1. U pdates on the development of the NTP National Strategic Plan 2015-2020 GC National TB Conference Pokhara, July 14-15, 2014 Giampaolo Mezzabotta Medical Officer/Tuberculosis World Health Organization Country Office for Nepal

2. Why do we need a NSP? The current NSP (2010-2015) is going to expire in July next year; A new, very ambitious strategy to eliminate TB has been recently designed and approved for implementation by WHO member states; Most donors, and particularly the Global Fund, require detailed and costed planning to access funding opportunities.

3. What is a NSP? Regarding TB control, NSP is a key instrument to appropriately manage TB control programmes. It highlights the overall aim of the national policy to control TB and clearly defines the goal(s) that need(s) to be reached as well as the operational objectives that should be achieved through TB control efforts. To this end, a sound NSP defines a clear process, specifying the appropriate strategic interventions to reach these objectives and goal(s). Interventions and objectives need to be logically linked. Moreover, activities and sub-activities inherent to each intervention need to be clearly specified. A comprehensive NSP should highlight a clear target for each intervention and identify where, when and how each activity or sub- activity will be implemented and who will implement it.

4. Components of a NSP A comprehensive NSP should include five components: 1. core plan which should include: a. The analysis of TB and TB control situation, including a clear description of the gaps; b. Definitions of the goals and operational objectives; c. Identification of strategic interventions and their related activities and sub-activities; 2. detailed budget plan which includes the costs for each intervention, activity and sub- activity with reference to the relevant operational objective; 3. monitoring and evaluation plan with the indicators that need to be assessed for the goal(s), the operational objectives, the strategic interventions and some activities; 4. operational plan that provides, for each activity and sub-activity, relevant and detailed information on the process of their implementation; 5. technical assistance plan identifying interventions and activities that need technical assistance. It also provides detailed information on how the technical assistance should be carried out.

5. Core plan for Nepal NSP VisionReduce the Tuberculosis morbidity and mortality to such a level so that Tuberculosis is no longer a Public Health problem by 2050. Goal By the year 2020 the TB Prevalence shall be reduced by 40%. Operational Objectives: Objective 1: By the year 2020 case detection shall reach 82% or 45,000 TB cases will be notified annually. Objective 2: Treatment success rate shall be maintained at 90% up to year 2020. Objective 3: By 2020 75% of estimated MDR-TB annual cases will be detected and enrolled for treatment. Objective 4:By 2020 the treatment success rate of MDR-TB shall be increased from the current 70% to 75%. Objective 5:By 2020 the Childhood TB burden will be reduced from the current 5% (among all TB cases) to 3%. Objective 6: In the next 5 years strengthen capacity and development of human resources at Central level and all Districts.

6. The Core Plan in details Vision: Reduce the Tuberculosis morbidity and mortality to such a level so that Tuberculosis is no longer a Public Health problem by 2050. Goal: By the year 2020 the TB Prevalence shall be reduced by 40%. Objective 1: By the year 2020 case detection shall reach 85% or 45,000 TB cases will be notified annually. 1.1 Strategic Intervention Continued and sustained facility based case finding 1.1.1 ActivityReplacement of 10% of microscopes annually with LED microscopes 1.1.2.1 Sub activityProcurement of 60 LED Microscopes annually 1.2.1 ActivityStrengthen and Expand of PAL and Capacity Building in all Districts 1.2.1.1 Sub activityExpand PAL in 28 Districts each year in the first 2 years 1.2.2.1 Sub activityProvide PAL Training 1.2.3.1 Sub activityProcure commodities for PAL

8. The NSP development process in Nepal (to date) June 2013: a team of 12 international, independent, consultants conducted an in-depth review of NTP; Feb. 2014: NTP members and international consultant trained in France by WHO and Global Fund on the new standard approach to NSP development; April-May 2014: Gap analysis performed in each region with NTC facilitation; May-June 2014: the WHO consultant supported NTC and partners to complete the first draft of the NSP 2015-2020; July-August 2014: NTP and partners to complete the NSP.

9. The NSP development process in Nepal (next steps) Before finalization, the NSP should be fully aligned with the Five Years National Health Strategic Plan III currently being produced by MoHP and with the post-2015 Global TB Strategy; An international consultant will carry out an epidemiological appraisal of NTP data and M&E system (Oct. 2014) The most immediate use of the NTP NSP will be by the CCM for the development of the Concept Note to apply to the New Funding Mechanism of the Global Fund in January 2015.

10. Fund & awareness raising Beside being a strong management tool, NSP is also an essential instrument for negotiating donor and government support in that it provides a clear plan, based on sound objectives, concrete strategic interventions and a justified budget to achieve national and global goals, eventually leading to the elimination of tuberculosis from Nepal in 2050.