1. Facilities for TB Control in SAARC The National TB Control programmes of all SAARC Member Countries use the DOTS Strategy

2. DOT prolongs survival of HIV-infected TB patients SCC with DOTSCC without DOT

4. Bangladesh ç Total Population 125 millions ç Population Covered by DOTS 114 millions ç Percent of Population Covered by DOTS90% ç Estimated Number of New SS(+)ve.patients 137318 ç Number of New SS(+)ve Pts.treated ( Jan.-Sept 99 )29219 ç Treatment Success in DOTS areas ~80%

5. Bhutan ç Total Population 0.6 millions ç Population Covered by DOTS 0.6 millions ç Percent of Population Covered by DOTS 100 % ç Estimated Number of New SS(+)ve.patients 1275 ç Number of New SS(+)ve Pts.treated ( 1999 ) 315 ç Treatment Success in DOTS areas ~90%

6. India ç Total Population 1000 millions ç Population Covered by DOTS 300 millions ç Percent of Population Covered by DOTS 30% ç Estimated Number of New SS(+)ve.patients 818210 ç Number of New SS(+)ve Pts.treated ( 1999 )522800 ç Treatment Success in DOTS areas ~85%

7. Maldives ç Total Population 0.27 millions ç Population Covered by DOTS 0.27 millions ç Percent of Population Covered by DOTS 100% ç Estimated Number of New SS(+)ve.patients 107 ç Number of New SS(+)ve Pts.treated ( 1999 ) 176 ç Treatment Success in DOTS areas ~98%

8. Nepal ç Total Population 23 millions ç Population Covered by DOTS 20 millions ç Percent of Population Covered by DOTS 85% ç Estimated Number of New SS(+)ve.patients 20000 ç Number of New SS(+)ve Pts.treated 8000 ç Treatment Success in DOTS areas ~89%

9. DOTS and Community DOTS committeeDOTS committee District development committeeDistrict development committee MunicipalityMunicipality Village development committeeVillage development committee NGOsNGOs MediaMedia Community VolunteersCommunity Volunteers Social WorkersSocial Workers Teachers and studentsTeachers and students TB patientsTB patients

10. DOTS committee, key to success DOTS Committee: Group of motivated people: social workers, political leaders, civic leaders, health service providers, journalist, teachers, representatives of local organizations, I/NGOs, medical schools and colleges and TB patients.

11. DOTS and Medical colleges Frequent meeting with them NTP DOTS orientation Establish DOTS Centre –BPKIHS –Nepalganj Medical College (2 DOTS centres) –Bharatpur Medical College –TU Teaching Hospital Such activities are being carried to other SAARC member countries, Bhutan, Bangaldesh, Sri Lanka, India, Pakistan, Maldives

12. Pakistan ç Total Population 130 millions ç Population Covered by DOTS 10.4 millions ç Percent of Population Covered by DOTS 8%( in National Population ) ç Estimated Number of New SS(+)ve.patients 117,000 ç Treatment Success in DOTS areas ~85%

13. Sri Lanka ç Total Population18 millions ç Population Covered by DOTS17 millions ç Percent of Population Covered by DOTS 95% ç Estimated Number of New SS(+)ve.patients 5019 ç Number of New SS(+)ve Pts.treated ( 1999 ) 3734 ç Treatment Success in DOTS areas ~75%

14. SAARC TB Centre (STC) 1984Second meeting of Foreign Ministers identified TB as priority area 1990Fifth Summit of the head of states/governments decided to set-up STC in Nepal 1992First Governing Board meeting held to formulate rules & regulations 1994Staff recruited - STC started functioning

15. Governing Board ò Highest policy making body ò Composed of eight eminent experts in the field of Tuberculosis - one each nominated by seven member countries ò Director of STC is Member Secretary ò One nominated member of SAARC Secretary General participates in all meeting ò Focal point of host country participate in each meeting ò Meets once in a year or in emergency if required

16. Objectives of SAARC Tuberculosis Centre To work for prevention and control of tuberculosis & HIV/AIDS in the region by coordinating the efforts of National Tuberculosis Control Programmes of SAARC member countries

17. Functions of STC 1.To act regional co-ordination centre for tuberculosis control in SAARC region 2.Collection and dissemination of information 3.To establish net working arrangement among National Tuberculosis Control Programme of member countries 4.To initiate, undertake and co-ordinate the research and training on TB control in the region

18. 5.To assist member countries for harmonization of policies and strategies 6.To assist member countries of maintain adequate supply of low cost anti-TB drugs 7.To monitor incidence, prevalence and emergence of drug resistance in the region 8.To promote action on issues relating to HIV related tuberculosis 9.To carryout other important works identified by the technical committee

19. Organogramme of SAARC TB Centre Governing Board Director Deputy Director ICC Division Research & Training Division Epidemiology Division Bacteriology Division

