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Global DOTS Expansion Plan Concept and Progress Mario C. Raviglione Stop TB Communicable Diseases

Global DOTS Expansion Plan Concept and Progress Mario C. Raviglione Stop TB Communicable Diseases. Second DOTS Expansion Working Group Meeting 31 October 2001 Paris, France. Projected DOTS case detection Without accelerated expansion, World Health Assembly targets cannot be reached by 2005. 80.

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Global DOTS Expansion Plan Concept and Progress Mario C. Raviglione Stop TB Communicable Diseases

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  1. Global DOTS Expansion PlanConcept and ProgressMario C. RaviglioneStop TBCommunicable Diseases Second DOTS Expansion Working Group Meeting31 October 2001 Paris, France

  2. Projected DOTS case detectionWithout accelerated expansion, World Health Assembly targets cannot be reached by 2005 80 WHO target 70% 70 60 accelerated progress: target 2005 50 Cases notified under DOTS (%) 40 30 DOTS begins average rate of progress: 1991 20 target 2013 10 0 1990 1995 2000 2005 2010 2015 Year

  3. Background • Amsterdam Ministerial Conference, March 2000 • attended by 20 of top 22 high-burden countries ( 80% of global cases) • commitment to expand DOTS to detect 70% of SS+ cases by 2005 • Following Amsterdam: • WHA 2000: HBC request WHO assistance • International partners express readiness to contribute as part of strategic, co-ordinated plan • Development of GDEP in Cairo 11/2000 and launch at WHA in 5/2001 • Partners Forum in Washington, 10/2001, promoted GDEP in GPSTB

  4. What is the GDEP? A mid-term global strategic plan for accelerated expansion of DOTS the aim of which is to: • accelerate progress towards achievement of global TB control targets through: • co-ordinated global planning + mobilisation of resources • emphasis on partnerships Initial focus on the 22 “High-Burden” Countries

  5. At country level: 5-Year National Strategic Plan for DOTS Expansion Annual implementation plan A Coalition Government - Partners (N-ICC) Main Technical Collaborator Other Technical and Financial Partners identified Estimated Financial Needs and Gaps At international level: 5-year and annual plan of international technical support by partner agencies Regional plans and coalitions (R-ICC) Estimated financial needs and gaps What is the GDEP? (cont.)

  6. GDEP: situation now(31 October 2001) • Status of 5-year plans, national & regional • Status of national partnerships • Status of national and regional interagency committees (N-ICC & R-ICC) • Status of financial assessments

  7. Mid-term planning status in 22 high-burden countries - Late 2001 7: Plans under development or incomplete (in years or geographical coverage) 14: Complete Plans: Bangladesh, Cambodia, DR Congo, Ethiopia, Kenya, Indonesia, Myanmar, Pakistan, Philippines, South Africa, UR Tanzania, Uganda, Vietnam (Peru) 1: No Plans

  8. Status of 5-year country plans for 22 HBC New or improved plan since Cairo meeting Plan under developmentor incomplete Sound plan prior to Cairo meeting No plan CambodiaEthiopia Kenya Peru Tanzania Vietnam Bangladesh DR Congo Indonesia Myanmar Pakistan Philippines South Africa Uganda Afghanistan Brazil China India Nigeria Russian Fed Thailand Zimbabwe

  9. Status of regional strategic plans New or improved plan since Cairo meeting Plan under development Sound plan prior to Cairo meeting AFRO AMRO EURO WPRO SEARO EMRO

  10. Technical & financial partners identified for all 22 countries Russia: WHO USAID, CDC, DFID, FLA GTZ, NLHA, PIH, OSI, WB Cambodia: JICA, WHO JATA/RIT, WB, USAID China: WHO KNCV, DFID, IUATLD, WB Philippines: WHO JICA, KNCV, CDC, CIDA, USAID, WB Vietnam: KNCV WHO, CDC, NL, WB i Afghanistan; WHO ICD, NOR Pakistan: WHO/IUATLD KNCV, WB GLRA, ICD, DFID Brazil: WHO/IUATLD GLRA, DFB, USAID Peru: WHO PIH, IUATLD, CDC, WB Bangladesh: WHO USAID, WBIndia: WHO DFID, DANIDA, CIDA, USAID, WB Indonesia: KNCV WHO, AUSAID, NL, ?WB Myanmar: IUATLD/WHO UNDP Thailand: WHO IUATLD Ethiopia: KNCV/WHO WHO, NL, GLRA, IUATLD, WB DR Congo: IUATLD/DFB WHO Kenya: KNCV WHO, NL, CDC, WB Nigeria: WHO/IUATLD GLRA, DFB, NLR, WB S. Africa: IUATLD/WHO DFID, CDC, USAID, BEL, ?WB Tanzania: KNCV WHO, IUATLD, GLRA, SWISS, WB Uganda: WHO/IUATLD GLRA, LMI, ICD, DFID, WB Zimbabwe: IUATLD/WHO NL, DANIDA, ?WB

  11. Status of establishment of inter-agency committees (N-ICC) 7 no under dev. 3 2 not required yes 1 10 5 22 High-Burden Countries Regions

  12. Estimated annual needs and gaps, 22 HBC plus all other low and lower-middle-income countries

  13. Governments of high-burden countries contribute more than half the financial needs 1159M$ Gap436M$ Grants - 10M$ Loans - 24M$ Gvt Contribution689M$ 22 High-Burden Countries

  14. GDEP- current priorities, late-2001 • Plans for all 22 HBC to be ready after this meeting • Finalize immediately after the meeting: • detailed plan for the next year identifying which partners will fill existing technical and financial gaps • budget required for technical assistance (in addition to what is currently in plans) • Facilitation of expansion of DOTS beyond 22 HBC through WHO and partners’ regional strategic plans

  15. Outcomes for achieving the 2005 targets • 25 million lives saved by 2020 • 55 million cases averted by 2020

  16. Progress in TB Control, high-burden Countries, 1998-99 100 Brazil China 90 Vietnam Cambodia Peru Philippines Myanmar Bangladesh Tanzania 80 India South Africa Nigeria Kenya Russia 70 Ethiopia Zimbabwe DRCongo Treatment success (%) Pakistan Thailand 60 Indonesia 50 Uganda Afghanistan 40 30 0 10 20 30 40 50 60 70 80 90 100 DOTS detection rate (%)

  17. DOTS is expanding rapidly in India1998-2001 40% of the population now has access to the RNTCP

  18. 60 30 000 50 40 percentage 30 20 10 0 case fatality case fatality deaths averted (-programme) (+programme) TB deaths prevented every year in China through DOTS Expansion

  19. DOTS results in TB incidence decline The case of Peru 220 DOTS 1990 200 case finding 180 160 Pulmonary TB cases/100,000 140 120 PTB falling at 6%/yr 100 1980 1985 1990 1995 2000

  20. GDEP targets to be achieved • End 2001: all HBC will have a 5-year plan and all WHO ROs will have a medium-term plan for DOTS expansion • End 2002: 35% of all infectious cases detected under DOTS and all HBC will have a defined N-ICC • End 2005: 70% of all infectious cases detected under DOTS and 85% treated successfully • Plus by end 2002, WHO policy for community involvement in TB control and, by end 2004, WHO policy for involvement of private practitioners in TB control

  21. Next steps: • Endemic countries: finalize plans and budgets, establish N-ICC and commit to expansion • Technical agencies: assist endemic countries and define financial needs and gaps • Financial partners: mobilize resources for GDEP and GDF as integral parts of GPSTB • WHO: ensure coordination, start global financial monitoring, promote GDEP as a template to absorb new resources from Global Fund

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