Global Tuberculosis Report -- 2012.pdf

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5.1 Funding for TB care and control bycountry group, 2006–2013In the 104 countries for which trends in TB funding since2006 can be assessed and that report 94% of the world’sTB cases (listed in Table 5.1), funding is expected to reachUS$ 4.8 billion in 2013 (Figure 5.1). This is an increasein real terms from US$ 3.4 billion in 2006 and a smallincrease from US$ 4.6 billion in 2012.Brazil, the Russian Federation, India, China and SouthAfrica (BRICS), which report 48% of the world’s TB cases(Chapter 3), account for US$ 3 billion (63%) of theexpected total of US$ 4.8 billion in 2013 (Figure 5.1). Theother 17 high TB burden countries (HBCs) outside BRICS(listed in Table 5.2), which report 34% of the world’s TBcases, account for US$ 0.6 billion. A group of 10 Europeancountries other than the Russian Federation accounts fora further US$ 0.5 billion (80% of which is accounted forby three countries: Romania, Turkey and Uzbekistan).Patterns of funding for multidrug-resistant TB (MDR-TB) specifically are different, as described in Box 5.1.5.2 Funding for TB care and control bycategory of expenditure, 2006–2013In each year 2006–2013, the largest share of funding hasbeen used for the diagnosis of TB and treatment withfirst-line drugs (all categories of expenditure except thoselabelled MDR-TB in Figure 5.2 and Figure 5.4). However,funding for the diagnosis and treatment of MDR-TB hasbeen increasing and is expected to exceed US$ 0.7 billionin 2013 (Figure 5.2). Much of the increase is accounted forby BRICS, but allocations are increasing in other HBCsand the rest of the world as well (Figure 5.4).The relatively small amounts of funding reported forcollaborative TB/HIV activities (see Chapter 7 for furtherdetails) reflect the fact that funding for most of theseinterventions (including the most expensive, antiretroviraltreatment) is usually channelled to national HIVprogrammes and nongovernmental organizations ratherthan to national TB control programmes (NTPs).5.3 Funding for TB care and control bysource of funding, 2006–2013Domestic funding from national governments is thesingle largest source of funding for TB care and control(Figure 5.3), accounting for 90% of total expected fundingin 2013. 1 Of the remaining 10% that is expected fromdonor sources in 2013, most (88%) is accounted for byFIGURE 5.1 Funding for TB care and control in 104countries reporting 94% of global cases,by country group, 2006–2013US$ billions (constant 2012 US$)5432103.4 3.33.63.94.04.54.64.82006 2007 2008 2009 2010 2011 2012 2013Low- and middleincomecountries,excluding HBCs andEuropeLow- and middleincomecountries ofEurope, excludingthe RussianFederationHBCs, excludingBRICSBRICSFIGURE 5.2 Funding for TB care and control in 104countries reporting 94% of global cases,by line item, 2006–2013US$ billions (constant 2012 US$)5432103.43.33.63.94.04.54.64.82006 2007 2008 2009 2010 2011 2012 2013General health-careservices: MDR-TBGeneral health-careservices: DOTSOtherPPM/PAL/ACSM/CBC/OR/surveysTB/HIVMDR-TBDOTS aaDOTS includes funding available for fi rst-line drugs, NTP staff, programmemanagement and supervision, and laboratory equipment and supplies.FIGURE 5.3 Funding for TB care and control in 104countries reporting 94% of global cases,by source, 2006–2013US$ billions (constant 2012 US$)5432103.4 3.33.63.94.04.54.64.82006 2007 2008 2009 2010 2011 2012 2013<strong>Global</strong> FundGrants (excluding<strong>Global</strong> Fund)Government,general health-careservicesGovernment, NTPbudget (includingloans)1Domestic funding includes funding for outpatient visits andinpatient care in hospitals, the costs of which are not usuallyincluded in NTP budgets and expenditures. The amount ofdomestic funding for these inputs to TB treatment are estimatedby combining data on the average number of outpatientvisits and days in hospital per TB patient reported by countrieswith WHO estimates of the unit costs of outpatient visits andbed-days (see www.who.int/choice).GLOBAL TUBERCULOSIS REPORT 2012 53
