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can provide insights into progress towards universal health coverage (UHC), which is necessary to achieve the End TB Strategy milestones set for 2020 and 2025 (Chapter 2). Measurement of costs faced by TB patients and their households is also required to assess progress towards one of the three high-level indicators of the End TB Strategy; that is, the percentage of TB patients and their households who face catastrophic costs as a result of TB disease. The milestone of zero set for this indicator for 2020 requires progress in terms of both UHC and social protection (included under Pillar 2 of the End TB Strategy). These two topics – analysis of health financing data, and measurement of costs faced by TB patients and their households – are covered in Chapter 6. Further country-specific data on TB financing can be found in finance profiles that are available online. 1 7.1 Estimates of funding required for a full response to the global TB epidemic, 2016–2020 The latest estimates of the funding required for a full response to the global TB epidemic, to achieve the End TB Strategy milestones for 2020, have been set out in the Stop TB Partnership’s Global Plan to End TB, 2016–2020. 2 Worldwide, the amount for implementation of TB prevention, diagnostic and treatment interventions rises from almost US$ 9.5 billion in 2016 to US$ 14 billion in 2020 (Fig 7.1). Most of this total (75%) is for diagnosis and treatment of drug-susceptible TB, which grows from US$ 7.4 billion in 2016 (US$ 6.4 billion in low- and middle-income countries) to US$ 9.7 billion in 2020. However, the amount for drugresistant TB doubles from US$ 1.8 billion in 2016 to US$ 3.6 billion in 2020. 3 Relatively small amounts are needed for TB/HIV interventions, mainly because the figure does not include the funding needed for antiretroviral therapy for HIV-positive TB patients. 4 An additional US$ 9 billion is needed for TB research and development over the 5-year period (data not shown; this topic is discussed further in Chapter 8). Of the total of US$ 58 billion over 5 years (excluding research and development), US$ 52 billion was estimated to be required in low- and middle-income countries (growing from US$ 8.3 billion in 2016 to US$ 12.3 billion in 2020). Within this group of countries, estimates of the funding that could be mobilized from domestic and international donor sources were restricted to countries eligible to ap- 1 www.who.int/tb/data 2 The Global Plan to End TB, 2016–2020. Geneva: Stop TB Partnership; 2015 (http://www.stoptb.org/global/plan/, accessed 28 July 2016). 3 The burden of drug-resistant TB (in terms of cases per year) is not projected to increase between 2016 and 2020. Increased funding is required to close detection and treatment gaps (see also Chapter 4). 4 Funding needs for ART for HIV-positive TB patients are part of HIV resource needs estimates, and are not included in the Global Plan to End TB, to avoid double counting. For details on resource needs estimates for HIV/AIDS, see Stover J, Bollinger L, Izazola JA, Loures L, DeLay P, Ghys PD et al. What is required to end the AIDS epidemic as a public health threat by 2030? The cost and impact of the fast-track approach. PLoS One. 2016;11(5):e0154893 (http://www.ncbi.nlm.nih. gov/pubmed/27159260, accessed 28 July 2016). :: FIG. 7.1 Estimates of funding required globally for drugsusceptible TB, MDR-TB and TB/HIV in the Global Plan to End TB 2016—2020 (constant 2015 US$ billions) US$ billions 16 12 8 4 0 2016 2017 2018 2019 2020 Drug-susceptible TB MDR-TB TB/HIV Source: Data from Stop TB Partnership Global Plan to End TB 2016-2020 ply to the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund). 5 For eligible countries, the funding required over 5 years amounts to US$ 29 billion; it was estimated that about US$ 16 billion of this amount could be mobilized from domestic sources and that the remainder (an average of US$ 2.6 billion per year) would need to come from international donors. The Global Plan to End TB did not attempt to assess the broader investments required to increase the overall coverage and quality of health-care services, and to remove financial barriers to accessing care. Such investments are needed for many essential preventive, treatment and care interventions, not only for TB. Progress on these fronts is critical, as explained in Chapter 2, reflected in Pillar 2 of the End TB Strategy and discussed in Chapter 6. The costings in the Global Plan can thus be seen as the financial resources required for Pillars 1 and 3 of the End TB Strategy. 7.2 TB funding, overall and by category of expenditure and source of funding, 2006–2016 Data reported by NTPs to WHO since 2006 were used to analyse funding trends over the period 2006–2016 in 126 countries (Table 7.1). These countries accounted for 97% of the global number of TB cases reported in 2015, and included 126 low- and middle-income countries. The methods used to collect, review and analyse financial data are summarized in Box 7.1. In these 126 countries, funding for TB prevention, diagnosis and treatment reached US$ 6.6 billion in 2016, up from US$ 6 billion in 2015 and almost double the US$ 3.5 billion that was available in 2006 (all figures are in constant values for 2016, see Fig. 7.2). Of the total of US$ 6.6 bil- 5 Countries not eligible to apply to the Global Fund include Brazil, China, the Russian Federation and about half of the other 52 countries classified as upper middle income. GLOBAL <strong>TUBERCULOSIS</strong> REPORT 2016 :: 109
