TB DAY Milano 6.3.2008 LA RISPOSTA DELLA COOPERAZIONE ITALIANA NELLA LOTTA ALLA Tb: il caso Etiopia (2007/08) Carlo RESTI A.O. San Camillo - Forlanini, ROMA DGCS -Ministero Affari Esteri
Principali caratteristiche del contributo della Cooperazione Italiana Priorità (Africa Subsahariana e Afghanistan) Complementarietà tra investimenti multilaterali e versamenti al GF Utilizzo decrescente del canale bilaterale Contributi multilaterali su paesi high burden Valorizzazione di partnership specifiche (Stop Tb)
Principali caratteristiche del contributo della Cooperazione Italiana 0,1% AREA GEOGRAFICA 1,9% 2,4% AFRICA SUB- SAHARIANA AMERICHE MEDITERRANEO E MEDIO ORIENTE ASIA E OCEANIA 95,7%
Tb: tipologia dei finanziamenti Bilaterali: solo tramite ONG Multilaterali: contributi volontari AFGHANISTAN 1 MEuro AFRICA 3 MEuro Global Fund:2007 con arretrati e 2008 pledged
Global Fund 2007: 280 MEuro (di cui 130 del 2007, 130 di arretrati 2006 e 20 del 2005) 2008: 130 MEuro (pledge 2008) Italia 3 finanziatore dopo USA e Francia
Partnership specifiche Agenzia: Stop TB Department of the World Health Organization. Partnership con centri di eccellenza: ISS, HSR, Fondaz. Maugeri, Università di Brescia Finanziamento: 3 MEuro Periodo: 18 mesi (Q3 2007, Q4 2008)
Partnership specifiche (ct.) La situazione in Africa SubSahariana costituisce la sfida più grossa: 9 dei 22 paesi che rappresentano l 80 % di tutti i casi mondiali di Tb sono in questa regione (Democratic Republic of Congo, Ethiopia, Kenya, Mozambique, Nigeria, South Africa, Tanzania, Uganda and Zimbabwe) e dove fino all 80% dei casi sono co-infezioni HIV
Ragioni di fondo Sinergia con HIV /AIDS soprattutto nei high TB/HIV burden countries (HBCs). Fallimento dei servizi sanitari nel controllo della malattia Insufficiente partecipazione a livello di comunità Scarsa partecipazione del privato, della società civile e delle ONG nelle strategie nazionali di lotta Comparsa di forme resistenti (XDR Tb)
Italian Development Cooperation Commitment in the fight against TB, globally Financial and technical contribution to the Global Stop TB Partnership Technical collaboration in training and research (Italian WHO collaborating centres) Financial contribution to the Global Fund
Commitment in the fight against TB in Ethiopia: Since 1992, funding one of the first decentralised TB control programme, in Arsi and Bale, with an initial grant of 4,5 billion Lire, lately sustained up to 2001 Through the Italian Contribution to the HSDP (15million Euro) Through the collaboration with WHO in Stop TB partnership (3million Euro in Africa).
Italian Development Cooperation Areas for stronger commitment Fight against poverty Fight against HIV/AIDS Research (MDR TB, vaccine) Advocacy PARTNERSHIP
TB Indicators Increase in TB case detection rate to 32% in 2007 (still too low) 100 90 80 TREND IN TB CASE DETECTION, TREATMENT SUCCESS AND CURE RATES (ETHIOPIA, 1995-99 EFY) 81 82 81 76 85 TB case detection rate Increase in TB treatment success rate to 85% in 2007 Increase in TB cure rate to 69% in 2007 PERCENTAGE 70 60 50 40 30 20 10 0 66 44 45 63 65 34 1995 1996 1997 1998 1999 YEAR 30 62 32 69 TB treatment success rate TB cure rate
Treatment Success Rate Wide differences across regions from nearly 100% in Tigray to 34% in Gambella DISTRIBUTION OF TB TREATMENT SUCCESS RATE BY REGION (ETHIOPIA, 1998 AND 1999 EFY) 100 90 National Average in 1999: 85% 80 PERCENTAGE 70 60 50 40 1998 30 20 10 0 Tigray Afar Amhara Oromia Somali Benshangul/Gumuz SNNPR REGION Gambella Harari Addis Ababa Dire Dawa National 1999
Challenges in Prevention and control of HIV/TB and Malaria Human Resource (shortage and high turnover) Information exchange Liquidation of funds Translation of community conversation into action Poor implementation of Community DOTs
Two approved grants for Tb in ETHIOPIA Round 1 (26.9 M USD), approved in 2001, agreement signed in 2003, first disbursment in 2003, programme started in August 2003. This 5-year programme has proceeded very slowly, is currently ongoing, with still 6.5 million USD to be disbursed. Round 7 (11,8 M USD), approved in 2007, agreement signed in 2007, first disbursement in January 2008, programme started in February 2008.
HIV & Malaria share The GF funds approved for the TB component constitute the 5% of the total GF funds approved for Ethiopia (HIV: 78%, Malaria 17%). This is not a GF restriction, but it is due to the proposals submitted by the country to the GF.
Objectives of the Millennium TB campaign To increase national Case Detection Rate from 32% to 60% To increase and maintain treatment success rate from 84% to over 85% in all regions
Strategies 1. Involvement of HEWs in TB prevention and control activities 2. Enhanced ACSM 3. Human Resources Development (additional staff, Training of GHW) 4. Strengthening of M/E (supportive supervision, Recording and Reporting) 5. Funds mobilization and utilization 6. Ensure adequate provision of drugs and lab equipment
Critical issues Commitment at regional level is limited (lack of sense of urgency, inadequate human resources, multiple responsibilities of the existing TBL coordinators, etc ) HEWs involvement in TBL prevention and control is unsatisfactory Weak laboratory services (shortage of lab staff, weak EQA, low access to AFB microscopy) Lack of ownership on TB/HIV data (poor flow of TB HIV data from region)
Conclusioni Insistere sulla componente di rafforzamento dei servizi sanitari (HSS) Creare sinergie tra differenti attori (pubblico /privato) e differenti programmi (HIV) Promuovere e sostenere le strategie di gestione e sviluppo delle risorse umane (es. Health Extension Workers)
Children with Tuberculosis at Springfield House Open Air School, Clapham Common, London, United Kingdom, ACKNOWLEDGMENTS M.Madeo (UTL, Addis Ababa) M. Tadolini, T. Comolet (WHO, Addis Ababa) Nejmudin K, Zerihun T. (Ministry of Health) G. Riva, V. Racalbuto (DGCS MAE) Jacobson C. Lancet 2001;358:340 Photo: Hutton Getty