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World Bank Document 32926 WORLD BANK WORKING PAPER NO. 56 Stopping Tuberculosis in Public Disclosure Authorized Central Asia Priorities for Action Joana Godinho Jaap Veen Masoud Dara James Cercone Public Disclosure Authorized José Pacheco Public Disclosure Authorized Public Disclosure Authorized THE WORLD BANK WORLD BANK WORKING PAPER NO. 56 Stopping Tuberculosis in Central Asia Priorities for Action Joana Godinho Jaap Veen Masoud Dara James Cercone José Pacheco THE WORLD BANK Washington, D.C. Copyright © 2005 The International Bank for Reconstruction and Development/The World Bank 1818 H Street, N.W. Washington, D.C. 20433, U.S.A. All rights reserved Manufactured in the United States of America First Printing: June 2005 printed on recycled paper 1 2 3 4 5 07 06 05 World Bank Working Papers are published to communicate the results of the Bank’s work to the development community with the least possible delay. The manuscript of this paper therefore has not been prepared in accordance with the procedures appropriate to formally-edited texts. Some sources cited in this paper may be informal documents that are not readily available. The findings, interpretations, and conclusions expressed herein are those of the author(s) and do not necessarily reflect the views of the International Bank for Reconstruction and Development/The World Bank and its affiliated organizations, or those of the Executive Directors of The World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply and judgment on the part of The World Bank of the legal status of any territory or the endorsement or acceptance of such boundaries. The material in this publication is copyrighted. Copying and/or transmitting portions or all of this work without permission may be a violation of applicable law. The International Bank for Reconstruction and Development/The World Bank encourages dissemination of its work and will normally grant permission promptly to reproduce portions of the work. For permission to photocopy or reprint any part of this work, please send a request with complete information to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, USA, Tel: 978-750-8400, Fax: 978-750-4470, www.copyright.com. All other queries on rights and licenses, including subsidiary rights, should be addressed to the Office of the Publisher, The World Bank, 1818 H Street NW, Washington, DC 20433, USA, Fax: 202-522-2422, email: [email protected]. ISBN-10: 0-8213-6276-3 ISBN-13: 978-0-8213-6276-1 eISBN: 0-8213-6277-1 ISSN: 1726-5878 DOI: 10.1596/978-0-8213-6276-1 Joana Godinho is a Senior Health Specialist at the Human Development Department of the World Bank. Jaap Veen is Coordinator of the Europe Unit of the KNVC Tuberculosis Association. Masoud Dara is a TB Specialist at the KNVC Tuberculosis Association. James Cercone is an Economist and President of SANIGEST. José Pacheco is an Economist at SANIGEST. Photo by Jaap Veen: Previously mobile, but still functional X-ray unit operates in Central Asia. Library of Congress Cataloging-in-Publication Data has been requested. Contents Acknowledgments xi Acronyms and Abbreviations xiii Executive Summary xv Part I: Priorities for Action 1 Introduction 3 The Global TB Epidemic 6 TB in the Former Soviet Union 8 TB in Prisons 10 TB Control in the Former Soviet Union 12 2 Tuberculosis in Central Asia 17 Epidemiology of TB in Central Asia 22 TB Control in Central Asia 32 3 Main Findings and Key Actions to Stop TB in Central Asia 57 Main Epidemiological Issues 57 DOTS Implementation in Central Asia 60 Funding of TB Control in Central Asia 62 4 The World Bank Role on TB Control 65 Part II: Country Profiles 5 The Republic of Kazakhstan 69 Main Challenges in Achieving Global TB Targets 70 Profile Introduction 72 TB Epidemiology 72 Tuberculosis Control 76 Financing TB Control 83 6 The Kyrgyz Republic 99 Main Challenges in Achieving Global TB Targets 100 Profile Introduction 101 TB Epidemiology 102 iii iv Contents Tuberculosis Control 105 Financing TB Control 113 7 The Republic of Tajikistan 135 Main Challenges in Achieving Global TB Targets 136 Profile Introduction 138 TB Epidemiology 138 Tuberculosis Control 141 Financing TB Control 146 8 The Republic of Uzbekistan 159 Main Challenges in Achieving Global TB Targets 160 Profile Introduction 162 TB Epidemiology 162 Tuberculosis Control 166 Financing TB Control 175 References 193 LIST OF TABLES 1. Key Global TB Epidemiological and Financial Indicators 9 2. FSU and DOTS Approaches to TB Control 13 3. General Country Data 2002 18 4. Notification and Detection of TB in Central Asia 2002 23 5. TB