:: TABLE 7.1 126 countries included in analyses of TB financing, by income group and WHO region, 2016 a,b African LOW-INCOME (30/31 COUNTRIES REPRESENTING 13% OF NOTIFIED CASES GLOBALLY IN 2015) Benin, Burkina Faso, Burundi, Central African Republic, Chad, DR Congo, Eritrea, Ethiopia, Gambia, Guinea, Guinea-Bissau, Liberia, Madagascar, Malawi, Mali, Mozambique, Niger, Rwanda, Senegal, Sierra Leone, South Sudan, Togo, Uganda, UR Tanzania, Zimbabwe LOWER-MIDDLE-INCOME (48/52 COUNTRIES REPRESENTING 58% OF NOTIFIED CASES GLOBALLY IN 2015) Cabo Verde, Cameroon, Congo, Côte d’Ivoire, Ghana, Kenya, Lesotho, Mauritania, Nigeria, Sao Tomé and Principe, Swaziland, Zambia Americas Haiti Bolivia, El Salvador, Guatemala, Honduras, Nicaragua Eastern Mediterranean European South-East Asia Western Pacific Afghanistan, Somalia Democratic People’s Republic of Korea, Nepal Djibouti, Morocco, Pakistan, Sudan, Syria, Tunisia, Yemen Armenia, Kyrgyzstan, Republic of Moldova, Tajikistan, Ukraine, Uzbekistan Bangladesh, Bhutan, India, Indonesia, Myanmar, Sri Lanka, Timor-Leste Cambodia, Kiribati, Lao People’s Democratic Republic, Mongolia, Papua New Guinea, Philippines, Samoa, Solomon Islands, Tonga, Vanuatu, Viet Nam Excluded Comoros Egypt, Kosovo, Micronesia (Federal States of), West Bank and Gaza Strip UPPER-MIDDLE-INCOME (48/55 COUNTRIES REPRESENTING 26% OF NOTIFIED CASES GLOBALLY IN 2015) Angola, Botswana, Gabon, Mauritius, Namibia, South Africa Belize, Brazil, Colombia, Cuba, Dominican Republic, Ecuador, Grenada, Guyana, Jamaica, Mexico, Panama, Paraguay, Peru, Saint Lucia, Saint Vincent and the Grenadines, Suriname, Venezuela (Bolivian Republic of) Iran (Islamic Republic of), Iraq, Jordan, Lebanon Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Georgia, Kazakhstan, Montenegro, Romania, Russian Federation, Serbia, The Former Yugoslav Republic of Macedonia, Turkey BRICS (48% OF NOTIFIED CASES GLOBALLY IN 2015) South Africa Brazil Russian Federation 25 HIGH-BURDEN COUNTRIES EXCLUDING BRICS (37% OF NOTIFIED CASES GLOBALLY IN 2015) Angola, Central African Republic, Congo, DR Congo, Ethiopia, Kenya, Lesotho, Liberia, Mozambique, Namibia, Nigeria, Sierra Leone, UR Tanzania, Zambia, Zimbabwe Pakistan Maldives, Thailand India Bangladesh, Indonesia, Myanmar, Thailand American Samoa, China, Fiji, Malaysia, Marshall Islands, Palau, Tuvalu Albania, Algeria, Costa Rica, Dominica, Equatorial Guinea, Libya, Turkmenistan a Analyses focus on low and middle-income countries. b Additional countries included in trend analyses of TB financing compared with those included in previous global reports are shown in bold. China Cambodia, Democratic People’s Republic of Korea, Papua New Guinea, Philippines, Viet Nam 110 :: GLOBAL <strong>TUBERCULOSIS</strong> REPORT 2016
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GLOBAL REPORT TUBERCULOSIS 2016
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WHO Library Cataloguing-in-Publicat
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:: Abbreviations aDSM AE AIDS ART A
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The principal source of financial s
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Zhumagali Ismailov, Sarah Jackson,
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:: Executive Summary Background The
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TB prevention services South Africa
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Chapter 1 :: Introduction Tuberculo
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:: Box 2.1 The Sustainable Developm
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:: Box 2.3 The End TB Strategy at a
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:: TABLE 2.1 Top 10 indicators (not
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TABLE 2.2 :: The three TB high-burd
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Chapter 3 :: TB disease burden :: K
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:: Box 3.1 The WHO Global Task Forc
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:: Box 3.2 Updates to estimates of
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:: Box 3.3 Updated and interim esti
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:: FIG. 3.1 Strengthening national
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:: TABLE 3.2 Estimated epidemiologi
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:: FIG. 3.3 Estimated TB incidence
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:: FIG. 3.5 Global trends in the es
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:: FIG. 3.8 Trends in estimated TB
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:: FIG. 3.10a Top causes of death w
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:: FIG. 3.14 Trends in estimated TB
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:: FIG. 3.16 Data sources available
