planning and budgeting for tb control: opportunities for bank operations katherine floyd, andrea...
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1a. Epidemiological burden of TB and progress towards global targets for controlTRANSCRIPT
Planning and Budgeting for TB control: Opportunities for Bank Operations
Katherine Floyd, Andrea PantojaStop TB DepartmentWorld Health Organization
World BankWashington, 6 March 2008
1. Background Epidemiological burden of TB and progress towards
global targets for control The Stop TB Strategy and the Global Plan to Stop TB Planning/budgeting at country level vs. the Global
Plan
2. The WHO tool for planning and budgeting for TB control at country level What is it? Main features Why use it? Promotion and practical application to date
3. Opportunities for Bank operations, with particular attention to Africa
Overview
1a. Epidemiological burden of TB and progress towards global targets for control
9.2 million new (incident) cases 0.7 million among HIV-positive people 56% in Asia 29% in Africa
1.7 million deaths 0.2 million among HIV-positive people
14.4 million prevalent cases 0.5 million cases of multidrug-
resistant TB (MDR-TB)
Epidemiological burden of TB: latest WHO estimates for 2006
1. Impact targets (MDGs, Stop TB Partnership)
Halt and reverse incidence by 2015 (MDG 6) Halve cases and deaths by 2015 vs. 1990 baseline
2. Outcome targets, DOTS (WHA*, Stop TB Partnership) Detect ≥ 70% of new sputum smear-positive (SS+) cases Successfully treat ≥ 85% of detected new SS+ cases
* World Health Assembly
Global targets for TB control
0
50
100
150
200
250
300
350
400
1990
1992
1994
1996
1998
2000
2002
2004
2006
Cas
es p
er 1
00,0
00 p
opul
atio
n Africa
South-East Asia
WORLD
Western Pacific
EasternMediterraneanEurope
Americas
Cases in millions
02468
10
1990
1994
1998
2002
2006
Incidence rates stable or falling slowly9.2
Mortality
0
5
10
15
20
25
30
35
1990 1995 2000 2005 2010 2015
Dea
ths
per 1
00,0
00 p
opul
atio
n
Prevalence
0
50
100
150
200
250
300
350
1990 1995 2000 2005 2010 2015
Cas
es p
er 1
00,0
00 p
opul
atio
nTB prevalence and mortality
Falling… but need to fall faster to reach targets
Total deaths from TB in 2006 = 1.7 million
Target = 148 Target = 14
01020304050607080
AFRAMR
EMREUR
SEARWPR
World
Dea
ths
(per
100
000
/yea
r)
2006
target
Africa and Europe furthest from targets
Africa
Similar pattern for prevalence
Europe
0
10
20
30
40
50
60
70
80
1990 1994 1998 2002 2006 2010 2014
CD
R, s
mea
r-po
sitiv
e ca
ses
(%) Target 70%
All new sm+
DOTS sm+
61% in 2006
Case detection increasing but at slower rate than 2002–2005
Global Plan: 65% in 200678% by 2010
77 69 6752 52 46
020406080
100
Treatment success target almost reached (globally)
244,
662
2.34
m
illio
n
Europe: 70%, Africa: 76%, Americas: 78%
84.7
7779
7779
81 8082 82 82 83
84
70
74
78
82
8619
9419
9519
9619
9719
9819
9920
0020
0120
0220
0320
0420
05
Perc
enta
ge
Four of the 22 high-burden countries now in "target zone"
404550556065707580859095
100
0 10 20 30 40 50 60 70 80 90 100Case detection
Trea
tmen
t suc
cess
Zimbabwe
ChinaViet Nam
PhilippinesIndonesia
KenyaDR Congo
UgandaNigeria
Ethiopia MZBTanzania
Sot
South Africa
1b. The Stop TB Strategy and the Global Plan to Stop TB, 2006–2015
WHO-recommended Stop TB Strategy WHO-recommended Stop TB Strategy
The Global Plan to Stop TB, 2006–2015Plan is based on Stop TB Strategy and sets out scale at which interventions should be implemented in each year 2006–2015 to achieve 2015 MDG and Stop TB Partnership targets, globally and for 7 regions
Funding requirements 2006–2015 in the Global Plan to Stop TB
New diagnostics, US$ 0.5 bn
Advocacy, communication,
social mobilization, US$ 2.9 bn
Collaborative TB/HIV
activities, US$ 6.7 bn
DOTS treatment,
US$ 31.8 bn
New drugs,US$ 4.8 bn
New vaccines, US$ 3.6 bn
MDR-TB treatment, US$ 5.8 bn
Total requiredUS$56.1 billionExpected on current trendsUS$25.1 billionGap to fillUS$31 billion
The Global Plan – what does its success depend on?
