Dr Shyamkumar Sriram
What are Sustainable Development Goals?
The Sustainable Development Goals (SDGs), also known as the Global Goals, were adopted by the United Nations in 2015 as a universal call to action to end poverty, protect the planet, and ensure that by 2030 all people enjoy peace and prosperity
SDGs
Total 17 Goals
Goal 3: Good Health and Well-being
Ensure healthy lives and promote well-being for all at all ages
The UN has defined 13 Targets and 28 Indicators for SDG 3
Targets for SDGs
3.1 By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.
3.2 By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births.
3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.
3.4 By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
3.5 Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol.
3.6 By 2020, halve the number of global deaths and injuries from road traffic accidents.
Sustainable Goals 3.3
SDG Target 3.3 | Communicable diseases:
By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases�
Tuberculosis
Targets for 2030
Universal Health Coverage
3 Dimensions of Universal Health Coverage (UHC)
- Population: who is covered?
- Services: which services are covered?
- Direct costs: proportion of the costs covered?
Health for All with Financial Protection
Catastrophic Health Costs�and Tuberculosis
TB disproportionately affects the socially and economically weaker sections of the society, the financial aspect of the disease cannot be ignored
TB is linked with poverty, so the End TB strategy emphasis reducing financial burden on those affected with the disease.
Many countries, aims to provide diagnosis and treatment of TB free of charge
Services Provided Free of Charge
India provides diagnosis and treatment of TB free of charge through its public health facilities.
Advanced ‘patient-centric care’ services provided:
Defining Catastrophic Costs due to TB
Total Direct and Indirect costs that reach 20% of the TB patient’s household annual income
Are the catastrophic costs for Tuberculosis Treatment eliminated?
The 2020 milestone that no TB patients and their households face catastrophic costs as a result of TB disease
Tuberculosis Costs
CHE - Evidence from Global Studies
Globally, a systematic review and meta-analysis of CHE by TB patients (Ramy Mohamed Ghezt et al.)
5114 studies in the area were identified and 29 included in the final analysis
The pooled proportion of TB patients experiencing catastrophic costs was 43%
Main Predictors of Catastrophic Costs
Predictors | Catastrophic Costs |
Drug-sensitive | 32% |
Drug-resistant | 81% |
HIV-coinfection | 81% |
Passive case finding – 42%
Active case finding – 12%
Catastrophic costs varies by strategy of case finding:
Tamil Nadu Study
A community-based cross-sectional study done by Muniyandi et al. 2020
Pulmonary and extra-pulmonary TB patients registered in NTCP
The study showed catastrophic costs 31% (20% threshold)
Impoverishment due to Tuberculosis Treatment
Reducing Catastrophic Costs
Providing free medication is insufficient to prevent the catastrophic costs
MDR-TB requires a treatment of 24 months compared to 6 months for DS-TB – Leading to prolonged work absenteeism, more side effects, need for daily injections and more investigations
Households of TB should receive transport vouchers, reimbursement schemes, and food assistance to reduce or compensate for such catastrophic costs
Reducing Catastrophic Costs & Impoverishment
There is an increasing need for improving the Direct Benefit Transfer and Ayushman Bharat insurance scheme, for cash transfer to offset the expenditure impact of TB in the country.
Also, there is a need for better targeting especially among the illiterate, rural and poor sections of the society for these schemes.
There is also a need to consider the amount transferred under DBT as it would not be sufficient enough as compensation to manage the financial burden of TB of most patients.
There is a need for improved working and collaboration of private health facilities to provide TB care.
Malaria
The WHO Global technical strategy for malaria 2016-2030 – adopted by the World Health Assembly in May 2015 – provides a technical framework for all malaria-endemic countries.
The Strategy sets ambitious but achievable global targets, including:
Malaria
The cost of implementing the GTS was estimated at about US$ 101.8 billion over 15 years.
Global investments in malaria control was US$ 2.5 billion in 2015.
By 2025, the annual requirement is estimated at US$ 7.7 billion, and by 2030, US$ 8.7 billion.
A further estimated US$ 673 million is also needed each year to fund malaria research and development.
GTS implementation will translate into US$ 4 trillion of additional economic output over the 2016–2030 timeframe. The global return on investment is estimated at 40:1.
THANKS!
QUESTIONS?