Support to countries
Ghana, 1-5 February 2016
A mission on the TB situation has just ended in Ghana. The five-day mission (01-05 Feb 2016) was jointly undertaken by representatives from the Global Fund, USAID, the London School of Hygiene and Tropical Medicine and the World Health Organization, led by Dr Christian Gunneberg of WHO Headquarters.
The main objective was to review the progress of the New Funding Model Grant implementation which started mid last year. This grant has a special focus to improve case detection through active screening at out-patient clinics (OPD) and other points of patient entry. Discussions are for this approach which has the potential to increase case finding, ensure early diagnosis and reduce TB mortality and currently being implemented in 90 districts to be scaled to all 216 districts barring funding. While the true burden of TB have been established to be more than four times (290/100,000) the previously estimated level (71/100,000) and incidence rate of 165/100,000, need for additional resources cannot be overemphasized.
The prevalence survey showed are a high proportion sputum smear negative cases confirmed positive by culture which supports the use of more sensitive diagnostic approaches such as with Gene Xpert machines and Digital X-rays hence the decision to procure more Gene Xpert machines to enhance a wider coverage. Modelling carried out by the team from London School and based of the previous burden estimate indicates a more aggressive and proactive approach if targets are to be met.
The team visited four hospitals in three regions to observe the implementation of the OPD screening. The activity had taken off in earnest in all facilities visited and some recommendations were made for improving the specimen request, handling and transport within facility to address the in facility drop outs or missed cases for effective implementation. The NTP and partners have established an excellent monitoring system linked to the intensified case finding, and this is already providing very useful management information at national level. The mission recommended that resources being reprogrammed in the Global Fund Grant should definitely support the intensified supervision that the NTP is proposing to carry out in support of this important initiative.
Kenya, December 2015
Kenya was identified for intense partner collaboration for accelerated Global Fund grant implementation. Through the ‘TB Situation Room’, organized by the Global Fund, WHO led a joint partners’ mission with the Global Fund and the Stop TB Partnership to Kenya from 8-11 December 2015 to identify Global Fund grant implementation challenges and put in place measures that would ensure full absorption of available grant funding by the end of 2017. During the mission partners focused on the investments made and the current country capacity in implementing TB care and prevention, MDR-TB and cross cutting issues. The partners will continue to support the country team to implement the recommendations made in order to refocus resources to ensure impact of financial investments.
During 2015, the Global TB Programme mobilized TA in close coordination with technical partners (USAID, CDC)
- Epidemiological data analysis
- Programme Review
- National Strategic Plan development
- Community based-care
- MDR TB
- Drug resistance survey
- New diagnostics and laboratory strengthening
- Training of national stakeholders - Engage TB and GF NFM applications
- TB Prevalence survey
- Established linkages with existing social protection programmes, which in turn are due to improve quality of care, and limit catastophic costs.
- Built capacity of national stakeholders, which enabled the country to successfully mobilize resources without external support (only local TA)
- Available funding to scale up from 10 - 75% MDR TB detection and treatment within 3 years
Pakistan, November 2015
Supporting Pakistan to end TB: Pakistan was identified for intense partner collaboration for accelerated Global Fund grant implementation. Through the ‘TB Situation Room’, the Global Fund organised a mission on TB to Pakistan in November 2015 with WHO, USAID, Stop TB, GIZ and DFID to assess the current status of program implementation integrating national and provincial perspectives while discussing strategies to improve the case notification and enrolment of the MDR-TB cases. The mission reinforced the current plans to accelerate the MDR-TB roll out especially in the Punjab province, speed up the engagement with the private sector organizations and Lady health workers to strengthen case finding for TB, and strengthen the link between the Global Fund Principle Recipients and the Sub Recipients. Considerable resources are available for reprogramming to support the acceleration of these initiatives.