DOTS Expansion Progress and Next Steps Léopold Blanc Chris Dye Lisa Véron, Malgosia Grzemska DEWG secretariat Stop TB WHO This talk will outline the concept of GDEP endorsed by the 22 high-burden countries and the Stop TB partners during the last few months. It will also present the progress achieved thus far towards DOTS expansion. DEWG symposium Paris, 29 October 2003

What countries have achieved in 2002 Outstanding countries in 22HBC group: increase CD and cure India, Indonesia, Myanmar, Pakistan, Cambodia (Viet-Nam) Progress in non HBC Little or no progress: all other countries

Countries with good CD progress

INDIA: annualized new sm+ case detection rate and success rate, 1st quarter 1999 to 2nd quarter 2003 * Yearly total population projected from 2001 census. * Projected population based on 2001 census.

Total patients placed on treatment and population covered under DOTS each quarter, India (1994-2003) 238,204 Yearly total population projected from 2001 census.

Resource mobilisation Link with GFATM (189 M for 2 years round 1 and 2) - Coordinated support: WHO, IUATLD, KNCV, GLRA, DFB Regional workshops In-country support to prepare proposals (CIDA funds) - Stimulate applications in countries with large funding gap - Support with implementation and monitoring (Norwegian funds) - All HBC but three have received funding from GFATM round 1 or 2 (Brazil and Russia did not apply) MIP should now be convinced that DOTS expansion is a human right and a major public health priority. What can MIP do? MIP needs to support, promote and finance GDEP. MIP partners need to help establish national/regional partnerships. MIP should support integration of action by partners into GDEP. MIP can ensure GDF is part of GDEP. By virtue of our knowledge of plans, partners, and gaps, MIP can promote GDEP as a template for proper investment of funds and a means to strengthen international assistance.

Resource mobilisation Link with bilateral financial partners - Additional funds for countries from CIDA, DFID, Italy, and USAID among others - FIDELIS to support new approaches to increase case detection MIP should now be convinced that DOTS expansion is a human right and a major public health priority. What can MIP do? MIP needs to support, promote and finance GDEP. MIP partners need to help establish national/regional partnerships. MIP should support integration of action by partners into GDEP. MIP can ensure GDF is part of GDEP. By virtue of our knowledge of plans, partners, and gaps, MIP can promote GDEP as a template for proper investment of funds and a means to strengthen international assistance.

Public sector costs and funding gaps for HBCs Total cost US$1.3 billion Total cost US$1.4 billion Updated analysis based on new epidemiological data, review of GFATM proposals, Global Financial Monitoring Project Identified gap is gap as reported by HBCs and technical agencies Possible gap is (Total cost - Total assumed funding - Total identified gap) Total cost allows for public sector costs to increase in line with increased number of patients Main funding uncertainty: how much health service capacity exists to manage increase in cases associated with reaching targets?

Coordination and partnership Regional inter-agency coordination meetings in all regions National interagency coordination committee NICC: central role of the NTP Coordination 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

National Interagency Coordination Committee (ICC): status in 22 HB countries - Government leads N-ICC - ICC coordinates partners - WHO facilitate Gvt and partners efforts Russia*: ICC CDC, DFID, GTZ, KNCV, OSI, PIH, USAID, WB, WHO, Bangladesh*: ICC BRAC, CIDA , DFB, USAID, WB, WHO India*: (ICC) CIDA, DFID, DANIDA, GFATM, GLRA, USAID, WB, WHO Indonesia*: ICC ADB, AUSAID, CIDA, GFATM, KNCV, NL, USAID, WB, WHO Myanmar: (ICC) IUATLD, UNDP, WHO Thailand: no ICC CDC, GFATM, WHO Afghanistan*; ICC GLRA, ICD, MEDAIR, NOR, WHO Pakistan*: ICC DFID, GLRA, ICD, IUATLD, JICA, WB, WHO i Cambodia: ICC CIDA, JATA, JICA, RIT, USAID, WB, WHO China*: ICC CIDA, DFB, DFID, GFATM, Japan, KNCV, WB, WHO Philippines: ICC CDC, CIDA, JICA, KNCV, USAID, WB, WHO Vietnam*: ICC CDC, KNCV, NL, WB, WHO Brazil*: (ICC) CDC, DFB, GLRA, IUATLD, USAID, WHO For all 22 HBC, we have identified the main technical collaborator and the other key partners. Ethiopia*: ICC GFATM, GLRA, KNCV, NL, WB, WHO DR Congo*: ICC DFB, IUATLD, TLMI, USAID, WHO Kenya: CCM CDC, FHI, KNCV, NLR, WB, WHO Mozambique: no ICC GLRA , WHO Nigeria*: ICC DFB, GLRA, KNCV, NLR, IUATLD, WB, WHO S. Africa: no ICC CDC, DFID, IUATLD, KNCV, USAID, WHO Tanzania: ICC GLRA, KNCV, SWISS, WB, WHO Uganda*: ICC DFID, GLRA, ICD, IUATLD, TLMI, WHO Zimbabwe*: (ICC) IUATLD, WHO WHO office in all countries * : WHO TB staff

