OneImpactUkraine_2021.pdf - Администратор - Translation by Dure Technologies

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MONITORING REPORT ACCORDING TO THE RESULTS OF THE MOBILE APPLICATION 2021 This publication made to order by TBpeopleUkraine as part of project «Accelerate progress of reducing burden of tuberculosis and HIV in Ukraine», which is implemented by financial support The Global Fund with the support CО «100% life». From 2019 thanks to partner support we managed to build stable system of response to barriers faced by people with tuberculosis and to create an evidence base to advance models focused on the needs of people with tuberculosis. In partnership with government agencies we are jointly looking for solutions to level system barriers. The results of the OneImpact system implementation help not only to maintaining commitment to treatment, but also to be able to hear about patients' needs directly from them. This became possible due to support partners Stop TB Partnership, Centrul PAS, CO «100% life» with financial support The Global Fund counteraction HIV/AIDS, tuberculosis and malaria, and thanks to the PATN International Agency for financial support from the United States Agency for International Development (USAID), technical support of Dure Technologies, cooperation with non-governmental organizations and to everyone who is not indifferent to the problems of people with tuberculosis. REPORT PREPARED: Arseniy Verkhoturov, administrator OneImpact Ukraine Anastasia Burnukina, coordinator of the regional development department content OneImpact Ukraine mobile application update ..................................................................................... 2 Registration interface .............................................. 2 Main menu interface................................................ 3 Integration of new modules ................................... 4 Main tasks................................................................... 5 General statistical information ........................... 6 Expert group activities ........................................ 12 REGISTRATIONS INTERFACE The registration interface has hardly changed compared to the first option. To use the application the user must accept the User Agreement which consists of "terms of use" and "privacy policy". For registration you must enter your age, gender, type of user (person with TB, social worker, etc.) and the optional type of TB and belonging to one risk group. Now in test mode developed version of registration which contains which also includes the "username" and "contact phone number". After registration the application asks to allow access to devices geodata and offers a short instruction using the program. MAIN MENU INTERFACE Two user interface themes have been developed, one of which is in the format of boards. Currently the main menu contains 6 items: 1 Get information about your rights. 2 Get information about tuberculosis. 3 Get access (menu item allows you to find nearest medical institutions). An interactive map with the rating of establishments has been added, which will change as users conduct the poll. The database of institutions is constantly expanding and updating. 4 Join chats and private messages, where you can now register an anonymous profile for communication, with a choice of nickname and user avatar. 5 Submit an application - section contains 4 categories of barriers that a person affected by tuberculosis may face, and these 4 categories contain specific options for choosing a barrier. Test version with improved barrier breaking and the ability for the user to choose barriers from several categories is ready. Passing polls, which currently contain a survey of the 6 quality of services in TB establishments. Exist the ability to add any other polls. INTEGRETION OF NEW MODULES Added intellectual voice assistant system. You can call up this system by pressing the microphone in the lower left corner of the main menu. The functionality includes application navigation, the ability to submit an appeal, etc. In addition, chatbots have been developed and put into operation on the Facebook and Telegram platforms, they almost completely replicate the functionality of the mobile application. MAIN TASKS The new interface and functionality of the application is aimed at solving two problems: 1 Simplify the system for users. We aim to make working with the application as simple as possible that the user with little (or without) experience of using mobile applications could fully master its functionality. 2 Collect as many statistics as possible to help systematically broke the barriers that people with TB deal with. To achieve the first goal, we have simplified the user interface and reformulated some parts of the interface and information for easier use. To achieve the second goal, we have increased the amount of data collected by the application and significantly expanded the range of cases for which you can apply. In 2021 the total number of unique users who downloaded and used the application is 2051 people. The total number of appeals through the application and chatbot in 2021 — 1514. GENDER DISTRIBUTION: Man Woman Others Not specified Barriers in respect of which appeals were registered could be divided into systemic and individuals. To systemic barriers (these problems can and should be solved by the medical system) include problems with access to health care and services, inability to pay for expensive diagnostics,and lack or insufficient funding for the purchase of drugs to eliminate side effects. The division into systemic and individual (other) barriers is as follows: Individual (other) Systemic Appropriate advocacy measures are aimed at solving systemic barriers. They are designed to solve most of the barriers. To date targeted assistance more tangible to people but is only a temporary solution to certain barriers. SCHEDULE OF DIRECTIONS TO THE CENTERS OF FREE LEGAL AID (hereinafter - * CFLA) BY REGION Referral of people with tuberculosis who had a request for legal aid to the regional Centers for Free Legal Aid took place in 11 regions of Ukraine. This statistic is an indicator which more demonstrates the popularity of mobile applications in areas than the existence of legal barriers in these regions. Many people with TB just want to complain anonymously about such barriers which excludes the possibility of their appeal to the CFLA lawyers. Appeals with the specified location came from 21 regions of Ukraine. REGIONS DISTRIBUTION: In the old and new versions of the application, the