Way Forward

1
Way Forward

• Bellagio Dec 8, 2006.

2
Introduction to TB and poverty

• Very brief statement of data on TB and poverty
  citing some examples and emphasis of the links
  between MDGs 1 and 6, possible example of MDG 6
  formulation as symptomatic of the neglect of this
  issue to date, need to target the poor.

3
Why now?

• Plan to reach the MDGs, Global Plan 2006-2015
  and New Stop TB strategy, expanded beyond the 5
  elements of the DOTS strategy.
• 2005 as endpoint for targets of detection and
  treatment success
• New technologies coming closer to deployment
• Growing grassroots movement
• Diversity of mechanisms to address TB and poverty
  at different levels of the health system and
  across sectors

4

• More evidence on what works, opportunities for
  greater understanding of the increasing
  complexity of the TB situation
• Strong Partnership provides a mechanism to take
  action
• Change in thinking in the development communitygt
  G8, UNGA 05, and universal access, and increasing
  attention to equity issues including a rights
  based approach, gender equity,

5
New areas of emphasis

• Evidence base/research
• Vulnerable groups
• New Tools for Equity
• All three of the above areas informed by
  indicators and monitoring as contributors to good
  governance.

6
Evidence base/research

• Suspicion that we can meet global disease control
  targets while still leaving behind the poor
• Experience is being accumulated, but
• Need core set of standardised indicators,
  including quantitative and qualitative measures,
  and meta analysis of approaches and best
  practices to reaching the poor and addressing
  equity concerns
• Indicators and monitoringgt growing consensus on
  data needs and methods. Need to move beyond
  routine reporting. Additional effort neededgt
  surveys. Outcome of discussion group A
• TB patients and the affected community must be
  involved in developing and communicating the
  evidence base and in monitoring policy change
• Accountabilitygt A need to include equity
  indicators in programme management
• Accountability means shared responsibility for
  programme outcomes among all stakeholders,
• Cost effectivenessgt need to take into account
  the costs to the affected person, not only the
  costs to the health system in order to avoid
  increasing inequity
• Moving evidence through policy into action

7
Vulnerable groups

• HIV TB and MDR TB issues serve to magnify the
  particular challenges faced by vulnerable groups
  affected by TB
• Issues of access, greater disease impact
• Poor people with HIV TB and MDR TB face greater
  challenges and barriers in accessing care due to
  the increased complexity of the health
  interventions needed
• TB HIV and MDR TB have a more devastating effect
  on affected people due to catastrophic
  expenditures and effects on livelihoods
• Community based approaches have the potential to
  benefit those affected by MDR TB and HIV TB,
  particularly the poor
• Accountabilitygt TB patients and the affected
  communities equitable right to knowledge about
  their condition and services
• Sustainabilitygt these interventions are more
  costly, so this is a crucial concern
• Worldwide issue, not restricted to the developing
  countries

8
Equity and New Tools

• Short description of tools in the pipeline and
  improvements in existing toolsgt vaccines,
  diagnostics, and drugs
• Highlight potential of diagnostics to address
  equity in the shorter term and the potential
  synergies with innovations in treatment regimens
• PPPs provide a means of addressing IP (patents)
  and profitability issues and willingness to pay
  by healthy systems/governments in developing new
  tools while ensuring access to those technologies
  by the poor
• The Partnership is a means to addressing health
  systems issues in the introduction of new tools,
  eg laboratory group interacting with diagnostics
  group, integrating new tools in the PPM
  process.
• Prioritise new tools that will promote equity
• Ensuring equitable access to new technologies

9
Action plan

• Tasks
• Responsibilities and commitments
• Resources