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Washington, D.C., World Bank, Development Research Group, Human Development and Public Services Team, 2009 Apr. 14 p. (Policy Research Working Paper No. 4907)Aid to developing countries has largely neglected the population-wide health services that are core to communicable disease control in the developed world. These mostly non-clinical services generate "pure public goods" by reducing everyone's exposure to disease through measures such as implementing health and sanitary regulations. They complement the clinical preventive and treatment services which are the donors' main focus. Their neglect is manifested, for example, in a lack of coherent public health regulations in countries where donors have long been active, facilitating the spread of diseases such as avian flu. These services can be inexpensive, and dramatically reduce health inequalities. Sri Lanka spends less than 0.2% of GDP on its well-designed population-wide services, which contribute to the country's high levels of health equity and life expectancy despite low GDP per head and civil war. Evidence abounds on the negative externalities of weak population-wide health services. Global public health security cannot be assured without building strong national population-wide health systems to reduce the potential for communicable diseases to spread within and beyond their borders. Donors need greater clarity about what constitutes a strong public health system, and how to build them. The paper discusses gaps in donors' approaches and first steps toward closing them.
Improving effectiveness and outcomes for the poor in health, nutrition, and population: an evaluation of World Bank Group support since 1997.
Washington, D.C., World Bank, Independent Evaluation Group, 2009.  p.The World Bank Group’s support for health, nutrition, and population (HNP) has been sustained since 1997 -- totaling $17 billion in country-level support by the World Bank and $873 million in private health and pharmaceutical investments by the International Finance Corporation (IFC) through mid-2008. This report evaluates the efficacy of the Bank Group’s direct support for HNP to developing countries since 1997 and draws lessons to help improve the effectiveness of this support.
Journal of Health, Population, and Nutrition. 2008 Sep; 26(3):251-2.Add to my documents.
Washington, D.C., World Bank, Human Development Network, Health, Nutrition and Population Team, 2007 Aug. 51 p. (Policy Research Working Paper No. 4295)Tuberculosis is the most important infectious cause of adult deaths after HIV/AIDS in low- and middle-income countries. This paper evaluates the economic benefits of extending the World Health Organization's DOTS Strategy (a multi-component approach that includes directly observed treatment, short course chemotherapy and several other components) as proposed in the Global Plan to Stop TB, 2006-2015. The authors use a model-based approach that combines epidemiological projections of averted mortality and economic benefits measured using value of statistical life for the Sub-Saharan Africa region and the 22 high-burden, tuberculosis-endemic countries in the world. The analysis finds that the economic benefits between 2006 and 2015 of sustaining DOTS at current levels relative to having no DOTS coverage are significantly greater than the costs in the 22 high-burden, tuberculosis-endemic countries and the Africa region. The marginal benefits of implementing the Global Plan to Stop TB relative to a no-DOTS scenario exceed the marginal costs by a factor of 15 in the 22 high-burden endemic countries, a factor of 9 (95% CI, 8-9) in the Africa region, and a factor of 9 (95% CI, 9-10) in the nine high-burden African countries. Uncertainty analysis shows that benefit-cost ratios of the Global Plan strategy relative to sustained DOTS were unambiguously greater than one in all nine high-burden countries in Africa and in Afghanistan, Pakistan, and Russia. Although HIV curtails the effect of the tuberculosis programs by lowering the life expectancy of those receiving treatment, the benefits of the Global Plan are greatest in African countries with high levels of HIV. (author's)
Global Fund-supported programmes' contribution to international targets and the Millennium Development Goals: An initial analysis.
Bulletin of the World Health Organization. 2007 Oct; 85(10):805-811.The Global Fund to Fight AIDS, Tuberculosis and Malaria is one of the largest funders to fight these diseases. This paper discusses the programmatic contribution of Global Fund-supported programmes towards achieving international targets and Millennium Development Goals, using data from Global Fund grants. Results until June 2006 of 333 grants supported by the Global Fund in 127 countries were aggregated and compared against international targets for HIV/AIDS, tuberculosis and malaria. Progress reports to the Global Fund secretariat were used as a basis to calculate results. Service delivery indicators for antiretrovirals (ARV) for HIV/AIDS, case detection under the DOTS strategy for tuberculosis (DOTS) and insecticide-treated nets (ITNs) for malaria prevention were selected to estimate programmatic contributions to international targets for the three diseases. Targets of Global Fund-supported programmes were projected based on proposals for Rounds 1 to 4 and compared to international targets for 2009. Results for Global Fund-supported programmes total 544 000 people on ARV, 1.4 million on DOTS and 11.3 million for ITNs by June 2006. Global Fund-supported programmes contributed 18% of international ARV targets, 29% of DOTS targets and 9% of ITNs in sub-Saharan Africa by mid-2006. Existing Global Fund-supported programmes have agreed targets that are projected to account for 19% of the international target for ARV delivery expected for 2009, 28% of the international target for DOTS and 84% of ITN targets in sub-Saharan Africa. Global Fund-supported programmes have already contributed substantially to international targets by mid-2006, but there is a still significant gap. Considerably greater financial support is needed, particularly for HIV, in order to achieve international targets for 2009. (author's)
Improving performance of IDSR at district and facility levels: experiences in Tanzania and Ghana in making IDSR operational.
