Meetings and events

Back

Regional meetings

Meeting of National Managers of the Tuberculosis Control Programmes in the Eastern Mediterranean Region
(Rabat, Morocco, 17th-19th June 2003)

Regional Director's message (Arabic)

In the Name of God, the Compassionate, the Merciful

  Message from 

DR HUSSEIN A. GEZAIRY

REGIONAL DIRECTOR

WHO EASTERN MEDITERRANEAN REGION

to the

MEETING OF MANAGERS OF THE NATIONAL TUBERCULOSIS PROGRAMME
IN THE EASTERN MEDITERRANEAN REGION

Rabat, Morocco 17–19 June 2003

Distinguished Guests, Dear Colleagues, Ladies and Gentlemen, 

It gives me great pleasure to welcome you all to the meeting of national managers of tuberculosis control programmes in the Eastern Mediterranean Region. I wish first to extend my sincere thanks to the Government of Morocco for their kind offer to host the meeting and to His Excellency Dr Mohamed Cheikh Biadillah, the Minister of Health, for honouring us with his presence today to inaugurate the meeting. My special welcome also goes to the members of the Strategy and Technical Advisory Group on Tuberculosis Control in the Region.

Ten years ago, in 1993, the World Health Organization declared a global emergency on tuberculosis, and asked countries to strengthen tuberculosis control activities. During these 10 years, countries of the Region have made commendable progress. In 21 countries, DOTS is widely implemented throughout the health service network of ministries of health. The regional average for successful treatment outcome stands at 81%. More than half million people with tuberculosis have received care from DOTS activities in the Region during the past 5 years. DOTS is one of the few health interventions that has been expanded so widely and has saved such a large number of lives in such a short period.

Morocco is one of the best examples of this progress. The national programme has detected more than 28 000 cases of tuberculosis a year and successfully treated almost 90% of them. I would like to extend my appreciation to H.E. Dr Biadillah for his commitment and leadership on tuberculosis control.

However, the current DOTS expansion in the Region has yet to result in a real decline in the burden of tuberculosis. The incidence and mortality of tuberculosis in the Region remain high. To reduce the burden, it is essential for all countries of the Region to achieve the global targets for tuberculosis control on time, namely detecting 70% of the existing cases of tuberculosis and successfully treating 85% of them by 2005. This meeting is therefore very important. We have only two and half years to achieve the targets, and the current situation in the Region is not promising.

Treatment success rate is in general good. However, it is still less than 80% in some countries. More importantly, the DOTS case detection rate is very low in general, the regional average being only 28% in 2002 according to the latest information. The low case detection rates in Pakistan and Afghanistan, standing at 11% and 25% respectively, are one reason for this. However, the detection rates in the other 21 countries are also low, at an average of 47% only. Unless we drastically improve case detection, it will be difficult to achieve the global targets on time.

At our last regional meeting with programme managers in September 2002, we discussed these problems involved extensively and identified the causes behind them. The causes identified included issues of programme performance, such as laboratory network development, surveillance and intersectoral collaboration, and issues concerning estimated incidences. The Regional Advisory Group developed recommendations to address these issues. The Regional Office has since taken several steps to implement the recommendations.

Many countries questioned the estimated incidences, and the Regional Office undertook an extensive exercise to review these. In some countries, the estimated incidences were revised and lowered, and thus the case detection rates were increased. However, the revision was possible only in countries with extensive epidemiological data on morbidity and mortality of tuberculosis, and their trends. This has made us realize the importance of strengthening surveillance activities. Surveillance is important to monitor tuberculosis control activities closely and to take the corrective action necessary, but it is also important for collecting the epidemiological information necessary to review the estimates. The Regional Office is in the process of introducing a nominal case reporting system in countries where that is feasible and mechanisms for effective use of the current district-based case reporting system in other countries.

The Regional Office conducted a quick survey on the status of laboratory network development. We found that the network still needs further expansion within the general health services as in some countries diagnostic laboratories are not adequately distributed. Moreover, a quality assurance system for sputum microscopy is not fully functional in many countries.

The Regional Office also conducted a quick survey on the involvement of private and other sectors in DOTS activities. Based on the survey, we assisted several countries in developing proposals on intersectoral collaboration and in submitting them to the International Union Against Tuberculosis and Lung Disease (or IUATLD) for funding. We would like to initiate a similar project in other countries.

With regard Afghanistan and Pakistan, the Regional Office assisted them in strengthening partnerships. Funding has been drastically improved, and the number of technical partners increased. Both countries have fulltime international staff on tuberculosis control and have a sufficient amount of anti-tuberculosis drugs for DOTS expansion. We hope that steps will now be taken to expand DOTS as planned.

Operational research was further promoted. In this year’s Small Grants Scheme, nine proposals on tuberculosis were approved for funding. Seven of these were actually formulated in the Intercountry Training Workshop on Research Methods for Tuberculosis and Other Communicable Disease that we held jointly with the IUATLD in October 2002. An anti-tuberculosis drug resistance survey has been started in some countries with the help of the WHO headquarters.

Ladies and Gentlemen,

I am sure the countries of the Region have also worked hard to implement the recommendations of the Advisory Group. I am very keen to hear about progress and challenges in the countries. As I said previously, we have only two and a half years to achieve the global targets, and this meeting is very important to streamline our activities. In this connection, I would like each one of you to think about and respond to the following three questions.

The first question is: Are you going to achieve the global targets on time? The second question is: What are the gaps that need to be filled if you think it will not be easy to achieve the targets on time? The third question is: How can you address the gaps identified and ensure the accomplishment of the targets on time? The response to this question is actually the most important because the real outcome of this meeting is action in the countries, and not discussions in the meeting per se. We have also to complete plans for the next biennium, 2004 to 2005, for the Joint Programme Review and Planning Mission, or JPRM.

By the end of this meeting, each country is expected to have a clear idea on how to achieve the global targets on time. I know you have a very busy schedule in front of you. I would like to end my address now. I am very keen to see the national plans as well as the recommendations of the meeting. I wish you all success, and a pleasant stay in Rabat.

Thank you.