“Key Practical Steps�in Implementing MAF-TB:�Global Good Practices”
�Quick visual overview of 10 practical steps for MAF-TB implementation�
Dr. Sayohat Hasanova, Joint Infection Diseases programme, WHO Europe
Main steps for MAF-TB adaptation at national and local levels.
“Key Practical Steps�in Implementing MAF-TB:�Global Good Practices”
Brazil experience:�Establishing an inter-ministerial committee and linked plan on TB elimination and other socially dangerous diseases with the involvement of parliamentarians��(MAF-TB steps 3 - 6)�
84,593 people fell ill with TB in 2023
Treatment coverage rate increased from 75,8% to 83%
Brazil: a high-burden country with continental dimensions
TB caused 5,984 deaths in 2023
1,817 people died of HIV-associated TB
~30% of people affected by TB are
at social risk
People living with HIV, people deprived from liberty, indigenous people, people experiencing homelessness,
people with lived experience of immigration, people enrolled in cash transfers programs
Men (69.2%), young (47.8%), black (51.8%)
Source: SES/MS/Sinan. Preliminary data. Data extracted in Sep/2024
The vulnerability to tuberculosis is affected by issues of gender, social class, and race
Brazil has 5,570 municipalities.
100 cities account for 57% of the TB burden in the country
Prevention, diagnosis and treatment of TB are available free of charge.
Source: Maciel et al. The economic burden of households affected by tuberculosis in Brazil: First national survey results, 2019-2021.
TB's Economic Impact: A Reality Even with Free Access to Care
Source: WHO Global TB Programme
Despite free TB care policy,
48% of people with TB in Brazil experienced catastrophic costs
The largest portion of costs comes from non-medical expenses and income losses
44% people with DS-TB
78% people with DR-TB
Health and Social Protection: fundamental right of citizenship secured through collective advocacy
In 1988, the Brazilian Constitution defined health as a universal right and a state responsibility
The so called “citizen constitution” is the result of a popular and political movement for democratization after 21 years of military dictatorship.
The healthcare reform that led the establishment of Brazil's unified health system (SUS) was inspired by Alma-Ata Declaration
Health means that people have something more than just not being sick. Additionally, health is the right to housing, water, education, and work.
Multisectoral coordination is present in the three pillars of the national strategic plan
Multisectoral engagement initiatives
Working Group with representatives from the Ministry of Social Development; Ministry of Human Rights; Ministry of Science & Technology; National Penitentiary Department and Housing Secretariat
First attempt to establish a high-level interministerial committee. The suspension of the presidential decree for the creation of new committees halted the initiative.
2017
2018
2020
2019
2021
Close collaboration with the National Penitentiary Department.
'Prisons Free of TB' (2017-2021) and joint TB response guide for prisons during the pandemic (2020).
Technical cooperation agreements with the Ministries of Social Development (2021), Human Rights (2022). Joint guidelines on social protection and combating stigma.
Joint efforts with Ministry of Defense for TB response at the northern border and among people who have immigrated.
2022
2023/2024
Joint calls for research and innovation with the National Council for S&T Development / Ministry of S&T (2021, 2022 and 2023)
Establishment of the Interministerial Committee to end TB and other socially determined diseases, launch of the Healthy Brazil Program
Interministerial Committee on Climate Change
Creation of the Parliamentary Front for the Fight Against Tuberculosis of the Americas, initiated by the National Front in partnership with the Pan American Health Organization
Parliamentary Front for the Fight Against Tuberculosis 10 Years of Existence
2016
2017
2019
2018
2020
2021
2022
2023/2024
Establishment of a working group by the Social Security and Family Commission to monitor the implementation of the first phase of the Brazil Free from Tuberculosis Plan.
Creation of a special subcommittee within the Social Security and Family Commission to monitor government policies on poverty-related diseases.
