Financing DOTS expansion
17. Financial data were received from 123 countries, 77 of which provided complete data on 2003 budgets (including 17 HBCs), and 74 of which provided complete, disaggregated expenditures for 2002 (including 15 HBCs).
18. Expenditure on TB control in the HBCs in 2002 was US$ 834--884 million. This was lower than the anticipated expenditure of US$ 976 million, the sum that would have been required, in our estimation, to achieve 70% case detection by 2005. Total estimated costs for the HBCs in 2003 amounted to approximately US$ 1 billion. This is an increase of about US$ 150 million on 2002 expenditures, but probably still too little to meet the target for case detection by 2005.
19. In 14 HBCs, the cost per patient treated was in the range US$ 125--380. For three others (Brazil, the Russian Federation, and South Africa), costs per patient were significantly higher (> US$ 700) because the prices of labour and capital are high, or because they rely more on inpatient care. In all HBCs that reported data for both years, the cost per patient increased between 2002 and 2003. The reasons were made clear in some budgets (e.g. a prevalence survey in Viet Nam, equipment in Myanmar), but not all.
20. In 2003, the governments of HBCs contributed (from national funds and loans) 70% of funds specified in NTP budgets, and 87% of total costs. But government contributions to total costs varied from 0% (Afghanistan) to 100% (e.g. Brazil), and tended to be greater in richer countries. External grants contributed about one half or more of the NTP budgets of Afghanistan, Bangladesh, DR Congo, Ethiopia, Pakistan, and Tanzania.
21. The overall funding gap reported by HBCs was US$ 41 million in 2003 (excluding South Africa and Zimbabwe, for which there were no data), about 4% of total costs, but a much larger fraction of the costs in poorer countries. Between 2002 and 2003, the funding gap narrowed in seven countries, mainly because more funds were promised by governments (including loans) and the GFATM. The gap increased in five countries because more (unfunded) activities were planned to accelerate DOTS expansion.
22. By the end of 2003, the GFATM had approved grants (for up to 5 years) of US$ 608 million for TB control activities and US$ 319 million for collaborative TB/HIV activities in 56 countries. The total for the first 2 years is US$ 294 million for TB control and US$ 90 million for TB/HIV. Approximately 70% of the combined total is for HBCs. Although the GFATM grants will make a major contribution to TB control in some countries, the disbursement of money has been slow.
23. We estimate that, if the 2005 targets for case detection and cure are to be met, US$ 0.95 billion must be spent in the HBCs (except the Russian Federation) in 2004, and US$ 1.1 billion in 2005, compared with US$ 0.65 billion spent in 2002 and US$ 0.85 billion budgeted for 2003. The Russian Federation reported a budget of around US$ 400 million for 2004, of which US$ 200 million is yet to be found.