�TEN STEPS �OF MAF-TB �AND KEY ROLES �FOR OTHER SECTORS IN �THE TB RESPONSE�

Dr. Sayohat Hasanova, Joint Infection Diseases programme, WHO Europe

Dr. Hannah Moniсa Dias, Global TB Programme, WHO HQs

• TB is driven by complex health and social determinants such as undernutrition and poverty

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• Half of people who develop TB disease face significant financial hardship because of their illness

IMPORTANCE OF STRENGTHENED MULTISECTORAL ENGAGEMENT

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Key commitments

and targets

SDGS

Global tuberculosis targets ��set out in the ��2023 Political Declaration of the High-level Meeting of the General Assembly on the Fight Against TB

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Highlights of commitments

and requests

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made in 2023

2^nd UN High-level meeting on TB

Highlights of commitments

and requests

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made in 2023

2^nd UN High-level meeting on TB

• Foreword
• Acknowledgement
• Abbreviations and acronyms
• Executive summary

1. About the Operational Guidance

• Aim and objectives
• Target audience
• Process of development

2. Overview

• Background
• About MAF-TB
• WHO leadership and role: adaptation and implementation of MAF-TB
• Key highlights: Adaptation of MAF-TB at national level

3. Key steps for MAF-TB adaptation and implementation at national and local level

4. MAF-TB sustainability

• References
• Annexes

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WHO MAF-TB OPERATIONAL GUIDANCE

Main steps for MAF-TB adaptation at national and local levels.

1. Awareness-raising among stakeholders
2. Building national/local ownership
3. Appointment of one or more MAF-TB focal point(s)

4. Multisectoral dialogue to plan MAF-TB adaptation

An important outcome should be a clear allocation and agreement of roles for all stakeholders to build accountability

Examples of CSOs engagement:

• Advocate at high-level for the MAF-TB initiation to address TB social determinants and risk factors and advance people-centred models of TB care;
• Ask the MoH for support in launching the MAF-TB, including by MAF-TB assessment;
• Request a Head of Government/State to support a periodic review of the TB response by all sectors and stakeholders under high-level leadership;
• Advocate for the allocation of sufficient financial resources for an effective multisectoral TB response;
• Actively participate in the national multisectoral consultation on MAF-TB.

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https://www.who.int/publications/m/item/who-multisectoral-accountability-framework-for-tb-(maf-tb)-baseline-assessment-checklist-for-country-use-in-pursuing-a-national-maf-tb

Examples of CSOs engagement:

• Include focal points from CSOs and TB-affected communities in the MAF-TB assessment core team;
• Participate in the baseline assessment, including data collection, analysis and consolidation of results, and the development of recommendations, with the focus on engagement of CSOs and affected communities in the four components of MAF-TB at country level;
• Participate in the NTP Reviews;
• Participate in the multisectoral endorsement and use of MAF-TB baseline assessment results.

• Annex 2 with information on: How to perform a MAF-TB baseline assessment

Sectors/institutions visited:

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• National TB Control Centre (NTCC)
• WHO Country Office;
• Social Development Division, National Planning Commission;
• Minister of Labor;
• Ministry of Industry, Commerce and Supplies;
• Medical college;
• International Organization for Migration;
• Private sector: private doctors and private pharmacies, PPM mobilizers
• MAF-TB initiatives at sub-national levels: an ambitious, innovative and potentially transformative TB Free Initiative (TB free palika)
• ACF at factory;
• FAST (Find Actively Separating

& Treating Effectively) strategy

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MAF-TB assessment as part of NTP Review:

Examples: Nepal, April 9-21, 2023

Sectors/institutions visited:

• Ministry of Health and National TB Control Centres;
• WHO Country Offices;
• Parliamentarians; National TB Caucuses;
• CCM at national and subnational levels and CCM working groups;
• Ministry of Social Protection;
• Ministry of Education (Medical universities);
• Ministry of Justice (TB in prisons);
• National Stop TB Partnerships;
• Civil society and affected communities at national, regional and district levels;
• Technical agencies and development partners;
• Regional and district level authorities;
• HIV and other co-morbidities programmes

MAF-TB assessment as part of NTP Review:

Azerbaijan (June 2023), Tajikistan (October 2023), Georgia (2024), Kazakhstan (August 2024), Turkmenistan (October 2024)

Function

• an overall coordination, harmonization and alignment of activities undertaken by different government sectors and other stakeholders

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Requirements

• Institutionalized and sustainable;
• has the mandate and capacity to operationally support implementation and review of the national MAF-TB;
• led by high level government representative;
• includes relevant government sectors and other relevant stakeholders, including civil society and TB affected communities and development agencies.