Bethesda, Maryland, Abt Associates, Partners for Health Reform Plus, 2006 Sep.  p. (USAID Contract No. HRN-C-00-00-00019-00)Recognition of the need for effective disease surveillance and response is growing worldwide due to increased risks of infectious diseases associated with population mobility, globalization, and emerging and resurging diseases. The Integrated Disease Surveillance and Response (IDSR) strategy, promoted and supported by the World Health Organization (WHO) Regional Office for Africa (AFRO), has been adopted throughout the region's 46 countries to strengthen surveillance systems such that they inform public health decisions and disease control actions. This document describes the efforts of the Partners for Health Reformplus (PHRplus) project in Ghana and Tanzania to support improvements in the performance of IDSR. Ghana and Tanzania sought to address concurrently the technical, organizational and workforce issues that could impede IDSR performance. The most notable improvements were seen in reporting, analysis, and interpretation of surveillance data. Strengthening and maintaining IDSR performance, however, is also dependent the following: ensuring on-going supervision and follow-up; ensuring IDSR visibility and leadership at all levels; understanding the links between IDSR and health system decentralization; and addressing structural barriers to IDSR that are a function of the overall health system. (author's)
Bulletin of the World Health Organization. 2007 Aug; 85(8):631-636.Following the destruction of Cambodia's health infrastructure during the Khmer Rouge period (1975-1979) and the subsequent decade of United Nations sanctions, international development assistance has focused on reconstructing the country's health system. The recognition of Cambodia's heavy burden of tuberculosis (TB) and the lapse of TB control strategies during the transition to democracy prompted the national tuberculosis programme's relaunch in the mid-1990s as WHO-backed health sector reforms were introduced. This paper examines the conflicts that arose between health reforms and TB control programmes due to their different operating paradigms. It also discusses how these tensions were resolved during introduction of the DOTS strategy for TB treatment. (author's)
Lancet Infectious Diseases. 2007 Jul; 7(7):439.The 2007 Group of Eight (G8) summit, which took place in Heiligendamm, Germany, on June 6-8, has been described by John Kirton (G8 Research Group, University of Toronto, Canada) as an "emerging centre of democratic global governance". Like many self-appointed elites, the G8 is an idiosyncratic club. The eight started as six in 1975 with a meeting in Rambouillet, France, of the heads of government of France, West Germany, Italy, Japan, the UK, and the USA-the most economically powerful democratic nations. This annual forum for discussion of matters of mutual interest was joined by Canada in 1976, by the European Union in 1977, and by Russia in 1997. Although the G8 nations account for nearly two-thirds of world economic output, the Russian economy is not among the world's top eight, whereas China with the fourth largest economy remains outside the G8 club. (excerpt)
Bulletin of the World Health Organization. 2007 May; 85(5):325-420.In 1991, the 44th World Health Assembly set two key targets for global tuberculosis (TB) control to be reached by 2000: 70% case detection of acid-fast bacilli smear-positive TB patients under the DOTS strategy recommended by WHO and 85% treatment success of those detected. This paper describes how TB control was scaled up to achieve these targets; it also considers the barriers encountered in reaching the targets, with a particular focus on how HIV infection affects TB control. Strong TB control will be facilitated by scaling-up WHO-recommended TB/HIV collaborative activities and by improving coordination between HIV and TB control programmes; in particular, to ensure control of drug-resistant TB. Required activities include more HIV counselling and testing of TB patients, greater use and acceptance of isoniazid as a preventive treatment in HIV-infected individuals, screening for active TB in HIV-care settings, and provision of universal access to antiretroviral treatment for all HIV-infected individuals eligible for such treatment. Integration of TB and HIV services in all facilities (i.e. in HIV-care settings and in TB clinics), especially at the periphery, is needed to effectively treat those infected with both diseases, to prolong their survival and to maximize limited human resources. Global TB targets can be met, particularly if there is renewed attention to TB/HIV collaborative activities combined with tremendous political commitment and will. (author's)
