1. Practical Approach to Lung Health
(PAL)
a way forwards towards
Health System Strengthening
in Bangladesh
Dr. Ahmed Parvez Zabeen
MBBS,MPH, C.C. H.E (DU)
Divisional Consultant
Dhaka Division
National Tuberculosis Control Program

2. Introduction
• Bangladesh is number sixth TB-High
Burden country in the world
• Respiratory diseases are high,
usually represent 50% of the outpatients at
PHC in Bangladesh

3. Tuberculosis Control in Bangladesh
• TB-a Major Public Health Problem since long
• 1965- TB Services, mainly curative,
(based in TB clinics/hospitals)
• 1993- adopted DOTS strategy
• 2003- 99% of the Geographical Coverage
• 2006- 100% DOTS Geographical Coverage
Case Detection Rate-73.7% (2010)
Treatment Success Rate-91%( 2008 cohort)

4. Practical Approach to Lung Health
PAL means quality diagnosis and treatment of
common respiratory illness (over the age of five
years) at primary healthcare facility (PHC).

5. Practical Approach to Lung Health (Contd)
• WHO initiated PAL in early 1998
• WHO integrated PAL as a component of Stop
TB Strategy, Health System Strengthening
(HSS) linking TB control for proper case
management of all common respiratory
conditions in 2005

6. Practical Approach to Lung Health (Cont.)
What is the focus of PAL
• Tuberculosis
• Acute Respiratory Infection (ARI)
especially pneumonia
• Asthma
• Chronic bronchitis
• Chronic obstructive pulmonary disease (COPD)

7. Respiratory Symptoms Outpatients
TB suspects 50% Non Tb 50%
Smear+ Smear-
10% 90%
antibiotics
Management is not
standardized
smear
+ -
UHC
+ Chest X Ray -

8. Objectives
Successful development and implementation of
PAL strategy
1. Increases TB case detection
2. Improves care quality of acute and chronic respiratory
patients at PHC
3. Decreases unwanted drug prescription particularly
antibiotics and adjuvant drugs
4. Reduces drug prescription cost per patient

9. Methodology
NTP has taken up necessary actions for
development and successful implementation of
PAL strategy in the country
• Mobilization of resources
• Constitute National PAL Working Group (NPWG)
• Develop guideline and training materials
• Supply equipments
• Initiate Piloting at UHC and CDC

10. Results
NTP organized a visit of International expert
- assessed the situation and opined,
PAL strategy can be successfully implemented
in Bangladesh
Following situation analysis NTP incorporates
PAL strategy as one of the Service Delivery
Area, (SDA)

11. Results
• Equipment will be supplied, improve capacity at PHC
• Skills of MO will be developed by training.
Simple standardized evidence based management will
be introduced and capacity of patient management will
be improved
• Good practice rules, specially about antibiotics
prescription shall be proposed

12. Conclusion
PAL can be successfully implemented with the
expected results
• Improvement of the quality care for respiratory
patients
• Increase and improve TB case diagnosis
• Strengthens the confidence of the population in
PHC services

13. Conclusion
Impact of PAL on TB control
• Secures and empowers TB control in
epidemiological transition
A TB free world

14. THANK YOU