The GLC mechanism

1
The GLC mechanism

• New resources urgently needed to ensure
  sustainability of a
• successful partnership initiative
• Thelma E. Tupasi, MD
• Acting chair of the Working Group on DOTS-Plus
  for MDR-TB

2
Response to MDR-TB by linking concepts
RATIONAL USE OF DRUGS
ACCESS Price quality
GLC mechanism
Training
Technical assistance
Monitoring
Prequalification
GLC review
POLICY FOR TB CONTROL
Pooled procurement
Guidelines development
Operational research
3
Scaling up of DOTS-Plus through the GLC
April 2005 34 projects
4
WHO-GLC approved DOTS-Plus projects by March 2005
Abkhazia Bolivia Costa Rica Dominican
Republic Egypt El Salvador Estonia
Georgia Haiti Honduras India Jordan Kenya
Kyrgyzstan Latvia Lebanon Malawi Mexico Moldova
Nepal Nicaragua Peru Philippines Romania Russia
Syria Tunisia Uzbekistan
GLC-approved DOTS-Plus projects
5
GLC Lessons Learned

• DOTS is priority and is a GLC requirement
• Prevents the emergence of MDR-TB
• DOTS-Plus can be integrated in a well functioning
  DOTS programme
• It is feasible, effective and cost-effective in
  countries of limited sources
• DOTS-Plus strengthens DOTS
• Enhancing laboratory capacity
• Increasing case finding
• Enhancing treatment delivery and improving cure
  rates of all TB cases.

6
The crucial role of the GFATM
Bolivia Dominican Republic Ecuador Egypt El
Salvador Georgia Honduras India
Kenya Kyrgyzstan Moldova Mongolia Nicaragua Parag
uay Peru Philippines Romania Russia
Serbia Uzbekistan Bangladesh China Indonesia Mya
nmar Turkmenistan Uganda Viet Nam
GFATM approved
GFATM pipeline
7
GFATM current and future savings using the GLC
mechanism (round 1-4)
No of MDR TB patients to be enrolled in GFATM
approved projects 13,943
Projected cost according to prices in low
income country 160 millions (USD)
Cost using the GLC mechanism 46 millions
(USD)
Total savings 115 million (USD) !!
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Second-line drug use, October 2004
No information yet Second-line drugs NOT
available Second-line drugs widely available
9
Resistance Pattern of Cases
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Basic DOTS is not enough in these settings
Kazakhstan 2002
14.2 MDR among new and 56.4 MDR among
re-treatment Survey 47 retreatment
Retreatment 26 of ss 6/ 31 provinces
surveyed MDR among new cases (2.1 10.4) MDR
among retreatment (17.5 36.6)
China 2003
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GLC related challenges and constraints in the
rapid expansion phase

• The GLC faces a severe financial crisis to
  support
• Manpower WG/ GLC secretariats (same since 2000)
• The comprehensive package of GLC operations
• Coordination of SLD Procurement
  prequalification
• Compensation for GLC member institutions and
  partners involved in technical assistance/monitori
  ng
• Intensified DOTS-plus capacity-building

12
Budget situation 2005 DOTS-Plus and global
drug-resistance surveillance
13
Resources neededDOTS-Plus global coordination
costs, 2006-2015, 60 million USD
14
What is needed to survive 2005 and to scale up

• How much?
• 1.5 million USD minimum to prevent a collapse of
  the GLC in 2005
• 6 million USD annually for a comprehensive
  package to control MDR-TB
• To support partners involved in global
  coordination and, pooled drug procurement and TA
  IUATLD, CDC, KNCV, MSF, PIH, WHO.

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EVA, 24, STUDENT, GOT THAT CHANCE IN A GLC
PROJECT!