Questions/Answers
Question 1
Please briefly describe the initiative, what issue or challenge it aims to address and specify its objectives (300 words maximum)
Tuberculosis is a communicable disease, widespread over the world including Thailand. World Health Organization (WHO) sets Thailand as one among 30 countries with high burden of TB. TB provides negative socioeconomic impacts as well human resources. TB was found at first time in 1882. In 2020, WHO reported 9.9 million TB patients of the global and 1.2 -1.3 million were Thais. Thailand has been combating with TB leading with long history. Royal family members are leaders. First time, since Father of His Majesty of the King Rama 9 wrote an article of Tuberculosis in Thailand. From then, Thai people know TB. Moreover, His Majesty the King Rama 9 provided his personal budgets to build a hospital for TB patients, procured TB drugs (PAS) and supported Thai Red cross to produce BCG vaccine. At present, His Majesty the King Rama 10 launched a project of TB screening for all prisoners in all prisons over Thailand. Moreover, His Majesty the King supported digital Mobile X-ray for 100 % TB screening in the prisons. The Royal Thai government is also a leader for TB control. Division of Tuberculosis, Department of Disease Control, Ministry of Public Health, takes responsibility as National TB program, working collaboratively with involving partners until Thailand is out of list 1 among 30 countries with TB high burden.
Question 2
Please explain how the initiative is linked to the selected category (100 words maximum)
Thailand, by Prime Minister announced our aim to join an achieving the targets of SDG goals in UN meeting since September, 2015. SDG goal for TB is to end TB by 2035. Thailand developed National Strategic plan for TB endorsed by the Royal Thai cabinet to reduce TB incidence by 12.5 per 100,000 populations per year. By 2021, Thailand reduces TB incidence from 171 per 100,000 populations to be 88 per 100,000 populations.
Question 3
a. Please specify which SDGs and target(s) the initiative supports and describe concretely how the initiative has contributed to their implementation (200 words maximum)
In UN summit meeting No. 70, 25th September, 2015 at Geneva, Thailand and UN member countries 193 countries endorsed SDG goals 2030 to be a global agenda composed with 17 target goals and 169 sub-target goals as a framework for a development of Social, Economics and environment with concept of there is no one left behind. TB program aims for a reduction of death 90% and an incidence 80 % from baseline in 2015 following SDG goal 3.3, ending TB by 2030. To be healthy, and living with good health in all ages groups.
b. Please describe what makes the initiative sustainable in social, economic and environmental terms (100 words maximum)
Tuberculosis – TB is disaster in an era of Covid-19 pandemic. TB is in a priority to be eliminated as soon as we can follow SDG goal, 2030. To reduce death, will reduce the negative impact to human resource and socioeconomic, directly. Division of Tuberculosis conducted the study of catastrophic cost of TB in Thailand; found that expenditure of TB patients 10,000 ฺBaht/ month/ family, for all TB patients in Thailand would be hundred million Baht.) There are other costs which could not calculated to money; Job-opportunity, and quality of life. It would be catastrophic of the country.
Question 4
a. Please explain how the initiative has addressed a significant shortfall in governance, public administration or public service within the context of a given country or region. (200 words maximum)
Ending TB is for all Thai and non-Thai.; migrant worker, prisoners, stateless people, rich and poor. This is according to policy of leaving no one behind and access for all with health insurance. This is the concept of new development regime of the global after Millennium Development Goals. Which is Sustainable Development Goals – SDG to get equitability of Human right for all with same healthcare services in all country and in all sectors of society.
b. Please describe how your initiative addresses gender inequality in the country context. (100 words maximum)
TB program is for all gender as their equitability of standard of services.
c. Please describe who the target group(s) were, and explain how the initiative improved outcomes for these target groups. (200 words maximum)
TB control programs in Thailand were implemented continuously over a hundred year. The TB control services increase. Division of Tuberculosis (DTB) created an innovation of active case finding with high technology of laboratory and diagnostic tests; moreover, AI innovation for chest X-ray interpretations for TB diagnosis. AI innovation reduced workload of physician doctors to interpret the result of the chest-X-ray and shorten time. Furthermore, DTB developed an innovation of National TB Information Program (NTIP). NTIP benefits directly to TB control program; to report, collect data of TB patients from diagnosis to treatment, follow up, and monitoring by case. NTIP connects from community to top level of nation. Then, all levels can use information from NTIP to close a gap of TB problem. Especially, TB drug resistance (DR-TB), which is a problem. Moreover, add an extremely drug resistance TB (XDR-TB) to be in act of harmful disease. Furthermore, include benefit of TB services to cover under health insurance scheme. In 2021, WHO announced Thailand out of list of DR-TB in 14 high burden countries of DR-TB after the DR-TB prevalence survey in Thailand in 2020 found 0.8 % MDR-TB (Kamolwat, P. and et al., 2020).
