Evaluation of the Tuberculosis Control Assistance Program (TB CAP)

TB CAP is a highly successful project that has had significant impact, is well-managed, and is achievingits goals. Given the progress TB CAP has made in some countries to improve conditions for TB controlprograms worldwide, the evaluation team strongly recommends that USAID continue and expand itssupport for it.Although TB CAP has effectively achieved many of its project expectations, USAID has a moreambitious goal: If USAID is ―to contribute significantly to the global reduction of morbidity and mortalityassociated with tuberculosis,‖ 2 as it desires, it should take a more long-range and ambitious approach tothe TA it provides. Certainly the TB CAP project has demonstrated sound strategic principles that shouldbe even more rigorously embedded in future USAID support for TA, notably the TB CAP emphasis onenhancing the institutional and managerial capacity of national systems of TB controlsupporting a variety of technical areas, with a focus on ensuring that the fundamental building blocksof an effective TB control program are in place, especially effective drug management and sufficientcapacity and coordination of laboratory networksstrengthening and integrating directly observed treatment (DOTS) systems between governmenthealth facilities and nongovernmental institutions and providers, such as community-based volunteerscustomizing support to align it with each country’s state of development and national TB controlstrategy and priorities, policies, and technical guidelines.To realize its overarching goals USAID should shift its focus from short-term, high-yield activitiestoward longer-term, country-wide activities that convert the experiences of TB CAP for greater nationaland global impact. This would not require wholesale refashioning of the current TB CAP model, but itwould require more closely aligning some of its elements:USAID should encourage its Missions to develop multiyear workplans for TB control, linked tonational strategies and plans, and formally support their approval, while providing for annualadjustments and resourcing based on needs, progress made, and availability of funds. Longer-termplanning would make country TB control measures more sound and help stimulate investment intechnical capacity to meet demand.The future implementing mechanism should include a governing board to deal with issues ofgovernance, program strategy, and budgeting, mandated to develop and implement a strategic agendafor scale-up of support to countries. Medium- and long-term strategic oversight is essential to ensurethe best possible support to countries, maximum benefits to the global community, and efficient andresponsible use of USAID funding.The administrative arm should be empowered within the sphere of its responsibility to makemanagement decisions—seeking USAID or board-level approval when necessary and operatingefficiently and transparently.USAID should also consider improving the TB CAP model, which has already demonstrated itseffectiveness, to assure the quality of TB control measures in health facilities, promote timelier financialforecasting and reporting by implementing agencies, and adopt more effective approaches to collecting,analyzing, and sharing experiences. To accomplish overarching USAID goals, this mission should bereset at an even higher level and structured to achieve it.2 US Agency for International Development: Expanded Response to Tuberculosis, January 2009.viiiEVALUATION OF THE TUBERCULOSIS CONTROL ASSISTANCE PROGRAM (TB CAP)