DOTS Expansion WG DOTS Expansion WG Report of the secretariatReport of the secretariatProgress and Next StepsProgress and Next Steps

Karam Shah ChairKaram Shah ChairLLééopoldopold Blanc, Amy Blanc, Amy PiatekPiatek, , MalgosiaMalgosia GrzemskaGrzemska

DEWG secretariatDEWG secretariat

DEWG meeting Paris, 27-28 October 2004

Overview of the presentationOverview of the presentation

What has been achieved by countriesWhat are the next steps Life of the DEWG

What countries have achieved in 2002What countries have achieved in 2002

Outstanding countries: increase CD, high cure China, India, Indonesia, Myanmar Increase case detection but low cure: South Africa, ThailandSome progress: Bangladesh, Cambodia, Nigeria, Pakistan, PhilippinesDecrease in case detection and cure: Ethiopia, Zimbabwe

What countries have achieved in 2002What countries have achieved in 2002

Four HBC have achieved case detection > 70% (Viet Nam, South Africa, Myanmar, Thailand)

Only Viet Nam has achieved both CD and cure targets

4 HBC with high HIV prevalence have reported success rate at or close to 80% DR Congo, Kenya, Mozambique and Tanzania

DOTS Progresses DOTS Progresses the link with implementationthe link with implementation

0

10

20

30

40

50

60

70

80

1990 1995 2000 2005 2010 2015Year

Cas

e de

tect

ion

rate

, all

form

s of

TB

(%

)

average rate of progress, 1995-2000

DOTS begins

(b)

Cairoprep

impl

scale up

accel

2004 ?

Countries with good CD progressCountries with good CD progress

0

10

20

30

40

50

60

70

80

90

100

1999 2000 2001 2002 2003Year

Perc

ent d

etec

tion

DO

TS

INDMYAINOCHN

70%

Progress in resources for TB controlProgress in resources for TB controlChina India

Total TB control costs

0

20

40

60

80

100

120

140

160

180

2002 2003 2004 2005

US$

mill

ions

GapGFATMGrantsGovernment

Total TB control costs

0

20

40

60

80

100

120

140

160

180

2002 2003 2004 2005

Sources:NTP expenditures (2002, 2003)NTP projected budgets (2004, 2005)Estimates of costs not covered by NTP(WHO estimates using NTP data)

Sources: NTP expenditures (2002, 2003)NTP projected budgets (2004, 2005)

NTP budgets as reported to WHO, 22 NTP budgets as reported to WHO, 22 HBCsHBCs2004 (US$ millions) 2005 (US$ millions)

133 (41%)

65 (20%)

41 (13%)

46 (14%)

35 (11%) Government

Loans

GFATM

Other Grants

Gap

Unknown

154 (43%)

31 (9%)22 (6%)

52 (14%)

56 (16%)

42 (12%)

Total = US$321 millionChina + India = 164

Missing data: DR Congo, Pakistan, Russia, S. Africa, Uganda

Total = US$ 357 millionChina + India = 204

Missing data: as for 2004 plus Cambodia, Tanzania

Very small budgets for TB/HIV and DOTS-plus (< US$10 million each)

Total TB control costs, 22 HBCs2004 (US$ millions) 2005 (US$ millions)

321 (61%)97 (18%)

110 (21%)

NTP costsHospital daysClinic visits

357 (62%)

106 (18%)

116 (20%)

Total = US$ 528 million

Missing data: DR Congo, Pakistan, Russia, S. Africa, Uganda

Total = US$ 578 million

Missing data: as for 2004 plus Cambodia, Tanzania

Previous estimates suggest Russia and S. Africa add about US$500-600 million p.a.

Human resourcesHuman resources

- Global Joint Learning Initiative: global problem- HR as a point for discussion in regional NTP mtg- TFT: training modules "Management of TB at health

facility level" and a guide on how to organize training- Training of focal person for HR for TB in HBC- Collaborative for training and education: library for

Russian speaking people- Training for consultants- Task analysis: human resource assessment

TB and povertyTB and poverty

- Network for action on TB and povertyMainstreaming pro-poor approachesFostering research(Secretariat of the network in Malawi)

- Preparation of a guide to addressing poverty in TB control

ISAC ISAC -- PurposePurpose

A special emergency initiative to accelerate DOTS expansion and reach

the 2005 targets, within the Global Plan to Stop TB, and ultimately the

2015 MDGs

Stop TB DepartmentStop TB Department

ISAC ISAC --

ISAC is an EXTRAORDINARY and ADDITIONAL effort to accelerate TB

control

regular efforts to support all 22 HBCsand other countries in need continue

Stop TB DepartmentStop TB Department

ISAC ISAC -- Countries Countries 1st tier1st tier

1st Tier:

