Unite to end TB: Fast Tracking access to quality diagnosis and treatment International Meeting for Ending TB,21 March 2016,New Delhi

Address of Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia Region

Honourable Minister of Health & Family Welfare, Government of India, Mr J P Nadda, Experts on TB Control from countries of South-East Asia Region, our valued partners in the fight against TB, Excellencies, ladies and gentlemen,

As public health advocates and practitioners, we often use words and slogans to advocate for public health results.

Inevitably, after much repetition, the meaning of these catch-all statements can become diluted. What were once galvanizing words of courage and vision become mantras devoid of inspiration.

As we enter a new era in TB care and control, the word ‘bold’ has increasingly come to define our thoughts, words and policy prescriptions. It is a term used in WHO’s Global End TB Strategy, which was endorsed by the World Health Assembly in May 2014. And it is a term used in WHO SEARO’s Regional Strategic Plan, which will come into effect this year. As we at this meeting prepare to End TB, and to align national policies with the Regional and global plans, it is worthwhile to pause and reflect on this important concept: To be Bold.

Indeed, what exactly does it mean to be bold? Moreover, how and why is it desirable and what does it look like in real terms to be bold?

Ladies and gentleman,

As we gather here today, being bold means acknowledging that to End TB, ‘business as usual’ is not an option.

The numbers in the South-East Asia Region are alarming.

Our Region is home to 26% of the world’s population, but accounts for 41% of the global burden of TB.

Given the high disease burden of TB in our Region, delays in progress here will also impact progress at the global level. These delays also risk increasing MDR-TB transmission, which would, in turn, result in higher mortality,

Make no mistake, however. We have made progress.

The South-East Asia Region has achieved the 2015 Millennium Development Goal of halting and reversing TB incidence. It has also achieved the Stop TB Partnership’s target of halving the TB mortality and prevalence rates compared to 1990 levels. Access to TB care has expanded substantially. Almost 22 million TB patients have been treated in the past 10 years.

But it is not enough. Recognizing that these gains are inadequate is essential to pursuing bold new policies to accelerate progress. Current trends clearly show that without such policies and approaches, the SEA region, including India, will fail to meet the SDG targets to End TB by 2035. In a Region with a high TB burden and high at-risk populations, we must think out of the box to find innovative ways to tackle the problem of TB.

I suggest the following four ways to move ahead.

First, alongside providing integrated, patient-centered care and prevention, achieving Universal Health Coverage is a priority. Universal Health Coverage means unreached and marginalized populations can access TB screening, and, if infected, can receive the care they need. With approximately 1 million missing cases in the Region, increased screening and treatment will also prove critical to stopping TB transmission, particularly of the disease’s drug-resistant strains. Universal Health Coverage also allows the opportunity to implement more robust regulatory frameworks for case notification, vital registration, and rational use of medicines. In essence, it is indispensable in the battle against TB.

Second, we must address the social determinants of TB. TB remains a disease of the poor and the marginalized, with a disproportionate number of TB cases found among people living with HIV, migrants, refugees and prisoners. Addressing poverty and other determinants will have a dramatic effect on the disease’s burden. Policies in this regard could include increasing access to safe housing and providing viable social security among other options. TB isn’t only a health problem. Therefore its solutions must also encompass the full range of multisectoral dimensions and multi-stakeholder engagement. It is one of those diseases that require health in all policies, coupled with strengthening the full spectrum of human rights that guarantee a TB patient the right to the best treatment possible.

Third, to End TB we must reach out to and engage with communities directly. Overcoming stigma, increasing awareness, and obtaining community buy-in at the grassroots is as valuable as any assemblage of experts and policymakers. Community engagement is essential for case detection, treatment completion, and addressing out-of-pocket expenditures. Forging partnerships with civil society groups and between public and private care providers will likewise ensure that present gaps are closed, and that a society-wide movement to End TB develops.

And fourth, political commitment at the highest level, which is already strong, must be reinforced. The mission-like zeal with which polio and HIV/AIDS have been fought must be reproduced in the battle against TB, and must lead to organizational and programming shifts. TB programs must be given a special place within the health sector; structural and operational efficiencies maximized so that a strong, efficient and effective control programme exist in every country. Our commitment to these changes and the wider mission can only be expressed and measured via real-time program delivery. In this regard, we are all on notice.

Ladies and Gentlemen, Finally, we must not forget that along with high level commitment and a strong programme, effective resource mobilization is essential to accelerate and sustain TB control activities. The funding required for a full response to the global TB epidemic in low- and middle-income countries was estimated at 8 billion USD per year in 2015. This figure excludes research and development. Based on reporting by countries, in 2015 6.6 billion USD was available for TB prevention, diagnosis and treatment, leaving a funding gap of 1.4 billion USD. International donor funding dominates in low-income countries. To bridge the funding gap, both domestic and international funding needs to be enhanced.

We must all renew our commitments.

To this end, the opportunity this meeting provides for countries to share experiences – both positive and negative – on TB control and prevention is immensely important. As Member States strive to align their national TB policies with WHO SEARO’s Regional Strategic Plan, I can assure you of WHO’s unflagging support. As part of the End TB strategy, WHO is intensifying TB-related research and innovation. The discovery, development and rapid uptake of new tools, interventions and strategies will optimize the impact of the Strategy, and will thereby enhance efforts to combat the disease.

On this occasion, I would also like to congratulate the initiative of India’s Ministry of Health in convening this meeting and providing us this important forum. On the eve of World TB day, India’s commitment to addressing the TB problem and to working with other high TB-burden countries in the Region to share technical knowledge and best practices is heartening. With such a strong showing of senior health ministry officials and leaders from across the Region, I am sure the sessions will prove immensely informative and will stimulate much-needed thought, discussion and action.

We must unite to end TB.

Thank you.