The Chairman of the Partnership Coordinating Board, The Executive Secretary of the Stop TB Partnership, Distinguished Members of the Board, Dear guests and colleagues, Ladies and gentlemen
Please permit me to begin by thanking the Stop TB Partnership Coordinating Board and Secretariat for inviting me to address this special session. TB control is a subject close to my heart and central to our work at WHO. I also wish to place on record our appreciation of the decision by the Stop TB Board to hold its first meeting this year in our region. This is important to us especially as we begin to intensify our focus on TB control in the context of the Millennium Development Goals.
TB burden in the African Region
We are all aware that TUBERCULOSIS is one of the most important communicable diseases of public health importance in Africa. I also believe that you are all familiar with some of the sobering statistics on the prevalence of TB in our region. Let me mention some of them: 2.4 million cases of TB are estimated to occur each year in Africa, with some 500.000 deaths. Africa, with only an estimated 11% of the world's population, contributes not less than 27% of notified cases annually. 74% out of 46 Member States in the African Region have TB rates equal to, or greater than, 300 per 100,000 population.
Part of the TB explosion is due to its association with the HIV infection, which, itself, has become the most important risk factor for increased TB incidence and mortality. The prevalence of HIV among TB patients exceeds 70% in some countries in southern and eastern Africa, much higher than is known for any other HIV risk groups. People living with HIV run an estimated 10% risk of developing TB every year, whereas those without HIV run only a 10% risk in their whole lifetime. As a result of the HIV/AIDS epidemic, the capacity of health services to provide care for TB patients is being seriously compromised.
Progress made
The daunting TB statistics as I have just mentioned to you concur with the fact that Africa is the only Region where TB incidence and mortality is raising. But, I believe that the situation would be worse without the valiant efforts made by the global TB control community, in partnership with high burden countries.
DOTS is currently the most effective and affordable strategy for detecting and curing infectious TB patients; and cure is the only way to prevent the spread of infection.
However, the current regional treatment success rate of 73% is still below the global target of 85%, and is the lowest among WHO regions.
In order to further improve access, TB services are being decentralised and there is increasing participation of communities and the private sector. Initiatives to strengthen health systems are also being implemented. Countries are being supported to improve the availability of essential drugs, the performance of laboratory networks and the management of human resources for health, in particular staff motivation and retention.
Constraints
I must add, however, that despite the progress we are making, major constraints still remain. In general, the functionality of the health care delivery systems in the region is still poor. Hospital services are overwhelmed; laboratory services are not adequately equipped and decentralised; drug and logistics management systems are weak, and the human resource base for health is limited.
In addition to these obstacles, we must bear in mind that:
- Financing for TB control services is inadequate;
- Current technologies for TB diagnosis and treatment are still labour intensive and not friendly enough to the poor;
- TB treatment still lasts too long;
- The best treatment combinations are not yet available to all who need it;
- The increasing poverty levels amongst the majority of the population contribute to high TB morbidity and mortality;
- The scourge of HIV/AIDS epidemic creates much higher demand of health care and overloads the already weak health systems.
- And therefore TB services in particular, are constrained by limited coverage and weak performance of health systems. These constraining factors call for a renewed commitment of Governments and Partners to accord higher priority to TB services if we have to achieve the health Millennium Development Goals (MDGs)
Working with partners
In spite of these constraints, we are taking advantage of new opportunities to do more. We are actively exploring the different contexts of ongoing macro-economic reforms in countries, and the international development initiaves and mechanisms, to push the health agenda. In this regard, I applaud the decisions taken by African Heads of State and governments at various summits, in which they recognized the importance and committed themselves to fight against AIDS, TB, and Malaria in Africa. Moreover, the New Partnership for Africa's Development (NEPAD) developed a health strategy in which TB control is mentioned as one of the priorities.
We are working to expand the partnership for health within the African region; in this regard we held last week a Consultation at the Regional Office of WHO for Africa in which we made arrangements with the African Union, the Economic Commission for Africa and the Regional Economic Communities, to work together in supporting countries, towards the achievement of health MDGs.
It is of crucial importance therefore that we translate these policies into action. Governments should earmark and allocate adequate resources for combating these diseases. Funding for containing them should also be mainstreamed into international development agendas such as the MDGs, GFATM, the Commission for Africa and others.
Disbursements by the Global Fund and other funding initiatives have significantly increased the financial means of some countries to execute their disease control programmes. For example, through the Stop TB Partnership, more than 30 countries in this region have accessed free anti-TB drugs from the Global Drug Facility, and a similar number of countries have accessed funds from the Global Fund for the fight against HIV/AIDS, Tuberculosis and Malaria during the first four rounds. We expect that this support will be sustained and expanded to more countries.
We would like to call upon the Stop TB Partnership to continue to promote the implementation of DOTS strategy and assist countries to attain agreed international targets. We invite the Partnership to reconsider the number of African countries involved and adopt strategies that direct international focus on a larger number of African countries. We also suggest the Partnership to advocate for research on new and appropriate technologies for TB diagnosis and treatment; to support for the use of best drug combinations as minimum standard of care; and to promote the scale up of TB/HIV interventions.
In this context I am very keen to listen to your views in regard to the proposed Draft Roadmap to intensify action to reach the TB MDGs in the African region. We expect the final version of the Roadmap to be owned by African Governments and Partners and become the reference to guide the resource mobilisation and scaling-up of TB related interventions at national and community levels.
These actions we call for should include the strengthening of health infrastructures in particular human resources for health, functional laboratory networks, drugs and logistic management and a system for monitoring and evaluating progress.
Distinguished Members of the Stop TB Coordinating Board:
We are in process of decentralizing WHO resources to boost our capacity at country level and leverage resources for the implementation of TB Roadmap in the African region.
We count on your support towards this endeavour!
I would like to end by thanking you, once again, for giving me the opportunity to address this special Session of the Board devoted to Africa. I am particularly motivated, since we intend to find out, during this session, innovative ways and means to rapidly scale-up TB control efforts across Africa to reach the MDGs.
Let me conclude by thanking the STOP-TB PARTNERSHIP for its major support in TB control in the African region. I should also recognize the outstanding role of our partners such as the International Union Against TB and Lung Disease (IUATLD), the Royal Dutch TB Association (KNCV), the Canadian International Development Agency (CIDA), the World Bank, the African Development Bank (ADB), USAID, CDC, the French Cooperation, the Damien Foundation, the German Leprosy Relief Association (GLRA), the UK Department for International Development (DFID), the Global Fund, civil society and many others too numerous to mention here. I would like to address a special note of thanks to our colleagues from WHO/HQ under the leadership of Dr Mario Raviglione, for their good collaboration in support to regional TB activities.
We have all partnered with Governments and People in this fight!
We look forward to do better in the African Region, still lagging behind in relation to the overall progress of TB control in the world. Without concerted action focussed on TB, the epidemic will continue to worsen with high mortality rate and keeping millions of African TB patients in the trap of poverty.
On a personal note, I pledge my commitment and that of WHO Secretariat to work with the STOP-TB Partnership to combat TB in our region.
I thank you all for your attention and look forward to the recommendations of this session.