Report of the 2nd ad hoc Committee on the TB epidemic Jaap F. Broekmans STOP TB Partner’s Forum NEW DELHI June 2004

2nd ad hoc Committee on the TB epidemic 2nd ad hoc Committee on the TB epidemic 19981st ad hoc Committee, London 2000Ministerial Conference for 20 HBCs, Amsterdam 2001Global Plan to Stop TB 20032nd ad hoc Committee, Montreux 2005WHA targets 2010G8 Okinawa targets 2015Millennium Development Goals

Objectives of 2nd ad hoc Committee (1) review status of TB epidemic and of TB control efforts (2) review progress in implementing the 1st ad hoc Committee recommendations (London, 1998) (3) analyse constraints in HBCs (DEWG) (4) make recommendations in defining a mid-term strategic direction for the DOTS expansion movement

Time perspective of 2nd ad hoc Committee recommendations WHA targets Millennium Development Goals Mid-term strategic direction (about 5 years) 2010 Okinawa G8 targets

Process of developing and endorsing 2nd ad hoc Committee report 2nd ad hoc Committee secretariat Consultations 1st draft (constraints identified by DEWG) challenges identified report finalised recommendations DEWG STB Cd Bd Sept 03Mar 03June 03 June – Aug 03 Dec 03 Partners’ forum (New Delhi) report endorsed Apr 03 STAG STB Cd Bd MDGs Oct 03 2nd ad hoc committee

Main recommendations (1) Consolidate, sustain and advance achievements (2) Enhance political commitment (3) Address the health workforce crisis (4) Strengthen health systems, particularly primary care delivery (5) Accelerate response to the HIV/AIDS emergency (6) Mobilise communities and the private sector (7) Invest in research and development to shape the future

(1) Consolidate, sustain and advance achievements The Stop TB Partnership should (1) demonstrate the effectiveness and added value of the Partnership, GDF, GLC and its collaboration with the GFATM; (2) involve a wider range of stakeholders at all levels; (3) use existing mechanisms at national level, e.g. NICCs, Sector-Wide committees, CCMs; (4) strengthen its relationship with the GFATM; (5) seek enhanced and sustained donor support for GDF; (6) advocate for support for TB activities based on success stories of TB as pathfinder for health system reform.

(2) Enhance political commitment The Stop TB Partnership should (1) explore complementary “top-down” (e.g. lobbying by high- level missions, political mapping and analysis) and “bottom-up” approaches (social mobilisation and communications); (2) seek financial support from a broader donor base; (3) argue the case for increased donor budget commensurate with global TB burden, e.g. GFATM; (4) adopt the 2015 MDGs relevant to TB as impact targets while retaining WHA 2005 targets as process targets.

(3) Address the health workforce crisis The Stop TB Partnership should collaborate with governments and international bodies to: (1) develop policies to remove administrative barriers to creating and filling posts; (2) develop policies to promote terms and conditions of service attractive to employees; (3) promote assessment of human resource needs; (4) support human resource planning and training; (5) explore strategies for mobilising human resources from the full range of primary care providers, especially community groups.

(4) Strengthen health systems, particularly primary care delivery The Stop TB Partnership should (1) promote reflection of TB control needs in design and implementation of health reform strategies; (2) ensure that TB programmes contribute to broader health system strengthening; (3) foster NTP stewardship capacity; (4) explore strategies for harnessing the contribution of the full range of health care providers; (5) encourage partners in Global TB Monitoring and Surveillance Project to intensify collaboration with other programmes and improvements in accuracy of estimates of progress towards targets. (6)

(5) Accelerate response to the HIV/AIDS emergency The Stop TB Partnership should (1) urgently step up collaboration with HIV/AIDS partnerships to implement strategy of expanded scope to control HIV-related TB; (2) support countries in delivering TB care as part of the HIV/AIDS care package; (3) support countries in making progress towards the “3 by 5” goal, by promoting HIV testing among TB patients and referral for ART; (4) support ART programmes in making use of lessons learned from TB programmes in applying public health principles to large scale diagnosis and treatment of a chronic communicable disease.

(7) Invest in research and development to shape the future The Stop TB Partnership should (1) ensure a framework to support interaction between the WGs on new tools and the WGs on implementation; (2) work with the research community on advocacy for new tools, funding and preparation of trial sites; (3) promote operational research; (4) develop and articulate arguments in favour of increased research capacity building to encourage OECD countries to increase funding for this.

Main implications for Stop TB Partnership (1) Speed of progress in reaching WHA 2005 targets now depends on collaboration with other programmes and other constituencies. (2) Need to reach out to other programmes within the health sector, in addressing the key health system issues, e.g. human resources, general health infrastructure, primary care providers, health system reform. (3) Need to reach out to other sectors beyond health, in enhancing political commitment, expanding the resource base, and mobilising communities.