Active participation of Parliamentary Front members in Global TB Caucus activities, a group of parliamentarians worldwide focused on TB control
Public hearings on tuberculosis held in 2019, 2020 and 2021
Political efforts by Parliamentary Front President, Deputy Antônio Brito, to establish technical cooperation agreements between the Ministry of Health, the Ministry of Citizenship (2021), and the Ministry of Women, Family, and Human Rights (2022).
Participation of Deputy Antônio Brito in the 2nd United Nations High-Level Meeting on Ending Tuberculosis.
Creation of the "External Commission for Developing Proposals to Address Tuberculosis as an International Commitment to Eliminate this Disease as a Public Health Issue by 2030”.
Healthy Brazil Program
(Presidential decree nº 11.908, February 6th, 2024)
HEALTHY BRAZIL PROGRAM PILLARS
Tackling hunger and poverty to lessen vulnerabilities that lead to or result from diseases and infections caused by social factors
Reducing inequalities and promoting human rights and social protection
Improving communication skills of key stakeholders, including civil society
Supporting science, technology, and innovation
Improving infrastructure and efforts in water, sanitation, and hygiene (WASH)
HEALTHY BRAZIL PROGRAM PILLARS
STRATEGIC PLANNING OF HEALTHY BRAZIL PROGRAM
PILOT PROJECTS IN 5 CITIES
ESTABLISHMENT OF AN ADVISORY COMMITTEE WITH DONORS AND FUNDERS
NEXT STEPS
Interministerial Committee to end TB and other socially determined diseases
(Presidential decree nº 11.494, April 17th, 2023)
Multisectoral engagement with cross-sectional governance to strengthen efforts, optimize resources, and fast-track the elimination of TB and other 15 socially determined diseases and infections as public health problems in Brazil by 2030.
Chagas´disease, Schistosomiasis, Filariasis, Geohelminthiasis, Malaria, Onchocerciasis, Trachoma, AIDS, Hepatitis, Hansen´s disease, vertical transmission of Hep B, HIV, HTLV, Syphilis, Chagas
Interministerial coordination: promoting a high-level agenda
Interministerial Committee on Climate Change
(Presidential decree nº 11.550, June 5, 2023)
Ministries such as Environment, Health, Agriculture, Energy, Indigenous Affairs and Racial Equity were brought together to coordinate and implement policies that help the country adapt to the impacts of climate change.
In response to the Interministerial Committee on Climate Change, the Ministry of Health formed a working group to develop the health sector's climate adaptation plan, emphasizing civil society engagement and equity in care.
The methodology for a national MAF-based review mechanism was developed and tested through a pilot project led by an external consultant and with support from PAHO
Desk review
MAF components "commitments and actions“ were analyzed using epidemiological data and executive reports from the NTP. A detailed debrief of the desk review was crucial for providing information to the next phase.
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2
3
Virtual focus groups with key stakeholders
Assessment grid
Responses regarding the progress towards commitments and the MAF components implementation in Brazil were the inputs to create the final assessment grid.
4 groups (national managers involved with TB or with sectors strategic to the TB response, local level managers, civil society representatives, and TB researchers)
Additional data on participant perspective on MAF implementation through MAF checklist application
The external consultant's coordination enhanced autonomy and transparency throughout the review process.
Qualitative analysis from the focus groups recordings allowed a detailed registering of the participants speech.
The results will be published and can be used as an advocacy tool for civil society and other stakeholders
LESSONS LEARNED
Social vulnerability needs to be measurable
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2
High level political commitment is a game changer
3
A strong NTP capacity in planning and monitoring is crucial
CHALLENGES
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2
3
Resources are needed not only for health but for other ministries
Interministerial relations are complex: role of the executive office
Data analysis and prioritization: When? Who? How much?
