TUBERCULOSIS

Chapter 2 :: A new era of global TB monitoring
From 2000 to 2015, global and national efforts to reduce
the burden of tuberculosis (TB) disease were focused on
achieving targets set within the context of the Millennium
Development Goals (MDGs). The MDGs were established
by the United Nations (UN) in 2000 and targets were set
for 2015. Target 6c of MDG6 was to “halt and reverse” TB
incidence. The Stop TB Partnership, established in 2001,
adopted this target and set two additional targets: that
TB prevalence and TB mortality rates should be halved by
2015 compared with their levels in 1990. The global TB
strategy developed by WHO for the decade 2006–2015,
the Stop TB Strategy, had the overall goal of reaching all
three targets.
WHO published its assessment of whether the 2015
global TB targets for reductions in TB incidence, prevalence
and mortality were achieved in October 2015. 1 The
assessment indicated that the MDG target was achieved
on a worldwide basis, in each of WHO’s six regions and in
16 of the 22 countries that were classified by WHO as high
TB burden countries during the period 2002–2015. Globally,
the TB mortality rate fell by 47% between 1990 and
2015, with most of that improvement occurring after 2000.
The target of a 50% reduction was met in four WHO regions
– the Region of the Americas, the Eastern Mediterranean
Region, the South-East Asia Region and the Western
Pacific Region – and in 11 high TB burden countries. Globally,
TB prevalence fell by 42% between 1990 and 2015.
The target of a 50% reduction was achieved in three WHO
regions – the Region of the Americas, the South-East Asia
Region and the Western Pacific Region – and in nine high
TB burden countries.
The MDGs (2000–2015) have now been superseded by
the Sustainable Development Goals (SDGs), which have
an end date of 2030. Similarly, WHO’s Stop TB Strategy
has been replaced by the End TB Strategy, which covers the
period 2016–2035. With the Global tuberculosis report 2016
being the first such report in the post-2015 era, this chapter
provides an overview of both the SDGs (Section 2.1) and
the End TB Strategy (Section 2.2), including the indicators
that will be used to monitor progress. For the first 5 years of
this new era (2016–2020), WHO has also defined updated
lists of high burden countries (HBCs) for TB, TB/HIV and
multidrug-resistant TB (MDR-TB). The updated lists are
presented and explained in Section 2.3.
1
World Health Organization. Global tuberculosis report 2015. Geneva:
WHO; 2015 (http://apps.who.int/iris/
bitstream/10665/191102/1/9789241565059_eng.pdf, accessed 27
July 2016).
2.1 The Sustainable Development Goals
The SDGs were adopted by all UN Member States in September
2015, at the UN General Assembly. 2 The 17 goals
are shown in Box 2.1. Departures from the MDGs include
a broader agenda (17 goals compared with the previous
eight), one consolidated goal on health compared with
three health-related MDGs, and a desire for universal relevance
rather than a focus on issues mostly of concern to
developing countries.
SDG3 is to “Ensure healthy lives and promote well-being
for all at all ages”, and it includes 13 targets (Box 2.2). One
of these targets, Target 3.3, explicitly mentions TB: “By
2030, end the epidemics of AIDS, tuberculosis, malaria and
neglected tropical diseases, and combat hepatitis, waterborne
diseases and other communicable diseases”. The
language of “ending epidemics” is also now a prominent
element of global health strategies developed by WHO and
the Joint United Nations Programme on HIV/AIDS (UN-
AIDS) for the post-2015 era, 3 including the End TB Strategy
(Section 2.2). Such language is much more ambitious than
the MDG language of “halting and reversing” epidemics (or
“stopping” them, as in the Stop TB Strategy). The TB indicator
for Target 3.3 is TB incidence per 100 000 population.
SDG3 also includes a target (Target 3.8) related to universal
health coverage (UHC). The WHO/World Bank definition
of UHC is that all people receive the health services
they need, while at the same time ensuring that the use of
these services does not expose the user to financial hardship.
4 Indicators for Target 3.8 include coverage of tracer
interventions for prevention and treatment (including TB
treatment coverage), 5 and financial coverage provided by
health insurance or a public health system.
Across the SDG indicator framework as a whole, the
definitions of many indicators include much greater emphasis
on within-country disaggregation compared with
the MDGs. This includes disaggregation by age, sex, geog-
2
United Nations. Sustainable Development Goals (https://
sustainabledevelopment.un.org/topics/
sustainabledevelopmentgoals, accessed 27 July 2016).
3
World Health Organization. Accelerating progress on HIV,
tuberculosis, malaria, hepatitis and neglected tropical diseases: A new
agenda for 2016–2030. Geneva: WHO; 2015 (http://www.who.int/
about/structure/organigram/htm/progress-hiv-tb-malaria-ntd/en/,
accessed 27 July 2016).
4
World Health Organization/World Bank Group. Tracking universal
health coverage: first global monitoring report. Geneva: WHO; 2015
(http://apps.who.int/iris/
bitstream/10665/174536/1/9789241564977_eng.pdf?ua=1,
accessed 28 July 2016).
5
There are many different prevention and treatment interventions. In
this context, a few interventions are selected to act as tracers for
progress towards UHC for all interventions.
6 :: GLOBAL TUBERCULOSIS REPORT 2016