The Challenge

Tuberculosis (TB) is a disease of poverty, mainly affecting young adults in their most productive years. It is one of the greatest causes of death among women ages 15-44. In 2009, 1.7 million deaths were attributable to TB, including 380,000 people with HIV. In 2010, multidrug-resistant TB (MDR-TB) rates were reported to be at their highest levels ever. According to a WHO MDR-TB survey, new TB cases peaked at 28 percent in some areas of the former Soviet Union. Extensively drug-resistant TB (XDR-TB) cases were reported in 58 countries. To meet these challenges, the Bank has adopted a multi-pronged approach to TB control.

The Approach

The Bank addresses TB directly but also supports tobacco control measures, health systems strengthening, and the improvement of public housing and environment. The Bank supports full-scale implementation of the WHO-recommended “Directly Observed Treatment Strategy” (DOTS). From 2005-2010, the Bank's cumulative commitments to TB control totaled about US$250 million in 17 projects in 15 countries and 3 multi-country projects in Africa and Central Asia. During FY2011, 3 additional projects totaling about US$20 million were approved including in Swaziland and Argentina.

The Bank also invests in projects to reduce smoking prevalence; smoking increases the risk of TB by a factor of more than two-and-a-half times (WHO). Health system strengthening activities that support TB control include the modernization of public health laboratory networks, health personnel training for timely detection and diagnosis, and improved technical capacity at various levels of the health system. This is important for monitoring and evaluation, which is a key building block for disease surveillance, program management, and tailoring policy to the specific needs of the country. The Bank also supports improvements in public housing—in particular indoor air pollution—which contribute to the risk of contracting TB.

The Results

The Russian Federation
From 2003-2008, the Bank, in coordination with other supporting organizations, implemented the TB/AIDS Control Project in Russia. Successes included improved access to quality services, including development of guidelines for prevention and treatment of patients, strengthened laboratory capacity that was critical for active case detection, timely diagnosis and scale treatment and patient follow up, provision of drugs, personnel training, and improved surveillance systems. As a result, the Russian health system was strengthened to provide TB control services for both civilians and prisoners— a good example of a disease-oriented program having a system-wide impact. During the project time period, TB mortality in the total population decreased by 18 percent. Among the most vulnerable group, prisoners, TB mortality decreased by 37 percent.

India
India carries one-fifth of the world’s TB burden. Since the Bank began supporting India TB control, treatment success rates have tripled from 25 percent to 86 percent. TB death rates have decreased seven-fold from 29 percent to 4 percent and about 1.7 million additional lives have been saved. Currently, Bank resources are being used to purchase first-line drugs, expand laboratory capacity, and train community health workers. In 2010, disbursements for the TB-II project totaled US$ 35 million. Seven million people have been screened for TB and 780,000 have been successfully treated. Since December 2009, 969 MDR-TB patients have enrolled in a newly launched treatment program.

East Africa

East Africa is beset with co-infection of TB and HIV. MDR-TB and regular TB in AIDS patients need specialized laboratories for diagnosis and treatment. In May 2010, the East Africa Public Health Laboratory Networking Project launched to establish a network of efficient, high-quality, accessible public health laboratories for the diagnosis and surveillance of TB and other communicable diseases.

The Future

The Bank continues to be committed to fighting the global TB epidemic through its investments across relevant sectors and engagement in global partnerships. In India, the Bank is engaged in policy dialogue regarding the country’s five-year national TB Control program while stepping up work on tobacco taxation. In Swaziland, where the highest co-infection of TB and HIV in the world exists, the Bank has approved a project this year to improve access to quality health services with a particular focus on primary health care, maternal health and TB. The Bank’s multi-pronged approach will also continue in the future with a project in Argentina aimed at strengthening the role of the federal public health system and increasing the coverage and clinical governance of priority public health programs, including TB.

 The Bank’s Role in the STOP TB Partnership

The Bank provides funds to the partnership through the Development Grant Facility (DGF) and is a permanent member of the Partnership's Coordinating Board. Bank staff actively seeks collaboration with other Stop TB partners at the global and country level. This year, 2011, marks the halfway point for the Global Plan to Stop TB (2006-2015).

For more information, check out the Results-Based Financing for Health Website’s blog “Testing Texting and Incentives to Cure TB”.