Regional Response Plan for Programmatic Management of Drug-resistant Tuberculosis: Report of meeting of WHO country offices’ focal points SEARO, New Delhi, 4–6 April 2011 [PDF 191 KB]

World TB Days

Well-functioning national TB control programmes in the Region have resulted in low levels (Range: 1.7- 4.2%) of multidrug-resistance (MDR) among newly detected cases. Among the previously treated cases in the Region, MDR-TB rates range from 10.0 - 34.7%. However, given the large numbers of TB cases in the SEA Region, this translates to 130 000 MDR-TB cases (110 000–170 000) accounting for nearly one third of the world’s total.

During the past few years, steady progress has been made in the Region in initiating MDR-TB cases on treatment. The Green Light Committee had approved the case management of patients with MDR-TB under national programmes in 10 countries. Until the end of 2010, more than 5000 patients with MDR-TB had been registered for treatment in the Region. Extensively drug-resistant TB (XDR-TB) has also been reported from five countries in the Region. MDR-TB could potentially replace drug-susceptible TB and constitutes a threat to global public health security. In areas of high HIV prevalence, the potential for increased transmission of MDR-TB is high.

Public-private Mix: A Practical Approach to Lung Health in TB Control: Report of a Regional Workshop Kathmandu, Nepal, 19 to 23 September 2011 [PDF 313 KB]

The third and fourth components of the Global Plan to Stop TB, 2011-2015, are to “Strengthen health systems based on primary health care” and “Engage all care providers,” an approach to ensure universal access to high quality TB services through the involvement of all public, voluntary, corporate and private providers and the adoption of the “International Standards for Tuberculosis Care (ISTC)”. The plan emphasizes the need to strengthen the health system through an innovative approach such as the Practical Approach to Lung Health (PAL), which is based on improving the quality of care of all respiratory patients above five years of age, and focuses on the primary health care level.

      The South-East Asia Regional Response Plan for Drug-resistant TB Care and control 2011 -2015 [PDF 1.6 MB]

In 2010 there was an estimated prevalence of 650 000 cases of multidrug-resistant TB (MDR-TB) globally, and global mortality exceeded 150 000.  Well-functioning national TB control programmes in the SEA Region achieving high cure rates have resulted in maintaining a slow but steady decline in TB incidence rates during the past decade. This has also led to low levels of multidrug resistance among new cases. Extensively drug-resistant TB (XDR-TB) has also been reported from six countries of the SEA Region. MDR-TB could potentially replace drug-susceptible TB, and constitutes a threat to global public health security.

As per the Regional Strategic Plan for 2006–2015, the overall goal for TB control is to reduce morbidity, mortality and transmission of TB until it is no longer a public health problem. The South-East Asia Regional Response Plan for Drug-Resistant TB Care and Control 2011–2015 complements the Regional Strategic Plan for reducing morbidity, mortality and transmission of DR-TB. By fully implementing this Response Plan, the realization of the overall goal for TB control will become an achievable target. This report contains the salient features of the Plan, including goal and objectives, strategies and interventions, strengthening of health systems and other pertinent details.

      Report of the Meeting of the SEA Regional Technical Working Group on Tuberculosis [PDF 254 KB]

The World Health Organization’s South-East Asia (SEA) Region has the highest burden of tuberculosis in the world. Appreciable progress has been made with TB control using the DOTS strategy, and several countries in the Region have reached the global targets. Renewed emphasis has been placed on reaching universal case detection and treatment of all forms of TB through improving diagnosis and management of all forms and, in particular, better managing multi- and extensively drug-resistant tuberculosis and HIVassociated TB.

The specific objectives of the Meeting of the SEA Regional Technical Working Group on Tuberculosis were to review progress and constraints in implementing the Stop TB strategy in Member States of the WHO SEA Region; and provide guidance on adopting and applying the revised WHO policies and guidelines to more comprehensively address TB control in the specific context of the Region.

