Background
The countries of the WHO Eastern Mediterranean Region
have made good progress in tuberculosis (TB) control.
Eighteen countries achieved nationwide implementation of
the DOTS (directly observed treatment, short-course)
strategy (DOTS ALL OVER) by 2000. Five countries are
lagging in DOTS expansion; of these, two will achieve
DOTS ALL OVER in 2002. The remaining three countries are
working to expand coverage of the DOTS strategy while
facing obstacles such as civil strife (Afghanistan and
Somalia) and/or extremely high TB incidence (Pakistan).
All in all, countries of the Region have laid the
groundwork for establishing effective and sustainable TB
control.
Three challenges must be met for further progress in TB
control in the Region. One of these challenges is to
improve the quality of DOTS activities, as measured by
the case detection rate and treatment success rate.
Although treatment success rates are usually more than
80% in the Region, case detection rates in general are
still lower than 50%. DOTS activities should be of
higher quality. The second challenge is to increase the
comprehensiveness of DOTS activities, as several key
players in the health sector, particularly the private
health sector, are not fully involved in the DOTS
strategy. DOTS activities should be comprehensive, with
the involvement of all health care providers. The third
challenge is to expand DOTS activities in the countries
that are lagging. Pakistan and Afghanistan account for
55% of the regional TB burden, and still have less than
25% DOTS coverage. DOTS expansion in these countries is
critical for the overall progress of TB control in the
Region.
In light of the progress of and challenges to TB control
in the Region, the WHO Regional Office for the Eastern
Mediterranean and Member States developed and adopted
new regional targets in 2000 : detect 70% of TB cases
and successfully treat 85% of them by 2005; enrol all
detected TB cases in DOTS by 2005; and reduce TB
prevalence and deaths by 50% by 2010. In order to
achieve the new targets and bring TB under firm control,
the Regional Office has prepared a Strategic Plan for TB
Control (2002–2005). The plan aims to establish
sustainable high quality DOTS activities that
comprehensively cover all populations and all TB
patients in the Region. The strategic plan is intended
for health policy-makers, TB programme managers and all
concerned partners, including members of the Regional
Inter-Agency Coordination Committee and Regional
Technical Advisory Group for TB control.
