The goal of this series of annual reports is to chart progress in global TB control and, in particular, to evaluate progress in implementing the DOTS strategy. 1 , 2 The first targets set for global TB control were ratified in 1991 by WHO’s World Health Assembly. 3 They are to detect 70% of new smear-positive TB cases, and to successfully treat 85% of these cases. Since these targets were not reached by the end of year 2000 as originally planned, the target year was deferred to 2005. 4
In 2000, the United Nations created a new framework for monitoring progress in human development, the MDGs. Among 18 MDG targets, the eighth is to “have halted by 2015 and begun to reverse the incidence of malaria and other major diseases”. Although the objective is expressed in terms of incidence, the MDGs also specify that progress should be measured in terms of the reduction in TB prevalence and deaths. The target for these two indicators, based on a resolution passed at the 2000 Okinawa (Japan) summit of G8 industrialized nations, and now adopted by the Stop TB Partnership, is to halve TB prevalence and death rates (all forms of TB) between 1990 and 2015. All three measures of impact (incidence, prevalence and death rates) have been added to the two traditional measures of DOTS implementation (case detection and treatment success), so that the MDG framework includes five principal indicators of progress in TB control. All five MDG indicators will, from now on, be evaluated by WHO’s Global TB Surveillance, Planning and Financing Project. The focus is on the performance of NTPs in 22 HBCs, and in priority countries in WHO’s six regions.
Some other MDGs are indirectly relevant to TB control. For example, Goal 1 is to eradicate extreme poverty and hunger, and Goal 3 is to promote gender equality and empower women. Goal 8 is to develop a global partnership for development, in which the Stop TB Partnership will have a role. A discussion of these goals is beyond the scope of this report, but further details can be found at web site: unstats.un.org/unsd.
While the MDGs set out the main objectives for global TB control, numerous specific activities must be carried out to meet these larger goals. This technical report, the ninth in the series, describes many of the details. It presents plans and budgets for DOTS expansion, and costs, expenditures and sources of funding. It also summarizes the progress made on special initiatives such as collaborative TB/HIV activities, improvements in the laboratory network and DOTS-Plus projects for the management of drug-resistant TB.
Since 1980, 81 million TB patients have been reported through WHO’s surveillance system, including 17 million notified by DOTS programmes since 1995. The financial monitoring system has accounted for US$ 4.3 billion spent on TB control in the HBCs since its inception in 2002. Thus, the Global TB Surveillance, Planning and Financing Project has become a formidable instrument for monitoring and evaluating progress in TB control.
1 Framework for effective tuberculosis control. Geneva, World Health Organization (WHO/TB/94.179).
2 An expanded DOTS framework for effective tuberculosis control. Geneva, World Health Organization (WHO/CDS/TB/2002.297).
3 Resolution WHA44.8. Tuberculosis control programme. In: Handbook of resolutions and decisions of the World Health Assembly and the Executive Board. Volume III, 3rd edition (1985–1992). Geneva, World Health Organization, 1993 (WHA44/1991/REC/1).
4 Stop Tuberculosis Initiative. Report by the Director-General. Fifty-third World Health Assembly. Geneva, 15–20 May 2000 (A53/5, 5 May 2000); available at http://www.who.int/gb/ebwha/pdf_files/WHA53/ea5.pdf, accessed 11 January 2005).