Health Surveillance and Disease Prevention and Control / Communicable Diseases / Tuberculosis
Regional Plan for Tuberculosis Control, 2006–2015
Errata: There are two minor errors in the PDF version of the text of the Regional Plan, which are corrected on this HTML page but which persist in the full-text PDF version, in both languages:
In view of the above, users should go by the text on this page and not by the PDF version.
The authorship of this document is based on a collaborative effort made by the PAHO Regional Tuberculosis (TB) Program with the National Tuberculosis Control Programs (NTPs) and Ministries of Health of PAHO Member States.
Introduction | Preface by PAHO Director
The Pan American Health Organization, in response to the epidemiological challenge that tuberculosis represents, declared tuberculosis a health priority in Directing Council Resolution CD39/20 in 1996, convening and committing the Member Countries' governments to implementing the DOTS Strategy.
Since then, a Regional policy was designed that seeks to attain the following work objectives:
Up until 1996, only six countries had implemented the DOTS Strategy at a national scale, covering 9.9% of the Region's population. Between 1996 and 2003, DOTS Strategy implementation was started and later expanded to practically all the countries, eventually covering 78% of the population of the Americas by 2003.
Donor agencies and partners played an important role at that stage, and joint activities that were carried out resulted in an increase in the economic resources available to the national tuberculosis programs for the implementation and expansion of the DOTS Strategy, and to the Regional Program for strengthening the technical capacity of the national programs.
However, despite the efforts made in recent years, tuberculosis continues to cause suffering and economic losses in the Americas. In light of this reality, PAHO, together with the countries of the Region, has decided to intensify TB control by strengthening the DOTS Strategy and implementing new initiatives to stop TB and overcome the new challenges produced by the spread of HIV/AIDS, multidrug-resistant tuberculosis, increasing inequity, and poverty. These new initiatives should respond to immediate and long-term goals designed to reduce the disease burden and reach the Millennium Development Goals.
The 46th Session of the Directing Council, held in September 2005 in response to the new challenges posed by TB control, adopted Resolution CD46.R12, "Regional Strategy for Tuberculosis Control for 2005–2015." This resolution reaffirms the commitment of the countries to ratify TB control as a priority in health programs, and to allocate the necessary financial and human resources, and endorses the Regional Plan for Tuberculosis Control, 2006–2015, as the basis for the formulation of national plans.
The Regional Plan for Tuberculosis Control, 2006–2015, has been drafted on the basis of the experience with the expansion of the DOTS Strategy in the Region and is strengthened by the countries' renewed commitment to TB control with the plan to implement the new WHO Stop TB Strategy.
The Region of the Americas has made great strides in tuberculosis (TB) control with the successful implementation of the DOTS Strategy, which has enabled some of the countries to reach the targets of the Millennium Development Goals (MDGs). Nevertheless, according to World Health Organization (WHO) estimates, there were 370,000 new cases and 53,000 deaths from TB in the Region in 2004—largely in poor countries.
These figures are unacceptable in our time, when effective treatments are available that could prevent the pain and suffering caused by TB. In response to this burden of disease and death, the Pan American Health Organization (PAHO), in conjunction with the national tuberculosis control programs (NTPs) in the Member Countries, has prepared the Regional Plan for Tuberculosis Control, 2006–2015, whose vision is a tuberculosis-free Western Hemisphere by 2050. The mission is to guarantee each patient with TB full access to quality diagnosis and treatment in order to reduce the social and economic burden and inequity caused by the disease.
The new challenges for TB control, represented basically by TB associated with infection by the human immunodeficiency virus (HIV); the resistance of Mycobacterium tuberculosis to tuberculosis drugs; the growth of inequity stemming from the rising poverty of our peoples; and the presence of weak health systems in many countries, have led to marked differences in the epidemiological and TB-control situation in the countries of the Region.
The Regional Plan for Tuberculosis Control, 2006–2015, includes cost-effective control strategies, such as DOTS, that facilitate timely diagnosis and equity in the community. The Plan also includes integrated care, with emphasis on the prevention and control of TB/HIV coinfection and multidrug-resistant TB (MDR-TB). Other strategies facilitate access; reduce the cost to the patient; shorten delays in diagnosis through the involvement of all health care providers; improve health systems, especially in the area of primary care; strengthen laboratory networks and human-resource policies; and provide integrated care for patients with respiratory illness. The Plan includes research into the work of the TB-control programs as a complement to evaluation, identifying appropriate interventions. Patients with TB and the community are involved in control activities, promoting advocacy, communication, and social-mobilization strategies.
These strategies are reflected in six lines of work that identify interventions at the national and regional levels, differentiated by the varied epidemiological situations. These lines of work assist in the development of priority strategies that bridge the epidemiological and control gaps among and within the countries.
The Regional Plan has been conceived as an instrument for accelerating achievement of the targets proposed for 2005 in countries that have been left behind, and for reaching in each of them the Millennium Development Goal of halving TB prevalence and mortality by 2015 over 1990 figures as a step toward eliminating TB as a public-health problem.
Implementation of the Plan will require resources in the amount of US$1,800 million. The resolutions "Sustainable Financing for Tuberculosis Prevention and Control" (WHA58/7), adopted by the 58th World Health Assembly, and "Regional Strategy for Tuberculosis Control for 2005—2015" (CD46.R12), adopted by the 46th Directing Council of PAHO, reinforce the countries' commitment to contributing national resources and call on partners to provide sufficient external resources to meet the TB control targets.
This Regional Plan, widely debated and aligned with the Global Plan to Stop TB, outlines the interventions to pursue over the next 10 years—2006 to 2015—to attain the MDGs. Its strategic lines of work are consistent with the Global Plan to Stop TB; actions to be taken are detailed and the resources required have been estimated. What remains is to demonst rate our steadfastness and ability to enlist other social actors, secure political commitment, and obtain the financial resources for its execution.