dr. k. samson world health organization ist/esa, harare · dr. k. samson world health organization...

Dr. K. Samson World Health Organization

IST/ESA, Harare

Division of Health Systems and Services Development

Outline

• Background

• Underlying orientations

• Strategic priorities

• operationalization

• Funding

• Monitoring and Evaluation


BACKGROUND


Context analysis

• region still bears a disproportionately high burden of tuberculosis;

• high levels of HIV co-infection rates, constitutes a challenge to effective TB control;

• The emergence of multi and extensively drug resistant strains;

• Gap in access to high quality TB diagnosis and treatment still limited especially in vulnerable populations (Children, the poor, prisons, difficult to reach areas etc.);

• Inadequate scale up of TB/HIV interventions, and programmatic management of drug resistant tuberculosis;

• Health systems challenges posing significant constraints to effective TB control especially in the Africa High-HIV countries;

• Inadequate engagement of all care providers and community support;

• Weak coordination of technical assistance delivery mechanisms in the African region;

• Inadequate financial resources for TB Control in the African Region.


Purpose of the Plan

• Determine strategic directions for WHO support to

member states response to the TB/HIV co-epidemic

in line with the regional orientation;

• Serve to allocate resources to enable WHO/AFRO

provide technical support in an efficient manner.

• Serve as a resource mobilization tool for TB control

in the region.


Conceptual framework

Draft strategy

Consultations including partners

Peer review

Final draft

The process


STRATEGIC PRIORITIES


Strategic priorities -1

• improved quality and access with focus to vulnerable population.

• laboratory strengthening including introduction of new diagnostic tools (LED microscopy, GX, LPA, MGIT etc)

• Rapid scale of mycobacterial culture and DST in the region;

• Advocacy for higher and sustained political commitment among member-states; and international level;

• Scale up of collaborative TB/HIV activities;

• Expand community-based TB Care to improve access to quality TB care,

• Expand and strengthen public-private mix DOTS (PPM DOTS) approaches;


Strategic priorities -2

• Develop/strengthen strategic linkages with maternal child health (MCH); and non-communicable diseases (NCDs);

• Better coordination between TB programmes, anti-poverty initiatives and health system strengthening;

• improve access to second line TB treatment by member states;

• Promote National Stop TB Partnerships to forge multi-sectoral involvement and coordination.

• Advocate for measures to address social determinants of health;

• support research activities to inform scale up of best practices;


GOALS AND STRATEGIC

OBJECTIVES


Vision and Goal

• Vision:

• A TB-free African region

• Goal

• the achievement by all member states of the TB-related Millennium Development Goal targets by 2015.


Strategic objectives

1. Strengthen Regional and member-states national capacities and response mechanisms to fight TB; and attain MDGs by 2015;

2. Strengthen the quality of DOTS, TB/HIV, MDR-TB prevention and management in the African Region;

3. Strengthen health systems for effective TB control interventions in the African.

4. Increase responsiveness and quality of WHO TB technical assistance delivery to member states;

5. Mobilize additional resources for TB control in the African Region


Underlying orientations

• Global orientations

• Millennium Development Goals (MDGs)

• World Health Assembly (WHA 1991) TB Control Targets

• Stop TB Partnership targets for TB control

• Beijing call for action on M/XDR-TB – May 2009

• Regional orientations

• African Government’s Commitments

• Abuja Heads of State Summit on AIDS, Malaria, Tuberculosis and other diseases (April 2001)

• The WHO Regional Committee for Africa Declaration of TB as an Emergency

• African Union Gaborone Declaration

• Abuja Summit (2006) on Universal coverage

• The call for intensified action for HIV prevention and TB, HIV and AIDS co-infection control in Rwanda (2009)

• The Regional Director’s Orientations 2010-2016


OPERATIONALIZATION


Strengthen member states capacity

• Expected outcomes: • All Member States make significant progress towards reducing the burden

of tuberculosis in line with the MDGs.

• Strategies: • Support advocacy for implementation of universal access;

• Support strengthening of response mechanisms through development/updating of country policies and strategy documents;

• Interventions: • Organize Consultative meeting of TB Control stakeholders in the African

Region.

