Thailand - Stop TB Partnership

tool for the NTP to improve its access to marginalized groups such as migrant workers,
ethnic minorities, and former prisoners. 152
Collaboration with multilateral organizations and
bilateral donors
Over 90 percent of the national response to TB and TB/HIV is funded from the government
budget and out-of-pocket spending. 153 Thai TB experts insist that assistance from bilateral
and multilateral donors should reinforce national health systems and contribute to health
policies and programming that are sustainable in the long term.
Participants at one roundtable meeting unanimously emphasized the importance
of balancing donor interests and requirements with the need for funded projects
to complement existing structures and programs. For example, one prominent regional
health administrator insisted that donor-supported TB projects must support the NTP, take
steps to ensure support from the communities in which they are to be implemented, and
avoid replacing essential TB control activities and functions that should be managed by the
Thai government. In the administrator’s view, the NTP must always be able to “do without
donor-supported supplemental activities if it has to.” 154 For this reason, some health officials
express concern about the fact that Global Fund resources have supported such core activities
as training programs for health workers, which have not received sufficient funding
from the NTP since the health reforms. They emphasize that these resources should be seen
by the NTP only as a short-term opportunity to build a stronger base for programs that will
have to be continued without donor funding in the future. 155
There are positive examples of donor projects that fulfill these requirements in the
eyes of their Thai partners. For example, the director of one Bangkok-based health center
identified a collaborative project with the U.S. Centers for Disease Control and Prevention
in which the donor organization arrived with one idea of what to fund, but proved willing to
change the parameters of the project in response to local feedback and suggestions on what
was needed. The result was a PPM DOTS program that has posted significant successes,
enjoys strong local support, and provides a strong basis for scaling-up. It demonstrates the
benefits of international donor/public sector partnerships that are firmly rooted in the communities
they serve and that can provide a long-term return on a short-term investment. 156
Another donor organization that has adapted the assistance it provides to locally
identified needs is the Research Institute of Tuberculosis (RIT) in Japan. The RIT has
provided long-term support for the improvement of laboratory capacity, provincial-level
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