1. Whether or not country plans are consistent with the regional-level plans included in the Global Plan
2. Whether or not all the funding required for country plans is mobilized
3. Whether or not all planned activities/interventions are actually implemented (and have expected impact)
1c. Planning and budgeting at country level vs. the Global Plan
Comparisons with the Global PlanDR CONGO
0
10
20
30
40
50
60
70
GP CR GP CR
2006 2007
US$
mill
ions
Other
GHS
ACSM
TB/HIV
MDR
DOTS
INDIA
0
50
100
150
200
250
GP CR GP CR
2006 2007
US$
mill
ions
Other
GHS
ACSM
TB/HIV
MDR
DOTS
BRAZIL
0
1020
3040
50
6070
80
GP CR GP CR
2006 2007
US$
mill
ions
Other
GHS
ACSM
TB/HIV
MDR
DOTS
UGANDA
0
5
10
15
20
25
30
35
40
GP CR GP CR
2006 2007
US$
mill
ions
Other
GHS
ACSM
TB/HIV
MDR
DOTS
Comparisons with the Global PlanNIGERIA
0
20
40
60
80
100
120
GP CR GP CR
2006 2007
US$
mill
ions
Other
GHS
ACSM
TB/HIV
MDR
DOTS
PAKISTAN
01020304050607080
GP CR GP CR
2006 2007
US$
mill
ions
Other
GHS
ACSM
TB/HIV
MDR
DOTS
INDONESIA
0102030405060708090
GP CR GP CR
2006 2007
US$
mill
ions
Other
GHS
ACSM
TB/HIV
MDR
DOTS
CHINA
0
50
100
150
200
250
GP CR GP CR
2006 2007
US$
mill
ions
Other
ACSM
TB/HIV
MDR
DOTS
Global Plan to Stop TB
Country budgets
Available funding
$2000m
$2500m
$3000m
$3500m
$1000m
$500m
$1500m
General health services
TB/HIV
Other
Operational research
ACSM/CTBC
MDR-TB
PPM/PAL*
DOTS
Planning and funding of TB control, 2007Total$3.1 billion
Total$2.3 billion
Total$2.0 billion
Based on 84 countries with 90% global TB cases
Comparison of country reports with Global Plan in Africa, 2007
0
200
400
600
800
1000
1200
1400
1600
Global Plan Country report Available funding
Based on 27 countries, 87% regional TB burden
US$
mill
ions
Available funding
General healthservicesTB/HIV
Other
OperationalresearchACSM/CTBC
MDR
PPM/PAL
DOTS
509
1251
436
MDR/XDR-TB treatment in 2007
Based on 106 countries with estimated 84% of global MDR cases
0
10000
20000
30000
Glo
bal P
lan
CR
Glo
bal P
lan
CR
Glo
bal P
lan
CR
Glo
bal P
lan
CR
Glo
bal P
lan
CR
Glo
bal P
lan
CR
EUROPE SE ASIA W PACIFIC AMERICAS AFRICA EMR
Thou
sand
s of
pat
ient
s Russia
All other countries
IndiaChina
Behind Global MDR/XDR Response Plan targets in the 3 regions where most treatment is needed
CR = Country report
2. The WHO TB planning and budgeting tool
Why has a TB planning and budgeting tool been developed?
To assist planning and budgeting in general, and in particular country planning and budgeting in line with the Stop TB Strategy and the Global Plan
Called a "planning and budgeting" tool to highlight that:
Plans should include a budget, but sometimes do not Budgets should be based on and in line with plan
goals, objectives and planned activities
Development process
Date Work done
April–May 2006 Draft version of tool developed:Building on planning frameworks developed for Global Plan and STB workshops for Global Fund proposal development
June–Dec 2006 Field-testing + practical application:Malawi, Indonesia, Kenya, Somalia, South Africa, regional planning workshop for 10 priority countries in Latin America
June–Dec 2006 Revisions and finalization based on field-testing
Oct–Dec 2006 Accompanying documentation + sharepoint site prepared
January 2007 Translation into French, Spanish, Russian
2007 and early 2008
Two sets of major updates/revisions, most recent to facilitate Rd 8 Global Fund applications
The tool: what is it?1. Excel-based tool that provides a ready-made
framework for planning and budgeting for all recommended components of TB control
2. Components defined according to the Stop TB Strategy and related Global Fund "Service Delivery Areas" required for TB grant applications
3. One worksheet for each major component of TB control, within which there is a ready-made list ("checklist") of inputs/activities to consider for each component of TB control and default values to help users, including default values from the Global Plan
See: www.who.int/tb/dots/planning_budgeting_tool/en/index.html(includes tool and accompanying documentation)
The tool – what is it? Choosing country via menu system selects correct set of epi/ demographic/financial historical data, projections and default values incl. from the GP
Ready-made framework for planning/budgeting for each component of TB control
Guidance available within tool
Menu-driven system
Application options to enhance user-friendliness
Please select an intervention
NNN
N
NNNNNNNNNNNNNN
Reports / Outcome
Version 5.14 >> Application Options <<
Use of general health services
Summary of costs and funding sources Total costs - Figure
Budgets & sources of funding
Sources of funding - Figure Total costs by Stop TB Strategy component
Planning & Budgeting for TB Control
SEARIndonesia
Routine programme management and supervision activities
Staff involved in TB control First-line drugs Estimating TB patients to be treated Current situation: budget reported 2006
Other M&E
ACSM
Operational Research CTBC
International technical assistance
PAL
Training
PPM
MDR-TB Collaborative TB/HIV activities
Laboratory inputs Patient support
For your information, this workbook allows countries to plan and budget for TB control in line with the Global Plan to Stop TB 2006-2015 and the Stop TB Strategy. It is a flexible tool that you can adapt to your own circumstances if needed.