The recommendations for WHO and technical partners were to collaborate with countries to improve the estimates for the TB burdens; gather evidence to guide countries in more accurately defining case suspects based on symptoms other than cough in order to improve case detection; evaluate the performance of diagnostic algorithms in the context of smear-negative EPTB and childhood TB, and consider appropriate revisions; assist countries in deploying new tools or developing operational research on new diagnostic tools; and elaborating guidelines on the basis of the outcomes. This document is a report of the meeting.

      Report of the Regional Workshop on Programmatic Management of Multi-drug Resistant Tuberculosis [PDF 279 KB]

The World Health Organization’s South-East Asia (SEA) Region has the highest burden of tuberculosis in the world. Appreciable progress has been made with TB control using the DOTS strategy, and several countries in the Region have reached the global targets. Renewed emphasis has been placed on reaching universal case detection and treatment of all forms of TB through improving diagnosis and management of all forms and, in particular, better managing multi- and extensively drug-resistant tuberculosis, as well as HIV-associated TB. The specific objectives of this meeting were to review progress and constraints in implementing the Stop TB strategy in Member States of the SEA Region; and provide guidance on adopting and applying the revised WHO policies and guidelines to more comprehensively address TB control in the specific context of Member States of the Region.

The overall recommendations for WHO and technical partners were to collaborate with countries to improve the estimates for the TB burden in the countries; gather evidence that can guide countries in more accurately defining case suspects based on symptoms other than cough (>2 weeks) in order to improve case detection; evaluate the performance of diagnostic algorithms in the context of smear-negative EPTB and childhood TB, and consider appropriate revisions; assist countries in deploying new tools, developing operational research on new diagnostic tools, and elaborating guidelines on the basis of the outcomes.

      Report of the Regional Workshop Advocacy, Communications and Social Mobilization for TB Control [PDF 650 KB]

A good progress has been made in TB control in the Region. For further improvements and expansion of scope of TB services to reach those who do not benefit from current efforts, a higher level of advocacy and more effective communication for greater understanding, commitment and resources for TB control activities in countries, social mobilization for TB patients to access services effectively is necessary. With this background, the World Health Organization (WHO) South East Asia (SEA) Regional Office organized a Regional Workshop on Advocacy, Communications and Social Mobilization (ACSM) for TB control in collaboration with PATH, and KNCV, from 14 to 17 September, 2010, in Colombo, Sri Lanka. The focus of the workshop was to share regional and country TB programme updates; review ACSM concepts; develop and apply practical skills using ACSM techniques and tools; and develop country specific ACSM action and follow-up plans.

National TB Control Programmes (NTPs) were recommended to finalize national plans and to organize workshops to plan and develop capacity for ACSM interventions; establish inclusive national partnerships for effectively conceptualize, plan, implement, and create an enabling environment for all stakeholders to contribute to ACSM. WHO and technical partners were recommended to finalize and disseminate the Regional Framework on ACSM; with NTPs to identify technical assistance for the development, implementation and monitoring of national plans for ACSM; to adapt standardized training materials to build capacity in countries and disseminate best practice examples from around the Region to facilitate the uptake of effective interventions for ACSM.

      TB Control in the Context of Health Systems Strengthening [PDF 633 KB]

Effective control of tuberculosis (TB) depends on strong health systems. A Regional Workshop on TB Control in the Context of Health System Strengthening was held in response to a felt need to identify ways for TB control programmes to both benefit from and contribute to on-going health systems development. This report reflects the deliberations, main issues, challenges, and next steps that were identified for national TB programmes, other departments within ministries of health, the international community and other partners, to strengthen the delivery of TB services through national health-care systems, while at the same time enhancing the contribution of the TB control services themselves to the strengthening of health systems.