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How to establish

• to leverage existing bodies in health and beyond

or set up a new mechanism

Examples of CSOs engagement:

• Organize a transparent process to nominate representatives of CSOs and affected communities to represent a united voice in any multisectoral and multistakeholder coordination and review bodies/mechanisms;
• Ensure that appointed civil society and affected community representatives seek input from broader constituencies and report back on outcomes;
• Actively participate in all activities of the national multisectoral coordination and review mechanism.

Annex 3: Examples of roles and responsibilities of various sectors and associated performance indicators

Annex 2 with information on:

• How to develop the national MAF-TB document or component for inclusion in national plans?
• How to align MAF-TB and national strategic plan development processes?

Depending on the country’s context and the country’s own decision:

• As a stand-alone plan, or
• As a component of the National TB Strategic Plan

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Good practices in TB strategic planning incorporating MAF-TB principles:

• Government stewardship and ownership
• Multisectoral and multistakeholder engagement;
• Alignment with the End TB Strategy and other relevant global and regional strategies;
• Alignment with the national health strategy and other health programmes;
• Promotion of quality care that is effective, safe and people-centred.

Key consideration:

• should include vision/interventions for sustainable multisectoral collaboration and accountability to achieve national commitments to End TB.
• should provide description of four components of MAF-TB adopted and implemented at national/regional levels:
• national commitments,
• required multisectoral actions,
• monitoring and reporting mechanism to track progress
• high-level reviews

Advocacy

Target audience

Public leaders or decision-makers

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Communication

Individuals or subpopulations in the public

Broad public and specific communities

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National MAF-TB financing should be clearly identified and allocated as part of NSP-TB or health sector plans and other sector-specific plans related to the TB response:

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• domestic funding from the health and other sectors
• international or bilateral resources

High-level advocacy can help to drive domestic and international investment in the national TB response

Knowledge-sharing

• Improving access to the full range of people-centred services as part of general health services through:
• Decentralization; service integration; TB screening and TPT; supportive services
• Ensuring the quality of services through:
• development and implementation of essential and specific packages of TB services health service within health insurance schemes
• Developing and implementing system-wide regulatory frameworks in a TB-sensitive manner:
• regulation of production, quality and use of TB diagnostics and medicines
• mandatory notification of TB
• improved recording of TB deaths within vital registration

Enforcement of national legislation to guarantee equitable access to ethical, people-centred, rights-based TB services.

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Possible actions to change discriminatory policies and laws include:

• Combating involuntary isolation and coerced or compulsory treatment, including compulsory hospitalization of people with TB
• Improving policies, practices and laws affecting care for mobile populations, such as refugees and other migrants;
• Improving workplace/ occupational policies and laws to address occupational risks;
• Improving prison conditions and policies;
• Enabling legal and policy frameworks to ensure access to TB services for vulnerable population;
• Reforming regulatory frameworks for medicine registration

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Addressing the social determinants and risk factors of TB through social protection:

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• Assess key drivers of and direct risk factors for TB;
• Non-health-sector stakeholders to have a clear mandate to formulate and take action on social determinants;
• Governments to develop and pursue overarching poverty reduction and social protection strategies and policies;
• Social protection measures should be harnessed and mainstreamed in the policies of other sectors.

I. Periodic High-level Reviews

• Review progress in the TB response by all relevant sectors and stakeholders against their performance indicators, as well as the 14 SDG indicators associated with TB;
• Create sustainable high-level political will to end TB;
• Adopt multisectoral governance decisions based on the monitoring and review results for implementation across sectors;
• make recommendations for future action and ensuring its implementation.

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II. External reviews

• National TB program reviews or joint monitoring missions;
• High-level opportunities like World TB Day, World Health Assembly and UN General Assembly to promote high-level review

Requirements for effective high-level review:

• high-level leadership (Head of Government/State)
• multisectoral perspective, with the engagement of sectors beyond health;
• engagement of all relevant stakeholders.

Civil society and TB affected communities should be part of both reviews

WE NEED ALL HANDS-ON DECK TO END TB!

THANK YOU!

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TB Europe Coalition

10 October 2024

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Sharing experience of conducting a comprehensive baseline assessment on 3 Annexes of MAF-TB Checklist in EECA countries, considering the qualitative research component.