Question 5
a. Please describe how the initiative was implemented including key developments and steps, monitoring and evaluation activities, and the chronology. (300 words)
An attempt to control TB starting in the past, by treatment and develop new effective drugs regimens, new technology of laboratory and diagnosis as molecular biology under WHO recommendations to save lives. The ten year past, policy was driven for TB control in prison for prisoner over the country. Experience of TB control in prison was adapted to be used in other 7 risk groups of TB patients. The TB control in these recent few years, DTB developed NTIP for TB patient data record case by case. NTIP helps the TB control program to provide almost real time data because NTIP is electronic base. Moreover, DTB developed an AI innovation for chest X-ray screening to active case screening in community and reduce the workload of physician doctor. All Tb intervention in TB control programs and innovations gathering for closing the gap for TB control, in time.
b. Please clearly explain the obstacles encountered and how they were overcome. (100 words)
Thailand has no problem in the system management, if TB control personnel work follow the national strategies and take their responsibility, seriously. It is because Thailand has strong healthcare system and networking is very function.
Question 6
a. Please explain in what ways the initiative is innovative in the context of your country or region. (100 words maximum)
NTIP records TB patients information by case. From hospital level, the data was collected to as community to provincial, regional and national level, respectively. The data was records as registry, diagnosis, treatment, follow up, transfer and complete the treatment. NTIP brings successfulness of the TB control program, reducing time consumer and workload, better than paper base system. DTB registered NTIP to be patented since 4 August, 2021. Other innovation is AI for chest X-ray interpretation. This reduces workload for physician doctor and time to know TB infection status. Moreover, it can do TB scoring of TB infection.
b. Please describe, if relevant, how the initiative drew inspiration from successful initiatives in other regions, countries and localities. (100 words maximum)
Innovation of NTIP and AI is very helpful. NTIP was developed from the old database record which is paper base. In the past, hospital has to submit the report to provincial administrator, then the administrator collect the reported to regional administrator and national level later. All processes took time, in total 1-2 months to get the data from the hospital to be national data. But NTIP is electronic base, the data and information is almost exactly real time.
c. If emerging and frontier technologies were used, please state how those were integrated into the initiative and/or how the initiative embraced digital government. (100 words maximum)
Innovation of NTIP and AI are very modern in this period of time. They could be synchronized to other database system. Fore instance, National data base of National Health Security Office in order to reimburse budget for TB services. Then this innovation is an answer for digital government, absolutely.
Question 7
a. Has the initiative been transferred and/or adapted to other contexts (e.g. other cities, countries or regions) to your organization’s knowledge? If yes, please explain where and how. (200 words maximum)
DTB used to get reword of TB program implementation in prison in 2018. 143 prisons over the country join the program for 100 % TB screening for all prisoners and be strengthen in every year. This program reduce inequity of human because all human should get service wit same standard and benefits, equally. NTIP and AI were implemented to support the TB program. This innovation also support and announcement of WHO that Thailand is out of list of MDR-TB burden among 30 high burden countries in 2021
b. If not yet transferred/adapted to other contexts, please describe the potential for transferability. (200 words maximum)
DTB expanded the successful experiences of TB control program in prisons to all risk groups of TB problems; 1) Contacts to TB patients, 2) prisoners, 3) HIV co-infection, 4) low immunity (Diabetes, kidney disease, 5) elderly 6) narcotic drugs users, 7) health personnel by chest X-ray and apply NTIP and AI to be supported.
Question 8
a. What specific resources (i.e. financial, human or others) were used to implement the initiative? (100 words maximum)
Healthcare personnel from DTB, office of Disease Control at regional level, and Bangkok, hospital under Ministry of Public Health (MOPH) and non MOPH, and stakeholders in other department, other Ministry, public and private hospitals and TB experts from University and international Institute from Japan, United State of America, France and England. Government budget which is about 800 for TB screening, diagnosis, and treatment are allocated to DTB and National Health Security Scheme for diagnosis and treatment with an increasing trend. Global fund support budgets for laboratory equipment, agents, Ant-TB drug, research and budgets 250 million Thai Baht.
b. Please explain what makes the initiative sustainable over time, in financial and institutional terms. (100 words maximum)
TB control program is in a priority of national agenda with SDG. The government support budget with increasing trend as well as support of the global fund budget, National Health Security Scheme, and Civil society. This is because the government considers that it is cost effective to support the TB control program rather than let TB cause catastrophic problem to the country as well as socioeconomic and health problems.
