Evaluation of the Tuberculosis Control Assistance Program (TB CAP)

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International Standards for Tuberculosis Care (ISTC) is an example of tools that help countriesworldwide. Its function supports the enhancement and expansion of DOTS programs. TB CAP workserved as the ideal test bed for validating and refining ISTC. The reputation of the partners in TB CAPfacilitated its rapid adaptation, adoption, and introduction by countries. Very quickly, in relative terms,the ISTC has become a global standard and is now part of the WHO M&E indicators collected from allmember states. Although ISTC’s success is also due to its unique nature and genesis (it was created by asociety of medical practitioners rather than more traditional public health organizations) and a lack ofcompetitive tools, there can be no doubt that it would not have reached the current level of acceptance asquickly (or at all) without TB CAP.The ISTC represents the best that TB CAP has to offer. Unfortunately, the same cannot be said ofeverything TB CAP partners produce. For a variety of reasons, many of those interviewed claimed thatthe tools developed by TB CAP (and in the global community at large) far outnumber those activelybeing used. Nevertheless, TB CAP support has accelerated development of some valuable internationaltools and their adaptation and adoption. However, guidance for adapting technical guidelines to uniquecountry conditions and stage of program development is at times insufficient.RecommendationsTB CAP should leverage the activities conducted to promote the ISTC with application in countriesof proven methods of involving private practitioners in management of TB patients according tonational guidelines.TB CAP should only produce new tools when it is clear that existing tools cannot be adapted.TB CAP should analyze successful tools and experiences from its projects and establish a process fordisseminating them and monitoring how they are used.G. PLANNING AND IMPLEMENTATIONThe number of USAID Missions buying into TB CAP has increased dramatically, from 10 Missions inAPA1 to 22 in APA4, as did the total value of these buy-ins (from US$4.2 million to US$40.7 million;see Figure 1).Figure 1: Total US Dollar Value of USAID Mission Buy-Ins to TB CAP in $MillionsUSAID gives priority to supportingcountries with a heavier burden of TB,among other criteria. 7 By APA4 32countries had received some support fromTB CAP (see sidebar). Of these, 17 wereTB high-burden countries, and 28 wereUSAID priority countries.While Missions and countries continue tobe well satisfied with the technical qualityof the assistance they receive, partners seethe requirement to prepare and approvenew plans each year as duplicative andinefficient. Furthermore, the one-year7 USAID’s TB efforts are concentrated in 38 countries to maximize impact and focus financial resources, TA fromUSAID/Washington and its partners, and staffing; 20 of the countries are designated as Tier One, which gives themhigher priority for funding than the 18 countries in Tier Two.14 EVALUATION OF THE TUBERCULOSIS CONTROL ASSISTANCE PROGRAM (TB CAP)
focus is seen as being inconsistent with the goals of optimizing and linking TB CAP activities to nationalstrategic plans.Responding to Requests for SupportTB CAP typically moves into a new country after the Mission, having consulted with USAID/Washington, makes a request for a TB CAP project. Upon learning of the Mission need, TB CAP selectsa partner to coordinate the TB CAP activity—a delicate process affected by such factors as the type andamount of support required and the technical capacity and interests of partners.The selection of a coordinating partner is complicated because the scope and complexity of the work isoften great, and there is a need to accommodate the experiences and desires of the USAID Mission andNTP staff. USAID Missions or the NTP may have an established relationship with an existing partner,and request to work with them. If the partner is already involved in other health activities in the country orhas an established operation that can be used to support and manage the TB CAP effort, this is often anadditional factor to be considered.RecommendationsUSAID Missions should be better informed about the added value of longer-term investments thatstrategically strengthen the institutional capacity of national TB control programs.TB CAP should offer, upon request, TA to Missions to increase their understanding of strategic andprogrammatic issues in TB control and coordination of TB with other health activities, such as HIVand primary health care.Assessing Country NeedsIn preparation for a country project, PMU staff often visit the country to assess needs, interview nationalstakeholders, and draft a preliminary plan for support before officially selecting a partner to coordinatethe work. Although the PMU advises partners of a forthcoming assessment mission, some partners reportthey were unaware that TB CAP was in the country.Such assessments also do not appear to follow a standardized format or produce a formal record of theanalysis that is shared with all partners. In addition to PMU staff, assessments may sometimes involveother partners, particularly when there is a previous relationship between a partner and the country.RecommendationsThe Mission, the PMU, and the NTP should jointly undertake a standardized assessment for everypotential new country before coordinating and collaborating partners are selected.TB CAP should periodically reevaluate the support it is providing to a country to ensure that what isbeing done remains effective in light of new needs or changed national policies.Selecting Coordinating and Collaborating PartnersBased on the outcomes of the visit to the country and taking into account these many practicalconsiderations, the PMU identifies a suggested coordinating partner. At that time, the PMU circulates thisinformation to all partners and requests volunteers to serve as collaborating partners, asking that eachexplain the role they would play in the project. The PMU then establishes a suggested composition for thecoordinating partner and subpartners and circulates final information to all.EVALUATION OF THE TUBERCULOSIS CONTROL ASSISTANCE PROGRAM (TB CAP) 15
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DateThursday, April 2, 2009Intervie
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Global Health Technical Assistance
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Evaluation of the Tuberculosis Control Assistance Program (TB CAP)

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