To achieve the targets set forth in the Global Plan, countries face numerous challenges. To overcome these challenges, the Global Plan, therefore, identifies eight fundamental changes, shifting to more patient-centered and community focused TB response.
1. Change in mindset
To end TB, governments of countries with high burden will need to be ambitious, declaring that TB has no place in the future of their societies and that the current paradigm – controlling the disease with modest incremental gains – will be replaced by an energized and sustained effort to end TB. Progress as dramatic as that envisioned in the End TB Strategy can only be achieved once a country’s leadership announces to its people – and its health services – that TB will be fought on a long-term campaign basis, similar to HIV or even polio, and that it will dedicate the resources needed to end TB in the country. All stakeholders need to adopt a mindset of responding to TB in a manner that will end the disease.
2. A Human-Rights and gender-based approach to TB
A human-rights-based approach to TB is grounded in international, regional and domestic law. These laws establish rights to health, non-discrimination, privacy, freedom of movement, and enjoyment of the benefits of scientific progress, among others. Human rights law also establishes the legal obligations of governments and private actors.
In order to implement a human-rights-based approach to TB, countries should:
- PROHIBIT DISCRIMINATION AGAINST PEOPLE WITH TB
- EMPOWER PEOPLE TO KNOW THEIR TB STATUS and establish legal rights to access TB testing and treatment, including the elimination of financial and physical barriers to treatment and care.
- ENSURE THE PARTICIPATION OF PEOPLE WITH TB IN HEALTH POLICY DECISION‑MAKING PROCESSES
- ESTABLISH MECHANISMS TO ADDRESS RIGHTS OF PEOPLE WITH TB and ensure their implementation
- PROTECT THE PRIVACY OF PEOPLE WITH TB
A gender-based approach to TB aims at addressing the social, legal, cultural and biological issues that underpin gender inequality and contribute to poor health outcomes. It encourages activities that are gender-responsive investments to prevent new cases of TB and strengthen the response to fulfill the right to health of women and girls, men and boys in all their diversity.
Wherever applicable, these protections should be included in constitutional law or legislation. If this is not possible, they should be incorporated as legal rights in national and local TB policies.
3. Changed and more inclusive leadership
Ending TB will require the mobilization of a broad spectrum of government officials - presidents and prime ministers, members of parliament, mayors, and community administrators – to work with civil society organizations and individual citizens in a long-term effort to diagnose, treat and prevent TB. This effort will demand political commitment and coordination at the highest levels that tie together government ministries – especially ministries of finance and labour – and will require effective alliances between government, civil society, affected communities, and the private sector for action on poverty, social protection, justice and labour reform. Furthermore, this will require greater South-South collaboration on capacity-building in countries, as well as strategic regional initiatives.
4. Community- and patient-driven approach
People with TB and the groups that represent them must be at the heart of the paradigm shift. Affected communities must be included in every area of decision-making, serving on boards of organizations and institutions that provide care, and sharing their experience and knowledge as equal and valuable partners in all TB forums. The community must also be resourced and empowered to form caucuses, to choose its own representatives, and to interact with the media. People with TB and their communities must be partners in the design and planning of strategies to end TB, and given a key role in monitoring and evaluation, especially at the point of need. New tools, including social media, social auditing and social observatories, have the potential to be used alongside traditional tools to make progress in this area.
5. Innovative TB programs equipped to end TB
The paradigm shift requires that TB programmes be equipped to end TB as an epidemic. National authorities responsible for the fight against TB need to be empowered to undertake necessary policy changes, to allocate resources, and to implement activities that will have an impact. These programmes need to respond to the needs of local settings, identifying TB hot spots and areas that will require more intensive efforts, such as areas with high levels of poverty.
TB programmes must focus not only on saving lives, but also on stopping transmission through early case detection and stronger prevention, with a targeted approach to serve communities at high risk. TB programmes should be equipped to leave behind the past approach of slowly scaling up pilot projects in order to more rapidly scale up treatment and care for drug-sensitive and drug-resistant TB. This will require programmes to look for innovative approaches in service delivery, embracing the use of social media and m-health. Local programmes need to be empowered to find innovative solutions to identify and treat vulnerable groups. It will require the collection of high-quality data, real-time monitoring, and private-sector expertise. Programmes must also be equipped to rapidly and efficiently roll out any new medicines, diagnostics and vaccines that reach the market before 2025.
6. Integrated health systems fit for purpose
Integrated health systems are essential for ending TB. The fragmentation and isolation of TB programmes within country health systems must end, as must the separation of programmes aimed at tackling different forms of TB and coinfections with specific diseases. Instead, TB interventions should be integrated to the greatest extent possible with HIV/AIDS and maternal and child health programmes and made part of the efforts to deliver primary health care in the context of universal health coverage. Efforts to tackle TB should also include zoonotic TB, embracing the One Health approach that recognizes that the health of humans is connected to the health of animals and the environment. There is an urgent need to increase the human resources available to end TB, and to improve the collection and analysis of data to better inform and correct programming.
7. New, innovative, and optimized approach to funding TB care
A sustained increase in funding for TB programmes and TB R&D, with significant front-loaded investments in the period of the Global Plan, will be required to end TB (see Chapter 7 on resource needs). Significant changes should also be made to the way that funds are raised and deployed.
TB programmes must make a compelling business case for increased and frontloaded budgets and then make efficient use of resources -prioritizing investments and pooling resources with other programmes. Innovative financing approaches, including better use of incentives, present an opportunity to increase TB resources. Results-based financing approaches are being rolled out in numerous countries, and is beginning to generate positive results by providing financial incentives to providers and facilities for specific results attained – TB programmes must be part of such initiatives.
Furthermore, TB programmes must engage the business sector and private-sector health providers as partners, harnessing companies’ consumer-led approaches and embracing their ability to generate revenue through social business models. As social health insurance initiatives and innovative, blended finance mechanisms scale up, TB programmes need to proactively align and integrate with these initiatives.
8. Investment in socioeconomic actions
Medical interventions alone will not be enough to end TB. Nonmedical actions and investments, such as in improved housing and sanitation, poverty reduction, and strengthened social safety nets, will drive down the numbers of people becoming ill and dying from TB. Planning for and investing in such nonmedical activities cannot wait, as they normally take several years to implement and to affect TB incidence.