“Key Practical Steps�in Implementing MAF-TB:�Global Good Practices”
Implementing MAF-TB Action Plan
and Expanding Engagement of Key Stakeholders
BANGLADESH
Dr. Md. Zahangir Kabir
Programme Manager
NTP Bangladesh
National TB Control Programme
Directorate General of Health Services
Ministry of Health and Family Welfare
Estimates of TB Burden in Bangladesh, 2023
Indicators | Number | Rate per 100,000 pop |
Total TB incidence | 379,000 (276 000- 499 000) | 221 (161- 291) |
TB/HIV incidence | 740 (380- 1200) | 0.43 (0.22- 0.71) |
MDR/RR-TB incidence | 5 000 (1 400- 8 600) | 2.9 (0.84- 5) |
HIV -ve TB mortality | 44,000 (26 000- 66 000) | 26 (15- 38) |
HIV +ve TB mortality | 170 (100- 250) | 0.1 (0.06- 0.15) |
Source: WHO Global TB Report 2024
National TB Control Programme
Directorate General of Health Services
Ministry of Health and Family Welfare
Trends in TB Incidence and Mortality rate
National TB Control Programme
Directorate General of Health Services
Ministry of Health and Family Welfare
Estimated TB Cases
Notified TB Cases
TB Treatment Coverage (%)
Trends of TB Incidence, Notified cases, Notification and Treatment Coverage
National TB Control Programme
Directorate General of Health Services
Ministry of Health and Family Welfare
Bangladesh hosted the “First Global Forum on Advancing Multisectoral and Multistakeholder Engagement and Accountability to END TB” in June 2024�Organized by WHO HQ, and�Supported by WHO Country Office
National TB Control Programme
Directorate General of Health Services
Ministry of Health and Family Welfare
Multisectoral Accountability Framework for TB in Bangladesh
Bangladesh participated and was a signatory of-
National TB Control Programme
Directorate General of Health Services
Ministry of Health and Family Welfare
Aim of MAF-TB in Bangladesh
To guide the strengthening of accountability by the national political and administrative leadership and multisectoral partners and stakeholders to achieve and assess progress towards implementing political commitments and targets agreed upon.
National TB Control Programme
Directorate General of Health Services
Ministry of Health and Family Welfare
Commitments
National TB Control Programme
Directorate General of Health Services
Ministry of Health and Family Welfare
A Snapshot of MAF-TB Platforms, Strategies and Actions in Bangladesh
National TB Control Programme
Directorate General of Health Services
Ministry of Health and Family Welfare
MAF-TB
in Bangladesh
National TB Control Programme
Directorate General of Health Services
Ministry of Health and Family Welfare
Specific Activities by the Key Ministries for TB Elimination
Ministry | Strengths | Areas of collaborations |
Ministry of Local Government, Rural Development and Co-operatives |
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Ministry of Education |
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National TB Control Programme
Directorate General of Health Services
Ministry of Health and Family Welfare
Specific Activities by the Key Ministries for TB Elimination
Ministry | Strengths | Areas of collaborations |
Ministry of Women and Children Affairs |
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Ministry of Planning |
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National TB Control Programme
Directorate General of Health Services
Ministry of Health and Family Welfare
Specific Activities by the Key Ministries for TB Elimination
Ministry | Strengths | Areas of collaborations |
Ministry of Finance
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Ministry of Home Affairs |
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National TB Control Programme
Directorate General of Health Services
Ministry of Health and Family Welfare
Specific Activities by the Key Ministries for TB Elimination
Ministry | Strengths | Areas of collaborations |
Ministry of Defense |
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Ministry of Posts, Telecommunications, and Information Technology |
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National TB Control Programme
Directorate General of Health Services
Ministry of Health and Family Welfare
Specific Activities by the Key Ministries for TB Elimination
Ministry | Strengths | Areas of collaborations |
Ministry of Social Welfare |
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Ministry of Industries |
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National TB Control Programme
Directorate General of Health Services
Ministry of Health and Family Welfare
Collaboration with specific departments in the MOH&FW
National Nutrition Services (NNS) |
Non-communicable Disease Control (NCDC) |
