Tailored Review Proposal for Tuberculosis NTCP

Background for Material Change Bhutan is Gearing Towards Ending TB by 2035 National Guidelines for Management of TB/DR -TB guideline revised Moving towards treating latent TB infection JMM mission recommendations (2016)

Moving towards Active Case finding from Passive case finding Enhancing Infection Control Measures Targeted and focused intervention-More cases are concentrated in 8 districts- including districts bordering neighboring countries

High prevalence of MDR-TB-10% of all new TB cases, and 37% among retreatment cases. Expanded prevention and care to high-risk populations. Expand diagnosis and care for the treatment of RR-/MDR-TB as recommended by the WHO. WHO 2013 recording and reporting tools updated

Epidemiology Update

Estimate of TB Burden, 2015 MDGs achieved in 2015

Estimated Vs Notified

TB Case Notifications (2009-2016)

TB Case notification by Dzongkhags (2016) 993 cases in 8 districts accounting to 87% of the notified cases (Wangdi, S/jong, Sarpang, Chukha, Thimphu, Samtse, Mongar and Paro)

Estimated Vs. Notified

Notification of MDR-TB Cases: 2005-2016

Gearing towards TB Elimination by 2030 National Strategic Plan II (2017-2023) Gearing towards TB Elimination by 2030

Goal To reduce TB and DR-TB burden until it no longer poses a public health problem in Bhutan

Objectives To increase case notification rate of at least 90% among estimated TB and MDR-TB To maintain treatment success rate of at least 90% among Drug susceptible TB and 75% among MDR-TB To Improve TB/HIV co-infection case detection and ensure 100% registration To strengthen programmatic management of TB at all levels.  

Implementing Partners Grant Recipients Principal Recipient Ministry of Health Implementing Partners University of Medical Sciences of Bhutan

Modules and Interventions selected TB care and prevention Case detection and Diagnosis Treatment MDR-TB TB-HIV TB-HIV Collaborative interventions Resilient Sustainable Systems for Health (RSSH) Health Management information system and M& E

Targets The milestones for End TB strategy for 2030, the target year for the SDGs: To reach 90% of people who need treatment and treat them successfully by 2030 To reduce TB deaths by 90% by 2030 To reduce TB incidence by 80% by 2030 (less than 20 cases per 100,000 population)

Total Funding Need and Funding Request Total NSP is USD 9.68 Million (2017-2023) Total NSP Need for Funding cycle is USD 4.26 Million (2018-2021) Anticipated Domestic Resources- 2.54 Million Anticipated other resources-USD 30,000

National Strategic Plan(funding requirement ) Module Y1 Y2 Y3 Key AP 15500 MDR-TB-C&D 390300 124850 218650 MDR-TB-Treat 228050 176550 207710 Others 17500 RSSH 525214 478564 460214 TB care & prevention-C&D 263850 311578 242268 TB care & prevention-Treat 142900 88350 98400 TB-HIV 32600 88860 86800 Total 1615914 1301752 1347042

Anticipated Domestic Resources RGOB support 804,515 848,599 892,019 Module Y1 Y2 Y3 Key AP 8045 8486 8920 MDR-TB-C&D 120677 84860 89202 MDR-TB-Treat 201129 127290 133803 Others 16090 16972 17840 RSSH 254580 267606 TB care & prevention-C&D 241355 TB care & prevention-Treat 64361 67888 71362 TB-HIV 32181 33944 35681 Total

Financial Gap- for the funding cycle

Total Allocation for Tuberculosis 2019-2021 USD 1,074,146.00 (1.074Million)

Module wise budget forecast (%)

Module wise budget forecast

Sustainability Commitment from RGOB First Line TB Drugs procured through RGOB support Infrastructure and HR Bhutan Health Trust Fund mechanism

Proposal Development Process Sl Activity Date Remarks 1 35th CCM endorsed for Tailored Made Proposal 7th June 2017 Completed 2 Retreat to develop Zero drat proposal with TWG members 3rd -9th July 2017 3 Submitted Zero Draft to PDC,WHO and TWG members for comments 10/07/2017 4 Received comments from WHO, SEARO and GF 20/07/2017 and 21/07/17 5 Reviewed and Incorporated the comments from technical Experts 11/08/2017 6 Submitted the first draft to PDC, TWG and WHO 28/07/2017 7 17/08/2017 8 Submitted the 2nd Draft to PDC, TWGs, WHO and GF for further comments and feedbacks 18/08/2017 9 Received Comments and feedbacks from GF and WHO/PDC members 21/08/2017 10 Review of the comments Ongoing 11 Meeting with TWGS members to further review before the submission of proposal 24th August 2017 To be held 12 Online Submission 28th August 2017 Will be done

Thank you