choice of barriers for the client when applying are different. Percentage barrier diagram according to the old version of the application: Tuberculosis services (including drugs and diagnostics) Secondary services (including food and social support) Human rights violation Stigma Percentage barrier diagram according to the new version of the application: Access to medical care and support Quality of services Financial aid Had to pay for yourself Stigma Impact of information activities on the number of downloads of OneImpactUkraine: After realization webinars on the use of the application and during the period of appropriate training for patients there are peaks in the diagram which indicates an increase in the number of downloads of the application and the positive impact of such measures on its popularity. It is also worth noting the latest large peak on the chart, which was observed after the webinar with the use of videos (instructions for use in the form of video recordings from the smartphone screen), which may indicate the advisability of replacing screenshots with videos in future presentations. For two years in a row the Expert Group on Overcoming Barriers and Violations of the Rights of People with TB has been implementing continuous activity. It includes experts from regional teams, Representatives of the Public Health Center of the Ministry of Health of Ukraine and other specialists. The operation of the Expert Group is supported by the Public Health Center of the Ministry of Health of Ukraine (hereinafter - PHC) together with the TBpeopleUkraine. The main functions of the group are to strengthen monitoring of compliance with tuberculosis people rights by using digital solutions, and the establishment and development of mechanisms to respond to barriers and human rights violations for tuberculosis people and their close communication. Within the framework of these tasks, it is planned to ensure a stable functioning of mechanisms of joint response at different levels to overcome barriers in treatment and violation of rights of TB patients. PHOTO MATERIALS FROM THE VISITS OF THE EXPERT GROUP: As of the end of the year, 12 meetings of the expert group on were held planning of activity, development of algorithm of interaction and response to appeals, etc. GLOBAL CASES AT THE CONTROL OF T H E EXPERT GROUP: Lack of funds at local and state levels for tuberculosis diagnostic to children Statistics show that the state of TB diagnostics has deteriorated. Ukraine ranks 4 in the world by the level of adult TB disease and 5 in the level of child disease. The prevalence of all forms of active tuberculosis among children aged 0-14 years, including in 2020, was 504 cases in Ukraine as a whole. Coverage of children with TB profiles decreased from 90% to 36%. 1. No programs at the local and state levels provide funds for TB diagnostics in children (namely CT, MRI). 2. There is no algorithm of actions when TB is detected among pupils of educational institutions. The following measures are taken within the framework of the expert group’s decision: A letter was sent from TBpeopleUkraine to the Regional State Administrations of Ukraine concerning consideration of this issue at the regular sessions of the collegium, with the hearing of heads of specialized structural subdivisions and financial departments, as well as further informing about the results of the consideration and the decisions made. Absence of TB drugs or interruption of their supply The absence of TB drugs or supply interruptions have a number of negative consequences: • is one of the reasons for the interruption of treatment or leads to additional financial costs on the part of patients and their families; • creates an additional moral and material burden on patients and their relatives, which undermines trust in the tb care system. Shortages of medicines are due to delays in procurement procedures and lack of accuracy in drug planning. The problem of supply interruptions of anti-TB drugs is still, for example, with regard to Linezolid and other new drugs because there is no effective system of planning the need for drugs at the regional and national levels. The following measures are taken within the framework of the expert group’s decision: According to the results of the Expert Group on TB issues, including barriers and violations of patients’ rights, which was established under the working group of the state institution “Center for Public Health of the Ministry of Health of Ukraine”, proposals were made to the Ministry of Health of Ukraine and the state enterprise “Медзакупівлі” concerning three-year, and possibly, and five-year planning of purchase of drugs. Barriers to TB treatment among homeless people The list of barriers faced by homeless people in the context of TB diagnosis and treatment is as follows: 1. Lack of residence (lack of interaction between centers for homeless people, non-government organizations and health care facilities). 2. Absence of declarations with family doctor: Impossibility of receiving medical aid without documents and without electronic referral from family doctor in connection with tuberculosis (National Health Service of Ukraine cannot pay for medical aid for a patient without referral); impossibility of receiving treatment at the outpatient stage. 3. Difficulties with the restoration of documents caused by the necessity of payment of state duty. The following measures are taken within the framework of the expert group’s decision: A number of joint calls and meetings were conducted, as well as a number of letters were written to work out the algorithm of interaction. Counterparties and partners in the context of the solution of the mentioned problem were: Ministry of Social Policy of Ukraine, state institution “Center for Public Health of the Ministry of Health of Ukraine”, Regional State Administrations of Ukraine, non-government organizations and representatives of centers for homeless people. 