India (first ISAC)ChinaIndonesiaKenyaPakistanRomaniaRussian FederationUgandaPeru*

*plan not yet available

Stop TB DepartmentStop TB Department

Resource mobilisationResource mobilisation

Link with bilateral financial partners- Funds for ISAC countries from GFATM,

CIDA, Japan, Italy, and USAID among others- FIDELIS to support new approaches to

increase case detection

Resource mobilisationResource mobilisation

Link with GFATM- Coordinated support: technical partners- In-country support to prepare proposals - Stimulate applications in countries with large

funding gap- Support with implementation and monitoring - All HBC but three have received funding from

GFATM

Situation analysis from previous Situation analysis from previous roundsrounds

15 %153,035,87830%21 TB7143 %26,618,3803 %2 TB/HIV8 %67,850,15124 %18 TB7431 %8,414,0001 %1 TB/HIV18 %115,020,91826 %25 TB98210 %54,762,7388 %4 TB/HIV17 %96,425,41023 %12 TB551

TB % of all approved 2-year funding (all diseases)

Approved 2-year

funding for TB(US $)

TB% ofall

approvedcomponents

Number of

approvedcomponents*

Totalnumber ofapproved

Components(all dseases)

Round

Summary of GFATM approvals, rounds 1-4Number of components and Amount of funding

* TB/HIV component refers to stand alone proposals only. TB/HIV activities received approval in 28 countries in total, the majority as part of a TB proposal

Situation analysis from previous Situation analysis from previous roundsrounds

• TB control expenditure in HBCs too low: US$ ~850 million in 2003, vs. estimated US$ 976 – sum required to reach 70% case detection by 2005.

• By end 2003, the GFATM approved grants (for up to 5yrs) of US$ 608 million for TB, and US$ 319 million for TB/HIV, in 56 countries.

• First 2yrs total is US$ 294 million for TB, and US$ 90 million for TB/HIV, but only 16% had been disbursed by end 2003.

Regional inter-agency coordination meetings in all regions. Regional Stop TB partnership in EURONational interagency coordination committee NICC: central role of the NTP, linked to CCMNational Stop TB partnership in Pakistan, Mexico, UgandaCoordination 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

Coordination and partnershipCoordination and partnership

Next stepsNext stepsLaboratory issues

• Under funded and under equipped

• Under staffed in quantity and quality

• Weak organisation, no QC and supervision

• Weak coordination with NTP

• Absence of a clearly defined national reference lab

• Absence of standardization of procedures and of training material

Next stepsNext stepsIncrease case detection

Study different approaches to increase case detection

- PPM sub-group: to engage private sector in TB controlto link public systems/servicesto address urban TB

- Laboratory sub-group: to strengthen network transfer new technology

- Childhood TB sub-group: define standards and policy- Community participation in TB control

Next stepsNext stepsLink with GFATMNeed to broaden scope of activities and include - Laboratory strengthening- Engage all health care providers in DOTS: PPM-DOTS- Human resources- Secure quality drug supply (GDF)- Advocacy and communication- Building partnership and fund it - DRS and MDR-TB- TB/HIV- Monitoring : internal and external

Main TB/HIV publications issued in ain TB/HIV publications issued in 20042004

MDRMDR--TB TB

Addressing MDR-TB:

links with DOTS + working group and GLC where relevant

DOTS plus at different phases PreparationExpansion and mainstreaming Part of programme in Latvia, Peru, Russia ….

Beyond DOTSBeyond DOTS

Expanded DOTS framework for TB control- 1994 framework for effective TB control (10 years old)- 2002 Expanded framework (2 years old) include among other points

Treatment of all TB patients (no priority for Sm+) Use of culture and DST where possible TB/HIV and MDR-TB

Planning the period 2006-2015Global DOTS expansion plan Regional plans and country plansThink about the possible availability of new tool

Conclusion Conclusion

Financial gaps are progressively decreasingNeed to address limited capacity by all health care providers, look at the health system issues

Year 2001 : preparationYear 2002 : implementationYear 2003 : scaling upYear 2004 : accelerating actionsYear 2005 : broadening the scope of interventions

DEWG: Chair: Karam Shah (Oct 2003)Secretariat: WHO

DEWG core team renewed in March 20043 permanent members: IUATLD, KNCV and WHO 5 HBC: Indonesia, Pakistan, Cambodia, India & UgandaOther technical agency: RITFinancial partner: USAID, CIDA

Life of the DEWGLife of the DEWG

Sub Sub -- groups groups

PPM DOTS

Laboratory capacity strengthening

Childhood TB