Professional Documents
Culture Documents
tuberculosis control
in Indonesia
A brief history of
tuberculosis control
in Indonesia
WHO/HTM/TB/2009.424
Table of contents
Acknowledgements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IV
Abbreviations and glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V
Executive summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . VII
1. Tuberculosis control before 1995. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2. The health system. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
3. Laying the foundation partnership & training. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
4. Scaling up - the first strategic plan - the DOTS era (20022006). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.1 Funding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.2 Human resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.3 Drug supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.4 Pilot projects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
6
8
8
9
7.1.1
7.1.2
7.1.3
7.1.4
Laboratories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Training and human resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Monitoring and evaluation systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
An effective drug supply and management system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
16
17
17
7.2
7.2.1 TB/HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
7.2.2 Drug resistance surveillance and treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
7.3
7.4
7.5
7.6
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
8. Funding needs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
9. Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
III
Acknowledgements
The World Health Organization (WHO) gratefully acknowledges the contributions of the individuals listed below, who
assisted in the preparation of this document.
Y Anandita
National Tuberculosis Control Programme (NTP)
Indonesia (Advocacy, communication and social
mobilization [ACSM] Unit and Tuberculosis [TB] Unit)
Carmelia Basri
Expanded Programme for Immunization (EPI) Indonesia
Besral
University of Indonesia (ARI surveys)
Ari Probandari
Gajah Mada University, School of Medicine (hospital
evaluation) Indonesia
Erwin Sasangko
WHO Indonesia (WHO Country Office)
Jane Soepardi
NTP Indonesia (Manager, sub-directorate)
FX Budiono
NTP Indonesia (Partnership and planning coordinators)
Jan Voskens
KNCV Tuberculosis Foundation, Country Office,
Indonesia
Franky Loprang
WHO Indonesia (WHO Country Office)
Nadia Wiweko
NTP Indonesia
Firdosi Mehta
WHO Indonesia (WHO Country Office)
Yudarini
University of Indonesia (ARI surveys)
This work was carried out as part of a project supported by the Bill & Melinda Gates Foundation, and we thank the
Foundation for its support.
IV
GDF
Global Drug Facility
ACSM
advocacy, communication and social mobilization
GDP
gross domestic product
ADB
Asian Development Bank
GERDUNAS
Gerakan Terpadu Nasional Penanggulangan TB
(Indonesian Stop TB Partnership)
ARI
annual risk of infection
GLC
Green Light Committee
Askeskin
asuransi kesehatan orang miskin (health insurance for
the poor)
Global Fund
The Global Fund to Fight AIDS, Tuberculosis and Malaria
ATS
American Thoracic Society
GNI
gross national income
AusAID
Australian Agency for International Development
HDL
hospital DOTS linkage
CI
confidence interval
HIV
human immunodeficiency virus
CIDA
Canadian International Development Agency
IMA
Indonesian Medical Association
DFID
Department
Kingdom)
for
International
Development
(United
DOTS
The basic package that underpins the Stop TB Strategy
EPI
Expanded Programme for Immunization (Indonesia)
FDC
fixed-dose combination (drugs in the form of a tablet)
IMAI
integrated management of adult illness
INH
isoniazid
ISTC
International Standards of TB Care
JICA
Japan International Cooperation Agency
KNCV
KNCV Tuberculosis Foundation
Puskesmas
Pusat Kesehatan Masyarakat (community health centres)
KuIS
Coalition for Health Indonesia
SCC
short-course chemotherapy
MDG
Millenium Development Goals (United Nations)
SCVT
Stichting Centrale Vereniging ter Berstrijding van de
Tuberculose
MDR-TB
multidrug-resistant TB
MoH
Ministry of Health (Indonesia)
MSH
Management Sciences for Health (Indonesia)
NGO
nongovernmental organization
NIHRD
National Institute of Health Research and Development
(Indonesia)
NTP
national TB control programme
PAS
para-aminosalicylic acid
PCR
polymerase chain reaction
PERSI
Indonesian Hospital Association
PIPKRA
Pertemuan Ilmiah Pulmonologi dan Kedokteran Respirasi
PMTCT
prevention of mother-to-child transmission
VI
STP
Stop TB Partnership (international)
TB
tuberculosis
TBCAP
TB Control Assistance Programme
TBCTA
Tuberculosis Coalition for Technical Assistance
THE
total health expenditure
TORG
TB Operational Research Group, NTP
UNITAID
the international drug purchase facility
USAID
United States Agency for International Development
WHO
World Health Organization
Executive summary
This report summarizes the history of tuberculosis (TB) control in Indonesia, assesses the impact of the countrys National
TB Programme (NTP) on the epidemiology of TB in Indonesia, and outlines barriers to future progress. It was prepared as
part of a World Health Organization (WHO) project, with contributions from the KNCV Tuberculosis Foundation (KNCV) and
the NTP, and was funded by the Bill & Melinda Gates Foundation. The target audience is the Government of Indonesia, its
partners, the community at large, donors and other NTPs, all of whom can learn from the experience described here of
investment in TB control the approaches used, the outcomes achieved and the challenges faced.