Maternal, Neonatal, Child & Adolescent Health (MNC&AH) |
Directorate General of Drug Administration (DGDA) |
Central Medical Store Depot (CMSD) |
Hospital Services Management |
Waste Management Services |
NEMEMW (National Electro Medical Equipment Maintenance Workshop) |
Health Education Bureau |
Directorate General of Medical Education (DGME) |
National AIDS/ STD Control (ASP) |
Health Engineering Department (HED) |
Bangladesh Medical Research Council (BMRC) |
National TB Control Programme
Directorate General of Health Services
Ministry of Health and Family Welfare
Operationalizing MAF-TB Actions in Bangladesh
36
National TB Control Programme
Directorate General of Health Services
Ministry of Health and Family Welfare
Activities for Operationalizing MAF-TB
National TB Control Programme
Directorate General of Health Services
Ministry of Health and Family Welfare
National TB Control Programme
Directorate General of Health Services
Ministry of Health and Family Welfare
“Key Practical Steps�in Implementing MAF-TB:�Global Good Practices”
BRAC’s Approach in Implementing Bangladesh’s Multi-sectoral Accountability Framework on TB
Dr. Farhana Nishat Seheli
Senior Manager, Technical
BRAC Health Programme
Introduction
Our Approach in Health Provisions
Stakeholders Engagement: MOH&FW
Service Delivery System Strengthening
Health System Strengthening
Stakeholders Engagement (Social Determinants & TB): Beyond Health Ministries
Ministry of -
Stakeholders Engagement: Non Government Sectors
Stakeholders Engagement for TB services
Thank You�
“Key Practical Steps�in Implementing MAF-TB:�Global Good Practices”
KEY PRACTICAL STEPS IN IMPLEMENTING MAF-TB: UKRAINE’S EXPERIENCE
YANA TERLEIEVA
Head of TB Management�and Counteraction Department
Interregional online meeting ‘Key Practical Steps in Implementing MAF-TB: Global Good Practices
TB AS A HIGH-LEVEL POLITICAL ISSUE
On September 22, the High-Level Meeting of the UN General Assembly on TB took place in New York (USA), where the political declaration was presented
2023 became a landmark year for the global TB-response community
MULTISECTORAL APPROACH SET IN THE LAW
Article 1. Definitions
multidisciplinary and multidisciplinary approach to elimination of TB is a way to organize state TB response activities so that the state’s responsibility for ensuring epidemic well-being of the people is shared between central and relevant local executive authorities not directly involved in healthcare, and is led by other agencies (in the areas of social protection, education, environment protection, agriculture, energy, emergency and disaster response, corrections and probation, internal affairs, etc.)
�
The National Council on TB and HIV/AIDS Response is the consultative advisory body of the government responsible for coordination of the multisectoral TB response
THE LAW OF UKRAINE ‘ON ELIMINATION OF TB’
KEY STEPS FOR ADAPTING AND IMPLEMENTING MAF-TB AT THE NATIONAL AND LOCAL LEVELS
Create a favorable environment to initiate MAF-TB at the national/local level, including close cooperation with the civil society
Perform MAF-TB baseline assessment
Create or strengthen the national multisectoral coordination and review framework
Establish connections with other sectors and ministries beyond healthcare, incl. with the private sector
Develop a component or plan for MAF-TB implementation
Step up advocacy and resource mobilization for national level MAF-TB implementation
Promote universal health coverage and countering health-related risk factors as a part of national level MAF-TB implementation
Facilitate equal access to ethical, person-centered TB services and counter the key factors of the epidemic
Perform regular monitoring and reporting on national level MAF-TB implementation
Provide for periodic reviews of multisectoral TB response activities
Step 1
CREATE A FAVORABLE ENVIRONMENT TO INITIATE MAF-TB AT THE NATIONAL/LOCAL LEVEL, INCLUDING CLOSE COOPERATION WITH THE CIVIL SOCIETY
National Council for TB and HIV Response
Stop TB Partnership. Ukraine
Ukraine’s National TB Caucus
effective consultative and advisory tools
Planning and preparation
Assessment using the MAF-TB checklist
Analysis
Report with findnigs and recommendations
Multisectoral approval of the results
Step 2
PERFORM MAF-TB BASELINE ASSESSMENT
Implemented in 2021 and 2023
On 17 March 2021, the line Committee of the Parliament of Ukraine had hearings, which, together with the baseline MAF-TB assessment led to recommending the Cabinet of Ministers of Ukraine to provide for development of a multisectoral cooperation and accountability framework for political commitments and targets regarding TB elimination.
