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TB Expansion Progress and Next Steps

This presentation provides an overview of the progress made by countries in the fight against tuberculosis (TB) in 2002, including achievements, responses, and the role of the DOTS Expansion Working Group (DEWG). It also discusses financial needs, resource mobilization efforts, coordination and partnership, and human resources for TB control.

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TB Expansion Progress and Next Steps

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  1. DOTS ExpansionProgress and Next StepsLéopold Blanc Lisa Véron, Malgosia GrzemskaDEWG secretariatStop TB WHO DEWG meeting The Hague, 7-8 October 2003

  2. Overview of the presentation • What has been achieved by countries • What are the responses • Life of the DEWG

  3. What countries have achieved in 2002 • Outstanding countries: increase CD and cure: India, Indonesia, Myanmar, Pakistan, Cambodia (Viet-Nam) • Increase case detection but low cure: South Africa • Some progress: Mozambique, Afghanistan, Philippines • Very little or no progress: all other countries - year 2001: year of preparation in many countries - year 2002: year of implementation - year 2003: year of scaling up (expect higher progress)

  4. What countries have achieved in 2002 • Three HBC have achieved case detection > 70% (Viet Nam, South Africa, Mozambique) Only Viet Nam has achieved both CD and cure targets • 2 HBC with high HIV prevalence have reported success rate > 80% Kenya and Tanzania • Philippines and Myanmar closer to targets

  5. Countries with good CD progress

  6. New Sm+ case detection rate (%) in DOTS areas and % population covered by quarter 1999-2005

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

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

  9. Financial needs and monitoring - Completion of cost estimates in HBC Some countries need to refine estimates of needs in particular for additional activities to increase cure and case detection - Cost estimates for all high incidence countries: ongoing using financial monitoring - Financial monitoring system for country: in place but low response

  10. Analysis published March 2002 Identified gap total = US$512 M,  US$100 million p.a. Total gap (identified+possible): may be  US$300 million p.a.

  11. Identified funding gapMarch vs. Oct 2003 Identified gap 2001-5 reduced from  US$500 to  US$200M Unidentified funding gap of around 200M per year

  12. 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)

  13. 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

  14. 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

  15. Status of establishment of inter-agency committees (N-ICC, R-ICC) Not yet established Established 3 SA, Moz, Not active Thai 4 Zim, Bra, Ind, Mya, 15 Afg, Ban, Cam, Chi, DRC. Eth, Indo, Ken, Ngria, Pak, Phi, Rus, Tan, Uga, Viet N-ICC in 22 High-Burden Countries

  16. 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

  17. 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)

  18. 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”

  19. 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

  20. 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

  21. 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

  22. 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

  23. 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

  24. Next Year Plan Laboratory Subgroup • Continue the laboratory assessment of the 22 HBCs • Technical assistance to the countries to improve their TB Diagnostic Services including the implementation of EQA • Support to training programme of TB laboratory services • First meeting of the Subgroupin Italy 10-11 December 2003

  25. 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

  26. 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

  27. Life of the DEWG • DEWG: Chair: Mario Raviglione Secretariat: WHO Cairo: 2000 Paris: 2001 Montreal: 2002 • 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)

  28. Election of the chair person DEWG • Term of chair person: 2 years, renewable once • Nomination committee: not candidate for chair 5 DEWG members Susan Bacheller and Nils Billo: core team 3 additional: volunteers to contact NB or SB • Nomination committee - Define criteria for selection of chair - Collect names of candidates for the Chair during the afternoon - Select 3 names suitable for chair (criteria) - 3 names proposed to DEWG members for decision

  29. Replacement DEWG core team members • Core group members term is 2 years renewable • Nomination committee will contact DEWG members by e-mail to request nomination of core team members

  30. Requests to include additional sub-groups • Currently 2 sub-groups: PPM DOTS Laboratory strengthening • Core team examined request for Paediatric TB: scope and objectives found suitable to form a sub-group • Other requests are being studied but need some additional information: - Nursing - Operational research

  31. Venue of next DEWG meeting2004 3 possibilities will be examined by the core team • Paris: end October- 2 November 2004 • In a HBC: need to be candidate • In connection with a regional meeting Meeting evaluation form distributed tomorrow afternoon

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