The fifth review of the Bangladesh National Tuberculosis Control Programme took place from 2 to 12 October 2010. A team consisting of international and national reviewers including NTP staff, TB experts, public health experts, donor representatives and other stakeholders Fifth Joint Monitoring Mission of reviewed programme documents, visited various parts of the country and interviewed key informants in order to get first-hand experience of the Bangladesh National TB control in Bangladesh. The partnership approach and the availability of significant Tuberculosis Control Programme amounts of donor funding together with the leadership role played by the Government of Bangladesh are the basis of the success of the programme. This has resulted in achieving set programme targets and successful implementation of different components of the programme. 2-12 October 2010 The introduction and scale-up of new tools and the expansion of specific programme areas (such as management of drug-resistant tuberculosis, TB/HIV, engaging the private sector and strengthening the overall health system) pose new challenges. Provided adequate support is made available, the review team believes NTP is in a position to address all challenges. SEA-TUB-45 BAN-TUB-45 Distribution: General Fifth Joint Monitoring Mission of the Bangladesh National Tuberculosis Control Programme 2-12 October 2010 © World Health Organization 2011 All rights reserved. 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Printed in India Contents Page Acronyms............................................................................................................... v Executive summary ............................................................................................... ix 1. Introduction...................................................................................................1 2. Goal and objectives of the fifth Joint Monitoring Mission................................2 3. NTP goal, objectives and structure.................................................................4 4. Epidemiology and case notification trends .....................................................7 5. Laboratory services, EQA and laboratory network ........................................10 6. Tuberculosis case-finding.............................................................................13 7. Treatment....................................................................................................17 8. Supervision, monitoring and evaluation .......................................................18 9. Drugs and supply management....................................................................20 10. Childhood tuberculosis ................................................................................24 11. Programmatic management of drug-resistant tuberculosis ............................25 12. TB/HIV ........................................................................................................31 13. Infection control ..........................................................................................33 14. Public-private mix........................................................................................35 iii 15. Advocacy, Communication and Social Mobilization.....................................37 16. Operational research ...................................................................................40 17. Human resource development for TB ..........................................................46 18. Health Systems ............................................................................................50 19. Financing.....................................................................................................54 Annexes 1. List of reviewers...........................................................................................57 2. Programme..................................................................................................59 3. Places visited and people met......................................................................60 4. Map indicating upazilas and metropolitan cities visited ................................70 iv Acronyms ACSM advocacy, communication and social mobilization AIDS Acquired immunodeficiency syndrome BGMEA Bangladesh Garments Manufacturers and Exporters Association BIRDEM Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders BSSMU Bangladesh Sheikh Mujib Medical University CDC chest disease clinic CMSD Central Medical Store Depot CPC Cethylpyridinium chloride DGHS Directorate General of Health Services DOT directly observed treatment DST drug susceptibility testing EQA external quality assessment FDA Fluorescein diacetate FDC fixed-dose combination GDF Global Drug Facility GFATM Global Fund to Fight AIDS, Tuberculosis and Malaria GLC Green Light Committee HIV Human immunodeficiency virus HNPSP Health, Nutrition and Population Sector Programme HRD human resources development ICDDR,B International Centre for Diarrhoeal Disease Research, Bangladesh v ICT Immunochromatography assay IEDCR Institute for Epidemiology, Disease Control and Research IT information technology LED light-emitting diode MBDC Mycobacterial Disease Control MDG Millennium Development Goal MDR-TB Multidrug-resistant tuberculosis MoF Ministry of Finance MoH&FW Ministry of Health and Family Welfare MoLGRD&C Ministry of Local Government, Rural Development and Cooperatives MoU Memorandum of Understanding MTB Mycobacterium tuberculosis M&E monitoring and evaluation NASP National AIDS and STI Programme NATAB National Anti-Tuberculosis Association of Bangladesh NGO nongovernmental organization NIPSOM National Institute for Preventive and Social Medicine NTP National Tuberculosis Control Programme NIDCH National Institute of Diseases of Chest and Hospital NTRL National Tuberculosis Reference Laboratory OPD outpatient department OR operational research PMDT Programmatic management of drug-resistant tuberculosis PPM Public–private mix SOP standard operating procedure SRL supranational reference laboratory TB tuberculosis vi Fifth Joint Monitoring Mission of The Bangladesh National Tuberculosis Control Programme TB IC Tuberculosis infection control TLCA Tuberculosis and Leprosy Control Assistant UHC Upazila health complex UH&FPO Upazila Health and Family Planning Officer VCT Voluntary counselling and testing WHO World Health Organization XDR-TB Extensively drug-resistant tuberculosis Page vii Executive summary This report provides the findings and recommendations of the fifth review of the National Tuberculosis Control Programme (NTP) of Bangladesh, conducted on 2-12 October 2010. This joint monitoring mission evaluated programme performance since the fourth review held in 2007. Recommendations are related to the implementation of the Stop TB strategy during the period 2011-2013 aiming at achieving the Millennium Development Goals (MDGs) by 2015. Tuberculosis (TB) remains a major public health problem in Bangladesh. The World Health Organization (WHO) estimated that in 20081 there were approximately 660 000 TB cases in the country (range 420 000-980 000). The number of new cases occurring in 2008 was estimated at approximately 360 000 (range 290 000-430 000). Of these, approximately 170 000 were infectious cases transmitting TB in the community (range 140 000-210 000). It was further estimated by WHO that about 79 000 TB patients, most of them not registered, had died of TB in 2008 (range 31 000-150 000). General Observations An important observation of the review is that a good opportunity exists to sustain the progress made in reducing the TB prevalence and mortality compared to 1990, for the following reasons: (i) the overall capacity and quality of DOTS (directly observed treatment, short course) implementation at field level is good; the commitment and contribution from