Notification and Mortality Rate in Central Asia in 2003 23 6. HIV and TB/AIDS Cases in Central Asia 28 7. TB Notification and Mortality in Prisons in Central Asia 2003 30 8. MDRTB in Prisons in Central Asia in 2002 (%) 31 9. TB/HIV Cases in Prisons in Central Asia 2003 31 10. Infrastructure of TB Services in Central Asia 35 11. DOTS Strategy in Central Asia 37 12. DOTS Coverage in Central Asia 1998–2003 (%) 37 13. Estimated Percentage of all TB Cases Notified 39 14. TB Control in Prisons in 2002 43 15. TB Treatment Outcome 2002 46 16. DOTS Treatment Success 1995–1999 (%) 46 17. Public TB Spending by Country in 2002 47 18. Gaps in TB Spending by Country 2002 48 Contents v 19. TB Costs, Indirect Costs and Rates of Return 49 20. Donor Contributions for TB Control in Central Asia (thousands) 50 21. TB Notification and Mortality Rates per 100,000 in Kazakhstan 74 22. TB Notification and Mortality among the Prison Population 75 23. Percentage of Sputum Smear Positives among all TB Cases Notified 78 24. Treatment Outcomes for New Smear-Positive Cases Treated Under DOTS 83 25. Donor Assistance to TB Control in Kazakhstan (US$) 85 26. Donor Assistance to TB Control in Kazakhstan 86 27. Cost-Benefit Analysis 95 28. Direct, Indirect, and Total TB Costs in a Typical Year 96 29. Kazakhstan—SWOT Analysis 97 30. TB Notification and Mortality Rates per 100,000 103 31. TB Notification and Mortality Rates per 100,000 Prisoners 104 32. TB Institutional Structure 106 33. TB Beds and DOTS Coverage in Kyrgyz Prisons 109 34. Treatment Outcome in New Sputum Smear Positive Pulmonary TB Patients 112 35. Treatment Outcome in Re-Treatment Cases of Pulmonary TB Cases 112 36. Treatment Outcome of New Sputum Positive TB Patients in Prisons 113 37. Public Funding of TB Control Program in the Kyrgyz Republic 113 38. Donor Funding for TB Control Programs (US$) 117 39. TB Performance by Oblast and Inputs 131 40. Cost-Benefit Analysis 132 41. Direct, Indirect and Total TB Costs in a Typical Year 133 42. TB Notification and Mortality Rates in Tajikistan 138 43. TB Case Notification and Mortality among Prisoners 140 44. Percentage of Sputum Smear Positives among all TB Cases Notified 142 45. Treatment Outcome of New Smear Positive Cases in Dushanbe City (3 Cohorts) 145 46. Donor Funding for TB Control Programs (US$ thousands) 148 47. TB Performance by Oblast and Indicator 155 48. Cost-Benefit Analysis 156 49. Direct, Indirect and Total TB Costs in a Typical Year 157 50. TB Notification and Mortality Rates per 100,000 163 51. TB Notification and Mortality Rates per 100,000 by Oblast 164 52. TB in Prisons 166 53. New Pulmonary TB Cases 169 54. Inputs for TB Control in Prisons 1998–2002 170 vi Contents 55. Treatment Outcome in New Sputum Smear Positive TB Cases 174 56. Donor Assistance to TB Control (US$ thousands) 177 57. Donor Assistance to TB Control in Uzbekistan 178 58. Oblast Orientation by TB Budget Category, 2002–2004 182 59. Oblast Budget Profile and TB Outcomes 183 60. TB Performance by Oblast and Indicator 190 61. Cost-Benefit Analysis 191 62. Direct, Indirect and Total TB Costs in a Typical Year 192 LIST OF FIGURES 1. TB Notification Rates in Kazakhstan, Kyrgyz Republic, Tajikistan, and Uzbekistan xvi 2. HIV Infections Newly Diagnosed per Million Population 11 3. TB Notification Rates in Kazakhstan, Kyrgyz Republic, Tajikistan, and Uzbekistan 1990–2002 22 4. TB Mortality Rate in Central Asia per 100,000 Population 1990–2003 25 5. Estimated Number of Lives Saved by DOTS in Kazakhstan 1999–2001 27 6. Increase of TB/HIV Dual Infection among 20 years-old in Kazakhstan 29 7. Organizational Chart of the Kyrgyz National TB Program 33 8. TB Hospital Performance by Country 2002 45 9. TB Public Spending in Central Asia 2002 48 10. Donor Contributions by Country, 2002 51 11. Salaries and Drugs in National TB Programs 52 12. TB Costs as Percentage of GDP by Country 53 13. TB Performance Indicators by Country 54 14. TB Incidence Rates by Country or Region, 2002 55 15. Population Covered by DOTS 2002 55 16. Percentage TB Notification per Age Group in 2002 73 17. TB Notification and Mortality Rate per 100,000 73 18. Estimated Number of Lives Saved by DOTS in Kazakhstan 1999–2001 74 19. TB Beds per 100,000 Persons by Oblast in 2003 81 20. Turnover Rate and Bed Occupancy Rate in Kazak TB Hospitals in 2003 82 21. TB Public Spending in the Economy in 2002 84 22. Cost per TB Patient by Oblast in 2002 84 23. Distribution of TB Contributions by Donor 2002–2007 86 24. TB Budget Structure in 2002 87 25. Contribution for TB Control by Account in 2002 88 Contents vii 26.
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