The WHO South-East Asia Region covers Bangladesh, Bhutan, DPR Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste

1.5 billion people live in these eleven countries, including half of the world’s poor

Five countries – Bangladesh, India, Indonesia, Myanmar and Thailand – belong to the 22 countries globally with the highest burdens of TB

<1010 to 2425 to 4950 to 99100 to 299300 or moreNo Estimate

Global TB incidence rates

TB traps people in a vicious cycle of poverty and disease—in South-East Asia, the economic and social costs are staggering —

TB levies a cost of about US$ 4 billion every year

A TB patient loses on an average, three months’ wages

A death due to TB means a loss of 10-15 years of a household’s income

In India alone, 300 000 children drop out of school and

100 000 women are forced out of their homes every year due to TB

THE BURDEN

Five million people suffer from TB in the South-East Asia Region and over half a million die every year

Incidence rates per 100,000 pop

The boundaries shown on the above map do not imply official endorsement or acceptance by WHO

The Global Plan to Stop TB and the Regional Strategic Plan for TB Control 2006-2015, outline actions towards achieving the TB-related targets under the Millennium Development Goals—halting and reversing the incidence of TB by 2015.

Over the next 10 years in the South-East Asia Region, and towards reaching the MDGs, countries aim to:

Treat and cure 25 million TB patients, including those with HIV co-infection and drug-resistant TB; and thereby,

Save 5 million people from dying of TB

THE VISION

Over the past ten years, 15 million TB patients have been cured in the South-East Asia Region and 1.5 million people saved from dying of TB.

Due to rapid expansion of high quality services,

The entire population in the Region now lives within access of DOTS facilities

Nearly 2 million new TB patients are started on treatment every year

Treatment success rates have consistently stayed over 85% and case detection rates are approaching the 70% target

PROGRESS

DOTS case detection and treatment success rates SEA Region, 1997-2005

100%

90%

80%

70%

60%

50%

Trea

tmen

t Suc

cess

Rat

e

DOTS detection rate

0% 20% 40% 60% 80% 100%

1997 1998 1999 2000 2001 2002 2003 2004 2005

DOTS coverage in the SEA Region100%

80%

60%

40%

20%

0%1997 1998 1999 2000 2001 2002 2003 2004 2005

CHALLENGESThe need to extend quality services to find and successfully treat all TB patients who have not yet been reached

Improving access to quality laboratory services as well as drugs and support for patients until they are cured, to prevent multi-drug resistance (MDR-TB)

HIV-associated TB and anti-TB drug resistance which threaten to reverse hard-won gains in TB control

Establishing close collaboration between TB and HIV/AIDS control programmes to address the needs of patients dually affected, through a patient-friendly “one-stop-shop” approach, and treating those with drug resistant TB

Limited public and private partnerships

Involving all health care providers, other ministries and departments, NGOs, business, industry and civil society at large, to ensure an equitable access to TB services

DOTS coverage in the SEA Region

1997 1998 1999 2000 2001 2002 2003 2004 2005

CHALLENGESIgnorance, stigma and misconceptions leading to poor community utilization of available services

Sustaining communication and social mobilization approaches adapted to local situations, so that people use and help themselves to use services already in place

Overstretched national health systems with limited infrastructure, scarcity of skilled staff

Developing and better managing staffing and financing for health, effectively integrating and streamlining services, through innovative approaches

Insufficient resources particularly in the longer term—the sustainability of TB control in the Region is at risk

Leveraging regional resources, complemented by external resources, to ensure human, financial and operational capacity, until we begin to reverse the epidemic

Sustaining and enhancing DOTS to reach all TB patients, improving case detection and treatment success rates

Ensuring quality diagnostics and universal access to treatment for all TB patients, while simultaneously evaluating and monitoring programme performance and impact

Establishing interventions to address HIV-associated TB and drug-resistant TB

Jointly implementing HIV/AIDS and TB prevention, treatment, care and support for those dually affected, and providing quality diagnosis and treatment with second-line drugs for those with drug-resistant TB

KEY STRATEGIES

Costs for TB control activities National TB Programmes

KEY STRATEGIESForging partnerships to ensure equitable access to an essential standard of care to all TB patients

Consolidating existing partnerships with all stakeholders including all providers, attracting new partners and engaging communities and patients to extend an equitable access to services

Contributing to health systems strengthening

Developing and better managing human and other key resources, and contributing to health systems development through integrated and innovative approaches

