Results: Financing DOTS expansion
Funding sources and gaps for fiscal year 2003 in high-burden countries
The relative contributions of different funding sources to NTP budgets and total TB control costs in the HBCs are shown in Figures 18 and 19. Overall, the governments of the HBCs contributed 70% of money specified in NTP budgets, through loans (12%) and national funds (58%). Government contributions to the total cost of TB control were higher, because governments typically fund all the general health care staff and infrastructure used by TB patients during treatment. In 2003, the government contribution to total costs in the HBCs was 87%, of which 5% came from loans and 82% from national funds. Grants contributed 20% of the funds for NTP budgets and 9% of total costs.
The funding gap for HBCs totalled US$ 41 million, excluding South Africa and Zimbabwe, which did not provide data. This is a decline from the previous estimate of US$ 52 million,5 which excluded South Africa. Bangladesh, Brazil, China, DR Congo, Ethiopia, Nigeria, Pakistan and the Philippines reported a decrease in the funding gap since the publication of last year's report. Except for Nigeria, the decline reflects the availability of increased funding, largely from governments (including loans) and the GFATM. It is not clear why the funding gap was reduced in Nigeria. Other HBCs reported an increase in the funding gap, including Cambodia, Indonesia, Kenya, Myanmar and Uganda. The increased funding gap followed an increase in overall budget requirements, reflecting additional planned activities that support acceleration of DOTS expansion. The budgets for these countries suggest that they have been planning effectively to meet the targets for case detection and treatment success. The budget gap in Afghanistan increased due to a decline in external funding.
The importance of grant funding and funding gaps was greater in some countries than overall figures for the HBCs suggest. Grant funding was large as a share of both the total NTP budget and total TB control costs in Ethiopia, Afghanistan, Bangladesh, Pakistan, and as a share of the NTP budget in Tanzania and DR Congo. Funding gaps that are large relative to total needs remain in Myanmar, Mozambique, Uganda, Afghanistan, Cambodia, Kenya, Nigeria and DR Congo.
Wealthier countries generally financed a larger proportion of their TB control costs (Figure 20 , Table 18). The governments of all HBCs with a GNI per capita of more than US$ 400 contributed more than half of the total costs of TB control in 2003. In 5 of the 6 middle-income countries with GNIs of more than US$ 800 per capita, the governments covered more than 90% of all the costs in 2003. These included Brazil, the Philippines, the Russian Federation, South Africa, and Thailand. China had a GNI of US$ 940 and contributed 77% to the total cost of TB control. Government contributions in China and the Philippines included loans. Among the countries with a GNI between US$ 400 and US$ 800, the percentage of total costs covered by governments ranged from 59% in Pakistan to 91% in Vietnam. India and Viet Nam included loans as part of the government contribution to TB control. Among the countries with a GNI of less than US$ 400, the percentage of the total costs covered by governments ranged from 6% in Myanmar to 75% in Tanzania (the government contribution to TB control may be close to zero in Afghanistan, but no figure for non-NTP costs was available). The government contribution to total TB control costs was less than 10% in only 2 countries, Afghanistan and Myanmar. In all HBCs with some external funding, an increase in total TB control costs between 2002 and 2003 was accompanied by a decrease in the proportion of the costs covered by the government.
Government contributions to TB control were also considered as a share of overall government spending on health (Table 17). Among the HBCs, TB control costs accounted for between 0% (Afghanistan) to 8% (Nigeria) of government spending on health. The median was 2% (Bangladesh, India, Indonesia, Russian Federation, and Uganda). The percentage of government spending on health that was used for TB control increased between 2002 and 2003 in 6 of the HBCs. It did not decrease in any of the countries where data were available for both years.