1. Convegno, Stop TB Italia – Milano, 23-3-2017
Multi-sectoral accountability
Mario C. Raviglione
Global Health Centre - University of Milan
Mario C. Raviglione
Global Health
Convegno, Stop TB Italia – Milano,

2. Who carries the burden of tuberculosis?
…mostly, the most vulnerable
TB linked to HIV infection, malnutrition, alcohol, drug and tobacco use, diabetes
Migrants, refugees, prisoners, ethnic minorities face risks, discrimination & barriers to care
Half a million women and 250,000 children died of TB in 2016
TB spreads in poor, crowded & poorly ventilated settings
Mario C. Raviglione
Global Health

3. Why a multisectoral approach to end TB?
GOAL 1: SOCIAL
PROTECTION WHEN ILL
Environment
CROWDING, POOR VENTILATION
SILICA,
INDOOR AIR POLLUTION
POOR LIVING AND WORKING CONDITIONS
CONDUCIVE ENVIRONMENT FOR TRANSMISSION
VULNERABLE GROUPS
incl. children, women,
migrants, prisoners, etc.
MAL-NUTRITION
FOOD INSECURITY
STIGMA/DISCRIMINATION, MARGINALIZATION
IMPAIRED HOST DEFENCE/SUSCEPTIBILITY
AT-RISK BEHAVIOUR
GOAL 3:
HIV, NCD, RISK FACTORS
HIV/
AIDS
NCDs: diabetes, smoking, alcohol…
EXPOSURE
LATENT INFECTION
ACTIVE DISEASE
SUFFERING
AND DEATHS
GOAL 3:
UHC TB SERVICES
TB CARE

4. Formidable challenges remain… and they cannot be solved solely within the health sector
WITHIN NTPs and HEALTH
Addressing the “missed” cases, MDR-TB as a crisis, joint TB/HIV response
Increasing financing to close gaps
Intensifying research
HIV, tobacco, alcohol, diabetes
Universal health coverage
WHAT ABOUT BEYOND NTP & HEALTH ?
Poverty and lack of social protection
Malnutrition
Poor living or working conditions: slums, air pollution, mining, prisons
Discrimination, stigma, war, migration
Inequities and inequalities
Mario C. Raviglione
Global Health

5. ENDING TB IN THE SUSTAINABLE DEVELOPMENT ERA: A MULTISECTORAL RESPONSE
FIRST WHO GLOBAL MINISTERIAL CONFERENCE
ENDING TB IN THE SUSTAINABLE DEVELOPMENT ERA: A MULTISECTORAL RESPONSE
Conference Vision
Aim: to accelerate implementation of the WHO End TB Strategy and address gaps in access to care and the MDR-TB crisis Goal: to reach the End TB targets set by World Health Assembly and UN Sustainable Development Goals (SDGs) Through: national and global commitments towards clear deliverables and accountability, eventually endorsed at the UN General Assembly High-Level Meeting on TB in 2018
Mario C. Raviglione
Global Health

6. Finally, some visibility and sense of urgency
High-level commitment to End TB:
High Level Meeting on TB
Mario C. Raviglione
Global Health

7. ENDING TB IN THE SUSTAINABLE DEVELOPMENT ERA: A MULTISECTORAL RESPONSE
What is the key political recommendation today?
FIRST WHO GLOBAL MINISTERIAL CONFERENCE - Moscow 2017
ENDING TB IN THE SUSTAINABLE DEVELOPMENT ERA: A MULTISECTORAL RESPONSE
Mario C. Raviglione
Global Health

8. Accountability framework
Who is accountable?
What commitment/actions are accountable?
To whom is one accountable?
How is one held into account?
Not above WHA
No $$ backing
No high political level
No independent
No review in other sectors
No civil society review
Not at high level
No shadow report
Mario C. Raviglione
Global Health
Source: GTB/WHO,

9. Accountability Being responsible for commitments made and actions taken
Commitment is plenty, although at low level! Accountability is empty!
All are accountable in all sectors: governments, UN family, donors, philanthropy, partnerships, NGOs, academia, research institutions… even civil society
Accountability clear for governmental entities and UN agencies, much less so for the others
What is necessary? A UNGA agreed-upon framework with regular M&E and reviews at the highest levels nationally and internationally (WHA and UNGA)
Role of civil society and people is crucial, as well exemplified by the response to HIV/AIDS and other major health threats
Mario C. Raviglione
Global Health

10. Grazie a tutti
Mario C. Raviglione
Global Health