Financing Tuberculosis Control: The Role of a Global Financial Monitoring system/Financement De la Lutte Antituberculeuse: Role D'un Systeme Mondial De Surveillance financiere/Financiacion De la Lucha Antituberculosa: Papel De Un Sistema Mundial De Vigilancia Financiera

Introduction Control of tuberculosis (TB), like health care in general, costs money. Although some components of diagnosis and treatment can be provided free of charge, such as patient support provided by community volunteers, most inputs--such as national TB programme staff, drugs, laboratory supplies and primary healthcare staff and infrastructure--need to be paid for. Since sustaining TB control at current levels and making further progress to achieve global targets require money, data about funding needs, sources of funding, funding gaps and expenditures are important at global, regional, national and sub-national levels. Such data can be used to answer questions such as: How much money is needed for TB control globally, both in total and for different components of control? How much of the required funding is available, what are the major sources of this funding, and how is the total amount of funding changing over time? Which regions and countries have the biggest needs and funding gaps? To what extent are countries able to spend the funding mobilized for TB control? Have changes in funding for TB programmes had an impact on their performance and the burden of TB? In common with efforts to assess funding needs, and track funding and expenditures for other global health priorities, (1,2) WHO has established a system for global financial monitoring of TB control. (3-7) In this paper, we explain why this system was set up in 2002 and how it works in practice. We then illustrate its value by presenting major findings concerning the period 2002-2007, including results that are relevant to the achievement of the global TB control targets set for 2005 and 2015. Finally, we analyse the system's strengths and limitations, and its relevance to other health-care programmes. Why was the global financial monitoring system established? Establishment of a system for global financial monitoring of TB control reflected a major step-up in national and international commitment to TB control dating from around the year 2000. The Stop TB Partnership, which now consists of more than 400 partners, was formed in 2000. In March 2000, 20 of the 22 high-burden countries, which collectively account for approximately 80% of the world's TB cases, committed to achieving WHO's TB control targets through implementation of the internationally recommended DOTS strategy. (8) The targets were to detect 70% of new smear-positive cases and to cure 85% of detected smear-positive cases by 2005. (9) In July 2000, the G-8 countries pledged additional resources and set new targets for the control of HIV infection, TB and malaria. (10) The United Nations Millennium Development Goals (MDGs), which provide a framework for development efforts as a whole for the period 2000-2015, were also launched in 2000. They include targets related to TB control, the principal one being to reverse the incidence of TB by 2015. (11) The Global Fund to Fight AIDS, Tuberculosis and Malaria (referred to subsequently as the Global Fund) was established in 2002, providing a major new opportunity to improve the financing of TB control. These developments were associated with an increased demand for information about various aspects of funding for TB control, particularly in high-burden countries. During 2001, WHO made it a priority to assess funding needs and funding gaps in high-burden countries and other low- and middle-income countries for the period 2001-2005, using strategic plans, a standardized questionnaire and costing studies; these findings were published in March 2002. (12) Building on these efforts, but recognizing that systematic assessment of financing for TB control would be preferable to more ad hoc studies, WHO established a system for routine monitoring of financing for TB control in late 2002. The global financial monitoring system in practice The WHO global financial monitoring system has been operating for five years (five rounds of data collection, 2002-2006; and five rounds of annual reporting, 2003-2007). …