1. World Bank Project China Fidelis Demonstration projects Mobilising funding for TB & Poverty Are there effective, implementable strategies?

2. TB SA

3. WB programme since 1992 WB programme since 2002

4. The total amount of exempted expenses is only about 250 Yuan. (~ 14% of actual cost) Repeated hospital visits and unnecessary tests Liver protection drugs, liver monitoring and prolonged treatment

5. Conclusion The reimbursement of diagnostic tests and free TB therapy supported by World Bank and DFID, can help to some extent reduce the financial burden for the patients and their family. Current health financing policy is one of the main influencing factors of high TB related cost.

6. Principles Small projects of one-year duration (USD 150K-250K) Local solutions to local problems Encourage innovative ideas within existing programs Focus on populations with limited access Systematic monitoring and evaluation http://www.fidelistb.org/

7. Project implementation update 32 contracts approved 13 countries with at least one FIDELIS project  15 of 32 projects in China or Pakistan  24 of 32 in World’s six highest burden countries 7 of 15 projects approved for an additional year

8. FIDELIS results Main outcome measure Cost per additional weighted treatment success (AWTS) – target less than $80 USD Difference between the number of treatment successes during the project and the previous year Weighting based on proportion of new cases registered that have ‘limited access’ to care

9. Classification of access If the total treatment delay (from symptoms to initiation of treatment) is 12 weeks or greater the person is classified as having limited access to health services.

10. Example: For a US $200,000 projects that successfully treats 6,000 patients during the project with 80% designated as limited access and also successfully treats 3000 patients in the previous year with no reliable data on limited access proportions prior to the projects, cost per AWTS calculation would be as follows: Previous year weighted treatment successes (WTS) = 3000 x 50% (assumption) x 1 + 3000 x 50% x 0.5 = 2250 WTS Project year WTS = 6000 x 80% x 1 + 6000 x 20% x 0.5 = 5400 AWTS for project = 5400 - 2250 = 3150 Cost per AWTS = 200,000/3150 = US $63.49

11. FIDELIS results (to end 4 th quarter, 2004) Cost projections available for 21 of 32 projects 8 of 21 projects have a projected cost lower $80 5 projects have projected costs between $80 and $150 Few projects with high cost projections (e.g. $2 318)

12. FIDELIS (project-specific results) Enhancing diagnostic services in urban slums in Africa

14. FIDELIS (project-specific results) Enhancing diagnostic services in urban slums in Africa Mobilizing junior high school students in Anhui, China to screen family members for tuberculosis

16. Attribution of Results Trend in non-project and project areas SiteInterventionNon-projectProject HubeiHospital diagnosis158%147% HunanHospital referral119%214% GansuSputum collection198%191%

17. FIDELIS (future directions) Additional CAD 8 million from CIDA (initial $19 million)  ensure further funds for successful projects  allow further projects Independent review to assess all projects Documentation and publication of both successful and ‘unsuccessful’ approaches (sustainability?)

18. Demonstration projects Engaging informal sector (LHL funded) – see REACH Presentation.

19. Ideas for mobilising funding for TB & Poverty ?EU - EuropAid ?Multi – country (regional) bid for Health Systems strengthening to GFATM ?WB-Gates Global Health Equity Project ?Japan’s Health & Development Initiative (USD 5 billion)