Norma Oficial del Programa Nacional de Salud Respiratoria: Tuberculosis, Asma, Enfermedad Pulmonar Obstructiva Crónica

Objectives

The National Respiratory Health Programme is a national framework for improving respiratory health and quality of life, reducing morbidity and mortality, and addressing tuberculosis, asthma and chronic obstructive pulmonary disease (COPD) as major public-health concerns. It situates respiratory care within a public, universal, integrated and equitable health system in which health is a fundamental social right.[1][2][3]

• Promote respiratory health, healthier living conditions and healthy lifestyles across communities, schools, workplaces and families.[4][5][6]
• Prevent respiratory disease and modifiable risk factors through health education, action on social determinants, tobacco control, vaccination, early risk identification and community participation.[2][3][7][8]
• Provide comprehensive, timely and standardised prevention, diagnosis, treatment, rehabilitation and referral for tuberculosis, asthma and COPD across all levels of care.[9][3][10][11]
• Strengthen health-care networks from pre-clinical care through rehabilitation, particularly diagnostic capacity and effective supervised treatment in primary care.[4][3][5]
• Build individual, collective and professional capacities in respiratory-health promotion, disease prevention, clinical care, surveillance and rehabilitation.[3][12]
• Develop basic, clinical, epidemiological, social and operational research through a prioritised respiratory-health agenda.[5][12]

The programme covers the whole population for respiratory-health promotion and education, while directing tuberculosis case-finding, preventive treatment and clinical care towards people at risk of or affected by tuberculosis, asthma or COPD. Asthma action recognises the burden among children and adolescents, including hospital admission, school absence and reduced quality of life; COPD action particularly prioritises adults over 40.[13][9][14]

Disease-specific priorities include uninterrupted tuberculosis diagnosis and treatment, contact investigation, HIV testing among people with tuberculosis, notification and treatment-outcome reporting; asthma risk reduction, self-care and protocol-based management; and COPD education, smoking cessation, severity-based treatment, rehabilitation and specialist assessment.[15][8][16]

Implementation

Implementation uses a tiered, population- and community-oriented delivery model spanning national, state, Areas of Comprehensive Community Health or municipal, and local levels, and operating through primary, specialised outpatient and hospital networks. The Ministry of Popular Power for Health leads the programme through its collective-health, programme-management, safe-health and respiratory-health structures.[1][14][17][10]

• Coordinate national policy, standards, plans, manuals, protocols, education and research links, surveillance, supervision, reporting and technical advice on equipment and supplies.[18][17]
• Adapt implementation at state level to epidemiological and local conditions, establish coordinating teams, plan with local structures, manage logistics, and organise movement of samples, forms, medicines and supplies.[19]
• Implement programme activities through municipal or community-health authorities and local services, maintaining health information, supervising delivery and enabling organised community participation.[19][20]
• Assess local health conditions and prepare annual plans with community leaders, community assemblies and relevant institutions, supported by commitments to citizen and institutional co-responsibility.[20]
• Coordinate with epidemiology authorities and other health programmes, including HIV/AIDS, endocrine-metabolic health, tobacco control and immunisation, as well as education authorities, universities, scientific societies, multilateral bodies and community organisations.[5][6][21]

At first-level services, health teams undertake promotion, risk-factor identification, active respiratory-symptom case-finding, contact registration and investigation, Bacillus Calmette-Guérin vaccination verification, sputum collection and referral, supervised tuberculosis treatment, chemoprophylaxis, home visits, early asthma and COPD detection, emergency care, rehabilitation and referral.[20][10][7]

Specialised outpatient services form part of the tuberculosis diagnostic network, provide spirometry for asthma and COPD, manage referrals and direct presentations, support patient and family education, identify complications including HIV co-infection, and coordinate referral and counter-referral. Hospitals participate in tuberculosis diagnosis through sputum microscopy, with selected facilities providing culture and rapid testing, as well as spirometry, oximetry and blood-gas analysis for asthma and COPD.[10][11]

Professional development combines respiratory-health content in health-science university curricula with continuous in-service training organised by care level, professional role and function. Training and dissemination cover updated standards, manuals and protocols for promotion, prevention, treatment and control, including COPD teaching and continuing education.[12][18][16]

The programme relaunches integrated epidemiological surveillance for tuberculosis, asthma and COPD, including conventional and community-based surveillance, sentinel sites in facilities with high case occurrence, and further surveys where abnormalities require investigation. It uses the Ministry of Popular Power for Health Information System and local clinical, family and community records to monitor service delivery and programme performance.[21][17][10]

Monitoring includes periodic assessment of efficiency, efficacy, effectiveness and impact; supervision of operational, epidemiological and managerial components at each level; maintenance of current information systems; and reporting to corresponding normative levels and national and international organisations. First-level health-status reports include programme-defined indicators.[21][17][19][20][10]

Resource planning is based on population needs and level of care, including medicines, diagnostic equipment, laboratory materials, reagents, forms and administrative inputs. The extracts identify technical roles in calculating tuberculosis supply needs and supporting procurement and distribution, but do not specify programme budgets, allocations, financing sources or funding gaps.[6][18][19][11]

