Vietnam Investment and Finance for TB A presentation by Mr. Ho Minh Chien Director, Department of Labour and Socio-Cultural Affairs Ministry of Planning and Investment - Vietnam

Achievements 1997-2002 1995 TB a national priority 1996 National TB Development Plan 1999 100% DOTS coverage achieved 1997-2002 532,703 TB cases detected Target 70%: Achieved 82% 1997-2001 260,698 positive cases treated Target 85%: Achieved 92% On behalf of the Minister of Planning and Investment I would like to thank the Stop TB partnership for the award given to the National TB program of Vietnam last Wednesday on World TB day. Indeed the achievements of the NTP are impressive. Only a few years after the Government declared TB a national priority the DOTS strategy was implemented in all 628 districts of the country. The expansion was carefully planned in the National TB development plan, which was a very important instrument for resource mobilisation as well. During the period 1997-2002 the NTP detected more than half a million TB cases and surpassed the WHO target of case-finding by 12%. During 5 year the TB program treated more than 260,000 infectious cases and cured 9 out of 10 cases.

Reasons for Success High political commitment Extensive basic health care network Effective resource mobilisation Strong partnership with: Medical Committee Netherlands Vietnam KNCV TB foundation, Government of The Netherlands, WB, WHO, CDC and GFATM The main reasons for success, as identified during a review of the NTP in August 2003, are the high political commitment at all levels including the support of the mass organisations as the women and youth unions at the grass root levels and the well developed health care network. The high level of commitment and the technically sound development plan designed in accordance with the WHO recommended DOTS strategy greatly facilitated resource mobilisation with the development partners. A further reason of success is the strong partnership supporting the implementation of the DOTS strategy in Vietnam. This partnership was developed since 1985, initially with two Non Governmental Organisations from the Netherlands, the Medical Committee Netherlands Vietnam and the KNCV tuberculosis foundation. Later on since 1995 joined by the Government of the Netherlands, the World bank, the WHO and Centres of Disease Control and Prevention from USA. More recently in 2003 the Government signed an agreement with the Global Fund for AIDS, TB and malaria to reach tuberculosis patients among high risk groups, remote populations and people living with HIV and AIDS

Continuity of financing and drug supply Spend US$ 15 million Cost per case diagnosed: 28 US$ Cost per case cured: 30 US$ WB 51%: Mainly drugs Netherlands and NGO’s: 26%: Program coordination and TA Government: 23%: Staff and facilities Continuity of financing and drug supply was secured by the multi-donor supported budget of the NTP development plan. During the period 1997-2002 the National Program spend 15 million US$ to implement the DOTS strategy. 50% of the funds were available from a World Bank loan and most of these funds were used to procure TB drugs through International Competitive Bidding. Dutch support was used for capacity building, program coordination and supervision and technical assistance. The Government of Vietnam provided staff salaries and allowances and funds to manage facilities like laboratories and TB clinics. The program review in August 2003 established that the costs for the NTP per case diagnosed in Vietnam is US$ 28 and per case cured US$ 30.

Challenges Urgent need to mobilize resources for 2006 -2010 plan period, as  WB support ends March 2005  Dutch support ends December 2005, while HIV epidemic halts decline of TB and Health sector development policies may change focus This year the Government of Vietnam will need to develop the master plan for TB control for the period 2060 to 2010. Early resource mobilisation is needed as next year the agreements with the World Bank and the Government of the Netherlands will expire, while the agreement with the GFATM of 10 million US$ for 5 year will only cover part of the costs. A major challenge is posed by the HIV epidemic, which threatens to halt de decline of TB expected as a result of the successful DOTS program. One other challenge is to sustain TB control in a changing environment of health sector restructuring. A continued focus on public health problems as TB need to be assured.

Sustainable financing Needed 2006 -2010: US$ 30 million 6% average annual growth GDP last decade Current per capita spending for TB 0.3 US$ or 0.85% of overall government per capita expenditure on health Consider increase of government investment in TB control and coverage by health insurance The NTP estimates that 30 million US$ is needed to finance TB control at all levels during the period 2060-2010. As Vietnam has experienced an average annual growth rate of the GDP of 6% in the last decade, a trend which is likely to continue, the capacity of financing the program with government funds has increased as compared to the past. During the past plan period the government spend 30 dollar cents per capita on TB. An amount which represents only 0.85% of overall per capita government spending on health. Besides increasing direct government spending for TB control, it is as well considered to include TB diagnosis and treatment in the health insurance package, currently covering some 14% of the population. However, since TB predominantly affects the poor as a rule the DOTS package will continue to be provided free of charge.

Considerations Continuation of support needed in view of: Increasing number of cases (HIV) Implementation of DOTS plus Further development of diagnostic facilities Consolidation of the DOTS program Maintenance of reserves stocks of drugs While the Government aims at increasing direct funding of the NTP it is clear that continuation of support of the partnership remains critical during the next plan period. This is in particular important in view of the spread of HIV in Vietnam in recent years. Currently 3% of TB cases are HIV positive and as many of 10% of TB cases detected in Ho Chi Minh city. Further investments are needed to implement the WHO recommended DOTS plus strategy for the treatment of resistant TB cases, as untreated chronic cases spread multi-drug resistant TB in the community. Securing finances for the period 2060-2010 with support of partners will be essential to consolidate the TB program and maintain a sufficient reserve stock of anti-TB drugs. The government also plans to upgrade diagnostic facilities for TB and other respiratory diseases at the provincial level. TB control remains a high priority and a well defined component of the Poverty Reduction and Growth Strategy and Millennium Development Goals of the Government. The Government of Vietnam welcomes continued collaboration with it partners to fight TB and reduce poverty.