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    • External parties ability and willingness to fund health inte

    2019-04-24

    External parties\' ability and willingness to fund health interventions is also an important factor in how governments decide on their spending priorities. Historically, development partners have funded prevention and treatment for a key group of diseases. Furthermore, a diverse set of barriers prevents the private sector from providing a comprehensive set of services to all people. Governments have a part to play in addressing the disease burden that LY-411575 is ignored or only partly covered by the private sector and donors, and governments are wise to spend in a manner complementary to other major funders.
    In May 2014, the World Health Assembly officially approved the Draft Global Strategy and Targets for Tuberculosis Prevention, Care and Control after 2015. The target of the strategy is the elimination of tuberculosis as a public health threat by 2035. This target is ambitious, but the commitment to the end of tuberculosis is laudable. The recently published 19th WHO global tuberculosis report 2014, provides an opportunity to think once again on the global tuberculosis strategy, and to assess just how much further effort is needed before global tuberculosis control can be achieved. Previously, we declared that the 1·3 million deaths per year from tuberculosis reported in the 2013 WHO global tuberculosis report was unacceptable in the 21st century. The latest 2014 WHO global tuberculosis report has revised its estimates of new tuberculosis cases worldwide from previous years, and now shows that almost half a million more cases of tuberculosis occurred worldwide than in their 2013 estimate. Of an estimated 9 million people who developed tuberculosis in 2013, 1·5 million people died (deaths up from 1·3 million estimated in 2012). The 2014 WHO report also states that the problem of drug-resistant tuberculosis is worsening, with an estimated 480 000 new cases of multidrug-resistant (MDR) tuberculosis in 2013. This number too might be an underestimate, since estimates for the true burden of drug-resistant tuberculosis across sub-Saharan Africa, Asia, and eastern Europe are impaired by the fact that drug-resistance testing and treatment services are generally unavailable at most health-care facilities. Perhaps even more concerning was that, of the nearly half a million estimated cases of MDR tuberculosis worldwide, only 136 000 cases were officially diagnosed. The outlook for these patients is bleak, with treatment completion rates remaining at 48% and a widening gap between people who are diagnosed and those who receive treatment. Furthermore, 9% of people with MDR tuberculosis are estimated to have extensively drug-resistant (XDR) tuberculosis—ie, nearly 50 000 people worldwide have a form of the disease that, at present, cannot be treated. The increased revised estimates in the 2014 report arise from a series of studies in five high-burden countries: Gambia, Laos, Nigeria, Pakistan, and Rwanda. One of these countries, Nigeria, was reported to have a tuberculosis diagnosis rate of about 50%—ie, only half of all people with tuberculosis were notified that they had the disease. After the prevalence study, it was estimated that just 16% of all patients with tuberculosis were notified by the national treatment programme. Results from a similar study in Indonesia showed that prevalence had been substantially underestimated and the number of cases could be nearly one million more than were previously estimated. The report states that the rate of progress against the disease has remained largely unchanged. The number of new cases has decreased by roughly 1·5% each year between 2000 and 2013. At these present rates of progress, the target of elimination by 2035 seems remote. So what can be done by the global community to accelerate progress to achieve global targets? First, many cases of tuberculosis are clearly not officially diagnosed or treated. The so-called missing 3 million continue to be a major driver of the epidemic. This challenge was the theme of World Tuberculosis Day 2014. People with active tuberculosis who are not treated can transmit the disease to others, while people who are treated unofficially, outside national tuberculosis programmes, are at increased risk of developing drug-resistant strains of the disease. As the revised data and other studies suggest, the more tuberculosis is looked for, the more is found. Therefore, approaches are needed that look for tuberculosis more thoroughly, and diagnose more people as soon as possible, allowing them to receive the appropriate high-quality treatment. Fully funded projects like TB REACH, which has a proven record of piloting innovative ways to diagnose and treat great numbers of people, would be a good first step.