world health organization regional office for the western pacific the who end tb strategy: regional...
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World Health Organization Regional Office for the Western PacificWorld Health Organization Regional Office for the Western Pacific
The WHO End TB Strategy: Regional Perspective
Dr Nobuyuki Nishikiori, CoordinatorStop TB and Leprosy EliminationWorld Health OrganizationRegional Office for the Western Pacific
The Ninth Technical Advisory Group and National TB Programme Managers Meeting
Manila Philippines, 9-12 December 2014
World Health Organization Regional Office for the Western Pacific
Regional Situation
World Health Organization Regional Office for the Western Pacific
TB burden in the Western Pacific Region• Since 2000
- 10 million patients treated- 800 000 deaths averted
• On track for achieving the TB related MDGs and other targets by 2015
1.6 million(87 per 100 000)
110 000(5.8 per 100
000)
Estimate number of TB (all forms)
Estimated number of deaths due to TB*
Multidrug-resistant TB
71 000
HIV-associated TB 23 000
All estimates are for 2013.Source: Global TB Report 2014 (WHO)* Excluding death due to TB-HIV co-infection
World Health Organization Regional Office for the Western Pacific
World Health Organization Regional Office for the Western Pacific
Changes in TB incidence between 1994-2013
Estimates from Global TB Database
World Health Organization Regional Office for the Western Pacific
Changes in TB mortality between 1994-2013
Estimates from Global TB Database
World Health Organization Regional Office for the Western Pacific
The WHO End TB Strategy
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Challenges and Opportunities in the Western Pacific Region
World Health Organization Regional Office for the Western Pacific
Challenges
• Still many patients unreached• High-risk and socially vulnerable
populations• Only a small fraction of MDR-TB
patients diagnosed, yet treatment capacity insufficient
• Donor investment shrinking, threatening sustainability
• Health systems in transitions for efficiency and sustainability
• Regulatory approaches not fully utilized
World Health Organization Regional Office for the Western Pacific
3 qualities of the End TB Strategy
that are of high regional relevance
1. Transcending epidemiological settings with a long-term targets ‘Spectrum’ of TB epidemiologyTB control as a global public good for health
World Health Organization Regional Office for the Western Pacific
Evolution of the TB control components along with an epidemiological spectrum
Pillar 1. Quality TB services
Pillar 2. Bold support systems (vertical/top-down sustainable & integrated)
e.g. Surveillance: Basic system
e.g. Social protection: enablers income compensation comprehensive health-welfare link
Electronic / case-based system
High burden Low incidence Pre-elimination Elimination
e.g. Basic / resource constraint
* Only selected components are shown for the illustrative purpose.
Comprehensive / fully satisfy the standards of care
e.g. Contact investigation: Facility-based home-based active epi. investigation
Link with lab. info system gene/molecular surveillance
e.g. LTBI: PLHIV/Childhood contacts Expansion to other high risk groups
World Health Organization Regional Office for the Western Pacific
TB control asa global public good for health
• TB control in one setting will benefit everybodyNo body is prevented from benefiting (and vice versa)– “A classic example of how a health program might be considered a
global public good”
• “Weak link” characteristics—the maximum attainable level of control in any particular country can be impacted by the level of control achieved in the worst national TB control program.
• This principle is a key for continued advocacy and sustainable public financing
Smith R., Beaglehole R., Woodward D., Drager N. (ed.) Global Public Goods for Health: health economics and public health perspectives.