      The Thirteenth Meeting of the National Tuberculosis Programme Managers [PDF 3.9 MB]

The thirteenth Meeting of National TB Programme Managers from the WHO South-East Asia Region was held in Male, Maldives, in December 2008. Participants at the meeting included representatives of national TB programmes, technical agencies and staff from WHO headquarters, the Regional Office for South-East Asia and country offices. The meeting was organized concurrently with the eighteenth Meeting of the National HIV/AIDS Programme Managers to allow for a day for both programmes to jointly review the progress and challenges and discuss next steps to scale up a comprehensive package of interventions for HIV-associated TB in Member States of the Region.

Achievements in countries towards meeting the global targets set for TB control were presented. Key technical and programmatic issues, including interventions required for to effectively respond to multi-drug resistant and HIV-associated tuberculosis were discussed and country experiences shared. Member States also presented their plans for the coming year and the technical assistance and resource requirements to effectively carry out all planned interventions were identified

      TB in SEAR - The Regional Report: 2008 [PDF 757 KB]

This annual report on tuberculosis highlights the progress being made by national TB programmes in the Region, which are steadily detecting and successfully treating more TB cases. As a result, both occurrence of new cases of TB and deaths due to TB continue to show a slow but steady decline. National TB programmes are increasingly reaching out to the private sector, teaching and tertiary care facilities to ensure that patients now accessing these sectors are also registered within the national programmes to achieve similar high cure rates. Diagnosis and treatment services for TB patients co-infected with HIV and those with multi-drug resistant TB (MDR-TB)are also being expanded in several countries in the Region. WHO support focuses on the following broad areas: advocacy and planning, coordination and collaboration, technical support, capacity building, resource mobilization and operational research. A country profile for each country is also provided.

      Training Modules on Leadership and Strategic Management, WHO SEARO 2008 [PDF 2.9 MB]

This set of eight modules on Leadership and Strategic Management was developed by the WHO Regional Office for South-East Asia in response to a felt need to enhance management and leadership skills within national TB control programmes in the Region. Each module covers a specific aspect of effective leadership and management, namely, managerial styles, leadership and leadership styles, personal effectiveness, role efficacy, communication skills, team building, and building partnerships. The modules are designed to allow for self development and learning through interactive training methodologies. The modules may be used independently of one another, or as a complete package. While the primary purpose is to develop the managerial skills of staff working at national and intermediate levels of TB control programmes, the concepts and approaches could well be more widely applied to other public health programmes.

      Meeting of Partners for TB Control [PDF 2.3 MB]

The report summarizes the proceedings of the Meeting of Partners for TB control in the South-East Asia Region, held in Jakarta Indonesia, between 27 and 30 November 2006. Following a review of the situation and progress in TB control in the Region and presentation on experiences from countries, 

thematic round-table discussions on different areas that would support the implementation of the new stop TB strategy in the Region highlighted innovative mechanisms to raise and sustain human and financial resources, increase access to drugs and diagnostics, adopting a more professional approach to PPM DOTS, the means to fully realize the contributions from civil society and the need to document the contribution of TB services to health systems strengthening and their impact on the burden of disease in the Region.  The key messages were that there was an overwhelming burden of disease in Asia, that this needed to be effectively addressed, that investments made at this time to strengthen TB control and prevent any further increase in TB/HIV and MDR-TB in the Region, would not only be cost-effective, but were essential to achieving the TB targets under the MDGs globally. “A Call to Stop TB in Asia” was endorsed by the Stop TB Coordinating Board at this meeting.

      Towards A World Free of TB

This short advocacy brochure has been prepared to provide in an illustrative manner, a brief overview of the situation and progress made in TB control until 2005 using the DOTS strategy. The booklet also outlines the key strategies and approaches proposed to be implemented under the Regional Strategic Plan for TB control in the SEA Region between 2006 and 2015. The major challenges and opportunities for TB control in the Region and examples of successful interventions that have been undertaken in countries are highlighted. The overall costs of implementing TB control interventions in the Region until 2010 and the support TB control programmes in the Region receive presently, are also covered.