Question 9
a. Was the initiative formally evaluated either internally or externally?
Yes
b. Please describe how it was evaluated and by whom? (100 words maximum)
In 2020, WHO evaluates drug resistance situation of Thailand and revised the situation to be out of list of 30 burden countries with high incidence of drug resistance follow WHO criteria.
Then in 2021, WHO announced the successful of Thailand.
c. Please describe the indicators and tools used (100 words maximum)
WHO has a set of standard and criteria to evaluate the country for the TB situation, then WHO listed and ranked the countries. In 2020, WHO evaluated Thailand and found that Thailand had drug resistance situation lower than to be in the list of 30 countries with high DR-TB incidence. WHO also evaluate the process of DR-TB control of each country whether enough qualify or how much to be qualified.
d. What were the main findings of the evaluation (e.g. adequacy of resources mobilized for the initiative, quality of implementation and challenges faced, main outcomes, sustainability of the initiative, impacts) and how this information is being used to inform the initiative’s implementation. (200 words maximum)
The announcement of successful of Thailand, being out of 14 countries with high burden of DR-TB. This provides positive impact to Thailand significantly. Minister of Public Health announce three policies and strategies; 1) active case finding, 2) actively access to care, especially in vulnerable, prisoner, and HIV co-infection , 3) active diagnosis among TB close contact, children and HIV, to be early in access to care.
Question 10
Please describe how the initiative is inscribed in the relevant institutional landscape (for example, how it was situated with respect to relevant government agencies, and how the institutional relationships with those have been operating). (200 words maximum)
At present, DTB takes a leading role conducting TB control program as National program follow global agenda of SDG with strong collaborations of partners of TB control. Since 2015, WHO announced Strategy of Ending TB for WHO country members aiming to reduce TB incidence to be 10 per 100,000 populations by 2035. As institutional aspect, Thailand, we have the royal family leading TB control for a long time, then the royal Thai government take actions following leadership of the royal family to conduct TB control in a priority as national agenda leading by Division of Tuberculosis, to regional, provincial and until to community levels. Multi-stakeholder and TB control partners which are MOPH and non-MOPH, public and private sectors
Question 11
The 2030 Agenda for Sustainable Development puts emphasis on collaboration, engagement, partnerships, and inclusion. Please describe which stakeholders were engaged in designing, implementing and evaluating the initiative and how this engagement took place. (200 words maximum)
DTB conducts TB control programs as National TB program (NTP). DTB collaborates with multi-stakeholders to convey messages of knowledge, policy implementations, strategies, and actions plans. Multi-stakeholder and TB control partners are MOPH and non-MOPH, public and private sectors as national, regional and community levels. An example of collaborations which is very successful is bi-lateral MOU of MOPH and Ministry of Justice; we implement TB screening among prisoners in prison 100 %. DTB also collaborates with medical school for the technical support; Siriraj medical university and hospital, research institute, and etc. In the global level, DTB collaborates with WHO Thailand, and Research Institute of TB, Japan, and university in other countries.
Question 12
Please describe the key lessons learned, and how your organization plans to improve the initiative. (200 words maximum)
Thailand has conducted TB control program over a hundred year, seriously. With strong leader, and strong policy commitment lead Thailand to achieve targets, An attempt of DTB and partners work for TB control over the country gather to end TB. We implement TB control intervention; preventive and treatment program following national strategies. We invent innovation to support the program effectively, quicker than the past. Furthermore, our TB partners and stakeholder in-bound and out-bound, especially, WHO and global fund also support Thailand to achieve the target, efficiently. MOPH set TB control program with performance indicator of MOPH. The Permanent Secretariat of MOPH and DG of Department of Disease Control set the target of TB control as their performance of work. As these 3-5 years, the Royal Thai Government allocates more budgets for TB with increasing trend for expanding in vulnerable group and high risk group of TB patients. TB can be hidden in the bodies as long as our lives, then those infected with TB, they can become TB patients at any time. So, it is not easy to end TB, we need full attempts with strong policy commitment and close collaboration along a long distance