1. 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

8. 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

9. Countries with good CD progress

10. 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.

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

12. 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.

13. 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.

14. 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?

15. 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

16. 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

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

18. 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

19. 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

20. 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

23. 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

24. 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

25. 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

26. 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.

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

28. Life of the DEWG DEWG: Chair: Karam Shah Secretariat: WHO
Cairo: Paris: 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 )

29. 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”