Indonesia is ranked as having the third highest TB burden in the world, with 244 prevalent (active) TB cases per 100 000
population, which, in 2008, equated to an estimated 565 614 people living with TB. The prevalence of infection with the
human immunodeficiency virus (HIV) among the adult population nationally is estimated at 0.16%, and HIV infection is
characterized as a concentrated epidemic; however, in Indonesias Papua province, the prevalence is 2.5%, which is
considered a generalized epidemic. Twelve provinces have been identified as priority areas for HIV interventions, and an
estimated 193 000 people are living with HIV in Indonesia (1). Among incident (new) TB cases, the estimated prevalence
of HIV is 3.0% nationally (2). Multidrug-resistant TB (MDR-TB) is estimated to account for 2.2% of all TB cases nationally;
this is lower than the estimated South Asian regional average of 4.0%. Given the high burden of TB in Indonesia, the 2.2%
represents 12 209 MDR-TB cases emerging every year (3).
In the 1980s, through its Health Sector Development Plan, Indonesia established a public health system using a design
founded on primary health concepts (4). The model focuses on extending basic health services to the poor, and relies on
providers with modest training; the providers operate at the periphery, but use a five-tier referral system. The NTP is fully
integrated and is delivered through the primary health system.
The Health Sector Development Plan made health services more accessible for most of the population, and health
outcomes improved consistently from the 1980s until the present (4). In 1999, the Government of Indonesia initiated
a process of political and administrative decentralization, whereby districts became the key players in all fields of
governmental activities, including health care. Decentralization continues today.
Indonesia was one of the first countries to pilot short-course chemotherapy (SCC) for TB, in 1977. The Indonesian
Ministry of Health (MoH) then piloted the internationally recommended strategy for TB control DOTS in 1993, and
in 1995 it formally established DOTS as the national policy. Expansion of DOTS after 1995 was initially slow, and case
detection rates remained below 30% until the year 2002.
In 1999 and 2000, a foundation was laid for the acceleration of DOTS expansion. First, GERDUNAS (Gerakan Terpadu
Nasional Penanggulangan TB) a broad national TB partnership designed to bring wide acceptance of the DOTS strategy
and coordinate the activities of all TB partners was officially launched by Indonesias Minister of Health on World TB
Day in 1999. Then, in 2000, financial support from the Dutch Government was used to establish a comprehensive DOTS
human resource development programme that targeted all levels of the NTP (5). Expansion of DOTS was facilitated by
intensive collaboration with KNCV and WHO as technical partners (6).
In 2001, the first five-year strategic plan was developed, and 2002 marked the beginning of an era of increased funding for
TB control by external donors, notably from the United States Agency for International Development (USAID) through the
Tuberculosis Coalition for Technical Assistance (TBCTA), which was led by the Canadian International Development
Agency (CIDA) and KNCV. This funding focused on further capacity building and DOTS expansion in the heavily populated
VII
provinces of Indonesia. Grants from the Global Drug Facility (GDF) a allowed the country to establish TB drug buffer
stocks in the rapid expansion phase. During 2003, Indonesia received additional support from the Global Fund to Fight
AIDS, Tuberculosis and Malaria b (referred to as the Global Fund), which increased the funds available for TB control
by 40%. Through Global Fund support, the NTP was able to employ more staff, and to stimulate and scale up many of
its usual functions.
The TB case detection rate increased rapidly from 30% in 2002 to 76% in 2006. The treatment success rate has been
above 85% since the year 2000, and it reached 91% in 2007. Indonesia was the first high TB burden country in the WHO
South-East Asia Region to achieve the global targets for case detection (70%) and treatment success (85%).
Two successive nationwide prevalence surveys indicate that the incidence of TB has fallen by about 2.4% per year
since 1980; tuberculin surveys used to estimate the annual risk of TB infection carried out between 1972 and 1987 in
10 provinces of the country support this finding (7-9).