Bulletin of the World Health Organization. 2007 May; 85(5):325-420.The development and expansion of WHO's DOTS strategy was successful, with 83% of the world's population living in countries or parts of countries covered by this strategy by the end of 2004. Treatment success in the 2003 DOTS cohort of 1.7 million patients was 82% on average, close to the 85% target. Treatment success was below average in the African Region (72%), which can be partly attributed to occurrence of HIV co-infection, and in the European Region (75%), partly due to drug resistance. Drug resistance, specifically multidrug resistance and extensive drug resistance, is a serious threat to public health in all countries, especially in the Russian Federation, where the highest rates of multidrug resistance are presently accompanied by a rapid increase in HIV infection. Based on the experience of the first projects approved by the Green Light Committee, the treatment success of patients with multidrug-resistant tuberculosis (MDR-TB) is lower than that of drug-susceptible cases, but nevertheless reaches 70%. The collaborative effort of different organizations, professionals and communities is needed to address the development and spread of multidrug resistance and extensive drug resistance, which combined with the epidemic of HIV infection is one of the barriers to dealing effectively with TB. This effort should be directed towards facilitating the diagnosis and treatment of TB patients, in particular by improving access to drug susceptibility testing and strengthening treatment delivery by rigorous adherence to DOTS as outlined by the Stop TB Partnership. (author's)
Bulletin of the World Health Organization. 2007 May; 85(5):325-420.Laboratories and laboratory networks are a fundamental component of tuberculosis (TB) control, providing testing for diagnosis, surveillance and treatment monitoring at every level of the health-care system. New initiatives and resources to strengthen laboratory capacity and implement rapid and new diagnostic tests for TB will require recognition that laboratories are systems that require quality standards, appropriate human resources, and attention to safety in addition to supplies and equipment. To prepare the laboratory networks for new diagnostics and expanded capacity, we need to focus efforts on strengthening quality management systems (QMS) through additional resources for external quality assessment programmes for microscopy, culture, drug susceptibility testing (DST) and molecular diagnostics. QMS should also promote development of accreditation programmes to ensure adherence to standards to improve both the quality and credibility of the laboratory system within TB programmes. Corresponding attention must be given to addressing human resources at every level of the laboratory, with special consideration being given to new programmes for laboratory management and leadership skills. Strengthening laboratory networks will also involve setting up partnerships between TB programmes and those seeking to control other diseases in order to pool resources and to promote advocacy for quality standards, to develop strategies to integrate laboratories' functions and to extend control programme activities to the private sector. Improving the laboratory system will assure that increased resources, in the form of supplies, equipment and facilities, will be invested in networks that are capable of providing effective testing to meet the goals of the Global Plan to Stop TB. (author's)
Bulletin of the World Health Organization. 2007 May; 85(5):325-420.The Global Plan to Stop TB 2006-2015 is a road map for policy-makers and managers of national programmes. It sets out the key actions needed to achieve the targets of the Millennium Development Goals relating to tuberculosis (TB): to halve the prevalence and deaths by 2015 relative to 1990 levels and to save 14 million lives. Developed by a broad coalition of partners, the plan presents a model approach combining interventions that can feasibly be supplied on the ground. The main areas of activity set out in the plan are: scaling up interventions to control tuberculosis; promoting the research and development of improved diagnostics, drugs and vaccines; and engaging in related activities for advocacy, communications and social mobilization. Scenarios for the planning process were developed; these looked at issues both globally and in seven epidemiological regions. The scenarios made ambitious but realistic assumptions about the pace of scale-up and implementation coverage of the activities. A mathematical model was used to estimate the impact of scaling up current interventions based on data from studies of tuberculosis biology and from experience with tuberculosis control in diverse settings. The estimated costs of the activities set out in the Global Plan were based on implementing interventions and researching and developing drugs, diagnostics and vaccines; these costs were US$ 56 billion over 10 years. When translated into cost per disability adjusted life year averted, these costs compare favourably with those of other public health interventions. This approach to planning for global tuberculosis control is a valuable example of developing plans to improve global health that has relevance for other health issues. (author's)
Strategic and technical meeting on intensified control of neglected tropical diseases: a renewed effort to combat entrenched communicable diseases of the poor. Report of an international workshop, Berlin, 18-20 April 2005.