• Support National Partnering initiatives

• Support Development/Revision of national policies, strategies and guidelines;

• Provide technical support in implementation, monitoring and evaluation of country strategies;

• Strengthen TB Surveillance systems including prevalence and drug resistance surveys;


DOTS, TB/HIV, MDR-TB

• Expected outcomes

• Tuberculosis control outcomes in the African Region (TB case detection from 66% to at least 70% and treatment success rate from 80% to at least 85% ),by 2015;

• Strategies: • Promote implementation of quality DOTS including innovative

approaches targeting high risk groups, poor and vulnerable population to increase case finding and treatment delivery including patient support;

• support full implementation of TB/HIV framework for collaborative activities with particular emphasis on the three I’s;

• Promote implementation of programmatic management of DR-TB

• Addressing the bottlenecks in the health care systems, as outlined in the Beijing Call for Action and in the 62nd WHA resolution, that are preventing to accelerate increased diagnostic and treatment coverage in the region.


DOTS, TB/HIV, MDR-TB -2

• Interventions:

• Coordination and capacity building workshops for national TB programmes and WCO staff.

• NTP capacity building Paediatric TB. management

• Support countries in the adaptation of new TB diagnostics and assess their effectiveness to improving the overall TB programs performance

• Conduct situational analysis of TB in high risk groups

• Train NTP Staff on Programmatic Management of Drug Resistant TB.

• Support develop of DRS protocols

• Support GLC processes

• Support National Reference laboratories functions including EQA

• Support and link countries to SNLs

• Collaboration with NCDs

• Partnerships strengthening

• Strengthen procurement supply management systems in countries


Strengthening health systems for

effective TB control interventions

• Expected outcomes

• Strengthened programme management capacities to effectively respond to the TB/HIV, MDR-TB epidemic in the African Region;

• Strategies:

• Technical assistance to strengthen technical and managerial capacity;

• Support health system strengthening initiatives in member states.

• Promote programme-based operational research;

• Technical assistance to link TB programmes with MCH and NCD especially diabetic clinics


Strengthening health systems for

effective TB control interventions

• Expected outcomes • TA to strengthen technical and managerial capacities in

national TB programmes; • Support National TB Programme reviews • Support countries in the adaptation and roll-out of new TB

diagnostic tools. • Support assessment of radiological services in countries. • Promote integration of DOTS, TB/HIV, MDR-TB

management in pre-service curricular of health institutions and medical schools.

• Support to WHO research collaboration institutions • Training of National TB Programme staff on Research

methods. • Provide regular supportive monitoring visits to country

programmes to facilitate implementation; • Conduct cost and cost effectiveness of selected

interventions


Strengthen the TB TA mechanism:

• Expected outputs: • Strengthened partnership for TB technical

assistance in the region. • Technical and managerial capacity in TUB

strengthened;

• Strategies: • Maintain adequate technical and

administrative HR in AFRO/TUB; • Strengthen M&E capacity • Support TBTEAM functions in AFRO, ISTs

and Country levels • Support short-term and long-term courses

for NTP, AIDS Programme staff


Strengthen the TB TA mechanism:

• Interventions:

• Support TBTEAM functions in AFRO, ISTs and Country levels

• Maintain position of current TUB technical staff at regional, IST and country levels;

• Recruit and maintain additional relevant TUB staff

• Support short-term and long-term courses for NTP, AIDS Programme staff


Mobilize additional resources for TB

control

• Expected outcomes:

• Increased financial resources mobilized for TB Control in all members states of the African Region.

• Strategies:

• Technical assistance provision in the global fund and other partnership processes;

• Strengthen capacity of member states to access and effectively utilize global fund and other resources;

• Interventions: • Organize briefing meetings for Global Fund applicant countries.

• Provide technical assistance in proposal development.

• Organize mock (peer) technical review of country proposals.

• Consultants training on the Global Fund process

• Support countries in grant negotiations

• Support other country initiatives such as TB CARE I and II, TB Reach, and Expand TB,


FUNDING


Financial implications

S/No. Objective

2013

(USD)

x 1000

2014

(USD)

x 1000

2015

(USD)

x 1000

2016

(USD)

x 1000

2017

(USD)

x 1000

Total

(USD)

x 1000

1 Member-states

national capacities

843 622 929 686 1,024 4,103

2 Strengthen the

quality of DOTS,

TB/HIV, MDR-TB

2,760 2,804 3,043 3,195 3,355 15,156

3 Strengthen health

systems

1,750 1,838 1,929 2,026 2,127 9,670

4 Strengthen the TB

TA delivery

mechanism;

6,077 6,381 6,700 7,035 7,387 33,579

5 Mobilize additional

resources for TB

1,155 1,213 1,273 1,337 1,404 6,382

GRAND TOTAL 12,585 12,857 13,874 14,279 15,297 68,891


MONITORING AND

EVALUATION


Thank you

dr. k. samson world health organization ist/esa, harare · dr. k. samson world health organization...

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