TB EUROPE COALITION

�BRINGING CIVIL SOCIETY TOGETHER

TO END THE TUBERCULOSIS EPIDEMIC

BASELINE ASSESSMENT

The baseline assessment is conducted on Annexes 1-3 and baseline assessment checklist.

Annex 1: Government Ministries/Bodies involved in the TB Response

Annex 2: Community and civil society engagement

Annex 3: Adoption and Implementation of Global Tuberculosis Guidelines 

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BASELINE ASSESSMENT WITH THE USE OF THE ANNEX 2 of MAF-TB: geographical sites of the research

BASELINE ASSESSMENT WITH THE USE OF ANNEX 2: description of the research

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• Research period: January-June 2021 for Belarus, Moldova, Kazakhstan, Tajikistan, Ukraine. 2022 – Kyrgyzstan and 2024 – Azerbaijan.

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QUAL

Contextualized feedback, first-hand perspective of TB service delivery stakeholders (experiences, preferences, motives, challenges)

QUANT

Structured feedback, inclusion of TB service delivery, and broader stakeholders

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ALL PROCEDURES AND PARTICIPANTS

Interviews with the organization leaders/project managers

BASELINE ASSESSMENT WITH THE USE OF THE ANNEX 2 of MAF-TB: research methodology (1)

Quantitative research (survey):

SURVEY

All organizations including smaller organizations, organizations newly adopting a TB mandate alongside other priorities)

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The survey is online (Google forms), 21 questions, Likert scale-like answers

Is based on the MAF-TB Annex 2

(Are civil society and affected communities involved in regular monitoring meetings of the National TB Programme?  Are civil society and affected communities being consulted in the design of major TB-related surveys?)

BASELINE ASSESSMENT WITH THE USE OF THE ANNEX 2 of MAF-TB: research methodology (2)

Qualitative (Interviews and focus-groups):

• The framework method was used which included transcription; data familiarization; coding; development of a working analytic framework; application of the analytic framework to finalize themes; charting the data into a framework matrix; and interpreting the data.
• Coding was inductive (open) as well as deductive.

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Desk review:

• Desk review was used for analysis of “Commitments” section of the MAF-TB/Annex 2 Checklist.

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BASELINE ASSESSMENT WITH THE USE OF THE ANNEX 2 of MAF-TB: research participants

LEVERAGING MAF-TB TO STRENGTHEN ACCOUNTABILITY, COLLABORATION, AND ADVOCACY IN TB RESPONSE

• Transparent Monitoring System: Develop a system to monitor progress, flag issues and delays, and facilitate timely solutions.
• Enabling Environment: Create a space for sharing lessons, finding joint solutions, and nurturing resilience through enhanced multisectoral collaboration.
• Inclusion of Community and Civil Society (CS):Community voices, especially through community-led monitoring (CLM), play a critical role in informing the process, bringing diverse perspectives and roles to the MAF-TB framework.
• The assessment results can be used for:
• Developing National Strategic Plans (NSPs) and country proposals.
• Advocacy for stronger political commitment and robust policies.
• Mobilizing additional funding for key interventions.
• Establishing or strengthening national accountability mechanisms.
• Ensuring accountability among stakeholders in TB elimination efforts, including government bodies and civil society.

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TB Europe Coalition

Thank you for your attention

Joint in eliminating TB

KYRGYZSTAN EXPERIENCE OF CONDUCTING BASELINE ASSESSMENT USING ANNEX 2 OF THE MAF-TB CHECKLIST:

results of the assessment and plans for further application of the recommendations

Natalia Shumskaia

Director

Den Sooluk Nuru (DSN) Public Foundation

ORGANIZATION AND PERFORMANCE OF THE BASELINE ASSESSMENT

•Technical assistance from the TBEC (training, consultations);

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•Working meeting at the National Phthisiatry Center (hereafter - the NPC);

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•The checklist was completed by an NPC expert together with experts of civil society organizations (hereafter - NGOs);

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•In addition to this, interviews, focus group meetings and a survey were conducted for the purpose of data triangulation;

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•NGO mapping (negotiations with stakeholders: NPC, NGOs, donors);

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•Online meeting with NGOs. Presentation of MAF-TB, Annex 2;

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•Survey of 22 NGO leaders using a questionnaire based on Annex 2 of the MAF-TB checklist, sections ‘Actions’, ‘Monitoring and Repoerting’ and ‘Review’;

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•Making a list of prospective interviewees. Six interviews with leaders of organizations working to eliminate TB;

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•NGOs helped selecting focus group participants. Focus group meetings with three categories of participants:

1) Program coordinators (6 participants);

2) NGO and CSO field workers (11);

3) 2 focus groups including members of TB-affected communities

(6 participants in total: 3 participants per group).