As shown in Figure 1, the NTP has been improving case detection and cure for more than a decade (2) successfully
treating more than half a million TB patients (567 620) over 10 years. However, the existence of the programme does not
fully explain the estimated decline in overall TB prevalence over 25 years. The decline is probably due to the widespread
use of SCC, combined with overall socioeconomic improvement as demonstrated by the steady increase in gross
national income per capita (10) and other aspects of high-quality TB control, such as improved case detection, better
case holding and increased treatment success.
143937
140000
115478
120000
100000
80243
80000
65724
60000
40000
20000
2738
9592
11635
1996
1997
23144
23139
1998
1999
45730
46260
2000
2001
0
1995
2002
2003
2004
2005
Figure 1. TB cases successfully treated under the Indonesian NTP since the start of the DOTS strategy, 1995-2005
a The GDF, which is part of the Stop TB Partnership, is a mechanism to expand access to and availability of high-quality anti-TB drugs
VIII
Despite administrative and financial decentralization of the health system since 2006, 90% of TB programme operations
at the district level are still funded by the central TB programme or by donors (primarily the Global Fund), and few
operations are financed by the district or provincial governments. In 2007, due to problems with financial management
and oversight, the Global Fund officially restricted funding to Indonesia for all grant components for six months. The
restricted funding provided for continuation of life-saving activities during the six months, and for direct purchase of an
emergency supply of TB drugs through the GDF. During the restriction period, the NTPs dependency on donor funds and
its vulnerability quickly became apparent, as the programme faced severe attrition of staff whose positions had previously
been financed by the Global Fund, and cessation of funding for operational activities, such as monitoring and supervision.
Case detection and notification rates were reduced during this time, although treatment outcomes remained stable. The
long-term effects of the suspension have yet to be evaluated, but have opened a discussion about concerns surrounding
financial management, donor dependence and plans for future financial sustainability.
Indonesia is in transition in terms of epidemiological and demographic factors; it is also adjusting to the political and
administrative decentralization of the health sector that was initiated in 1999. The government has shown its commitment
to improving the performance of the health system by developing universal insurance schemes that target the poor and
by increasing the general government health expenditure as a percentage of total general government expenditure from
4.1% in 1995 to 5.3% in 2006. However, the total health expenditure as a percentage of gross domestic product (GDP)
remains low, at 2.2% in 2007 (11), and the global economic crisis, which began in 2008, is expected to lead to budget
cuts within the health sector.
Following major expansion of DOTS over the last decade, with clear improvements in case detection and treatment
success, the NTP has begun to implement a second strategic plan for 200610 (12). This plan is built on a solid DOTS
foundation with the aim of strengthening the quality of service delivery and increasing the participation of hospitals in
both the public and private sectors. New strategies include creation of hospital DOTS linkages, treatment of MDR-TB,
improvement in the laboratory network and strengthening of a quality assurance system; in addition, HIV collaborative
activities are poised for expansion.
As with the scale up of DOTS in the past, if the TB programme is to achieve the goals outlined in the second strategic plan,
sustained financing will be essential. A sustainable solution will mean dealing with weakness in financial mechanisms and
district-level contribution to health. The NTP, in line with objectives of the MoH, has developed strategies to encourage
district-based contribution to health budgeting, including contributions for control of TB. The strategies also focus on
central and local partnerships, to ensure collaboration and communication among all sectors to attain these goals. If case
detection continues to increase and treatment success remains high, the decline in TB incidence is likely to be sustained
or be even more rapid.
IX
1995
After Indonesian
independence in 1949,
diagnosis and treatment of TB
a Indonesia is divided into 33 provinces, each of which is subdivided into regencies and cities, which are further subdivided into districts.
b Abbreviations for TB treatment regimens follows standard WHO abbreviations and can be found in Treatment of tuberculosis: guidelines
two national
TB regimens,
the conventional course
and the SCC
standardized methods
directly-observed
120000
347,576 deaths averted
100000
80000
60000
40000
20000
0
2000
2001
2002
2003
2004
2005
2006
Figure 2. TB deaths averted under the Indonesian NTP since the DOTS strategy was introduced
2. The
health system
In the 1980s, the public sector component of Indonesias
health system was put in place under the Indonesian
Health Sector Development Plan, using a design founded
on primary health care concept (4). The model differed
from previous ones in that its focus was on extending
basic health services to the poor it relied on providers
with modest training and operated at the periphery.
