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DEWG symposium Paris, 29 October 2003

This document summarizes the progress made in TB control in various countries in 2002. It includes detailed data on case detection rates, funding sources, coordination efforts, and key partnerships in the fight against tuberculosis.

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DEWG symposium Paris, 29 October 2003

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  1. DOTS ExpansionProgress and Next StepsLéopold Blanc Chris DyeLisa Véron, Malgosia GrzemskaDEWG secretariatStop TB WHO DEWG symposium Paris, 29 October 2003

  2. What countries have achieved in 2002 • Outstanding countries in 22HBC group: increase CD and cure India, Indonesia, Myanmar, Pakistan, Cambodia (Viet-Nam) • Progress in non HBC • Little or no progress: all other countries

  3. Countries with good CD progress

  4. INDIA: annualized new sm+ case detection rate and success rate, 1st quarter 1999 to 2nd quarter 2003 * * Projected population based on 2001 census.

  5. Total patients placed on treatment and population covered under DOTS each quarter, India (1994-2003) 238,204

  6. Resource mobilisation Link with GFATM (189 M for 2 years round 1 and 2) -Coordinated support: WHO, IUATLD, KNCV, GLRA, DFB Regional workshops In-country support to prepare proposals (CIDA funds) -Stimulate applications in countries with large funding gap - Support with implementation and monitoring (Norwegian funds) - All HBC but three have received funding from GFATM round 1 or 2 (Brazil and Russia did not apply)

  7. Resource mobilisation Link with bilateral financial partners - Additional funds for countries from CIDA, DFID, Italy, and USAID among others - FIDELIS to support new approaches to increase case detection

  8. Public sector costs and funding gaps for HBCs Total cost US$1.3 billion Total cost US$1.4 billion • Updated analysis based on new epidemiological data, review of GFATM proposals, Global Financial Monitoring Project • Identified gap is gap as reported by HBCs and technical agencies • Possible gap is (Total cost - Total assumed funding - Total identified gap) • Total cost allows for public sector costs to increase in line with increased number of patients • Main funding uncertainty: how much health service capacity exists to manage increase in cases associated with reaching targets?

  9. Coordination and partnership • Regional inter-agency coordination meetings in all regions • National interagency coordination committee NICC: central role of the NTP Coordination of international partners (tech, fin) Coordination of national actors in TB control: public health care providers, private, NGOs, corporate sector Linked or part of the CCM

  10. National Interagency Coordination Committee (ICC): status in 22 HB countries - Government leads N-ICC - ICC coordinates partners - WHO facilitate Gvt and partners efforts Russia*: ICCCDC, DFID, GTZ, KNCV, OSI, PIH, USAID, WB, WHO, Bangladesh*: ICC BRAC, CIDA , DFB, USAID, WB, WHO India*: (ICC)CIDA, DFID, DANIDA, GFATM, GLRA, USAID, WB, WHO Indonesia*: ICC ADB, AUSAID, CIDA, GFATM, KNCV, NL, USAID, WB, WHO Myanmar: (ICC) IUATLD, UNDP, WHO Thailand: no ICC CDC, GFATM, WHO Afghanistan*; ICCGLRA, ICD, MEDAIR, NOR, WHO Pakistan*: ICCDFID,GLRA, ICD, IUATLD, JICA, WB, WHO i Cambodia: ICC CIDA, JATA, JICA, RIT, USAID, WB, WHO China*: ICCCIDA, DFB, DFID, GFATM, Japan, KNCV, WB, WHO Philippines: ICCCDC, CIDA, JICA, KNCV, USAID, WB, WHO Vietnam*: ICC CDC, KNCV, NL, WB, WHO Brazil*: (ICC)CDC, DFB, GLRA, IUATLD, USAID, WHO Ethiopia*: ICC GFATM, GLRA, KNCV, NL, WB, WHO DR Congo*: ICCDFB, IUATLD, TLMI, USAID, WHO Kenya: CCM CDC, FHI, KNCV, NLR, WB, WHO Mozambique: no ICC GLRA ,WHO Nigeria*: ICC DFB, GLRA, KNCV, NLR, IUATLD, WB, WHO S. Africa: no ICCCDC, DFID, IUATLD, KNCV, USAID, WHO Tanzania: ICC GLRA, KNCV, SWISS, WB, WHO Uganda*: ICC DFID, GLRA, ICD, IUATLD, TLMI, WHO Zimbabwe*: (ICC)IUATLD, WHO WHO office in all countries * : WHO TB staff

  11. Human resources/Task Force for Training - At country level survey in all HBC consultation on HR (RF and WHO): 27-28 August -At international level: workshops for consultants modules for health centres workshops for country HR focal person (8 Africa, 7 Asia)

  12. TB and HIV • Collaboration and coordination of TB and HIV/AIDS programmes where relevant - Publication of the framework for TB/HIV activities - Guidelines for TB/HIV collaborative activities - Interim policy - Challenge of the 3x5, contribution by StopTB

  13. MDR-TB • Addressing MDR-TB: links with DOTS + working group and GLC where relevant GLC and GDF convergence to increase efficiency, finance pooling technical expertise DOTS plus as part of programme in Peru and Russia

  14. Case detection Increase case detection Study different approaches to increase case detection - PPMsub-group: to engage private sector in TB control to link public systems/services to address urban TB - Laboratory sub-group: to strengthen network - Community participation in TB control - Linking actors operating at primary health care level

  15. PPM for DOTS subgroup of DEWG • Chair: Phil Hopewell Secretariat: Mukund Uplekar • First meeting: Nov 2002 Development of practical tools for PPM Analysis of projects Large scale implementation in the Philippines Projects in India, Indonesia, Kenya, and Viet Nam Workshop for 8 countries in Africa • Second meeting in early 2004

  16. Laboratory Subgroup of DEWG • Chair: Fadila Boulahbal Secretary: Sang Jae Kim provide support to strengthening TB Laboratory services. • Subgroup 20 SRLN and some partners organisation such as IUATLD, KNCV, RIT and CDC. • Development of laboratory assessment tool • Assessment of TB laboratory services in 4 countries:Bangladesh, Kenya, Pakistan, and Uganda • Participation in the National TB Programme Review:Indonesia, Vietnam

  17. Beyond DOTS • 2d ad hoc committee Review TB control - constraints - 1st ad hoc committee Major recommendations will serve as guidance for work during the next 3-5 years Need to work beyond DOTS, looking at political and health system issues

  18. Conclusion • Financial gaps are progressively decreasing • Need to address limited capacity by all health care providers, look at the health system issues Year 2001 : preparation Year 2002 : implementation Year 2003 : scaling up Year 2004 : accelerating actions

  19. WE’RE HALF WAY THERE Case detection 36/70 Treatment success 83/85

  20. Life of the DEWG • DEWG: Chair: Karam Shah Secretariat: WHO Cairo: 2000 Paris: 2001 Montreal: 2002 The Hague/Paris: 2003 • DEWGcore team (March 2002) 3 permanent members:IUATLD, KNCV and WHO 5 HBC: Indonesia, Kenya, Pakistan, Philippines, Uganda Other technical agency: RIT Financial partner: USAID, CIDA (co-opted for 2002-03)

  21. New Documents - Community contribution to TB care Guidelines based on community TB care projects experiences - Guidelines on “Expanding DOTS in the context of changing health system” - “The contribution of workplace TB control activities to TB control in the community”

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