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Linking social protection and TB g pcontrol: opportunities and barriers in five countries
Delia BocciaDelia Boccia
Debora Pedrazzoli
S i l i i i f TB l Ch h H 16th F b 2012Social protection interventions for TB control – Chatham House, 16th February 2012
A briefing paperA briefing paper • To provide background information forTo provide background information for our group work
• To spark discussion on opportunities & barriers for linking TB & SPbarriers for linking TB & SP
• To engage country stakeholders and g g ystimulate interest amongst participants in the expert consultationin the expert consultation
What & how: a scoping study
Peer reviewed & grey
literature
Key informants
Key informants
Peer reviewed & grey
lit tliterature
Country case studiesy
Estimated incidence rates, 2010. Source: WHO
Different SE & TB profilesDifferent SE & TB profiles
CountryHuman
development level
High TB Burden
High HIV burden
High MDR‐TB burden
Zambia Low •Pakistan Low • •South Africa Medium • • •Peru High • •Russia High • • •
Sources: UNDP & WHO 2011
Why here?...convenientWhy here?...convenient
FutureNetwork Future collaborations
Evidence (impact
evaluations)
Existing research
j
Distinct social
evaluations)projects
protection needs
Distinct epiprofiles
Inclusion criteria of social protection programmes
TB SENSITIVE
&
SOCIAL
&SPECIFIC
SOCIAL
PROTECTIONTB
PROTECTION
Country assessmentsCountry assessments
CountryExisting SP programme
TB sensitiveprogramme
TB specific programme
Scope forinclusion of TB control inprogramme programme programme TB control in
SP
South Africa • • •
Zambia • • •
Pakistan • • •
Russia • •
Peru • •
South AfricaSouth Africa
C h i ib d• Comprehensive contributory and non‐contributory social protection system (extensive t f i l t f ith hi h )set of social transfers with high coverage);
• Disability Grant (DG) as a TB sensitive social protection programme?
• Lack of evidence indicating the impact of DG on welfare and health status of beneficiaries;
• Hypothesis: DG could strengthen the resilience of yp gTB affected households;
• We need further research!We need further research!
ZambiaZambia
il h f h• Pilot cash transfer schemes;• Targeting destitute households affected by HIV/AIDS;
• Impact on reducing incidence of illnesses, p gincluding TB, amongst beneficiaries;
• Hypothesis: extending their inclusion criteria toHypothesis: extending their inclusion criteria to the families of TB patients may be a feasible and cost‐effective development, with substantial p ,impact on TB;
• However...However...
PakistanPakistan
• SP system is fragmented and financially constrained;
• TB specific intervention: Karachi MDR‐TB Programme implemented by IRD providesProgramme implemented by IRD provides support to MDRT‐TB patients in Karachi;
• Impact? Scaling up?
Russian FederationRussian Federation
D ti i l d i h f ll i th• Dramatic social and economic changes following the collapse of the Soviet Regime;
• MDR‐TB in Russia particularly affects patients with substance dependencies, mental health disorders, a phistory of incarceration, homelessness and previous treatment default;
• The Sputnik programme implemented by PIH in Tomsk Oblast Siberia: an innovative patient‐centred model ofOblast, Siberia: an innovative patient centred model of care for MDR‐TB patients and patients at high risk of default.
PeruPeru
Ab f i t t d lf t d i tit ti l• Absence of an integrated welfare system and institutional co‐ordination which affects its effectiveness;
• Juntos targets rural communities;
• Hard to hypothesise a link with TB control objectives as TB in Peru disproportionately affects urban areas, particularly the peripheral neighbourhoods surrounding the capital,the peripheral neighbourhoods surrounding the capital, Lima;
• The Innovative Socio‐economic Interventions Against Tuberculosis (ISIAT) project.
+South Africa+ Africa
ZambiaPakistanSOCIAL PROTECTION ENVIRONMENT
Pakistan
ENVIRONMENTRussia
P
‐
Peru
Low HighTB BURDEN
challenges...challenges...
resources type of SP conditions ypintervention
targeting treatment vs
preventionsocial
cohesion
Thank you very much for your attention
&the coming inspiring
discussion!