SUPPORT TO COUNTRIES WHO Regional and Country offices assist National TB Control Programmes with —

13%6%

12%

10%

10%

5% 5%

36%

3%

Policy, Planning, Coordination and Resource Mobilization

Advocacy, Communication and Social Mobilization

Surveillance, Monitoring and Evaluation

Addressing MDR-TB and TB/HIV

Strengthening Laboratory Networks

Establishing Private and Public Partnerships

Ensuring Effective Drug Procurement and Supply Management

Research

Operational Costs

TOTAL BUDGET 2006-2007: US$ 28 MILLION

REGIONAL OFFICE

WHO Support in the Region

Costs for TB control activities National TB Programmes

CLOSING THE RESOURCE GAP

Accelerated action and new approaches need more resources. These resources are required for: • Sustaining current successes under DOTS • Improving and expanding the scope of activities in

line with the new Stop TB Strategy • Establishing interventions to combat drug-resistant

TB • Effectively addressing TB/HIV • Forging partnerships with all health care providers

and other partners• Informing, involving and empowering communities • Strengthening health systems to deliver quality

services • Enabling and promoting research

2006 2007 2008 2009 2010

US$

mill

ions

Sustaining and Improving DOTSAddressing MDR TBCombating TB/HIVAdvocacy, Communication andSocial MoblisationGeneral Health Systems CostsGap

0

100

200

300

400

500

600

700

800

TOTAL BUDGET 2006-2007: US$ 28 MILLION

GAPUS $ 5 million

GAPUS $ 2.9 million

REGIONAL OFFICE

COUNTRYOFFICES

Country Offices

Regional Office

WHO Support in the Region

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SRI LANKA

TIMOR L’ESTE

MALDIVES

NEPAL

INDIA

BHUTAN

MYANMAR

THAILAND

INDONESIA

BANGLADESH

Key Partners in Action against TB in the SEA Region

National TB programmes, WHO Regional and Country Offices and Partners, covering 1.5 billion people

Compiling and articulating evidence in a credible way Monitoring progress, assessing trends and evaluating the impact of interventions Guiding policy, norms, standards, advocacy positions and plans through technical

support and evidence-based approaches Building sustainable national capacities for wider implementation, strengthening

laboratory networks, ensuring access to quality drugs and improving national health information systems

Convening and sustaining national and regional partnerships and leveraging resources

Setting the agenda for stimulating the development and testing of new approaches and tools through research.

THE NETWORK

RNTCPCIDA, DFID, GDF, GFATM, USAID, WB, WHO

NTP BNMT, DFID, GDF, GFATM, LHL, JICA, UNION, WHO NTCP GFATM,

WHO

NTPGDF, JATA, JICA, PSI, 3 Disease Fund, UNION, WHO

NTP BRAC & other national NGOs, DFB CIDA, GDF, GFATM, KNCV, UNION, USAID, WB, WHO

NPTCCD GDF, GFATM, WB, UNION, WHONTP GDF,

WHO

NTP CDC, GFATM, WHO

NTPCIDA, DFID, FHI, GFATM, GDF, KNCV, MSH, PATH, TBCAP, USAID, WHO

NTP CIDA GDF, WHO

NTP GDF, WHO, GFATM

The boundaries shown on the above map do not imply official endorsement or acceptance by WHO

TOWARDS A WORLD FREE OF TB

Private involvement in delivering TB services: The Mahavir Hospital, a private hospital in Hyderabad, India, successfully piloted a private partnership programme in collaboration with the government, to expand DOTS within the city through private medical practitioners. This initiative led the way for establishing wider model private and public partnerships for TB care.

National partnerships for wider sustainability: A wide social movement (Gerdunas) involving several organizations and groups has been established in Indonesia, creating TB awareness and broadening the national resource base for TB services. National partnerships of this kind will help sustain efforts in the years to come.

Realizing the potential in South-East Asia: South-East Asia is a manufacturing hub, already a major supplier of first-line anti-TB drugs to the Global Drug Facility. The pharmaceutical sector in the Region offers great potential for research and development as well as for manufacturing new and more effective tools for diagnosis and treatment.

Community-based TB Care: Women community volunteers, the shastho shebikas of BRAC in Bangladesh, demonstrated success of TB programmes in poor settings, and among unorganized groups with minimal resources. Today, several countries have established community-based models for TB care.

We can succeed! A number of innovative and successful interventions by governments, NGOs and the private sector have already inspired wider replication