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:: TABLE 3.5 Estimated incidence of
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:: FIG. 3.20 Estimated incidence of
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:: FIG. 3.22 Global progress in imp
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:: TABLE 3.6 Number of TB cases fou
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:: TABLE 3.7 HIV-negative and HIV-p
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:: FIG. 3.29a The prevalence:notifi
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:: FIG. 3.31b The average CFR by st
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SIM and SINAN case-based databases,
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Prompt and accurate diagnosis of tu
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:: FIG. 4.2 New and relapse TB case
Page 70 and 71: :: FIG. 4.5 Percentage of new and r
Page 72 and 73: :: FIG. 4.8 Global numbers of notif
Page 74 and 75: :: TABLE 4.4 National guidance in p
Page 76 and 77: :: FIG. 4.9 Percentage of bacteriol
Page 78 and 79: :: FIG. 4.12 Number of MDR/RR-TB ca
Page 80 and 81: :: FIG. 4.14 Case notification rate
Page 82 and 83: :: FIG. 4.16a The ten countries wit
Page 84 and 85: :: Box 4.5 Community contributions
Page 86 and 87: :: FIG. 4.18 Estimated ART treatmen
Page 88 and 89: issued in March 2013 and updated in
Page 90 and 91: :: FIG. 4.22 Treatment outcomes for
Page 92 and 93: :: Box 4.6 Active TB drug-safety mo
Page 94 and 95: Prevention of new infections of Myc
Page 96 and 97: :: TABLE 5.2 TB preventive treatmen
Page 98 and 99: :: TABLE 5.3 Provision of TB preven
Page 100 and 101: :: FIG. 5.5 Coverage of BCG vaccina
Page 102 and 103: This chapter aims to provide a tube
Page 104 and 105: :: FIG. 6.2 Government spending on
Page 106 and 107: :: Box 6.1 Implications for TB of e
Page 108 and 109: :: Box 6.2 Innovations in engaging
Page 110 and 111: :: Box 6.4 Reforming systems to exp
Page 112 and 113: :: TABLE 6.1 TB patient social supp
Page 114 and 115: :: FIG. 6.5 Surveys of costs faced
Page 116 and 117: :: TABLE 6.3 Status of selected SDG
Page 118 and 119: Continue current trend (base case s
Page 122 and 123: lion, most (US$ 4.4 billion, 67%) i
Page 124 and 125: :: Box 3.2 Updates to estimates of
Page 126 and 127: :: FIG. 7.5 Funding for NTP budgets
Page 128 and 129: :: Box 7.2 International donor fund
Page 130 and 131: :: FIG. 7.6 Reported funding gaps f
Page 132 and 133: :: Box 7.3 Methods used to estimate
Page 134 and 135: :: Box 8.1 WHO’s Global Action Fr
Page 136 and 137: is critical to allow for the time-s
Page 138 and 139: :: FIG. 8.2 The global development
Page 140 and 141: :: FIG. 8.3 The development pipelin
Page 142: Annex 1 Access to the WHO global TB
Page 145 and 146: A data dictionary that defines each
Page 147: Annex 2 Country profiles :: FOR 30
Page 150 and 151: Bangladesh population 2015 :: 161 m
Page 152 and 153: China population 2015 :: 1 376 mill
Page 154 and 155: Democratic Republic of the Congo po
Page 156 and 157: India population 2015 :: 1 311 mill
Page 158 and 159: Kenya population 2015 :: 46 million
Page 160 and 161: Myanmar population 2015 :: 54 milli
Page 162 and 163: Pakistan population 2015 :: 189 mil
Page 164 and 165: Russian Federation population 2015
Page 166 and 167: Thailand population 2015 :: 68 mill
Page 168: Viet Nam population 2015 :: 93 mill
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Central African Republic population
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Lesotho population 2015 :: 2.1 mill
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Namibia population 2015 :: 2.5 mill
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Sierra Leone population 2015 :: 6.5
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Zimbabwe population 2015 :: 16 mill
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WHO African Region WHO MEMBER STATE
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WHO Eastern Mediterranean Region WH
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WHO South-East Asia Region WHO MEMB
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Annex 4 TB burden estimates, notifi
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:: TABLE A4.1 TB incidence estimate
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:: TABLE A4.1 Table TB incidence A4
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:: Table TABLE A4.2 A4.2 Estimates
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Table :: TABLE A4.2 A4.2 Estimates
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:: TABLE A4.3 Measured percentage o
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:: TABLE A4.3 Measured Table A4.3 p
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:: TABLE A4.4 TB case notifications
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:: TABLE A4.4 TB case notifications
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:: TABLE A4.5 Treatment outcomes by
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:: TABLE A4.5 Treatment outcomes by
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ISBN 9 789241 565394 Ending TB by 2
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