TABLE 5.1 104 countries for which trends in TB funding could be assessed, by income group and WHO region,2006–2013 aWHO REGIONAfricanLOW-INCOME(GNI PER CAPITA US$ 1025 IN 2011)Benin, Burkina Faso, Burundi, CentralAfrican Republic, Chad, DemocraticRepublic of the Congo, Eritrea,Ethiopia, Gambia, Guinea-Bissau,Kenya, Liberia, Madagascar, Malawi,Mali, Mauritania, Mozambique, Niger,Rwanda, Sierra Leone, Togo, Uganda,United Republic of Tanzania, ZimbabweLOWER MIDDLE-INCOME(GNI PER CAPITA US$ 1026–4035 IN 2011)Cameroon, Cape Verde, Congo, Côted’Ivoire, Ghana, Lesotho, Nigeria,Sao Tome and Principe, Senegal,Swaziland, ZambiaAmericas Haiti Bolivia (Plurinational State of),El Salvador, Guatemala, Guyana,Honduras, Nicaragua, ParaguayEastern Mediterranean Afghanistan, Somalia Djibouti, Egypt, Morocco, Pakistan,Sudan, YemenEuropeanArmenia, Georgia, Republic ofMoldova, UzbekistanSouth-East Asia Bangladesh, Myanmar, Nepal Bhutan, India, Indonesia, Sri Lanka,Timor-LesteWestern Pacific Cambodia Kiribati, Lao People’s DemocraticRepublic, Micronesia (Federated Statesof), Mongolia, Papua New Guinea,Philippines, Solomon Islands, Tonga,Vanuatu, Viet NamUPPER MIDDLE-INCOME(GNI PER CAPITA US$ 4036–12 475 IN 2011)Botswana, Gabon, Namibia, SouthAfricaArgentina, Brazil, Colombia, DominicanRepublic, Ecuador, Jamaica, Mexico,Panama, Suriname, Venezuela(Bolivarian Republic of)Iran (Islamic Republic of), Jordan,Lebanon, TunisiaBulgaria, Latvia, Montenegro, Romania,Russian Federation, Serbia, TurkeyMaldives, ThailandChina, Malaysia, TuvaluaAnother 11 low- and lower middle-income countries with data available for the years 2011–2013 were included in the analyses of Figure 5.12: low-income, African:Guinea; low-income, European: Kyrgyzstan, Tajikistan; low-income, South-East Asia: Democratic People’s Republic of Korea; lower middle-income, Americas: Belize;lower middle-income, Eastern Mediterranean: Iraq, Syrian Arab Republic, West Bank and Gaza Strip; lower middle-income, European: Ukraine; lower middle-income,Western Pacific: Fiji, Marshall Islands.FIGURE 5.4Funding for drug-susceptible TB a and MDR-TB, b 2006–2013, by country groupUS$ millions (constant 2012 US$)BRICS300020001000Other HBCs6004002001000500Other low- and middle-income countriesDrug-susceptible TB,best estimate and5−95th percentilesMDR-TB, bestestimate and5−95th percentiles0002006 2008 2010 20122006 2008 2010 20122006 2008 2010 2012aCosts include fi rst-line drugs, NTP staff, programme management and supervision, laboratory equipment and supplies, hospital stays and clinic visits.bCosts include second-line drugs, programme management and supervision, hospital stays and clinic visits.54 GLOBAL TUBERCULOSIS REPORT 2012
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GLOBALTUBERCULOSISREPORT2012
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ContentsAbbreviationsivAcknowledgem
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AcknowledgementsThis report on glob
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WHO Western Pacific RegionShalala A
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Executive SummaryThe World Health O
Page 12 and 13: CHAPTER 1IntroductionBOX 1.1Basic f
Page 14 and 15: TABLE 1.1 Targets for the scale-up
Page 16 and 17: TABLE 1.2 Reporting of data in the
Page 18 and 19: BOX 2.1Uncertainty in estimates of
Page 20 and 21: TABLE 2.2 Estimated burden of disea
Page 22 and 23: FIGURE 2.5 Estimated TB incidence r
Page 24 and 25: FIGURE B2.2.1Reporting of notificat
Page 26 and 27: FIGURE 2.8Estimated TB incidence ra
Page 28 and 29: FIGURE 2.11 Countries (in blue) for
Page 30 and 31: FIGURE 2.12 Trends in estimated TB
Page 32 and 33: ● producing and widely disseminat
Page 34 and 35: FIGURE 2.16 Progress in global cove
Page 36 and 37: BOX 2.6Efforts by the Task Force to
Page 38 and 39: CHAPTER 3TB case notificationsand t
Page 40 and 41: BOX 3.1 1Definitions of TB casesDef
Page 42 and 43: TABLE 3.3 Contribution of public-pr
Page 44 and 45: BOX 3.4Integrating community-based
Page 46 and 47: TABLE 3.4 Estimates of the case det
Page 48 and 49: TABLE 3.5 Treatment success for new
Page 50 and 51: CHAPTER 4Drug-resistant TBKEY FACTS
Page 52 and 53: FIGURE 4.2 Percentage of new TB cas
Page 54 and 55: BOX 4.1Frequencies of resistance to
Page 56 and 57: FIGURE 4.6 Number of MDR-TB cases e
Page 58 and 59: FIGURE 4.7Notified cases of MDR-TB
Page 60 and 61: egimens globally, providing more su
Page 64 and 65: TABLE 5.2 NTP budgets, available fu
Page 66 and 67: FIGURE 5.5Trends in domestic and do
Page 68 and 69: FIGURE 5.6Domestic funding as a per
Page 70 and 71: FIGURE 5.8Cost per TB patient succe
Page 72 and 73: FIGURE 5.10 Total cost and unit cos
Page 74 and 75: ● The 14 countries not included i