Monitoring & Evaluation

The programme establishes a multi-level monitoring, surveillance and evaluation approach for tuberculosis, asthma and chronic obstructive pulmonary disease (COPD), combining epidemiological intelligence, routine health-information systems, supervisory review and community-level accountability.[21][17][10]It aims to use monitoring findings to assess service delivery, disease trends and implementation performance across national, state, Area of Comprehensive Community Health or municipal, and local levels.[17][19][20]

• Relaunch and integrate epidemiological-surveillance mechanisms for tuberculosis, asthma and COPD, including conventional and community-based surveillance coordinated with the General Directorate of Epidemiology.[21][17]
• Establish sentinel surveillance sites in facilities with the highest case occurrence in each state, and undertake further surveys where sentinel data reveal abnormalities requiring investigation or decisions.[21]
• Use the Ministry of Popular Power for Health Information System to monitor care delivery throughout the health network and maintain current operational, epidemiological and managerial information at state, municipal or Area of Comprehensive Community Health, local, specialised outpatient and hospital levels.[21][19][20][11]
• Strengthen the collection and processing of management information and conduct periodic monitoring and evaluation using efficiency, efficacy, effectiveness and impact indicators.[21]
• Analyse input, process and outcome indicators using the Integrated Basic Clinical Record, Family Record, community health-situation analyses, epidemiology forms and programme forms.[10]
• Base national programming on state plans, official manual updates, epidemiological conditions and tuberculosis operational information, while the central programme reviews and updates standards, plans, strategies, manuals, protocols and control actions.[18]
• Supervise compliance with programme standards and protocols at national level, with state, municipal or Area of Comprehensive Community Health and local structures monitoring and evaluating operational, epidemiological and managerial components.[17][19][20]
• Submit monitoring and evaluation results to the relevant normative level and report results to national and international organisations.[17][10]

Disease-specific reporting requirements are most explicit for tuberculosis. Health services are to identify respiratory symptoms among people aged 15 years and above attending for any reason, register symptomatic individuals, conduct two sputum examinations for tuberculosis microscopy, and investigate infectious pulmonary tuberculosis in accordance with programme standards.[7]Every person with tuberculosis is to receive HIV testing, while people with positive HIV serology are to be investigated for tuberculosis and notified through the epidemiological information system.[7][15]Services are also to evaluate all tuberculosis contacts, notify each case, issue a final treatment report, and report tuberculous meningitis, Bacille Calmette-Guérin vaccine complications and adverse reactions to antituberculosis medicines through specified forms.[15]

For asthma, registration, indicators and programme evaluation are to follow methodologies set out in programme manuals and protocols.[8]The framework also treats uninterrupted tuberculosis microscopy, culture processing and treatment administration as epidemiological priorities requiring continuity of service.[15]At first-level community services, health-status reports must include programme-defined indicators, and annual plans are presented to community assemblies for approval alongside commitments to citizen and institutional co-responsibility.[20]

The excerpts provide epidemiological baseline information for tuberculosis, including an average incidence of 21.5 cases per 100,000 inhabitants over the preceding decade and an incidence of 22.19 per 100,000 in 2015, when 6,796 new cases were notified.[4]District Capital, Zulia, Miranda, Anzoátegui and Carabobo together accounted for 52% of reported cases in 2015, while tuberculosis mortality risk was 2.2 per 100,000 inhabitants in 2012.[4]Although the programme refers to targets for specified periods, the available material does not specify numerical performance targets, indicator definitions, reporting frequency, data-quality procedures, named accountability sanctions or formal independent evaluation methods.[9][12][14][18]

Costing & Financing

Financing is framed principally as a State obligation within a public, universal and free national health system.[2][3]The programme requires resources for service delivery, surveillance, training, research, logistics and the supply of medicines, laboratory materials, diagnostic equipment, forms and other operational inputs, but the available material does not provide a costed implementation plan or monetary allocations.[6][17][19]

• Define resource requirements by level of care and coordinate medicines, equipment and other inputs according to population needs.[6][21]
• Plan the movement and logistics of samples, forms, medicines and supplies between health establishments, state coordination and, where necessary, national coordination.[19]
• Calculate national tuberculosis supply requirements and support procurement, acquisition and distribution of antituberculosis medicines, laboratory supplies and other priority inputs.[18]
• Manage or request the supplies, medicines, diagnostic equipment and other resources required by primary, specialised outpatient and hospital services.[10][11]
• Provide diagnostic capacity including tuberculosis microscopy, culture and rapid tests in selected settings, alongside spirometers, oximeters and blood-gas analysers for asthma and COPD diagnosis where designated.[11]

The policy acknowledges the economic burden of asthma through direct and indirect costs associated with hospital admissions, school absence and work absence.[13]It presents effective asthma management as potentially cost-saving while improving quality of life and supporting daily activity.[13]The broader policy background also refers to sustainable financing for tuberculosis prevention and control.[3]

No explicit programme budget, expenditure figure, funding source, allocation by disease or level of care, funding gap, donor commitment, resource-mobilisation target, unit cost, cost-effectiveness estimate or economic assumption is specified in the supplied material.[1][12][15][16]