Geneva, Switzerland, World Health Organization [WHO], Department of Control of Neglected Tropical Diseases, 2006.  p. (WHO/CDS/NTD/2006.1)Throughout the developing world, socioeconomic progress is impeded by ancient and entrenched infectious diseases that permanently diminish human potential in very large populations. These diseases have largely vanished from affluent nations but continue to flourish in tropical and subtropical climates under the living conditions that surround impoverished populations -- the people left behind by socioeconomic development. These neglected tropical diseases thrive in areas where water supply, housing and sanitation are inadequate, nutrition is poor, literacy rates are low, health systems are rudimentary and insects and other disease vectors are constant household and occupational companions. Neglected tropical diseases continue to permanently maim or otherwise impair the lives of millions of people every year, frequently with adverse effects starting early in life. They anchor affected populations in poverty and also compromise the effectiveness of efforts made by other sectors to improve socioeconomic development. For example, there is ample evidence that children heavily infected with intestinal worms will not fully benefit from educational opportunities and are more likely to suffer poor nutritional status. Adults permanently disabled by blindness or limb deformities may be a burden in rural agricultural communities that eke out a living from subsistence farming. In addition, the stigma attached to many of these diseases closes options for a normal family and social life, especially for women. Efforts to control these diseases thus free people to develop their potential unimpeded by disabling disease and, in so doing, increase the chances that efforts in other sectors, such as education and agriculture, will be successful. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], 2006. 93 p. (WHO/HTM/STB/2006.37)A significant scaling up of advocacy, communication and social mobilization (ACSM) will be needed to achieve the global targets for tuberculosis control as detailed in the Global Plan to Stop TB 2006--2015. In 2005, the ACSM Working Group (ACSM WG) was established as the seventh working group of the Stop TB Partnership to mobilize political, social and financial resources; to sustain and expand the global movement to eliminate TB; and to foster the development of more effective ACSM programming at country level in support of TB control. It succeeded an earlier Partnership Task Force on Advocacy and Communications. This work-plan focuses on those areas where ACSM has most to offer and where ACSM strategies can be most effectively concentrated to help address four key challenges to TB control at country level: Improving case detection and treatment adherence; Combating stigma and discrimination; Empowering people affected by TB; Mobilizing political commitment and resources for TB. (excerpt)
Strategic approach for the strengthening of laboratory services for tuberculosis control, 2006-2009.
Geneva, Switzerland, World Health Organization [WHO], 2006.  p. (WHO/HTM/TB/2006.364)Bacteriology is one of the fundamental aspects of national tuberculosis (TB) control programmes (NTPs) and a key component of the DOTS strategy. However, TB laboratory services are often neglected components of these programmes. Given existing constraints, it will be difficult for many countries to achieve the global targets of 70% detection of infectious cases and 85% cure of these incidents by the year 2005. Although the global success rate under DOTS has reached 82%, the detection rate of the estimated prevalence has increased at a far slower rate (53% in 2004). In order to improve the case-detection rate, a global strategy for the development and strengthening of TB laboratory networks needs to be implemented urgently. In addition to improving sputum smear microscopy, the strategy recognizes the need to upgrade existing laboratory services and to strengthen/build capacity to perform culture and drug susceptibility testing (DST) in areas experiencing a high burden of acid-fast bacilli (AFB) smear-negative TB associated with human immunodeficiency virus (HIV) infection and to support DOTS-Plus projects. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], 2006 Apr. 20 p. (WHO/HTM/TB/2003.328 Rev.2)The IDA Foundation is a non-profit organization supporting health care in low- and middle-income countries by providing high-quality drugs and medical supplies at the lowest possible price. In addition, IDA provides procurement agency services and offers consultancy and training on topics related to the various aspects of pharmaceutical supply management. IDA is based in the Netherlands and is ISO 9002-2000 and GDP certified. The quality of IDA products is verified in IDA's GcLP-approved laboratories. GLC is a subgroup of the Stop TB Working Group on DOTS-Plus for MDR-TB. GLC has been established to review applications from potential DOTS-Plus pilot projects and determine whether they are in compliance with WHO's Guidelines for establishing DOTSPlus pilot projects for the management of MDR-TB. Projects that are approved will benefit from second-line anti-TB drugs at concessional prices and from technical assistance from the GLC. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], Stop TB Department, 2006.  p. (WHO/HTM/TB/2006.361)The emergence of resistance to drugs used to treat tuberculosis (TB), and particularly multidrug-resistant TB (MDR-TB), has become a significant public health problem in a number of countries and an obstacle to effective global TB control. In many other countries, the extent of drug resistance is unknown and the management of patients with MDR-TB is inadequate. In countries where drug resistance has been identified, specific measures need to be taken within TB control programmes to address the problem through appropriate management of patients and adoption of strategies to prevent the propagation and dissemination of drug-resistant TB, including MDR-TB. These guidelines offer updated recommendations for TB control programmes and medical workers in middle- and low-income countries faced with drug-resistant forms of TB, especially MDR-TB. They replace two previous publications by the World Health Organization (WHO) on drug-resistant TB. Taking account of important developments in recent years, the new guidelines aim to disseminate consistent, up-to-date recommendations for national TB control programmes and medical practitioners on the diagnosis and management of drug-resistant TB in a variety of geographical, political, economic and social settings. The guidelines can be adapted to suit diverse local circumstances because they are structured around a flexible framework approach, combining a consistent core of principles and requirements with various alternatives that can be tailored to the specific local situation. (excerpt)
Engaging all health care providers in TB control. Guidance on implementing public-private mix approaches.
Geneva, Switzerland, World Health Organization [WHO], Stop TB Department, 2006. 52 p. (WHO/HTM/TB/2006.360)A great deal of progress has been made in global tuberculosis control in recent years through the large-scale implementation of DOTS. It has been acknowledged though that TB control efforts worldwide, although impressive, are not sufficient. The global TB targets -- detecting 70% of TB cases and successfully treating 85% of them, and halving the prevalence and mortality of the disease by 2015 as part of the Millennium Development Goals (MDGs) -- are likely to be met only if current efforts are intensified. Among the important interventions required to reach these goals would be a systematic involvement of all relevant health care providers in delivering effective TB services to all segments of the population. Therefore, engaging all health care providers in TB control is an essential component of WHO's new Stop TB strategy¹ and the Stop TB Partnership's Global Plan to Stop TB 2006-2015. (excerpt)
The Stop TB Strategy: building on and enhancing DOTS to meet the TB-related Millennium Development Goals.
Geneva, Switzerland, World Health Organization [WHO], 2006. 22 p. (WHO/HTM/STB/2006.37)Since the development of the DOTS strategy, WHO and partners have worked on complementary policies and strategies to address the remaining major constraints to achievement of global TB control targets. These include expanding access to diagnosis and treatment through community TB care, and public--private mix (PPM) approaches aimed at engaging all care providers -- state and non-state -- in DOTS implementation. Innovative mechanisms such as the Global Drug Facility and the Green Light Committee have been developed to improve access to quality-assured and affordable drugs in resource-poor settings. The collaborative activities that need to be implemented by TB and HIV/AIDS control programmes have been defined, and strategies for managing multidrug-resistant TB (MDR-TB) have been developed and tested. Impact assessment is being pursued as a means of evaluating progress towards the MDGs. New partnerships and academic research initiatives for development of new tools are beginning to produce results and several new diagnostics, drugs and candidate vaccines are in the pipeline. (excerpt)
Tuberculosis control in Bolivia, Chile, Colombia and Peru: Why does incidence vary so much between neighbors?
