WHO-EM/TUB/256/E Tuberculosis control in the Eastern Mediterranean Region Progress report 2009 WHO-EM/TUB/256/E Tuberculosis control in the Eastern Mediterranean Region Progress report 2009 WHO Library Cataloguing in Publication Data World Health Organization. Regional Office for the Eastern Mediterranean Tuberculosis control in the Eastern Mediterranean Region: progress report 2009 / World Health Organization. Regional Office for the Eastern Mediterranean p. WHO-EM/TUB/256/E 1. Tuberculosis, Pulmonary – prevention and control – economics – Eastern Mediterranean Region 2. Regional Health Planning 3. National Health Programs 4. Research I. Title II. Regional Office for the Eastern Mediterranean (NLM Classification: WF 300) © World Health Organization 2010 All rights reserved. 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Design, layout and printing by WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt Contents Foreword ............................................................................................................................................. 5 Executive summary ............................................................................................................................ 7 1. Introduction ................................................................................................................................... 9 2. Epidemiology ................................................................................................................................... 9 2.1 Estimated burden of tuberculosis ................................................................................................................ 9 2.2 Case notification ........................................................................................................................................... 10 2.3 Achievement of case detection and treatment success targets .......................................................... 10 2.4 Other challenges ........................................................................................................................................... 10 3. Main activities in DOTS expansion and enhancement .......................................................18 3.1. Political commitment .................................................................................................................................. 18 3.2 Case detection through quality-assured tuberculosis laboratory network ..................................... 18 3.3 Standardized treatment with supervision and patient support .......................................................... 26 3.4 Medicine supply and management ............................................................................................................. 29 3.5 Monitoring and evaluation ......................................................................................................................... 33 4. Challenges and high-risk groups ...............................................................................................40 4.1 Collaborative HIV/tuberculosis activities ................................................................................................. 40 4.2 Management of multidrug-resistant tuberculosis .................................................................................. 43 4.3 Management of household contacts ......................................................................................................... 49 5. Health system strengthening .....................................................................................................52 5.1 Leadership and governance ......................................................................................................................... 52 5.2 Finance ............................................................................................................................................................. 53 5.3. Workforce ...................................................................................................................................................... 53 5.4 Health service provision .............................................................................................................................. 57 5.5 The Practical Approach to Lung Health initiative .................................................................................. 58 5.6 Health information system ........................................................................................................................ 58 6. Public–private mix ......................................................................................................................59 6.1 Background ..................................................................................................................................................... 59 6.2 Achievements ................................................................................................................................................. 60 6.3 Challenges ....................................................................................................................................................... 64 6.4. Recommendations ........................................................................................................................................ 64 7. Empowering people with tuberculosis and communities ...................................................65 7.1 Advocacy, communication and social mobilization ................................................................................. 65 7.2 Technical support ........................................................................................................................................... 65 7.3 Advocacy products ....................................................................................................................................... 66 7.4 Case studies in six countries ..................................................................................................................... 67 7.5 Other advocacy activities ........................................................................................................................... 67 7.6 The Eastern Mediterranean Partnership to Stop TB ............................................................................. 67 8. Operational research ..................................................................................................................68 8.1 Operational research studies ..................................................................................................................... 68 8.2 Use of new technology and strategies ..................................................................................................... 68 8.3 Research capacity strengthening ............................................................................................................... 68 8.4 Research dissemination .............................................................................................................................. 72 8.5 Recommendations ....................................................................................................................................... 72 9. Impact measurement ...................................................................................................................72 9.1 The WHO Global Task Force on Tuberculosis Impact Measurement ................................................ 72 9.2 Progress to date in the three strategic areas of work .......................................................................... 73 References .........................................................................................................................................76