Tuberculosis (TB)

TB recommendations included in "Commission for Africa" report


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Health care delivery systems are in danger of disintegrating beyond repair. In high income countries, spending on health is more than US$2,000 per person per year. By contrast, in Africa in 2001, health spending averaged US$13 to US$21 per person. Of this only 38 per cent was government spending. 34 per cent was ‘out of pocket’ spending when ill. These costs are a cause of poverty for some people. The Commission for Macroeconomics and Health recommended that spending should rise to US$34 per person by 2007 and to US$38 by 2015 in sub-Saharan Africa, and mostly from a greater government spend. This is the minimum amount to deliver basic treatment and care for the major communicable diseases (HIV and AIDS, TB and malaria), and early childhood and maternal illnesses. This significant increase is required due to the past failure to prioritise the health sector or to expand spending with population increases. African countries must continue to prioritise health spending and increase levels over the long term. If growth continues at current levels and the tax base broadens, governments will be able to afford this level of spend in the long term. Until that point, donors should provide much greater levels of financing through partnerships with governments, in a predictable stream, to repair crumbling health systems. Programmes to combat specific diseases should also integrate at the national level and work behind national priorities.

Many of the health challenges faced by Africa lack effective diagnostic, preventive or treatment options. Africa accounts for just 1.1 per cent of the total value of the global pharmaceuticals market. This has meant that large pharmaceutical companies have not prioritised African health needs. More public funding is needed to support research and development for diseases that affect Africa. The Commission for Macroeconomics and Health has estimated that an additional US$3 billion is required globally for research and development for diseases that affect poor people. This should include building African capacity through engaging directly with the African research community, for example through the Product Research and Development for Africa (PRADA) Partnership. And it should be part of a broader investment strategy in Africa’s science, engineering and technology capacity. Pharmaceutical companies have key skills and expertise and should be partners in these efforts. Incentives are required to increase private sector investment in the diseases that affect Africa. Tax incentives can reduce the cost of research to companies, while advance purchase commitments to buy future priority products, once they have been developed, can guarantee a market and return on research investment. African governments should increase domestic funding for research and development to at least two per cent of domestic budgets. Recommendation: Donors should develop incentives for research and development in health that meet Africa’s needs. They must set up advance purchase agreements for medicines. They should increase direct funding of research led by Africa, coordinated by the Regional Economic Communities and in collaboration with the global health partnerships. Priorities include the development of microbicides, TB drugs and diagnostics, AIDS and malaria vaccines.

This Commission asserts that unless good healthcare delivery systems are in place, the problems of HIV and AIDS and other serious diseases such as TB and malaria cannot be addressed adequately. The international community should support integrated and co-ordinated mechanisms for financing African-led strategies to improve their health systems.

African governments should meet their commitment to allocate 15 per cent of annual budgets to health and put in place strategies for the effective delivery of health services. Donors should increase their funding to support these strategies, making up the shortfall, from an additional US$10 billion annually immediately and rising to US$20 billion annually by 2015. The assistance should go predominantly through national budgets. This level of funding would ensure delivery of a basic health package including TB and malaria treatment and prevention, as well as interventions for maternal health and childhood disease. The Commission for Macroeconomics and Health provides the most recent and thorough estimate of the funding shortfall in health for sub-Saharan Africa. This was US$18.7 billion per year by 2007 rising to US$27.5 billion per year by 2015. Here however, we have had to make some changes. The costs of HIV and AIDS are covered separately, and so this figure was reduced accordingly. In addition to this there are a number of costs not covered by their estimates – these include the full cost of more health workers, incentives for research, scaling up sexual and reproductive health services and TB treatment in light of the HIV and AIDS pandemic, recent developments in malaria treatment and prevention, scaling up the prevention of parasitic disease and micronutrient deficiencies as well as the funding gap for vaccines. Each of these additional interventions have costs in the region of one to three per cent of the total needed – except health workers – which as outlined above costs from one to six billion US dollars. The total investment therefore recommended for health is an additional US$20 billion each year – which again excludes the costs of responding to the HIV and AIDS crisis.

Some 70 per cent of the 14 million people worldwide who have both HIV and TB (which are often linked) are in Africa, where the TB epidemic is rising by four per cent a year and is now the most common opportunistic infection of people living with HIV. The integration of care for HIV and AIDS and TB would reduce the impact of TB among people living with HIV and AIDS and reduce the impact of HIV among TB patients. African governments must ensure collaborative TB and HIV programmes.

Recommendation: the World Health Organization’s ‘Two diseases, one patient’ strategy should be supported to provide integrated TB and HIV care. The allocation of US$0.25 billion each year for collaborative TB and HIV programmes would ensure that that all patients with TB are offered VCT and all HIV patients are tested and treated for TB.

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