International Journal of Tuberculosis and Lung Disease. 2006 Nov; 10(11):1292-1295.In 2003, Peru and Bolivia reported the highest annual tuberculosis (TB) incidence rates in the Americas. Neighboring Colombia and Chile had lower annual incidence rates despite their proximity. The objective was to determine what factors contribute to differences in TB incidence rates among Chile, Colombia, Bolivia and Peru. Multiple sources of literature dating between 1990 and 2005 were used and World Health Organization TB control guidelines were consulted for policy level comparisons. Comprehensive implementation of the DOTS strategy is the main factor explaining the differences in TB incidence rates, even after considering socio-economic factors. Cross-national comparisons suggest ways to improve regional DOTS implementation. (author's)
International Journal of Tuberculosis and Lung Disease. 2006 Oct; 10(10):1166-1171.The setting used was a tuberculosis control programme, southern region of Ethiopia. The objective was to assess the impact of the expansion of the DOTS strategy on tuberculosis (TB) case finding and treatment outcome. Reports of TB patients treated since the introduction of DOTS in the region were reviewed. Patients were diagnosed and treated according to World Health Organization (WHO) recommendations. Case notification and treatment outcome reports were compiled quarterly at district level and submitted to the regional programme. Of 136 572 cases registered between 1995 and 2004, 47% were smear-positive, 25% were smear-negative and 28% had extra-pulmonary tuberculosis (EPTB). In 2004, 94% of the health institutions were covered by DOTS. Between 1995 and 2004, the smear-positive case notification rate increased from 45 to 143 per 100 000 population, the case detection rate from 22% to 45%, and the treatment success rate from 53% to 85%. The default and failure rates decreased from 26% to 6% and from 7% to 1%, respectively. There was a steady increase in the treatment success rate with the decentralisation of DOTS. Although 94% coverage was achieved after 10 years, the stepwise scale-up was important in securing resources and dealing with challenges. The programme achieved 85% treatment success; however, with the current low case detection rate (45%), the 70% WHO target seems unachievable in the absence of alternative case-finding mechanisms. (author's)
Arlington, Virginia, Management Sciences for Health [MSH], Rational Pharmaceutical Management Plus, 2005 Oct. 13 p. (USAID Development Experience Clearinghouse DocID / Order No: PD-ACH-075; USAID Cooperative Agreement No. HRN-A-00-00-00016-00)USAID, through its SO5 TB global objective, promotes TB pharmaceutical management activities through the RPM Plus program. The global activities support the DOTS scheme, a WHO initiative, documented to break the transmission of TB when implemented correctly by national TB programs (NTP). One of the five primary elements of the DOTS scheme is an uninterrupted supply of TB drugs. RPM Plus provides technical assistance to the following WHO/Stop TB organizations: The Global TB Drug Facility (GDF): established in 2001 to provide free grants of TB medicines to countries unable to satisfy their medicine needs and to serve as a source of good quality TB drugs for those countries having their own funds; The Green Light Committee (GLC): technical support group for the DOTS Plus program. Initiated by the WHO and its partners to promote the correct treatment of multi-drug resistant (MDR) TB. The GLC makes medicines available to countries at affordable prices. As part of the global support RPM Plus also provides training in Pharmaceutical Management for TB at various World Health Organization consultant-training courses promoted by the Stop TB Department. (excerpt)
Rational Pharmaceutical Management Plus. Workshops on TB pharmaceutical management: trip report, Sondalo, Italy and Tbilisi, Georgia, July 6-17, 2005.
Arlington, Virginia, Management Sciences for Health [MSH], Rational Pharmaceutical Management Plus, 2005 Jul 31.  p. (USAID Development Experience Clearinghouse DocID / Order No: PD-ACH-073; USAID Cooperative Agreement No. HRN-A-00-00-00016-00)A regular supply of TB medicines is one of the main components of the DOTS and DOTS Plus schemes. RPM Plus contributes to these schemes through facilitation of training workshops in collaboration with other TB partners. In July 2005 RPM Plus participated in two training activities for pharmaceutical management of tuberculosis in Sondalo, Italy in collaboration with World Health Organization and in Tbilisi, Georgia in collaboration with GOPA/German Development Agency. There were 12 participants in the Sondalo workshop and 9 participants in the Tbilisi workshop representing the entire Caucasus region. (author's)
Bulletin of the World Health Organization. 2006 Sep; 84(9):688.Tuberculosis (TB) has been a major killer disease for several thousand years. Despite intensive efforts to combat the disease over the past twenty years, TB remains one of the leading causes of morbidity and mortality in many settings, particularly in the world's poorest countries. TB is primarily a disease of poverty, but is a significant public health problem also in wealthier countries where pockets of poverty and marginalized population groups exist. It is estimated that around 1.7 million people die each year from TB; and in 2004 figures indicate that approximately 8.9 million people developed the disease. (excerpt)
Lancet. 2006 Mar 25; 367(9515):961-964.In the past couple of decades, while there was modest growth and poverty reduction in the Middle East and North Africa (MEAN) region, impressive gains have been achieved in health status through improvements in technology, health-service delivery, public-health programmes, and socioeconomic development. In 2000, MEAN governments signed on to the Millennium Development Goals (MDGs), and most MEAN countries are on track to achieving most of the goals. But health outcomes are generally worse among the poorest than among the richest. The challenges facing the MEAN region can be grouped into health-transition and health-systems issues. (excerpt)