Support to National Tuberculosis Control Programme
Based on latest epidemiological situation, Iraq ranks 108 out of 213 countries and territories by estimated number of TB cases on the global level and is considered among eight high TB burden countries in Eastern Mediterranean Region (EMR). The annual estimation of new TB cases in Iraq is 15,000 (45/100,000 population).
The Government of Iraq considering TB as a major public health problem declared it as an emergency in Iraq and TB control program is placed high in the national health agenda. Achieving the MDG’s is a national priority which has been reiterated by the Government. The health system in Iraq is composed of two main sectors: public and private. In the public sector, the main health care provider is Ministry of Health (MoH).
Overall responsibility for TB control rests with the MoH. Within the MoH, National TB Program (NTP) is the technical core for TB control, and is responsible for formulation of policy and strategy, coordination with partners, planning, implementation and monitoring of TB control activities. TB program of Iraq was launched in 1989.
DOTS strategy adopted in Iraq in 1998 was extended to fully cover 15 governorates Respiratory and Chest Disease Clinics (RCDC) and partially in three northern governorates. However War in Iraq during 2003 – 2007 resulted in considerable damage to health infrastructure and manpower, resulting in disruption of health care services to majority of the population. Because of political situation, DOTS in Kurdistan region was fully introduced in 2008.
The available evidence suggests that the incidence is falling yet there is a significant gap between estimated incidence and notifications that is cases are not being detected, or are being detected but not notified to the National Tuberculosis Programme (NTP) that emphasize improving continuing the work to address all the needs to improve the outcome of the program which has been met through the implementation of several activities on different level to achieve the goals set for the TB Control program in Iraq but still the notifications of TB cases not matching the efforts given to improve it due to several challenges.
2014 witnessed security deterioration in Anbar Governorate in the first half of the year. At the beginning of the second half of the year the deleterious in the security status dramatically increased in other 4 governorates where Ninewa, Slahaldin, Anbar, several districts in Diayla and Kirkuk were under ISIS control, this has significantly affected TB control in theses governorates.
TB clinics in these governorates could not function normally due to different reasons; the health facilities were destructed, no electricity, interrupted or no supplies of drugs and medical items and consumables. Staff are often unable to report to their clinics because of inaccessibility or they have fled the violence and fighting there.
Consequently the notifications rate and the treatment success rates have been dropped in these governorates by the end of 2014, compared to 2013. TB clinics in governorates where IDPs settled are overloaded beyond their capacity with limited accessible roads that prevented rapid response in delivering drugs and medical items and consumables required for diagnosis and treatment.
NTP/MoH started revitalizing TB control with support from partners like GF and UNDP. Since January 2008 UNDP Iraq has been nominated at Principle Recipient (PR) to implement the GFATM grant approved for Iraq under round 6, subsequently a project document entitled “Strengthening TB control in Iraq particularly among poor and vulnerable populations” was approved (project ID56801).
The project document was amended in 2011 to reflect additional approved grant for Iraq under round 9 project document entitled “Support the National TB and HIV control programs” (project ID56801). The GFATM and GOI agreed to have UNDP as PR for the fund as GFATM is applying its Additional Safeguard Policy (ASP) to Iraq’s portfolio.
This project is designed in line with UNDAF outcome of “Improved Governance, including the protection of human rights” and UNDP’s Country Program (CP) outcome “Strengthened regulatory frameworks, institutions and processes in place for accountable, transparent and participatory governance at national and local levels”. By implementing this project UNDP is fully accountable to the GOI/MOH and Country Coordination Mechanism (CCM).
By the end of November 2012 UNDP had received total amount of $26,999,816. This project document is prepared to extend the project duration till 30th September 2015 based on the approval of the GFATM for Phase II of round 9 TB grant with an additional approved amount of $8,060,667 in order to scale up the TB care in Iraq serving the poor and most vulnerable population.
The total amount available for phase II of the project (Jan 2013- Sep 2015) under the TB grant only is equal to $ 13,393,902 since there is $ 2,716,649 undisbursed amount from GFATM to UNDP under phase I agreement and $ 2,616,586 cash balance with UNDP and WHO by the end of 2012. In addition the GFATM approves around $ 50,000 - $90,000/year for UNDP to support the CCM which is responsible for the oversight of the project implementation and submission of new applications for future funding opportunities from the GFATM.
UNDP through this project is committed to support the NTP to bridge all the gaps in fighting TB through its capacity development plan that emphasizing the adaptation to local requirements and performance expectation and that the individual skills can be changed by following series of systematic steps that will stimulate the strength of the work and improve the outcome which will be reflected on the program achievements. This project aims to provide technical and financial support to NTP and strengthen their capacity to ensure sustainability of the impact of the project activities after the end of the grant. The main two objectives of the previously mentioned projects are:
- Increase the Case Detection Rate of SS+ TB cases from 43% to at least 70% by 2014
- Maintain high treatment outcome among detected cases, the second objective is to ensure universal access to diagnosis, treatment and care for Drug-Resistant TB (DR-TB)
The project has a focus on capacity building and development through improving the infrastructure of the NTP health facilities with the supply of the needed equipment and medical items and consumables, the provision of training of the health staff at various levels and specialty. Furthermore the project deliver increasing in awareness and educating of the population through the Advocacy, Communication and Social Mobilization (ACSM) intervention.
Involvement of private and public health sectors was continued through the Public-Private Mix (PPM) strategic intervention. Procurement medicines, medical equipment and consumables was continued through the program period that provided strength and reliability in term of time, specify and sensitivity in in that diagnosis of TB Mycobacterium.
What have we accomplished so far?
- All patients in Iraq have access to DOTS services through all the PHCCs in Iraq
- Expanding the TB diagnostic labs from 20 in 2008 to be 277 in 2014
- Introducing 13 GeneXpert machines to be utilized in the National TB reference lab and other labs in other governorates
- Expanding the Culture labs from one in 2008 to be 12 in 2014
- Expanding the DST labs from one in 2008 to be four in 2015
- Procurement of second line anti-TB drugs to treat MDR-TB patients for the first time in Iraq in 2010
- Capacity developing in the form of training that has been provided for different medical staff on several level concerning various matters and subjects were provided since 2008
- Increasing the treatment success rate of all forms of TB to reach 93% in 2013
- Developing different manuals, guidelines and strandard operating procedures
- Engagement of non-NTP Public and Private Health sectors within NTP to control TB in Iraq
||Amount in US$
|The Global Fund to Fight AIDS, Tuberculosis and Malaria
|UNDG Iraq Trust Fund||104,954|
In 2014, this project delivered US$ 4,698,270.57.