One of the grants recently approved by the Global Fund is the first ever regional TB grant in Eastern Europe and Central Asia. The EECA is the region with the highest burden of the drug-sensitive and drug-resistant TB: Less than 50% of cases have been detected and successfully treated.
The full title of the project is “TB in Eastern Europe and Central Asia Project on Strengthening Health Systems for Effective TB and Drug Resistant-TB Care,” but it is commonly referred to as “TB-REP.”
TB-REP will target the systemic weaknesses that drive the TB epidemic in the region, i.e.: (a) the slow pace of transition of hospital-based services into patient-centered services; (b) poor out-patient management; (c) failures of active case-finding and contacts tracing; (d) low treatment success rates; (e) weak integration between HIV and TB services; (e) the shortcomings of infection control standards in hospitals; and (f) the passive involvement and immaturity of the civil society sector with respect to TB-related activities.
TB-REP has two core objectives: (1) to increase the political commitment of the country leaderships to end TB through cooperation and health system strengthening; and (2) to support countries in reforming health systems, including improving service delivery and spending money more efficiently.
The project intends to conduct high level advocacy among government ministries and prime ministers’ offices to ensure that governments prioritize reform of the system of TB care; that they spend the TB program funds more efficiently; that they increase funding for health; and that they support the development of community and ambulatory models of care.
The project will also stimulate interaction among governments.
The second objective requires enhancing skills and competences at the government level to implement policy reforms. Targeted and needs-based technical assistance will be provided. Technical support teams will help to develop health system strengthening action plans and frameworks.
According to the concept note that was submitted, the project will also provide support for developing transition plans, as some participating countries might not be eligible for Global Fund financing after 2018.
TB-REP is a three-year initiative, with an overall budget of $6 million. The project will start on 1 January 2016 and focus on the 11 countries that have the highest MDR-TB burdens: Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan.
The project will be implemented by a multi-stakeholder consortium consisting of the World Health Organization, a number of academic institutions, and a regional task force represented by government officials and the national TB programs of participating countries.