Intensified Support

1
Intensified Support Action Countries (ISAC)
A StopTB initiative to be implemented through the
DOTS Expansion WG
Stop TB Department
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ISAC - Purpose

• A special emergency initiative to accelerate
  DOTS expansion and reach the 2005 targets, within
  the Global Plan to Stop TB, and ultimately the
  2015 MDGs

Stop TB Department
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ISAC - A key Clarification

• The DEWG (and WHO) is fully committed to
  continue its regular efforts to support all 22
  HBCs and other countries in need.
• ISAC is an EXTRAORDINARY and ADDITIONAL effort
  to accelerate TB control

Stop TB Department
4
ISAC - Objectives

• Identify countries for immediate acceleration of
  TB control efforts through a variety of
  interventions
• Actively and intensively support such countries
  to achieve the 2005 targets

Stop TB Department
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ISAC - Criteria for Country Selection

• Burden of disease and/or of TB/HIV dual infection
  (absolute number and/or rate)
• Presence of, or desire to have, in-country WHO or
  Stop TB partners staff and intensified support
• Clear commitment and potential capacity to
  implement at country level and enabling
  environment
• Availability of funding for TB or TB/HIV control
  activities from GFATM, bilaterals and banks
• Potential for collaboration with GDF for drug
  procurement

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ISAC - Countries 1st tier

• 1st Tier
• India (already ISAC)
• China
• Indonesia
• Kenya
• Pakistan
• Romania
• Russian Federation
• Uganda
• Peru
• plan not yet available

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ISAC - Key Actions - India

• Massive increase in managerial capacity at
  district level (more than 100 additional
  qualified staff WHO local consultants)
• WHO intensified support to strengthening and
  implement PPM DOTS programme

Stop TB Department
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ISAC - Key Actions - China

• Massive increase in managerial capacity
  (additional qualified staff) at central and
  provincial units of NTP (WHO-CDC on the job
  training)
• WHO intensified support to strengthening link
  with hospitals and implement PPM DOTS programme
• Increasing WHO technical support to prepare and
  implement training activities

Stop TB Department
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ISAC - Key Actions Uganda

• Establish National STB Partnership
• Strengthen and expand monitoring and supervision
  capacity
• Strengthen technical capacity to expand community
  based TB care and laboratory network
• Increase WHO technical assistance

Stop TB Department
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ISAC - Budget Requirements
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ISAC Donors

• GFATM Principal recipient (China, Indonesia,
  Romania)
• USAID (global bureau and country missions)
• CIDA (grant to Stop TB)
• Italy government and region of Lombardy
• Japan, DFID, Norway

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ISAC Next steps

• Review activities and estimate potential outcomes
  (at 6 and 12 months)
• Review and confirm the list of 2nd year ISAC
  activities
• Review and start tier 2 countries (September 04)
• Phase out ISAC and incorporate technical support
  to countries as part of plans to scale up TB
  control (during 2005 for 2006 implementation)
• Keep ISAC as an emergency mechanism to intensify
  actions in special cases in the future

Stop TB Department
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ISAC - Countries 2nd tier

• 2nd Tier (for discussion)
• Bangladesh
• DR Congo
• Ethiopia
• Haiti
• Mozambique
• Myanmar
• Rwanda
• Tanzania
• Zambia
• Sri Lanka

Stop TB Department
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ISAC increases absorptive capacity
Needs for TB control activities
New financial resources
Increased capacity for TB control
x
TB control activities
National financial resources for TB
Health care system for TB
Human resources for TB
I S A C (additional capacity)
Stop TB Department
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China Progress Since Partners Forum

• State Council meeting on TB commitment to reach
  60 CDR by end of 2004, 70 by end of 2005
• Central government increased TB budget from 5
  million to 35 million for 2004-05
• Round 4 GFATM TB project approved (56 million)
• New policies to facilitate increase in
  case-detection being planned
• Continued DOTS expansion expected to reach 95
  population coverage by end of 2004
• Case-notification rate exceeding 2003 level

16
China Existing Constraints

• Insufficient human resource capacity in NTP,
  starting at central level
• Inadequate management of NTP
• Inadequate technical guidance provided by central
  level
• Technical elements of DOTS weak in many
  provinces quality of DOTS a problem
• Absorptive capacity a problem at peripheral level

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China ISAC Proposal

• National part GFATM
• Hire and place 24 staffs into 24 provinces
• CDC-WHO training programme for provincial staffs
  (2-yr)
• National consultants
• Equipment, vehicles, set-up of training center

• International part WHO
• Help train and manage 24 staffs
• Provide training and mentoring for trainee
• 3 international staffs 2 national staffs and
  short-term consultants to provide technical
  assistance