Background information about Yemen
Yemen has 20 provinces composed of 333 districts and 1995 sub-districts. The provinces include 225 cities, 40793 villages, 88817 sub-villages, 216 islands. This administrative distribution reflects geographical characteristics of Yemen where population are distributed on wide range of gatherings which affects health services and should be taken into consideration while planning for it.
Latest estimated population is 22,198,000 with 3% annual growth. The population is distributed between rural areas which has 15,750,116 (71%) of the population and urban areas with 6,447,884 (29%). The M/F ratio is 1.04 where male population is 11,323,706 and female population is 10,874,294. The total population is divided into 922,007 families in urban areas, and 2,186,900 families in rural areas giving average family size of 7 persons (U6.9-R 7.2)
Fertility rate is high 4.93 (R 5.27, U 4.19) as well as Fertility rate per women: 6.1 (R 6.75, U 4.78). Crude birth rate (CBR) is 39.73, (R 42.29, U 34.28) and the Crude mortality rate is 8.99.
Yemen is considered one of low to moderate income country with unemployment ratio of 15% (M 11.5, F40.9). Health workers are 1.3 % of all work forces (M 1, F 5). GDP per capita is 1029 USD annually. World Bank estimated that more than 42% of population is under poverty line (2006)
- General Information on Tuberculosis
- Strategy and Organization
- Goals of TB Control
- A new strategy for TB control
- Epidemiology of Tuberculosis
- Pathogenesis of Tuberculosis
- Case finding
- Events and Activities
- Executive Summary
- Tuberculosis control
In its widest sense TB control refers to all aspects of health protection i.e prevention of TB and of its complications , early diagnosis ,appropriate treatment, patient information and rehabilitation and research in different areas related to tuberculosis. TB control consists of a variety of activities carried out by different persons in Governmental, non-governmental and private organizations and institutions . These activities include immunization (BCG), case finding and treatment, health education, surveillance of the disease in the community.
- National Tuberculosis Control Programme
MOPH has established TB control program in 1995. It is a detailed plan of action for effective TB control. There must be four levels of responsibility to ensure efficacy of TB control : peripheral , district, governorate, and central levels. Each of these levels has well defined, but different tasks.
- Peripheral level (Health units): the NTP is implemented through the network of health centers and health untis at the peripheral level. A medical officer or medical assistant in-charge of the peripheral health facilities is responsible for the implementation.
- District level: it is the basic unit of management for DOTS implementation serving a population of 30,000-150,000. The Director General and PHC director of Governorate Health Office designate, in consultation with GTC, a District TB Coordinator (DTC), who is responsible of all TB control activities within the District (diagnosis, treatment, follow up, training, supervision, logistics, etc…..).
- Governorate level: Director General of Health Office gives guidance and support to the Primary Health Care (PHC) Director in implementing the NTP policies throughout the network of PHC in the Governorate. The Director General of Health Office appoints a Governorate TB coordinator (GTC) who is responsible of planning, and supervision all TB control activities within the Governorate. Director General of Health appoints also the Governorate Laboratory Supervisor (GLS) who is responsible for quality control of TB laboratories in the Governorate.
- Central level: The primary responsibility at is to ensure that TB control is implemented effectively and uniformly throughout the country. The Directorate of Tuberculosis Control and Ministry of Public Health and Population is the central unit of National Tuberculosis Control Programme under guidance and instructions of Director General of Public Health and Under-Secretary of Medical services and Primary Health Care.
TB Control Policy Package: the success of the international DOTS strategy as implemented by the NTP depends on the implementation of its five-point package:
- Government commitment to the National Tuberculosis Control Programme
- Case detection by sputum smear microscopy examination of TB suspects in health centers at district level
- Standardized short course chemotherapy to at least all smear positive all smear positive TB cases under proper case management conditions with the initial phase of treatment fully supervised
- Regular uninterrupted supply of all essential anti-TB drugs
- Monitoring system for program supervision and evaluation
Yemen introduced DOTS strategy in September 1995 in corporation with WHO and JICA. The NTCP expanded the DOTS strategy gradually to cover 290 districts among 333 in the country by the end of December 2006, and the DOTS population coverage is 93%. In DOTS sites the number of new smear positive cases was 3,347 (2003/2004), while in non DOTS sites the number was 208 cases (2004/2005). The organization of TB control in Yemen is illustrated in the following diagram .
Ministry of Public Health and Population
Republic of Yemen – Sana’a- Al-Hasaba Zone