23 regions of Ukraine were covered by the activity of the expert group within the case. Food care for patients of tuberculosis dispancers In accordance with the resolution of the Cabinet of Ministers of Ukraine of 27.12.2001 №1752 «About nutrition standards in TB facilities for people with TB and young and underage people infected with TB» the cost of one day for children is 98,37 UAH, and for adults – 105,46 UAH. In fact, in anti-tuberculosis institutions such payments vary at the level of 32,60 UAH. up to 42-44 UAH for one bed-day. The following measures are taken within the framework of the expert group’s decision: An appeal from TBpeopleUkraine to the Ministry of Health of Ukraine to direct to the relevant regional administrations the order to allocate funding from local budgets for food in TB facilities as needed. As well as to the deputy of the Verkhovna Rada of Ukraine, the head of the inter-faction association "Parliamentary platform to fight TB", Lady Bulah, on assistance in consideration of this issue at the regular meeting of the Committee with the participation of heads of regional state administrations. Also, communication from National Health Service of Ukraine in the format of calls and appeal was carried out. In addition, within the framework of this activity, on the basis of the conclusions of independent experts, the necessary amount of funding was calculated to provide TB patients with decent food. Barrier MRI and CT diagnostics The issue of interaction between medical institutions to ensure access to diagnostics fo TB patients remains unresolved and additional complicated by the insufficient number of primary care providers that lead TB patients. Lack of clear patient routes at regional levels, lack of control over availability of free services of laboratory and instrumental research for TB patients (The National Health Service of Ukraine specification does not specify the algorithm of providing these diagnostic services for all medical care services), which patients with MR TB and complex disease are particularly in need is still an inexhaustible list in the context of TB diagnostics. In 2021, TBpeopleUkraine received more than 50 complaints from patients with complaints about the request for payment of research in health care facilities. For these patients, this amount is not available, including due to loss of income sources due to illness. The following measures are taken within the framework of the expert group’s decision: A letter was sent from TBpeopleUkraine to the state institution “Center for Public Health of the Ministry of Health of Ukraine” to initiate advocacy activities involving the Ministry of Health of Ukraine and the National Health Service of Ukraine to improve the mechanism of payment of diagnostic services of CT and MRI for people who have encountered TB problem. From the Expert Group on TB, including barriers and violations of patient rights, proposals have been made to the Ministry of Health of Ukraine and the National Health Service of Ukraine to purchase these services in diagnostic centers. Also, a request to NGOs to support patients with complex needs was made. It provides a mechanism for collecting information about such cases and systematic transfer of these data to the TB Control Department of the Center for Public Health, the Ministry of Health and the agency responsible for TB at the regional level. Optimization of resources and budgets of municipal institution "specialized territorial medical association "Фтизіатрія " in Zaporizhzhya In order to prevent the optimization of the municipal institution "specialized territorial Medical Association "Фтизіатрія" in Zaporizhzhya, within the framework of the reform of the TB care system, we allocate a number of barriers: Insufficient funding of the oblast TB service through the National Health Service of Ukraine and local budgets, in particular, subdivisions in Berdyansk and Melitopol. Lack of coordination of local funding within the region. Inconsistency of simultaneous funding of local and national levels. The following measures are taken within the framework of the expert group’s decision: The process of communication is in progress. A request for Regional State Administration in Zaporozhye and a letter to the Chairman of the Verkhovna Rada Committee on Health of the nation, Medical Care and Medical Insurance, Mykhailo Radutsky, was sent. The issue of the premises in Kropyvnytskyi The problem of inconsistency of premises on the basis of which provision of anti- tuberculosis aid is provided is systemic. Lack of sufficient political will in local self- government bodies regarding the resolution of TB service issues in accordance with the Cabinet of Ministers of Ukraine resolution No. 1415 of 27.11.2019 «State strategy in the field of HIV/AIDS, TB and viral hepatitis for the period up to 2030.» in part, it is the cause of similar problems The need to renovate the building of a TB facility in Kropyvnytskyi is very urgent. The appropriate premises within the city can be allocated by the city authorities Kropyvnytskiy (the decision of the district Council of deputies of the city Kropyvnytskiy is necessary). Moreover, the issues of taking measures on prevention, diagnostics and treatment of TB and improvement of infection control in the region, which are key to reducing the level of disease, are not included in the agenda of local councils. The following measures are taken within the framework of the expert group’s decision: Communication with the local state administration, scheduled departure and meeting with the responsible persons has been established. DEVELOPMENT AND SUPPORT OF REGIONAL GROUPS An effective instrument for monitoring the rights of people affected by TB at the local level is the activities of regional groups on the provision of quality TB services, including violations of the rights of people living with TB. Such groups were created in 6 regions of Ukraine (the information includes all existing objects of the organization, which include development and improvement of mechanisms of monitoring and response to violations of rights of TB patients). The creation of similar groups in 3 regions is planned to be completed by the end of the current year. In these regions, it is planned to support further functioning of regional expert groups, verification and transmission of messages about barriers and violations of patients’ rights in protected regions, to solve problems faced by TB people, by regional groups with the involvement of all competent responsible persons. In order to strengthen cooperation and improve the response to barriers at the local level, regional offices and local NGOs will be involved in the work of expert groups, implementing programs and projects on psychosocial support for TB patients. 1. (GF) Rivne region — done 2. (GF) Cherkasy region — done 3. (GF) Poltava region — done 4. (GF) Lviv region — done 5. (GF) Zaporizhzhya region — done 6. (TB REP 2.0) Odessa region — done 7. (TB REP 2.0) Dnipropetrovsk region — expected to be created 23.12 8. (TB REP 2.0) Khmelnytsky region — in the process 9. (TB REP 2.0) Kirovohrad region — in the process Download OneImpact Ukraine Tell about violations of rights +38 067 100 93 07