sustained engagement of people or individuals in maintaining positive behaviours/ changing to desired behaviours. E.g., counselling, use of positive TB messages, message by TB champions, etc.
    2. Family: Interventions that create an enabling environment for promoting positive behaviour change and developing necessary skills for a person affected by TB. E.g., counselling of the entire family.
    3. Community: Mobilizes groups toward a common goal, raises local resources and fosters support and awareness for TB-related issues. E.g., conducting TB awareness campaigns in public meeting places, melas, street dramas, etc. 
    4. Society: Advocates for rights-based and socially inclusive approaches and seek support for the TB programme. E.g., workshops and seminars to drive change in legislation, policy, partnerships and resource allocation.

     

    Aimed at individuals, families, communities, and the society, varied ACSM activities are undertaken at the national, state, district and community levels to:

    • Create awareness and an enabling environment
    • Build capacities to bring about desired changes in TB-related health behaviour
    • Sustain positive behaviour

     

    These are shown in the figure below.

    Figure: ACSM Activities Spanning Across All Levels

    Resources

    Assessment

     

    Question​ Answer 1​ Answer 2​ Answer 3​ Answer 4​ Correct answer​ Correct explanation​ Page id​ Part of Pre-test​ Part of Post-test​
    ACSM activities span across which levels? Individual only. Individual, family, community, society and from central down to the village level. Individual and family levels only. ACSM activities do not span across any level. 2 ACSM activities must span across the individual, family, community, societal levels, and from the central down to the village level. ​