By the 1990s, the Government of Indonesia had built
and staffed more than 7100 health centres, 19 000
subcentres, 285 district hospitals and 50 special referral
hospitals (4). Health services in Indonesia are organized
at five levels: central, provincial, district, subdistrict and
village. Various facilities are used at the different levels,
but at the core of each level is the primary care centre,
which forms the basic unit. The system is supported by
a referral system consisting of district, provincial and
central hospitals, which provide secondary and tertiary
care.
Indonesias large private-health sector expanded rapidly,
partly as a result of the Ministry of Health (MoH) decision
to allow public-sector staff to work part-time in private
practice. The MoH saw this as a way to supplement low
public-service salaries and allowances, while retaining
qualified practitioners in the public sector. Currently,
MoH investment
Indonesia is
in transition in terms of
epidemiological and demographic
factors; although health
expenditure has risen, it
remains low.
improve quality
of services delivered
by increasing skills and improving
(20022006)
The first part of the Indonesian Health Sector Development
Plan (200206) was aimed at DOTS expansion. It
was based on the assumption that decentralization
would initially draw resources away from public health
programmes and, as such, would weaken the NTP.
Donor funding for the plan was targeted at securing
core operations for nationwide DOTS implementation,
including provision of finance directly to the district.
At that time, the level of funding contribution to health
by the district government was not known, but was
expected to be less than the amount needed to scale
up DOTS. This suspicion was later confirmed in a district
health financing survey undertaken by the University of
Indonesia (16). The strategic plan foresaw a gradual shift
from donor funding to local government sources over a
period of five years.
projected to
reach USD 80 million
4.1 Funding
In 2006, Indonesia spent approximately USD 7 billion on
health care, which was about twice the amount spent in
1995, although the total health expenditure (THE) as a
percentage of GDP remained low, being 2.2% in 2007
(Figure 3). About half of THE was from the government
9000
3.0
8000
2.5
7000
6000
2.0
5000
1.5
4000
3000
1.0
2000
0.5
1000
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
0.0
90
80
70
US$ millions
60
50
40
30
20
April - June 2004
(GF 19 Provs)
10
0
2002
2003
Government
Loans
2004
2005
2006
Grant
Global Fund
2007
2008
2009
Gap
DUTCH GOVT.
DFID - MDGs
25
60
20
50
40
15
30
10
20
5
0
30
10
1998
1999
2000
2001
2002
2003
2004
2005
2006
Donor funding
CDR
Development of human
resources in the NTP laid the
foundation for the rapid expansion of
a The GDF, which is part of the Stop TB Partnership, is a mechanism to expand access to and availability of high-quality anti-TB drugs
10
TB epidemiology
& measurement
5.1 Case detection, notification rates and
treatment success
14.0
the increase in
suspect evaluation rates,
sm+
suspect
& positive
12.0
2000000
1800000
1600000
8.8
1400000
8.0
8.0
11.6
11.3
10.4
10.0
12.5
12.3
12.1
1200000
1000000
6.0
800000
4.0
600000
400000
2.0
200000
0.0
2000
2001
2002
2003
2004
2005
2006
2007
2500
2005
2004
2006
2000
1500
1000
500
INDONESIA
NORTH SULAWESI
GORONTALO
11
WEST IRIAN
NORTH SUMATERA
Figure 7. TB suspect evaluation rate per 100 000 population by province, Indonesia, 20042006
CENTRAL SULAWESI
WEST KALIMANTAN
WEST NUSA
NAD
JAMBI
SOUTH KALIMANTAN
BENGKULU
WEST SULAWESI
PAPUA
SOUTH SULAWESI
MALUKU
WEST SUMATRA
BANGKA BELITUNG
CENTRAL KALIMANTAN
BANTEN
EAST JAVA
WEST JAVA
CENTRAL JAVA
DI YOGYAKARTA
EAST KALIMANTAN
SOUTH SUMATERA
LAMPUNG
BALI
RIAU
DKI JAKARTA
NORTH MALUKU
RIAU ISLANDS
140.0
120.0
51
new smnew EP
100.0
49
80.0
48
60.0
47
40.0
46
20.0
45
0.0
50
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
National - female
44
2001
2002
2003
2004
2005
2006
1000
100
100
10
10
2001
0 - 14
2002
2003
15 - 24
2004
25 - 34
2005
35 - 44
1000
2001
45 - 54
2002
2003
55 - 64
2004
2005
65+
Figure 10. TB notification rate by age group per 100 000 population, Indonesia, 20012006
Source: National TB Programme data
%
100
80
60
40
20
0
1997
1998
1999
Not evaluated
Died
2000
2001
2002
Transferred out
Completed
2003
2004
Defaulted
Cured
2005
2006
Failed
12
500
% fall cf 1990
400
300
28%
35%
200
Sumatra
1980 survey
Java - Bali
1990
KTI (East)
125
217
321
246
342
67
146
255
203
311
422
54%
433
42%
100
National
2004 survey
13
complemented previous
surveys of 1985
Two projects have been launched to strengthen the allcause-of-death reporting system and to generate better
TB-specific mortality estimates. In 2006, the National
Institute for Health Research and Development (NIHRD)
in collaboration with the NTP and supported by WHO
and DFID launched a pilot project to strengthen
the mortality and cause-of-death registration system
in Indonesia. A working group comprising different
ministries and stakeholders was set up to advise on
a streamlined mechanism for notifying deaths and
compiling mortality statistics. The approach developed
paid particular attention to maximizing accuracy of TB
death registration, and was piloted in three sites on Java
Island. A study on the accuracy of a verbal autopsy tool
was conducted in conjunction with this project; results
are being analysed (15).
