USAID TB Technical Assistance Model June 19, 2014

Overview TA in the Context of USG TB Strategy Accomplishments and Approach of TB Strategy USAID TA Model 2

USAID TB Funding Trends 1998–2013 Funding Level (Millions US $) * FY funds including all accounts

4 By 2012, TB prevalence in 27 USAID-supported countries decreased by 40%.

5 By 2012, TB mortality in 27 USAID-supported countries decreased by 41%.

Treatment Success Rate in Select Countries 6

Case Detection Rate in Select Countries (all forms of TB) 7

New patients with MDR TB initiated on treatment each year: (USAID focus countries) 8 Number of Patients (thousands) Target * These numbers differ from the past reports because they are adjusted to include only the current USAID countries to accurately reflect the trends.

9 USG TB Strategy: Key Approaches ApproachExamples Promote country ownership Develop 5-year NTP Strategic Plans Support development and implementation of GF grants Support NTP routine monitoring and supervisory systems Support participatory MOH led external evaluations Joint annual work planning with NTP and other partners Sustainable systemsStrengthen drug/supply chain management Strengthen facility level routine M&E system Develop/improve lab network at all levels Build primary health care capacity Leverage resourcesDevelop GF proposals to cover unmet needs in NSPs Coordinate TB/HIV funds through PEPFAR Expand health platforms (community, lab, drug mgmt.) Provide global technical leadership Develop and pilot new tools, policies, guidelines Provide TA to countries/in targeted technical areas Participate in WHO core working groups and STAG-TB Lead USG international TB efforts

Field level support: Response to local needs/gaps based on NTP Strategic Plan, GF grant, and PEPFAR COP TA to MOHs, private sector, and NGOs; coordinate with other partners Expansion of new approaches/technologies (e.g., PMDT and Xpert) Global Drug Facility (GDF) GH/regional bureaus support: Global policy and guideline development Global operational and implementation research Technical support for evaluation, program design, monitoring, mentoring, and project management Implementers: STB Partnership, WHO, CDC, TB CARE I and II, TO 2015, TREAT TB, SIAPS, USP, TB Alliance, GLC, TB TEAM Field and Regional 84% ($188 in FY13) GH 16% ($36m in FY13) Country Level Focus – supporting the field 10 In FY13, Washington managed 51% of the total USAID TB funding and 36% of the field support resources.

USAID TB Technical Assistance Model 11 USG convenes and leverages existing USAID bilateral program support to NTPs, preventing duplication, optimizing areas coverage and dovetailing Focus and concentrate in response to the GF changes, the new funding model, and evolution of the TB grants Principles of Approach Mirrors the inherently disease-specific NFM Focus on development and implementation of National TB Strategic Plans On-going Country dialogue Development of a disease-specific concept note and funding envelope – assist with technical trade-offs Disease-specific TA to ensure quality programming

Convener: Model focuses on actively triangulating information among all partners 12 USAID TB Team Convener Role Regular country phone calls with key stakeholders Ensure clear roles and responsibilities of stakeholders Monitor and evaluate progress GF/FPMPR/NTP In-country technical partners

USG Approach to Address GF grant TA support Shift in prioritized focus on a number of countries covering: 70% of the total GF grant funding for TB 88% of TB prevalence 88% of MDR-TB 84% of TB/HIV co-infection Focus on quality programming and areas of technical expertise required Focus on more in-country approach: more consistent TA providers that less fly-in and fly-out TA More strategically wrap around USG bilateral program and USG TB working group partners

Priority Country Selection & Analysis 14 Criteria: Burden (TB, MDR-TB, TB/HIV) Global Fund Performance Data (rating, disbursement rate, expenditures) Number and size of grants For MDR-TB: minimum of 1,000 projected treatments for Analysis of types of TA needed: Burden and performance thus far (are things moving?) Review t ypes of TA currently available through USG mechanisms Review of issues within countries based on past performance, stakeholders meetings/calls, discussions with partners and FPMs

PRINCIPLES TO RESULTS 15 Accelerated impact RESULTS 1.Full Implementation of National Strategic Plan 2.Meets GF grant targets with quality 3.Expends funds appropriately USG TA Model In-country TA: TB CARE I and II PATH TB TO Targeted TA: GDI (GLC) CDC Multi-partner TA: TBTEAM SIAPS GDF

USAID Country Mapping Example: Bangladesh 16 Bangladesh MDR Short-Term TA (NTP& GF) CDCUSAID Grant Management/Program Expansion TA In-country advisor (hired through TBCARE 2, builds coordination) Drug Management TA MSH/SIAPS Project (Mission funded) Coordination TA (bringing partners together) TBTEAM Technical experts visit countries to provide MDR-TB TA, and then project in country follows up. Experts provide additional virtual assistance to ensure things are moving forward In-country advisor works with partners/USG project to ensure that grant is moving forward and expanding, and identifies any TA needs. Also ensures that countries understand all CPs Ensures that country is doing proper quantification and that there is an adequate supply of drugs. Works with in-country advisor on any GF grant bottlenecks related to drug management Assists with partner coordination meetings/calls and Phase 2 renewal preparation

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