1. Challenges/barriers for moving forward Ernesto Jaramillo WHO/Stop TB Department Palliative Care and M/XDR-TB 18-19 November, 2010 Geneve, Switzerland

2. Non-exhaustive list of challenges Awareness Advocacy Assessment of need Policy-guidelines Financing Human resources Models for palliative care in M/XDR-TB Needs for technical assistance Monitoring and evaluation (indicators, targets, goals) Drug management in palliative care for TB

3. AWARENESS What else apart from anti-TB drugs are patients in need of?

4. ADVOCACY Health care workers and health care systems not only have the ethical duty but CAN deliver effective palliative care

5. Universal access to palliative care must match universal access to diagnosis and treatment of M/XDR-TB

6. Policy-guidelines …in need of updating

7. Financing What and hw to budget and fund palliative care in M/XDR-TB?

8. Models for palliative care in M/XDR-TB

9. Human resources

10. Needs of technical assistance

11. Monitoring and evaluation (indicators, targets, goals) How to measure coverage, quality, and impact of palliative care in the response to M/XDR-TB?

12. Drug management in palliative care for TB

13. Which are the challenges in the health systems for scaling up palliative care? Health System Building Blocks Bottlenecks Service delivery Health workforceInformation Medical products and technologies Health financing Leadership and governance Still major gaps in TB control Extremely weak M/XDR- TB management and care Health workforce crisis Inadequate laboratories Quality of anti-TB drugs not assured Limited access to drugs for pain relief Absent infection control Insufficient body of evidence on PC in TB Major financial gaps

14. What means a patient-centred approach in TB care and control without palliative care?