COUNTRY LOCATOR - RESULTS

Tuberculosis Coalition for Technical Assistance

In 2000, USAID awarded funding for TBCTA with KNCV Tuberculosis Foundation as the prime partner. The coalition of six organizations; ALA, ATS, CDC, KNCV, The Union and WHO, became the first formal collaborating mechanism of major technical TB organizations working as a true partnership with one goal at global and country level. Instead of working independently of each other, the partners achieved cohesion and coordination by pooling their resources to work more efficiently and effectively. In 2004, ALA withdrew from the coalition.

TBCTA was a unique resource for USAID, through which it increased its involvement in global TB control while learning from collaboration with experienced and well-respected international TB experts and key organizations. TBCTA was positioned to provide crucial coordination with other technical agencies and donor organizations to ensure the effective use of limited resources.

TBCTA aimed to support a specific USAID Agency Goal and one of its Strategic Objectives, in particular. The goal was “world population stabilized and human health protected, ” while the more specific objective was “ increased use of effective interventions to reduce the threat of infectious diseases of major public health importance. ” Through USAID support, the purpose of TBCTA was to significantly improve and expand the capacity of USAID to respond to the global TB epidemic. This was achieved by providing state-of-the-art, context-appropriate, technically sound and cost-effective consultation and technical assistance to high-incidence and USAID priority countries to improve TB control programs and accelerate implementation of the DOTS strategy.

The goal of TBCTA was: With other global TB partners, accelerate the pace of DOTS expansion by reaching the global target of at least 85 percent treatment success and 70 percent detection of infectious cases in selected countries by 2005.

Programmatic objectives consisted of the following:

1. Accelerate implementation and expansion of the DOTS strategy in developing countries.
2. Develop institutional and technical capacity for TB control in target countries.
3. Integrate TB control efforts within primary health care services more effectively.
4. Develop or strengthen linkages between TB control programs and HIV/AIDS prevention and treatment programs, and multidrug-resistance efforts.
5. Expand the capacity for providing high quality technical assistance worldwide by organizing training for and access to qualified consultants.

TBCTA’s main strategies were linked to the Amsterdam Declaration. They focused on providing technical assistance for DOTS and building the technical and institutional capacity of national TB programs in USAID priority countries.

• Technical assistance: Providing expertise, guidance and feedback to national TB programs to accelerate DOTS expansion. A key element of this support was to develop a comprehensive strategy for implementation of TB control activities, in full collaboration with national TB programs and their stakeholders. This strategy was called the National Mid-term Development Plan.
• Institutional and technical capacity building: TBCTA extended additional support with global and regional trainings for national TB program staff. A major focus was building managerial capacity and strengthening national TB programs. This support also addressed the human resource crisis plaguing most public health programs in developing countries. TBCTA increased the availability of TB consultants for the provision of quality technical assistance.
  

TBCTA activities fell into seven intervention areas:

• Increasing DOTS coverage by accelerating the implementation and expansion of the DOTS strategy in USAID priority countries. Included in this area were DOTS expansion, community DOTS, public-private partnerships, improving case management and multidrug-resistant TB.
• Strengthening national tuberculosis control programs, including monitoring and evaluation, supervision and program management.
• Increasing human resource capacity through development of institutional and technical capacity for TB control in target countries. Expand the capacity for providing high quality technical assistance worldwide by organizing training for and access to qualified consultants. This area included the creation of human resource development plans.
• Strengthening laboratory networks. Support was provided through assessment visits, elaboration of development plans, training of staff, assistance in obtaining other support for investments, and follow-up monitoring visits.
• Strengthening advocacy, communication and social mobilization, including information/education/communication (IEC).
• Increasing TB/HIV collaborative activities. The primary focus in this area was developing or strengthening linkages between TB control programs and HIV/AIDS prevention and treatment programs.
• Supporting and conducting research, including operational research and drug resistance surveillance.

In particular, TBCTA made three major contributions to global TB control and reaching the global targets:

• TBCTA support, within its fourteen target countries, began with the development, revision and finalization of mid-term development plans. These plans were critical for national TB programs to create comprehensive strategies and coordinate TB control activities. National mid-term development plans served as the foundation for achievements made in accelerating DOTS expansion at the country level.
• TBCTA was successful in creating the first collaborative efforts to address human resource development. In particular, the establishment of the Task Force on Training created a human resource development platform within TBCTA and significantly contributed to putting these issues high on the global TB control agenda.
• With the development of the International Standards of Tuberculosis Care, TBCTA significantly contributed to creating better collaboration and synergy between private and public health care providers in TB. The Standards are an essential tool for meeting the global TB targets.

Providing country-level technical assistance was TBCTA’s primary focus. In total, TBCTA provided significant support to fourteen countries: Brazil, Cambodia, Dominican Republic, Democratic Republic of Congo, Egypt, El Salvador, Haiti, Indonesia, Malawi, Mozambique, Namibia, Nigeria, Senegal and South Africa. Although smaller in scale, projects were also supported in Ghana and Mexico. Each country project was managed by one of the TBCTA partner organizations, as coordinating partner, in collaboration with one or more partner organizations.

Lessons Learned

1. Investing in partnerships of multiple technical organizations is beneficial for global TB control.
2. Investment in long-term technical assistance is critical to create and sustain momentum in implementing planned activities.
3. Strategic planning and good coordination at the country level are critical for accelerating DOTS expansion and reaching the global TB targets.
4. A broadly endorsed tool documenting the standards of TB diagnosis and treatment can facilitate the engagement all care providers in global TB control.
5. The establishment of a well functioning task force is an effective investment for placing issues high on the TB agenda.
6. Creative solutions can help address the shortage of TB consultants.
7. TB/HIV collaboration can be scaled-up at country level but requires a country-specific approach.

* If you want to learn more about TBCTA’s six years of operation and major achievements click here to download the final technical report.