1. Key issues in DOTS implementation
Dr Saidi M. Egwaga

2. TB in the world 2002 People infected 2 billion
New TB cases million
New ss+ TB cases 3.8million
Prevalence HIV in new adult cases 12%
Prevalence MDR in new cases %
Deaths from TB (inc HIV) m

3. Global targets for TB control MILLENNIUM DEVELOPMENT GOALS
WHA by 2005:
70% case detection, 85% cure
DOTS beyond public health services
MDGs by 2015:
Halve prevalence and deaths HIV/AIDS, drug resistance, migration

4. Progress towards Global TB Control targets
Case Detection Rate 36%
(target 70%)
Cure Rate 83%
(target 85%)

5. High treatment success in DOTS areas
100
DOTS smear+ 90
target 85%
non DOTS smear+ 80 70 60
Treatment success (%) 50 40 30 20 10
1995
1996
1997
1998
1999
2000
2001

6. What countries have achieved in 2002
Outstanding progress in some countries:
Increase case detection and cure:
India, Indonesia, Myanmar, Pakistan, Cambodia, Viet Nam
Increase case detection but low cure:
South Africa
Some progress:
Mozambique, Afghanistan, Philippines

7. Financial resources New sources available
GFATM 189 million to TB and TB/HIV control for 2 years
FIDELIS (CIDA)
WB,TBCTA, etc.
Gap to be addressed
200 million per year in countries
20 million per year for technical assistance

8. Major challenges Health workforce crisis High turn-over
Need for updated training and retraining (pre-service and in-service)
Retention
Brain-drain
Deployment
HIV epidemic
HRD is absent in MoH strategic planning

9. Major challenges Access to health services
Poor health care infrastructure
Weak laboratory networks
Health systems reform
Little involvement of some PHC providers in TB control
No link with other public health care providers (e.g. hospitals, prisons, etc)
Inadequate involvement of private sector
Inadequate cultural sensitivity

10. Major challenges Insufficient political commitment
Shortages of staff at different levels in some NTPs
Inadequate funding for training and supervision, monitoring and evaluation
No budget line for TB drugs in most countries

11. Major challenges TB / HIV epidemic in some countries
Overloaded health care services
Stigma
High death rates among TB patients
Competition for scarce resources
Collaboration between NTPs and NACPs

12. Country experience in addressing challenges
Training needs assessments (Indonesia)
Collaboration with training institutions (Tanzania)
Community involvement (Uganda)
Involvement of private sector (India, Philippines) and NGOs (Bangladesh)

13. Country experience in addressing challenges
Link with hospitals (Indonesia, India, China)
National Programme evaluation (China)
Rapid DOTS expansion (India)
Collaboration between NTPs and NACPs (Kenya, Tanzania, Brazil)
COMBI (Kenya, Bangladesh, India)

14. Total patients placed on treatment and population covered under DOTS each quarter, India (1994-2003)
238,204
Yearly total population projected from 2001 census.

15. STOP TB Partnership Very good positive spirit of the DEWG
Stop TB is working in countries
Progress in some countries despite difficulties
Countries gaining momentum and some very close to targets

16. HOWEVER... No time for complacency
2004 is the year of accelerating actions in TB control

18. Ultimate Goal: a generation of children free from tuberculosis