Page 76 and 77: on public health by an external Exp
Page 78 and 79: evised as a result of the introduct
Page 80 and 81: TABLE 6.2 Incorporation of WHO poli
Page 82 and 83: FIGURE 6.3The Supranational Referen
Page 84 and 85: of TB disease by 65%, irrespective
Page 86 and 87: FIGURE 7.3Percentage of TB patients
Page 88 and 89: BOX 7.1Accelerating progress in pro
Page 90 and 91: TABLE 7.2 Assumptions used to estim
Page 92 and 93: FIGURE 8.1 The development pipeline
Page 94 and 95: sputum specimens and TB isolates fr
Page 96 and 97: cal trial sites and building labora
Page 98: new TB vaccine candidate. A Phase I
Page 102 and 103: This annex explains the methods tha
Page 104 and 105: 2011. On average, 15 data points we
Page 106 and 107: may suffer from biases. These biase
Page 108 and 109: TABLE A1.3Parameter estimates used
Page 110 and 111: 5. Estimates of TB prevalence, 1990
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the Republic of Moldova, Romania, t
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AFGHANISTANPopulation 2011 32 milli
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BRAZILPopulation 2011 197 millionHI
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CHINAPopulation 2011 1 348 millionH
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ETHIOPIAPopulation 2011 85 millionH
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INDONESIAPopulation 2011 242 millio
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MOZAMBIQUEPopulation 2011 24 millio
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NIGERIAPopulation 2011 162 millionH
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PHILIPPINESPopulation 2011 95 milli
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SOUTH AFRICAPopulation 2011 50 mill
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UGANDAPopulation 2011 35 millionHIG
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VIET NAMPopulation 2011 89 millionH
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ANNEX 3Regional profiles
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WHO REGION OF THE AMERICASPopulatio
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WHO EUROPEAN REGIONPopulation 2011
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WHO WESTERN PACIFIC REGIONPopulatio
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SUMMARY BY WHO REGIONTable A4.1 Est
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MORTALITY (EXCLUDING HIV) PREVALENC
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NEW AND RELAPSENOTIFICATION RATE aY
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-% OF TB PATIENTS WITHKNOWN HIV STA
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AFRICAN REGIONTable A4.1 Estimates
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INCIDENCE (INCLUDING HIV) INCIDENCE
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NEW AND RELAPSENOTIFICATION RATE aY
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NEW AND RELAPSENOTIFICATION RATE a1
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TREATMENT SUCCESS (%) a1995-2010YEA
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YEARTOTALCONFIRMEDCASES OFMDR-TB aE
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MALEYEAR 0-14 15-24 25-34 35-44 45-
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REGION OF THE AMERICASTable A4.1 Es
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% OF COHORTTREATMENT SUCCESS (%) a1
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MALEFEMALEYEAR 0-14 15-24 25-34 35-
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EASTERN MEDITERRANEAN REGIONTable A
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EUROPEAN REGIONTable A4.1 Estimates
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SOUTH-EAST ASIA REGIONTable A4.1 Es
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SMEAR LABS % OF SMEARPER 100K LABS
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Estimates of mortality, prevalence
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YEARPOPULATION(MILLIONS)MORTALITY (
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YEARPOPULATION(MILLIONS)INCIDENCE (
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YEARPOPULATION(MILLIONS)INCIDENCE (
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SMEAR LABS % OF SMEARPER 100K LABS
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