Mexico

Since 1998 until 2007 TB morbidity has decreased with 29%, while in 2008 the TB morbidity rate slightly increased from 16.4 to 17.1 per 100.000 which may be attributed to increased case finding activities. The major TB caseload is located in 20 municipalities in 11 different states, each municipality reporting more than 100 cases. Mortality has decreased in the period with 71.3% between 1990 and 2007 to 1.7 per 100.000. The main diseases associated with TB are Diabetes Mellitus with a 20% prevalence, malnutrition 16%, TB/HIV 8% and alcoholism 7%. While the treatment outcomes of smear positive TB cases in the period 2005-2007 increased slightly from 77% to 79.5% the cure rate remains stable between 70-71%, below the WHO target. Defaulters (5.6%), death (6.5%) and not confirmed transfers (2.3%) as well as not evaluated cases (7-8%) are contributing to this low cure rate, which most likely is related to organizational problems and quality of treatment. At the end of 2008 541 MDR TB cases were notified of which 195 under treatment, 313 on the waiting list and 33 died without having received treatment. 

 
The project of Improvement Quality DOTS, supported with USAID funding, has contributed to increased case detection and better treatment outcomes in most of the targeted municipalities in 13 priority states. Successful contact tracing, improved follow up of patients and active case finding in waiting rooms at health facilities are interventions implemented by teams of health workers aware and empowered to improve their performance. The project ended in September 2009. Also another USAID supported project run by Project Concern International in selected municipalities in 13 states contributed to improved quality of care through a client centered approach and creating community support networks as well as patient support groups.

Role of KNCV Tuberculosis Foundation

KNCV together with the Union and MSF participate in the yearly missions to monitor all USAID support to the NTP.
As collaborating partner in the TBCAP project KNCV supports the PPM component of the TB program.

Achievements

• Training of 6 States in PPM, giving priority to improve linkages between big public Hospitals and DOTS referral system
• Step down training in 50% of the participating states in the months after the training
• Support to translation of Quality Improvement Guidelines
• M&E visit recommendations

Next steps

• Document methodology training in PPM to State level
• Training of 6 more states including other stakeholders like Social Security, Universities and Nurse Schools, Pharmacies and private sector
• Consolidate experiences in all trained states
• Document best practices in PPM

Comment concerning completing chart below:
If we measure with this criterion of yes or no involvement in SP writing and if SP is implemented, it will be difficult to measure performance of KNCV in countries where we are involved in other issues than this. This is because the country did not ask TA for this (MEXICO), or another partner is doing this (PAHO in the DR). I did not fill in this part in both Mexico as DR, as I am involved in PPM in Mexico only, and SP is done by PAHO in the DR.