WHO & Community-based TB Services: background, status, challenges

Lana Syed Global TB Programme, WHO HQ 27 March 2019

EvolutionofWHOresponseincommunityengagement

ENGAGE-TB:keymessages

ENGAGE-TB:examplesofintegratedcommunity-basedTB

activities

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HIV

Reproductive, Maternal, Newborn, Child and

Adolescent Health

Education

Agriculture

Livelihood development

Water, Sanitation & Hygiene

Primary Health Care

IntegrationthroughENGAGE-TBApproach

MonitoringandEvaluation

Gaps….

Integrationservicesatcommunitylevel:status

•  GFmajorfundingsource•  Community-basedactivitiesareinvastmajorityof

GFgrants–oftenunderfunded(comparedto%budgetinNSPs)

•  Indicatorstomonitorintegrationofcommunity-basedservicesabsent

•  Integrationexpansionishappening,butslow•  NotaGFrequirement(attentionto

implementationarrangementsvaries)•  SRsbetweenTBandHIVgrantsoftendifferent–

bottleneckforintegrationofservices

DSD:foodforthoughtfromTBangle

1.   PLHIVatgreaterriskofTBevenwhileonART•  Needforstrongcapacityofcommunityhealthworkers

orvolunteerstosystematicallyscreenforTB•  Needforfunctionalreferralmechanismsfrom

communityleveltoTBservices

2.   TBpreventivetreatment–shorterregimens•  Needforcarefulmonitoringofadverseeventsand

treatmentcompletion•  Garneringevidencefromimplementationneeded

WayForward•  RevivedfocusonPHCandUHCintheeraofSDGs:major

opportunityforscalingupTBandTB/HIVcommunity-basedservices

•  NewWHOguidelineonCommunityHealthWorkersstronglyrecommendsabsorptionofthiscadrewithinhealthsystems(pushforsalariedstaffwithcontracts)

•  Bothtopdown(targetingdonors)andbottomup(promotingbestpractices)advocacyisongoing

•  OngoingtechnicalassistanceinclosecollaborationwithGF