In 2007, cause-of-death
reporting mechanisms
were put in place at sentinel sites,
1400
1200
1000
800
600
400
200
0
30
25
20
15
10
5
0
1979
1984
1989
1994
1999
2004
14
The effects on TB
activities from the cessation of the
15
(20062010)
16
suboptimum areas of
human resource development
17
better surveillance
data are required
to estimate the
true magnitude
of TB/HIV coinfection
survey among the adult population (1549 years) in
Papua province indicated a 2.5% HIV prevalence in
the general population (1). From 2004, antiretroviral
therapy was provided free of charge and, by the end of
2007, Indonesia had 296 centres providing HIV testing
and voluntary counselling, 153 hospitals providing
HIV testing and antiretroviral treatment, 19 hospitals
providing prevention of mother-to-child transmission
(PMTCT) programmes and 20 referral networks for the
integrated management of adult illness (IMAI) (15). In
2007, 25% of HIV cases were on antiretroviral therapy.
There is no system of national surveillance of HIV among
TB patients. The prevalence of HIV among TB patients
was 1.9% (95% confidence interval (CI), 1.62.2%) in a
survey of TB patients in Jakarta a province with a low
prevalence of HIV (27). However, in some provinces,
TB/HIV coinfection is reportedly much higher. Better
surveillance data are required to estimate the true
magnitude of coinfection. The national estimate of HIV
infection among incident TB cases is currently 3.0%.
National TB and HIV programmes in Indonesia have
developed experience in implementing collaborative
TB/HIV activities. Best practices are being converted
into national guidelines (15). However, much remains
to be done in terms of refining policies and scaling
up services. Mechanisms for improved coordination
between the NTP and the HIV/AIDS programme at all
levels, especially in high-burden provinces, are being
drug resistance
surveys are planned in
seven provinces
18
drug resistance
have not yet been
standardized
or regulated in Indonesia.
Poor commitment of
local governments
has been demonstrated through
19
decreasing financial
contributions
to health and TB control
The one-gate
policy mentioned above was
introduced in 2008 to address the unrealized central
budget allocation for drugs. The NTP and the central
GERDUNAS committee are advocating for allocation
of additional budget for drugs, and an emergency GDF
grant application has been initiated to fill the gap. In
addition, the NTP has been actively assisting local
manufacturers to become prequalified and included
20
21
22
8.
Funding needs
The total budget required to support the planned
expansion of the TB control programme from 2006
to 2010 is USD 287 247 285, divided almost equally
throughout the five-year period. Currently, the difference
between the total estimated budget requirement and the
budget available (i.e. the funding gap) is USD 69 373 604,
or 24% of the total budget (12).
subject of ambitious
financing system
is not optimal.
23
Conclusions
450
400
2015
target
350
2015
target
300
250
200
150
100
50
0
Prevalence
1990
2007
46
500
39
92
2 22
TB cases
successfully treated
has consistently been above 85%
2 44
The proportion of
4 43
9.
Mortality
2015 target
24
important challenges
TB incidence
350
300
250
200
150
100
2006
2004
2002
2000
1998
1996
1994
1992
50
1990
400
25
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26