On 22 June 2021, MAF-TB baseline assessment results were presented to the National Council.
On 9 December 2021, MAF-TB development was discussed during the Second National Dialogue on Consolidation of Efforts and Planning Joint Actions of Public Institutions and Civil Society Organizations
CREATE OR STRENGTHEN THE NATIONAL MULTISECTORAL COORDINATION AND REVIEW FRAMEWORK
NATIONAL COUNCIL FOR TB AND HIV RESPONSE SET AS THE RESPONSIBLE BODY
Coordination of multisectoral TB response is the responsibility of the National Council for TB and HIV/AIDS response, a consultative advisory body of the government.
The meeting of the Government on 28 January 2021:
…implementation of the multisectoral approach to implementing the Political Declaration of the UN HLM on TB shall be responsibility of the National Council.
Step 3
ESTABLISH CONNECTIONS WITH OTHER SECTORS AND MINISTRIES BEYOND HEALTHCARE, INCLUDING WITH THE PRIVATE SECTOR
INTERSECTORAL COOPERATION AND COLLABORATION
�
DEVELOP A COMPONENT OR PLAN FOR MAF-TB IMPLEMENTATION
Good practices | Notes |
State leadership and responsibility | The process of development of the national strategic plan needs to be led and coordinated at the top level of the ministry of health in order to ensure alignment with national and subnational healthcare priorities and promote proper engagement and involvement of other key institutions and agencies within health sector and beyond. This may include promoting key stakeholder involvement, distribution of resources, management support in implementing the strategic plan, and responsibility and accountability of the government for meeting the national and global commitments. |
Multisectoral and multilateral stakeholder involvement at the national and subnational levels | Full-fledged engagement and involvement of relevant stakeholders and partners, including representatives of civil society and TB-affected communities throughout the whole development process. MAF-TB of the WHO and the Operational Guidelines form the basis for planning multisectoral and multidisciplinary participation and accountability at both national and local levels. |
Alignment with TB Elimination Strategy and other relevant global and regional strategies | The national strategic plan needs to be aligned with the TB Elimination Strategy and its three main components and four fundamental principles adapted to the local context. The NSP has to be aligned with other relevant global and regional strategies, including with the UHC principles. |
Alignment with the national healthcare strategy and other healthcare programs | The national strategic plan needs to be aligned with the national healthcare strategy and supplement the programs for countering TB co-morbidities, disability, social protection programs and so on. |
Facilitation of provision of quality-assured, effective, safe, and person-centered care | The national strategic plan has to advance and resolve the problems of quality of care throughout the whole healthcare system to ensure effective, safe, person-centered care free from stigma and discrimination based on human rights, equity and gender equality. |
NATIONAL TB, HIV AND HEPATITIS RESPONSE STRATEGY UNTIL 2039, AND STRATEGIC AND OPERATIONAL GOALS FOR COUNTERING TB AS A GLOBAL AND NATIONAL CHALLENGE
Operational goal 3.1.
Improve the system of TB care organization and provision
Operational goal 3.2.
Ensure effective case finding and prevent forming of drug-resistant TB strains
Operational goal 3.3.
Improve the quality and effectiveness of TB treatment
Strategic goal 3.
