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mobilization
Member countries
continue to be assisted in preparing proposals for submission to development
partners, donor governments and the Global Fund. A Global Fund grant
implementation and negotiation workshop was held in January 2008 and a workshop
on proposal writing organized in March 2008. The Regional office and country
office in Myanmar assisted the country in obtaining funding support through
the 3-Diseases Fund in Myanmar, which has brought in essential resources for
TB control for the
next five years.
Support provided
during the Global Fund Round 7 will bring in extra resources for TB control
in Nepal
and Timor-Leste. A total of nine Member countries
will continue to benefit from this and earlier rounds to the extent of over USD 600 million for TB control.
Bangladesh, DPR Korea, India, Indonesia and Nepal also receivedfunding through bilateral agreements with
Canadian Development International Agency (CIDA),
United States Agency for International Development (USAID),
Department for International Development (DFID),The
World Bank, and Gorgas. Additional funding was also
received from USAID for technical assistance to
countries at the regional level. Dialogue is ongoing with potential donors
who could provide funding for TB control
in DPR Korea. 5
Technical assistance
All 11 countries
in the Region continue to receive technical assistance through WHO Regional
and country offices, and international technical partners, namely, CDC, the
International Centre for Veterinary and Medical Sciences (IVMS),
the Royal Foundation for Tuberculosis in the Netherlands (KNCV),Institute of Tropical Medicine (ITM, Belgium), the Union
and a few independent consultants recruited through WHO. Technical partners
in the Region also provided technical assistance to countries during the
year. These are: Bangladesh
Rural Advancement Committee (BRAC), Damien
Foundation and ICDDR, B, in Bangladesh, and the three WHO Collaborating Centres, namely, The National TB Institute, (NTI) and TB Research Centre, (TRC)
in India, and the SAARC TB and HIV/AIDS Centre in Nepal.
Technical support
missions were undertaken to all 11 Member countries during the year.
Specifically, laboratory assessments and technical support to establish MDR-TB and TB-HIV interventions, and improve drug
procurement, supply management and data management were undertaken in
Bangladesh, Bhutan, DPR Korea, India, Indonesia,
Myanmar, Nepal, and Thailand.
The increase in
funding for TB control being made available to countries has generated a
manifold increase in the demand for technical assistance. In this context, a
TB Technical Assistance Mechanism (TBTEAM) aimed at
better coordination of technical assistance to countries has been developed
through the joint efforts of all technical partners over the past six months,
following preliminary discussions on the critical need for this at the Global
TB strategic technical advisory group meeting that was held in June 2007.
WHO/headquarters and all six regional offices, together with partner
agencies, have compiled three web-based tools detailing all proposed missions
and events in countries; mapping all expertise available within all technical
partner agencies; and providing names of all potential consultants available,
with their areas of expertise. The TBTEAM mechanism
will also serve to seek additional funding from the Global Fund or financial
partners for the necessary technical assistance.
Laboratory capacity
building
Laboratory
assessment and technical support missions were undertaken to Bangladesh, Bhutan,
DPR Korea, Indonesia,
Myanmar, Nepal, and Thailand during 2007. An
inter-country training of laboratory staff of national reference laboratories
(NRLs) on quality assurance, culture and drug
susceptibility testing (DST) was held in August 2007. Technical assistance,
coordinated through WHO, is being provided through the supra-national
reference laboratories (SNRLs) based at the
Institute of Medical and Veterinary Science (Australia), Institute of Tropical
Medicine (Belgium), Central Reference Laboratory, Gauting
(Germany), and Tuberculosis Research Centre (India), to help establish
culture and DST facilities in countries in a phased manner, in line with
national plans. Additional technical assistance requirements to support these
plans have been identified. Nine countries have formally established linkages
with SNRLs; Bhutan
and Sri Lanka
are in the process of being linked to the network of the SNRLs.
Human resource development (HRD)
India,
Indonesia, Thailand, Myanmar,
and to a lesser extent, Bangladesh
have been supported for further developing their national HRD
plans. National level trainings for programme staff
were supported in several member states.
Supporting interventions for
TB-HIV, MDR-TB and childhood TB
India,
Indonesia, Myanmar and Nepal
were supported in scaling-up TB/HIV activities, and Bangladesh
in finalizing national guidelines for TB/HIV. TB/HIV training modules have
been finalized and are in use for training programme
staff in India, Indonesia, Myanmar
and Nepal.