20. Achievements of STC Seminars and Workshops ç Socio-cultural aspects of TB - Dec. 1993 ç TB programme managers of SAARC - Nov. 1994 ç TB programme through PHC approach - Apr. 1995 ç Preparation of Health Education materials - Oct. 1995 ç Pilot Demonstration areas of TB control - Jan. 1997 ç Production and Distribution of ATD -Jul. 1997 ç Formulation of guidelines for coordination in Govt. and Pvt. Sector - Jun. 1997 ç Relating to research on TB/HIV in the region- Oct. 1997 ç SAARC-CIDA cooperation on TB/HIV - Mar.1999 ç Gender & Sociological Issues Related to TB-July 1999 ç SAARC Seminar for compilation and updating advocacy and IEC material relating to TB-Sept.2000

21. Achievements of STC T r a i n i n g èTrainers’ training for NTP - Jul. 1994 èTrainers, training for DTP managers - Jul. 1995 è Training for regional TB programme coordinators - Jul. 1996 è Training for Lab. Technicians on TB bact. Apr. 96 è Training for strengthening IEC activities on TB/HIV - Feb. 1998 èTrainers’ training for programme managers Jul- 1998 èTraining for TB coordinators - Dec. 1998 èTrainers’ Training - Jun. 2000.

22. Achievements of STC M e e t i n g çConsultative meeting on TB and AIDS - Oct. 1996 çMeeting of TB experts for compilation of TB control training manual - Jun. 1997 çTen meetings of Governing Board çExpert meeting for standardizing training curriculum and workshop on operational Research for TB control - Dec. 2000

23. Achievements of STC R e s e a r c h çMember countries have identified focal institute for research çResearch on TB bacillus, drug sensitivity pattern in SAARC region is in progress çPilot demonstration site with suitable strategy in TB control is being developed çInitiation of SAACR-CANADA project

24. Activities organized for TB & HIV/AIDS control by SAARC TB Centre çSAARC Consultative Meeting on TB and HIV/AIDS, 23- 25 Sept 1996, Kathmandu çWorkshop Relating to Research on TB and HIV/AIDS in SAARC, 28-29 Oct. 1997, Kathmandu çTraining Programme for Strengthening IEC activities with special emphasis on TB and HIV/AIDS, 10-23 Feb. 1998, New Delhi çWorkshop on SAARC-CIDA Cooperation for TB and HIV/AIDS, 1-5 March 1999 çSeminar for compilation and updating advocacy and IEC material relating to TB and HIV/AIDS, Oct. 2000 çCross Border Meeting for TB, HIV, Malaria and Kala- azar, March 2001

25. Achievement of STC Collection and Dissemination of the Information èA resource centre (Library) for TB and HIV has been developed èRegional TB and HIV AIDS epidemiological data base is being established. èInformation network in Member Countries has been created èDirectory of TB institutions and TB specialists has been prepared èRegular collection and dissemination of information is being done in the form of STC Newsletter, reports on workshops, meetings & seminars and materials on training and research èPresentations of scientific papers in international and national conferences

26. Achievements of STC èScientific Sessions have been chaired and Technical Papers on TB and HIV have been presented in global lung congresses and IUATLD meetings held in Paris, Bangkok, Hong Kong and Dhaka èRegional situation and progress on TB control has been presented in WHO meetings held in Delhi, Bangkok and Myanmar è Dr. K. Styblo International Public Health Award, has been awarded for outstanding contribution - 1998 èInternational Gold Star Award has been presented by International Friendship Society of India - 1999 Representation in International Conferences

27. Establishment of Resource Centre A Regional Library for TB and HIV/AIDS has been established in SAARC TB Centre for Health Workers, Medical Students, Researchers and the interested people.

28. Focal Training Institutes for TB control in SAARC Member Countries Bangladesh-TB Control Training Centre, Dhaka Bhutan-Division of Health Services, Thimphu India-National TB Institute, Bangalore Maldives-Chest Clinic, Male Nepal-National TB Centre, Thimi, Pakistan-Ojha Institute of Chest Disease, Karachi Sri Lanka-Respiratory Disease Control, Colombo

29. Services to NTPs of Member Countries from STC ‡ To provide platform for interaction and exchange of experiences ‡ Collection, compilation and dissemination of information ‡ Identification of problem areas in NTP ‡ Feedback suggestions with remedial measures to member countries ‡ Training and Research for support of NTP

30. SAARC-WHO Memorandum of Understanding MoU between SAARC and WHO has been signed in August 2000 çSTC has been identified as a collaborative Centre for WHO activities in TB and HIV/AIDS çSAARC-WHO meeting of potential consultants in TB control- Jan. 2001 çSAARC-WHO inter-country meeting on cross border initiative in HIV/AIDS, TB, Malaria and Kala-azar - March 2001 çOrganizing WHO/ SEARO Training on TB Control Management from 1997 for

31. SAARC-CIDA project on TB and HIV/AIDS çSAARC and CIDA signed a MoU in July 1997 for cooperation to Control TB and HIV/AIDS. çThe Project Document was prepared in March 1999. ç Member Countries have approved the Project in Sept. 2000 çThe project has been initiated.

32. Conclusions Burden of TB & HIV/AIDS in SAARC region is enormous TB control is not only national but international issue Cooperation is essential SAARC TB Centre is in unique position to facilitate cooperation Regional approach is needed to fight against tuberculosis Strong and sustainable NTPs with 85% cure and 70% case detection is key of the success There is a strong need of social mobilization and advocacy at each level in order to achieve objective of TB control