To Navigate, open the sheet you want to see and come back to the main menu by pressing the "BACK" button on the top right hand side of the sheet. Please take a look at the "USER GUIDE" to familiarize yourself with the colour code scheme and the use of default values.
2°: USER GUIDE - CLICK HERE!
1°: Please select your country
STATUS
Summary tables and figures automatically produced
Status Bar
Why use the tool? Main benefits
1. Plans and budgets for TB control set out comprehensively in one place, in standardized format
2. Solid foundation for resource mobilization from national/local governments, Global Fund and other donors
3. Automatically produces summary budget tables required for applications to Global Fund and entire tool is structured in line with Global Fund requirements
5. Provides framework for monitoring and evaluation of plan implementation as well as comparisons among and within countries
6. Automatically produces financial information requested on annual WHO TB data collection form
Promotion
1. Presentation of tool and how it can be used at Global Fund preparation workshops in all WHO regions
2. Training workshops for technical partners, NTP managers and WHO regional and country office staff
3. Highlighting its existence in presentations at international meetings whenever appropriate
4. Posted on the WHO Stop TB website
Practical application1. Priority in 2007 given to training and practical use in Africa
Two five-day workshops with follow-up have covered 35 of 46 African countries including all 9 "high-burden" countries and 2 of the other very "high-incidence" countries (Malawi, Zambia)
11 countries not covered: Algeria, Cape Verde, Comoros, Equatorial Guinea, Guinea-Bissau,
Mauritania, Mauritius, Rwanda, Sao Tome and Principe, Seychelles, Swaziland
2. Complete plans and budget in the tool for 8 high-burden countries and 2 of the highest-incidence countries:
DR Congo, Ethiopia, Gabon, Kenya, Malawi, Nigeria, South Africa, Tanzania, Zambia
3. In process for: Mozambique (due end March 2008), Uganda, Cameroon and others
although current status needs to be verified
4. Demand for regional workshops in 2008 in L. America, SE Asia
Examples: completed and in process…
0
20
40
60
80
100
120
140
US$
mill
ions
Other
Hospitalization,outpatient visitsACSM
Public-privatecollaborationTB/HIV
MDR-TB
DOTSimplementation
0
10
20
30
40
50
60
70
2008
2009
2010
2011
2012
US$
mill
ions
Other
Hospitalization,outpatient visitsACSM
Public-privatecollaborationTB/HIV
MDR-TB
DOTSimplementation
Nigeria
0
20
40
60
80
100
120
140
US$
mill
ions
Funding gap
Grants excl. GF
Global Fund
Loans
Government
Nigeria
Tanzania
Tanzania adapted time period in line with strategic plan, and funding categories
0
10
20
30
40
50
60
70
US$
mill
ions
Funding gap
Other
GLRA
CDC/PEPFAR
Global Fund
Government
Tanzania
Examples: completed and in process…
Zambia adapted time period for purposes of Global Fund application and funding categories; funding gaps now closed after Global Fund Rd 7 proposal approved
0
2
4
6
8
10
12
14
US$
mill
ions
Other
Hospitalization,outpatient visitsACSM
Public-privatecollaborationTB/HIV
MDR-TB
DOTSimplementation
02468
101214
2008
2009
2010
2011
2012
US$
mill
ions
Funding gap
TBCAP
PEPFAR
WHO/GDF
CIDA, KNCV
Global Fund
Loans
Government
05
1015202530354045
US$
mill
ions
Other
Hospitalization,outpatient visitsACSM
Public-privatecollaborationTB/HIV
MDR-TB
DOTSimplementation
Zambia Zambia
Kenya
05
1015202530354045
US$
mill
ions
Funding gap
Grants excl.Global Fund
Global Fund
Loans
Government
Kenya
3. Opportunities for Bank Operations
Examples of where the Bank can play an important role
1. Contributing to finalization of budgets using the tool e.g. via deployment of consultants, follow-up during WB missions
E.g. Cameroon, Swaziland
2. Helping to promote use of the budget figures in health sector-wide planning/budgeting
E.g. Kenya, Mozambique, Zambia
3. Using the budget figures as an input to sector-side work using the Marginal Budgeting for Bottlenecks (MBB) tool
4. Keeping WHO up-to-date/informed about relevant opportunities to feed the TB budgeting work into health sector-wide planning/budgeting/financing discussions