Key issues in DOTS implementation Dr Saidi M. Egwaga

TB in the world 2002 People infected 2 billion New TB cases 8.6million New ss+ TB cases 3.8million Prevalence HIV in new adult cases 12% Prevalence MDR in new cases 3.2% Deaths from TB (inc HIV) 1.8m

Global targets for TB control MILLENNIUM DEVELOPMENT GOALS WHA by 2005: 70% case detection, 85% cure DOTS beyond public health services MDGs by 2015: Halve prevalence and deaths HIV/AIDS, drug resistance, migration

Progress towards Global TB Control targets Case Detection Rate 36% (target 70%) Cure Rate 83% (target 85%)

High treatment success in DOTS areas 100 DOTS smear+ 90 target 85% non DOTS smear+ 80 70 60 Treatment success (%) 50 40 30 20 10 1995 1996 1997 1998 1999 2000 2001

What countries have achieved in 2002 Outstanding progress in some countries: Increase case detection and cure: India, Indonesia, Myanmar, Pakistan, Cambodia, Viet Nam Increase case detection but low cure: South Africa Some progress: Mozambique, Afghanistan, Philippines

Financial resources New sources available GFATM 189 million to TB and TB/HIV control for 2 years FIDELIS (CIDA) WB,TBCTA, etc. Gap to be addressed 200 million per year in countries 20 million per year for technical assistance

Major challenges Health workforce crisis High turn-over Need for updated training and retraining (pre-service and in-service) Retention Brain-drain Deployment HIV epidemic HRD is absent in MoH strategic planning

Major challenges Access to health services Poor health care infrastructure Weak laboratory networks Health systems reform Little involvement of some PHC providers in TB control No link with other public health care providers (e.g. hospitals, prisons, etc) Inadequate involvement of private sector Inadequate cultural sensitivity

Major challenges Insufficient political commitment Shortages of staff at different levels in some NTPs Inadequate funding for training and supervision, monitoring and evaluation No budget line for TB drugs in most countries

Major challenges TB / HIV epidemic in some countries Overloaded health care services Stigma High death rates among TB patients Competition for scarce resources Collaboration between NTPs and NACPs

Country experience in addressing challenges Training needs assessments (Indonesia) Collaboration with training institutions (Tanzania) Community involvement (Uganda) Involvement of private sector (India, Philippines) and NGOs (Bangladesh)

Country experience in addressing challenges Link with hospitals (Indonesia, India, China) National Programme evaluation (China) Rapid DOTS expansion (India) Collaboration between NTPs and NACPs (Kenya, Tanzania, Brazil) COMBI (Kenya, Bangladesh, India)

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

STOP TB Partnership Very good positive spirit of the DEWG Stop TB is working in countries Progress in some countries despite difficulties Countries gaining momentum and some very close to targets

HOWEVER... No time for complacency 2004 is the year of accelerating actions in TB control

Ultimate Goal: a generation of children free from tuberculosis