Bhutan, Indonesia
and Myanmar
were supported in preparing and submitting applications to the Green Light
Committee. DOTS-plus projects in India
and Nepal for the management
of MDR-TB cases are being supported to scale up,
while Bangladesh, Indonesia, Myanmar, and Timor-Leste were technically supported to begin implementation.
A regional workshop to train programme staff from
Member countries on the management of MDR-TB was
held in August 2007. National guidelines on the management of childhood TB
were finalized in Myanmar Bangladesh, Indonesia,
Myanmar and Nepal received their first year grant for anti
TB pediatric formulations through Global Drug Facility (GDF)
and DPRK and Sri Lanka applications were
approved for the pediatric grants.
Procurement and supply
management
Nine out of
eleven countries in the region have grant or direct procurement agreements
with GDF and thus have access to quality assured
affordable anti TB drugs on a regular basis.
Technical
assistance was provided to all Member countries through two Global Drug
Facility (GDF) Technical Officers, based at
WHO/SEARO and WHO/India, respectively for improved procurement and supply
management to ensure proper forecasting of requirements and quality assurance
standards for TB drugs. Additional drug manufacturers in the Region will be
assisted to qualify for the WHO white-list of pre-qualified manufacturers of
first-and second-line anti-TB drugs.
Operational research
Operational
research studies are being technically supported in several countries, by WHO and also through the small grants scheme of the
special programme for research and training in
Tropical Diseases (TDR). Private industry based in
the Region is contributing to the global procurement of anti-TB drugs
coordinated by the GDF, and is also engaged in new
drug development. The Revised National TB Control Programme
in India
is involved in field testing new diagnostics through the Foundation for
Innovative New Diagnostics (FIND).
Advocacy,
communication and social mobilization
In the area of
advocacy, communication and social mobilization, Indonesia has been technically
supported through a full-time technical officer based at the WHO Indonesia
country office for the past two years. Bangladesh
and India are being
supported to develop communication campaigns, while many communitybased
initiatives are going on in Bangladesh,
India Indonesia, Myanmar,
and Thailand.
These need to be properly documented and analyzed for costeffectiveness;
best practices emanating from these, should be disseminated.
Monitoring and
evaluation
Technical
assistance for strengthening monitoring and evaluation and performing impact
assessments was provided to Bangladesh, Bhutan, DPR
Korea, India, Indonesia, Myanmar, Nepal and Timor-Leste.
A national workshop evaluating the impact of the TB control interventions was
held in India,
and was attended by several national and international partners engaged in
the country. An ARTI survey was supported in DPR Korea and others will begin in Bhutan and Sri Lanka.
Missions to
review progress in TB control were jointly undertaken by WHO
and several technical and development partners together with the national TB programmes in Bangladesh,
Indonesia, Myanmar, Nepal
and Thailand
during 2007.
Programmatic data
on case notifications and treatment outcomes from all eleven national TB
control programmes has been compiled for analysis
of trends and reporting within the annual report on TB control in the SEA
Region and the global report on TB control, to be published in 2008. An
international expert has been recruited at SEARO to help with analyzing the
trends in programme data collected since routine
recording and reporting under DOTS was established in the Region.
Bangladesh, India, Myanmar and Nepal were assisted in further
improving national TB data management software. Training materials on data
management and analysis have been developed and used for training of programme staff in Bangladesh,
India and Myanmar.
Guidelines on undertaking ARTI assessments have
been published by SEARO and widely disseminated.
A health
economist has been recruited to analyze the cost-effectiveness of the
interventions in India
with a view to making this information available for advocacy and resource
mobilization. A similar effort has been supported in Indonesia.
National data
from routine surveillance on TB/HIV is already available in Thailand.
TB-HIV surveillance has been strengthened in India,
Indonesia and Myanmar, while efforts to further improve this
surveillance through better linkages between national TB and HIV programmes are being undertaken in Bangladesh, Nepal
and Sri Lanka.
India, Nepal and Thailand participated in the
fourth round of global drug resistance surveillance, the results of which
will be published in early 2008. Technical support for wider, more
representative drug resistance surveillance was provided through the SNRLs to the national programmes
in Bangladesh, India, Indonesia,
Myanmar, Nepal and Thailand during 2007.
Limited second-line drug resistance surveillance has begun
in Bangladesh, India, Indonesia,
Myanmar, Nepal and Thailand assisted through
designated SNRLs. Additional data from the other
countries will become available in early 2008.
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