Global TB Control Through Partnerships
April 9, 2013
Jacob Eckles
Intern, CSIS Global Health Policy Center
The U.S. Government is the leading bilateral donor for global tuberculosis (TB) control. Over the past 13 years, USAID has invested more than US$1.6 billion to support national TB programs in 28 high-burden countries through bilateral programming. USAID’s long lasting partnership with Netherland’s-based KNCV Tuberculosis Foundation has led to the diagnosis and treatment of more than 24 million tuberculosis patients throughout the world.
On March 21, KNCV honored USAID for the agency’s contribution to the field of global TB control. Dr. Ariel Pablos-Mendez, Assistant Administrator for Global Health, accepted the "Award for Eminence in TB Control" on behalf of USAID during a luncheon ceremony at the residence of the Dutch Ambassador in Washington, D.C. During the award ceremony, Ms. Gerdy Schippers, director of KNCV Tuberculosis Foundation, noted that successful global TB control is contingent on USAID’s past and future involvement in the efforts. Despite worldwide progress, the future holds many challenges. A luncheon followed the awards ceremony, at which Ambassador Eric Goosby, from the Office of Global Health Diplomacy at the U.S. Department of State, acknowledged the productive partnership of USAID-KNVC and noted the importance of these types of partnerships.
Ongoing Challenges
Globally, five out of six regions are on track to reach Millennium Development Goal number six for TB reduction because of the DOTS (directly observed therapy) program and other TB efforts. However, as Ms. Schippers noted, TB is a moving target; and the rise of multi-drug resistant tuberculosis (MDR-TB) is an ever increasing global threat, affecting rich and poor countries alike. Additionally, sub-Saharan Africa in particular bears a dual burden of HIV and HIV-associated TB epidemics. These epidemics have a devastating potential, especially since the majority of AIDS-related deaths are from TB; but, they can be mitigated through improved access to comprehensive TB and HIV care.
Policy Recommendations
Dr. Sharon Stash, Senior Fellow and Deputy Director at the Global Health Policy Center at the Center for Strategic and International Studies (CSIS), spoke at the awards ceremony and noted options for how the U.S. government can advance global TB control:
Maintain a focus on TB as a global health policy priority
U.S. global health policy faces hardships during this time of economic uncertainty. Resources at U.S. agencies involved in global health are already stretched thin; trying to ensure that patients continue to receive life-saving HIV treatment as PEPFAR progressively transitions programs to national hands. It is important that both the TB and HIV communities encourage Congressional leadership and the Obama administration to continue to support TB efforts around the world. Dr. Stash noted that, according to the WHO, the world will likely experience a global funding gap of US$1.6 billion for TB programs between 2012 and 2016. However, this funding gap does not present an insurmountable challenge if public and private sector partner together to support TB control efforts.
Expand services and support innovation through partnerships
Dr. Stash also stated that in the current budget environment, “sustained and substantial U.S. financial commitments to the Global Fund can provide an example to other donor countries that are also facing economic challenges.” Emphasizing partnerships in the public and private sectors (i.e., public-private partnerships) can help the U.S. government achieve further gains in TB control. Recent successful examples include both the partnership that developed the new rapid diagnostic, GeneXpert, and the partnership that negotiated a concessionary rate for the technology so that it is more affordable for poor countries and development partners.
Target technical assistance to today’s priorities
As the global development community increasingly emphasizes country ownership, targeted U.S. technical assistance can help countries strengthen national efforts. The U.S. government can continue to promote the use of health metrics to target resources toward the most effective interventions for the populations that need them, and to identify and remedy management efficiencies. Bi-lateral support can be used to encourage individual countries to approach topics that are politically and socially difficult for them to address. For the coming years, skillful diplomacy, careful analysis, and targeted technical support are needed to ensure that countries reach their most vulnerable populations. Finally, U.S. agencies can continue to work with Ministries of Health and other organizations to resolve management challenges that work against the effective integration of TB and HIV/AIDS control programs.
Continued Efforts by the Global Community
During his acceptance speech at the awards ceremony, Ariel Pablos-Mendez, Assistant Administrator of Global Health at USAID, noted that international partners are key in the future of global health development. Coordinating these partnerships and ensuring their quality and effectiveness is critical for TB-control.
As the final FY2013 budget is implemented, there will be a decrease in overall PEPFAR money, but an increase in US funding to the Global Fund to Fight AIDS, Tuberculosis and Malaria; US Global Fund donations are up 27 percent from FY 2012. This important partnership between the US government and the Global Fund is instrumental to elevate TB control measures, address a growing problem of drug resistance, and increase programmatic efficacy, and help to close the US$1.6 billion funding gap
