Convegno, Stop TB Italia – Milano, 23-3-2017 Multi-sectoral accountability Mario C. Raviglione Global Health Centre - University of Milan Mario C. Raviglione Global Health Convegno, Stop TB Italia – Milano, 23-3-2017
Who carries the burden of tuberculosis? …mostly, the most vulnerable TB linked to HIV infection, malnutrition, alcohol, drug and tobacco use, diabetes Migrants, refugees, prisoners, ethnic minorities face risks, discrimination & barriers to care Half a million women and 250,000 children died of TB in 2016 TB spreads in poor, crowded & poorly ventilated settings Mario C. Raviglione Global Health
Why a multisectoral approach to end TB? GOAL 1: SOCIAL PROTECTION WHEN ILL Environment CROWDING, POOR VENTILATION SILICA, INDOOR AIR POLLUTION POOR LIVING AND WORKING CONDITIONS CONDUCIVE ENVIRONMENT FOR TRANSMISSION VULNERABLE GROUPS incl. children, women, migrants, prisoners, etc. MAL-NUTRITION FOOD INSECURITY STIGMA/DISCRIMINATION, MARGINALIZATION IMPAIRED HOST DEFENCE/SUSCEPTIBILITY AT-RISK BEHAVIOUR GOAL 3: HIV, NCD, RISK FACTORS HIV/ AIDS NCDs: diabetes, smoking, alcohol… EXPOSURE LATENT INFECTION ACTIVE DISEASE SUFFERING AND DEATHS GOAL 3: UHC TB SERVICES TB CARE
Formidable challenges remain… and they cannot be solved solely within the health sector WITHIN NTPs and HEALTH Addressing the “missed” cases, MDR-TB as a crisis, joint TB/HIV response Increasing financing to close gaps Intensifying research HIV, tobacco, alcohol, diabetes Universal health coverage WHAT ABOUT BEYOND NTP & HEALTH ? Poverty and lack of social protection Malnutrition Poor living or working conditions: slums, air pollution, mining, prisons Discrimination, stigma, war, migration Inequities and inequalities Mario C. Raviglione Global Health
ENDING TB IN THE SUSTAINABLE DEVELOPMENT ERA: A MULTISECTORAL RESPONSE FIRST WHO GLOBAL MINISTERIAL CONFERENCE ENDING TB IN THE SUSTAINABLE DEVELOPMENT ERA: A MULTISECTORAL RESPONSE Conference Vision Aim: to accelerate implementation of the WHO End TB Strategy and address gaps in access to care and the MDR-TB crisis Goal: to reach the End TB targets set by World Health Assembly and UN Sustainable Development Goals (SDGs) Through: national and global commitments towards clear deliverables and accountability, eventually endorsed at the UN General Assembly High-Level Meeting on TB in 2018 Mario C. Raviglione Global Health
Finally, some visibility and sense of urgency High-level commitment to End TB: 2017-18 High Level Meeting on TB Mario C. Raviglione Global Health
ENDING TB IN THE SUSTAINABLE DEVELOPMENT ERA: A MULTISECTORAL RESPONSE What is the key political recommendation today? FIRST WHO GLOBAL MINISTERIAL CONFERENCE - Moscow 2017 ENDING TB IN THE SUSTAINABLE DEVELOPMENT ERA: A MULTISECTORAL RESPONSE Mario C. Raviglione Global Health
Accountability framework Who is accountable? What commitment/actions are accountable? To whom is one accountable? How is one held into account? Not above WHA No $$ backing No high political level No independent No review in other sectors No civil society review Not at high level No shadow report Mario C. Raviglione Global Health Source: GTB/WHO, 3-2018
Accountability Being responsible for commitments made and actions taken Commitment is plenty, although at low level! Accountability is empty! All are accountable in all sectors: governments, UN family, donors, philanthropy, partnerships, NGOs, academia, research institutions… even civil society Accountability clear for governmental entities and UN agencies, much less so for the others What is necessary? A UNGA agreed-upon framework with regular M&E and reviews at the highest levels nationally and internationally (WHA and UNGA) Role of civil society and people is crucial, as well exemplified by the response to HIV/AIDS and other major health threats Mario C. Raviglione Global Health
Grazie a tutti Mario C. Raviglione Global Health