Tuberculosis (TB)

WHO report 2008
Global tuberculosis control

3.9 Summary

The financial data reported to WHO in 2007 are the most complete since financial monitoring was initiated in 2002, with 90 countries that collectively account for 91% of the world’s estimated TB cases providing the entire budget and funding data that were requested. Expenditure data continue to be more challenging to report, but 80 countries (77% of total cases globally) submitted a complete report.

NTP budgets in HBCs amount to US$ 1.8 billion in 2008, up from US$ 0.5 billion in 2002; NTP budgets for the 90 countries reporting complete data total US$ 2.3 billion in 2008. In HBCs, budgets are generally equivalent to about US$ 100–300 per patient treated, but range from below US$ 100 in India to above US$ 1000 in the Russian Federation and South Africa. DOTS accounts for the largest single share of NTP budgets in almost all countries, but budgets for the diagnosis and treatment of MDR-TB have become strikingly large in absolute and relative terms in the Russian Federation and South Africa. In several African countries as well as Cambodia, collaborative TB/HIV activities account for a comparatively high proportion of the NTP budget.

With a few exceptions, NTP budgets do not include the costs associated with using general health system resources such as staff and infrastructure for TB control. When these costs are added to NTP budgets, we estimate that the total cost of TB control in HBCs will reach US$ 2.3 billion in 2008 (up from US$ 0.6 billion in 2002), and US$ 3.1 billion across the 90 reporting countries. Costs per patient treated are generally in the range US$ 100–400, and below US$ 100 only in India.

For the 22 HBCs, NTP budgets and our estimates of the total costs of TB control have stagnated between 2007 and 2008 in all but five countries, four of which are in Africa. This trend is worrying, because it suggests that the deceleration in progress towards the case detection and treatment success targets highlighted in Chapter 1 could persist into 2008.

Sustaining a trend evident since 2002, funding for TB control continues to grow, mainly from domestic financing in Brazil, China, the Russian Federation and South Africa and from Global Fund grants in other countries. Across HBCs in 2008, governments will cover 73% of the total costs of TB control and grants will cover 13% (including US$ 200 million from the Global Fund, out of total grant funding of US$ 297 million). For all countries, the figures are 75% and 12% respectively. Despite increases in funding, countries have reported funding gaps for 2008 that total US$ 328 million among HBCs (14% of total costs) and US$ 385 million across all reporting countries (13% of total costs). Only five HBCs reported that they had no funding gap for 2008.

Gaps reported by countries for 2007 and 2008 would be larger still if country plans and assessments of funding requirements were fully aligned with the Global Plan. In 2008, the gap between the total available funding based on country reports and the total funding requirements laid out in the Global Plan is US$ 0.8 billion in HBCs and US$ 0.9 billion across all 90 reporting countries. The discrepancy is mostly due to higher budgets for MDR-TB (South-East Asia and Western Pacific regions), collaborative TB/HIV activities (African and South-East Asia regions) and ACSM (all regions) in the Global Plan. These differences expressed in financial terms are consistent with results for the implementation and planning of interventions presented in Chapter 2.

More positively, there are several examples of countries with plans and budgets that are well aligned with the Global Plan, as well as a few that were well-aligned before the mid-2007 upward revision of targets for the treatment of MDR-TB. Many countries in Africa including all of the HBCs in the region have embarked upon, and in some cases completed, the development of medium-term plans and budgets using a WHO planning and budgeting tool that is designed to help countries to plan and budget in line with the Global Plan. Completion of this work as well as the development of country-owned plans and budgets based on Global Plan targets in further countries are now crucial and should form the basis for intensified efforts to mobilize the necessary resources from both domestic and donor sources.