World Health Organization Regional Office for the Western Pacific
3 qualities of the End TB Strategy
that are of high regional relevance
1. Transcending epidemiological settings with a long-term targets ‘Spectrum’ of TB epidemiologyTB control as a global public good for health
2. Focusing on the vulnerable and unreachedAddressing health inequityRe-tackling TB as a social disease
World Health Organization Regional Office for the Western Pacific
Pillar 1: Reach the Unreached
( Session 3)Situation• Contact investigation
strengthened in many countries
• Childhood TB Taskforce and national policy development
• Steady progress in TB/HIV• Hospital engagement in
relevant countries• TB screening project and
initiatives to address TB among high risk populations
Challenges• Policy implementation• Prioritization• Sound, regular evaluation• PPM: engagement and
regulation
World Health Organization Regional Office for the Western Pacific
Pillar 1: PMDT( Session 2 Lab,
Session 5 MDR-TB)
Situation• Significant PMDT expansion• Rapid adoption of new tools• Gradual capacity
development
Challenges• Treatment gap enlarging• Deterioration in treatment
outcome in some settings• Path towards universal DST
Diagnosed and notified
Enrolled in treatment
Gap
MDR-TB notification and enrollment in 8 countries
LFU
Success
World Health Organization Regional Office for the Western Pacific
3 qualities of the End TB Strategy
that are of high regional relevance
1. Transcending epidemiological settings with a long-term targets ‘Spectrum’ of TB epidemiologyTB control as a global public good for health
2. Focusing on the vulnerable and unreachedAddressing health inequityRe-tackling TB as a social disease
3. Emphasis on bold policies Integration and harmonization with health systems Whole-government and societal approaches
World Health Organization Regional Office for the Western Pacific
Pillar 2: UHC and social protection
( Session 6: 28-29)
Situation• Increasing social disparity
and health inequity• High economic burden on
TB patients • Various experience in
enablers and subsidies• UHC poses a major
opportunity
Challenges• Institutionalizing good
practices • Options to be explored to
mitigate patient economic burden
• Limited schemes available• Monitoring mechanism
World Health Organization Regional Office for the Western Pacific
Financial hardship of TB patients and familiesTB continues pushing people into poverty
• Many patients face catastrophic expense due to TB
• A half of the costs before TB diagnosis
• Patients take coping mechanisms that may be irreversible: – 75% of TB patients must take out a loan; – 50% sell household items
• Addressing catastrophic patient cost is essential
Annual direct medical cost spent by households with TB patients.
Unweighted summary of 9 studies in China (Long et al 2011)
World Health Organization Regional Office for the Western Pacific
Pillar 2: Sustainable financing( Session 6: 26-27)
Situation• Many countries in health
financing reforms• Financial sustainability is
threatened– Shrinking donor investment– Too small domestic fund
• Robust, costed NSPs in most countries
• Success in GF applications
Challenges• Building sustainable TB
financing suitable for each country context
• Protect essential public health functions
• Where applicable, effective integration into general health funding schemes including health insurance
World Health Organization Regional Office for the Western Pacific
Pillar 2: Drug regulations ( Session 6: 30)
Situation• A critical key for
MDR-TB prevention• TB drug regulation
meeting identified priority actions
• New TB drug introduction and PV
Challenges• Continued dialogue
and collaboration with NRAs
(Islam, T. Tisocki, K. et al. Public Health Action 3, 337–341 (2013).)
Drugs by public procurement
Drug sale in the private market
Notified TB cases
World Health Organization Regional Office for the Western Pacific
Pillar 2: Patient and community engagement ( Session 7)
Situation• Various experience in engaging
community based organizations in TB control
Challenges• Empower patient and
community organizations for effective engagement
• Expand the area of collaboration: patient support, advocacy, policy processes, etc
World Health Organization Regional Office for the Western Pacific
Regional document to support implementing the End TB Strategy
World Health Organization Regional Office for the Western Pacific
Regional Framework for Actionto implement the End TB Strategy (proposal)
Purpose• Facilitate the adaptation and implementation
of the End TB Strategy
Methods / scope • Elaborate policy options:
– Considering region-specific context– Spectrum of TB epidemiology (all countries)
• Major sources:– NSPs, Programme Reviews– Recent meeting findings/recommendations
(childhood TB, drug regulations, migration and TB)– Operational research publications/reports
• Regional experience and case studies• No new targets
Regional Framework for Action
to implement the End TB Strategy
World Health Organization Regional Office for the Western Pacific
A proposed process
• Dec 2014: TAG & NTP managers meeting– Agree on the scope and overall framework– Discussions and recommendations for each session will be fully
taken into account
• Dec 2014: Establish a drafting group • Feb 2015: First web-consultation • March 2015: Expert consultation meeting (HBCs +
selected IBCs)• (April 2015: Final web-consultation, as needed)• Aug 2015: UNION APR Conference• Oct 2015: RCM
World Health Organization Regional Office for the Western Pacific
Your comments are welcome!