Reduction of TB morbidity and mortality
Indicators of the Strategic goal 3. Reduction of TB morbidity and mortality
TB incidence reduced by 80%
TB mortality reduced by 90%
Success rate of treatment of all forms of TB exceeds 90%
DEVELOP A MAF-TB IMPLEMENTATION PLAN
�
STEP UP ADVOCACY AND RESOURCE MOBILIZATION FOR NATIONAL LEVEL MAF-TB IMPLEMENTATION
Step 6
Strategic advocacy
Covers the key steps and events in TB response, including the World TB Day, and reaches beyond the activities of TB response, including advocacy and promotion in related areas, such as universal healthcare coverage, antimicrobial resistance, non-contagious diseases and pandemic preparedness. Novel communication tools are used to ensure broad coverage.
Resource mobilization
National level sources of MAF-TB funding are clearly defined and distributed through the national strategic plan for TB response.
The sources of funding may include both domestic financing by healthcare and other sources and international resources for the main activities, including ensuring universal access to diagnostics, prevention, treatment and care for TB patients.
PROMOTE UNIVERSAL HEALTH COVERAGE AND COUNTERING HEALTH-RELATED RISK FACTORS AS A PART OF NATIONAL LEVEL MAF-TB IMPLEMENTATION
Strongly recommended risk groups
Clinic-based screening risk groups
Community-based screening risk groups
internally displaced persons, persons below the poverty line, persons who are in the facilities of psycho-neurological profile, persons living in shelters, military personnel
Етап 7
Step 7
FACILITATE EQUAL ACCESS TO ETHICAL, PERSON-CENTERED TB SERVICS AND COUNTER THE KEY FACTORS OF THE EPIDEMIC
Step 8
Section II. STATE POLICY FOR ELIMINATION OF TUBERCULOSIS; RESPONSIBILITIES OF EXECUTIVE AUTHORITIES AND LOCAL SELF-GOVERNMENT BODIES WITH REGARD TO THIS POLICY
Article 3. Foundations of the state policy for elimination of tuberculosis
Elimination of tuberculosis is an integreal part of the state policy based on ensuring:
Multidisciplinary and multisectoral approach to elimination of tuberculosis;
Adopting national programs, strategies to eliminate tuberculosis, as well as action plan to implement the programs and strategies;
Free and equal access to quality health services and necessary medications in case of tuberculosis, and to services of early diagnosis and prevention of tuberculosis, and social services;
Implementing the state health benefits program;
Organization of preventive health examinations.
Performing the actions to counter tuberculosis, ensuring that each person with TB gets free, accessible and equal opportunities to receive care, including by creating and operating a unified TB care system through healthcare facilities, both public and private, regardless of their subordination, and the system of social, physical and medical rehabilitation of people with TB are the responsibility of central and local executive bodies and local self-government authorities.
PERFORM REGULAR MONITORING AND REPORTING ON NATIONAL LEVEL MAF-TB IMPLEMENTATION
Step 9
To implement MAF-TB in the context of measuring the progress of national multisectoral TB response, the following monitoring and reporting elements have been introduced:
PROVIDE FOR PERIODIC REVIEWS OF MULTISECTORAL TB RESPONSE ACTIVITIES
Step 10
The main goal of the high-level review
is to provide for a periodic (preferably annual) review of multisectoral TB response to assess the progress in meeting the political commitments and reaching the national TB targets, and to review the progress in national level MAF-TB implementation
Yana Terleieva
THANK YOU FOR YOUR ATTENTION!
Public Health Center
of the Ministry of Health of Ukraine
“Key Practical Steps�in Implementing MAF-TB:�Global Good Practices”
Как мобилизовать политическую волю и ресурсы�для усиления межсекторального ответа на ТБ:�прогрессивный опыт стран мира
How to mobilize political will and resources�to strengthen a multisectoral response to TB:�progressive experiences from countries around the world
10 a.m. - 12 p.m. CET
11 ДЕКАБРЯ
11 DECEMBER