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•Presentation of results of the assessment at a round table meeting at the NPC (representatives of the regions took part via online means)

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Lack of engagement on the side of the NPC

BARRIERS AND CHALLENGES ENCTOUNTERED DURING THE ASSESSMENT

Wariness among NGOs

Challenges in recruiting people with TB to take part in the focus group meetings

NGO leaders being sluggish in completing the questionnaire

Conducting the focus group meetings online

Additional meetings with the senior personnel

Individual meetings to explain the purpose of the assessment

Work with the coordinators of the case managers taking care of the people with TB

Calls, reminders

RESULTS OF THE ASSESSMENT

According to the participants, multisectoral cooperation is a good approach to work in support of TB-affected populations.

NGOs work with healthcare facilities, both public and private. NGO efforts have made private healthcare facilities included in the list of available service providers

Electing CCM members from among the community of people with TB and NGOs

Cooperation platforms for various actors:

Public Helath Coordination Council (PHCC, also being mentioned in the data as the CCM), oblast-level coordination councils. Fragmentarity, lack of good coordination between the platforms

Cooperation with local administrations is limited

Inconsistent cooperation among NGOs

Limited partner relations with law enforcement, migration authorities, educational organizations, and media

RESULTS OF THE ASSESSMENT

Monitoring and review activities of NGOs: OneImpact, ReAct: monitoring of the Interagency Action Plan to Overcome Legal Barriers

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Accountability:

government and CSOs

TB-community-based organizations and CSOs need capacity building (specific knowledge)

Stigma and discrimination

People with TB lack IDs

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Gender aspects; migration

• Use the social contracting mechanism to work with NGOs under NPC to provide services to CSOs, incl. with regard to public monitoring;

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• Form the demand and involve CSOs at all stages of TB-related actions (planning, implementation, monitoring and reporting, operational studies, budget advocacy and other topics) by building up CSO capacity, including their representatives in wokring and monitoring groups, in developing annual TB reports, and participation in high-level review and other activities;

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• CSOs should create a database of organizations and TB-affected communities for the informatics and monitoring department of the NPC;

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• NPC should assign a person to establish cooperation and coordination with civil society;

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• CSOs in partnership with the NPC should create a mechanism for interaction between CSOs and NGOs, istitutionalize it and coordinate existing services and develop referral algorithm for clients of the organizations;

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• CSOs in partnership with the NPCS should build up the capacity of the patients and members of families affected by TB with regards to rights, social accessibility of the services, through direct counseling and awareness-raising activities;

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MAIN RECOMMENDATIONS

ОСНОВНЫЕ РЕКОМЕНДАЦИИ

ОСНОВНЫЕ РЕКОМЕНДАЦИИ

• CSOs should promote scaling up social support programs for people with TB receiving tretment (food packages, fare compensation, relief of utility payments, etc.);

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• Continue implementing OneImpact and REAct projects to monitor the needs of people with TB and enable them to provide feedback on the services they receive;

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• Conduct stigma index studies involving CSOs, NGOs and research entities in partnership with the NPC;

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• Support CSOs in shaping the environment favorable for mobilization and forming of a proactive of TB community, building up its capacity through training, facilitation of the activities of people facing TB, providing access to multisectoral cooperation and public communication platforms;

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• Scale up efforts to provide legal aid to people with TB by building up the capacity of the existing team of paralegals to provide and improve legal protection of people with TB

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• Expand the partner network of CSOs traditionally working with the people with TB and CSOs that conduct activities for migrants. Develop algorithms for TB-counseling of the citizens who become international labor migrants (leaving for Russia, Kazakhstan, Turkey, etc.)

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MAIN RECOMMENDATIONS

COMPLETED

A package of laws and regulations to implement state social contracting (SSC) has been adopted;

a plan for implementation of SSC has been developed;

SSC has been implemented.

The electronic database on TB now has an additional column indicating which CSO found the patient and accompanied them to a health institution

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A tender for a study of barriers to prevention treatment has been announced through the state procurement portal

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Workshops on TB for CSOs have been conducted (UNDP/GF, KNCV, Partner Network, DSN)

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Joint Assessment of Legal Environment and Human Rights for TB has been performed

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COMPLETED

Asessment for key TB populations has been completed

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TB stigma index

A member of the community of people with TB has joined the monitoring group for overcoming legal barriers

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An algorithm for counseling for migrants on TB has been developed, and training has been provided to organizations working with migrants

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recommendations were received.