Human resources/ Task Force for Training - At country level survey in all HBC consultation on HR (RF and WHO): 27-28 August - At international level: workshops for consultants modules for health centres workshops for country HR focal person (8 Africa, 7 Asia)

TB and HIV Collaboration and coordination of TB and HIV/AIDS programmes where relevant - Publication of the framework for TB/HIV activities - Guidelines for TB/HIV collaborative activities - Interim policy - Challenge of the 3x5, contribution by StopTB

MDR-TB Addressing MDR-TB: links with DOTS + working group and GLC where relevant GLC and GDF convergence to increase efficiency, finance pooling technical expertise DOTS plus as part of programme in Peru and Russia

Case detection Increase case detection Study different approaches to increase case detection - PPM sub-group: to engage private sector in TB control to link public systems/services to address urban TB - Laboratory sub-group: to strengthen network - Community participation in TB control - Linking actors operating at primary health care level

PPM for DOTS subgroup of DEWG Chair: Phil Hopewell Secretariat: Mukund Uplekar First meeting: Nov 2002 Development of practical tools for PPM Analysis of projects Large scale implementation in the Philippines Projects in India, Indonesia, Kenya, and Viet Nam Workshop for 8 countries in Africa Second meeting in early 2004

Laboratory Subgroup of DEWG Chair: Fadila Boulahbal Secretary: Sang Jae Kim provide support to strengthening TB Laboratory services. Subgroup 20 SRLN and some partners organisation such as IUATLD, KNCV, RIT and CDC. Development of laboratory assessment tool Assessment of TB laboratory services in 4 countries: Bangladesh, Kenya, Pakistan, and Uganda Participation in the National TB Programme Review: Indonesia, Vietnam

Beyond DOTS 2d ad hoc committee Review TB control - constraints - 1st ad hoc committee Major recommendations will serve as guidance for work during the next 3-5 years Need to work beyond DOTS, looking at political and health system issues

Conclusion Year 2004 : accelerating actions Financial gaps are progressively decreasing Need to address limited capacity by all health care providers, look at the health system issues Year 2001 : preparation Year 2002 : implementation Year 2003 : scaling up Year 2004 : accelerating actions MIP should now be convinced that DOTS expansion is a human right and a major public health priority. What can MIP do? MIP needs to support, promote and finance GDEP. MIP partners need to help establish national/regional partnerships. MIP should support integration of action by partners into GDEP. MIP can ensure GDF is part of GDEP. By virtue of our knowledge of plans, partners, and gaps, MIP can promote GDEP as a template for proper investment of funds and a means to strengthen international assistance.

WE’RE HALF WAY THERE Case detection 36/70 Treatment success 83/85

Life of the DEWG DEWG: Chair: Karam Shah Secretariat: WHO Cairo: 2000 Paris: 2001 Montreal: 2002 The Hague/Paris: 2003 DEWG core team (March 2002) 3 permanent members: IUATLD, KNCV and WHO 5 HBC: Indonesia, Kenya, Pakistan, Philippines, Uganda Other technical agency: RIT Financial partner: USAID, CIDA (co-opted for 2002-03)

New Documents - Community contribution to TB care Guidelines based on community TB care projects experiences - Guidelines on “Expanding DOTS in the context of changing health system” - “The contribution of workplace TB control activities to TB control in the community”