Of them, 13 have been implemented; 4 have been implemented partially

RECOMMENDATIONS FOR IMPROVING THE PROCESS OF ORGANIZING BASELINE ASSESSMENT IN THE FUTURE

• Public Health Coordination Center may commission the Assessment;

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• Experts of the community of people with TB and organizations may join the assessment team;

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• Joint assessment together with the NPC and oblast TB coordinators;

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• A plan needs to produced based on the assessment;

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• Plan implementation monitoring.

FOR YOUR TIME!

THANKS

MAF-TB efforts in Mongolia

Gantungalag Ganbaatar, MSc, MPH

Head of Tuberculosis Surveillance and

Research Department, NCCD

October 10, 2024

• Сүрьеэгийн бүртгэл мэдээллийн өнөөгийн байдал

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• Сүрьеэ өвчнийг бүртгэх мэдээлэх журам, тушаалууд

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• Тайлангийн үзүүлэлтүүд, анхаарах асуудлууд

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CONTENT

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1. Introduction
2. Multi-sectoral collaboration
3. Achievements
4. Challenges

INTRODUCTION

TB high burden 30 countries by WHO

1. 100,000 high prevalence in the population

• Prevalence 757 (22000 the patient)
• Incidence 437 (14000 the patient)

(Survey of Tuberculosis prevalence in Mongolia, 2014-2015)

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2. The prevalence of multidrug-resistant tuberculosis has increased

• New tuberculosis 5.3%
• Previously treated cases 16.5%

(Drug Resistance Surveillance Study-III, 2017)

3. 74% of all patients are under financial pressure

(The Costs of TB to Patients and families study 2017)

Source: Global TB report, 2023

MAF-TB Assessment integrated into�Joint TB Programme Review

• MAF-TB assessment questions integrated into thematic areas of Joint Programme Review, notably on social protection and private sector engagement.
• Findings from the programme review was included into the development of the national TB strategic plan

MAF - NATIONAL LEVEL

ORGANIZATIONS

• TB lobby group of Parliament members
• MOH:
• Health Insurance General Authority
• MMR Agency
• National Center for Health Development
• National Zoonotic Diseases Center
• National Mental Health Center - NMHC
• National Center for Public Health - NCPH
• Ministry of Education
• Ministry of Justice - TB in Prison
• Ministry of Social welfare
• Ministry of Finance
• Academic organizations (MNUMS)
• International donors and UN organizations - WHO, ADB, GLC, GDF, GF, KNTA, SATREPS

FRAMEWORKS

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• Policy
• Surveillance
• ACF
• Health promotion
• World TB Day - social media companies
• Journalist & media organizations
• Research and studies for data driven evidence for planning and decision making
• TB social support and disability grant, incentives
• Technical and financial support

MAF - PHC LEVEL

ORGANIZATIONS

Local government & Health sector:

• Local government organization
• District: khoroo’s governor
• Soum: bag unit’s doctor

Sub-recipients NGO’s:

• Mоngolian Anti Tuberculosis Association
• Mongolian AFS
• Mongolian Soum Doctors Association
• Mongolian Red Cross

Civil society organization

TB survivors & affected people

FRAMEWORKS

• Аctive Case Funding/ Contact tracing
• Specimen transportation system
• Health Education
• Health Promotion
• Treatment Follow-Up
• Vulnerabilities addressing and risk factors for social determinant and barriers (poverty, social support, substance abuse (alcohol and tobacco use)
• Co- morbidities (diabetes, HIV)
• World TB Day - social media companies
• Journalist & Media organizations

ACHIEVEMENT

About tuberculosis service:

• Started DOTS (1995) 🡪 ↓ Tb death
• Tuberculosis Prevalence Survey, 2014-2015
• TB drug resistance study- 3 times (1999, 2007, 2016)
• TB stream trial : 100% controlled, 2010-2022
• In 2017-2021, access to molecular diagnostics at the national level
• TB care infrastructure and capacity for TB diagnosis and treatment have improved.
• In 2019, Mongolian government starts directly buys TB drugs from Drug supply organization
• TB lobby group in parliament, 2018

About health sector:

• Health sector financing reform
• The salary of TB doctors and specialists increased by 30%.
• Specimen transportation system is fully implemented. (325 soum’s from 21 provinces)

Social welfare

• Access to various social welfare services has expanded

All level of health care and services

CHALLENGES

THANK YOU