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Eleventh Meeting of National Tuberculosis Programme Managers in the Eastern Mediterranean Region
(Cairo, Egypt, 4-6 September 2006)

In the Name of God, the Compassionate, the Merciful

Address by

DR HUSSEIN A. GEZAIRY

REGIONAL DIRECTOR

WHO EASTERN MEDITERRANEAN REGION

to the

Ladies and Gentlemen,

It gives me great pleasure to welcome you all to the Eleventh Meeting of National Tuberculosis Programme Managers in the Eastern Mediterranean Region. I would also like to welcome the members of the Regional Strategy and Technical Advisory Group for Tuberculosis Control, and our colleagues from the WHO Headquarters and the global Stop TB Partnership.

This is an important meeting, we have been meeting for 10 years and today, we are entering into a new decade of working together for TB control in the Region. The first meeting took place in Cairo, Egypt in 1995, and I still remember that I met many of you in that meeting. Since then, tuberculosis control has shown commendable progress. DOTS has been expanded in the Region. To date, a total of 2 million of people who suffered from tuberculosis in our Region have received care and treatment under DOTS. On behalf of these millions who have benefited from your DOTS activities, I thank you for your dedication, hard work and leadership.

This meeting, although marking good progress, is by no means an occasion for celebration. Our fight against tuberculosis is still far from complete. The disease is epidemic in many parts of the Region. We have yet to see significant decline in its incidence and prevalence. Every year, more than 140,000 people die in the Region from this totally preventable and curable disease. This is not acceptable. We need to continue to work hard to put tuberculosis under full control.

This 11th meeting has therefore a very important role to play. After a decade of hard work, we need to extensively assess where we stand now. This assessment is critical for us, it will define how we will proceed further, particularly because this is the year to evaluate our progress in relation to the global targets for tuberculosis control. As you know, the global targets are to detect 70% of the existing cases and successfully treat 85% of them by 2005.

In this regard, let me start asking you the first question of this meeting, which is: “Have you achieved the global targets?” The data you have brought to this meeting will enable us to tell whether you have achieved the targets or not.

The provisional data we received from you are not encouraging. While the Region has almost achieved the target for treatment success as its regional average is 82%, case detection is far below the 70% target: our Regional average for case detection is only 38%. In reality, this is the second lowest case detection rate among all six WHO Regions in the world.

This situation will automatically lead us to the second question of this meeting, which is, “Why our case detection is so low?” An answer to this major question must be found. We have jointly expanded DOTS rapidly and widely, and DOTS population coverage is 100% in almost all countries. The Regional average today is more than 95%. Why then is our case detection still at 38% which is half of the global target? This is a very serious issue.

We need to comprehensively assess our case finding activities. There are many technical questions to be answered. These include diagnostic procedures: network of quality assured bacteriology: management of tuberculosis suspects: collaboration with all health care providers: and advocacy, communication, and social mobilization. The main issue is whether our case finding activities are at high level of quality, that is to say is our DOTS meeting high quality standards?

In addition, we also need to review the estimated incidence and prevalence of tuberculosis in the countries of the Region. I am fully aware that many countries believe that their incidence is overestimated, and thus their case detection is considerably low. I do not disagree with such a notion, however, to confirm that, we should be very meticulous. We need to make a case by producing reliable epidemiological and programme information to suggest that the current incidence is overestimated.

At the same time, we should never forget the importance of political commitment. In many countries of the Region, tuberculosis control is a priority health programme: however, I am sorry to say but there are incidences that indicate political commitment is not always translated into actions. We are still in the middle of the fight against tuberculosis, and there should be no place for complacency.

After responding to the meeting questions the last issue to discuss would inevitably be about our way forward, our last question of the meeting will therefore be “how we can improve and achieve the targets in tuberculosis control?” It is an absolute must that we achieve, if not yet, the global targets without further delays. We will then need to accomplish the tuberculosis-related Millennium Development Goals by 2015 and eventually move forward towards realizing our Regional vision halving the burden and eliminating TB in the Region by 2050. We will discuss two issues relating to this last question in the meeting. One is the guiding principles and the other is a supporting mechanism.

The first guiding principle is the new Stop Tuberculosis Strategy. This is an extensive set of technical components for addressing tuberculosis care comprehensively. In the Strategy, pursuing high-quality DOTS, which is the main question of this meeting, is defined as a core component. The other guiding principles include the Global Plan to Stop Tuberculosis which incorporate the strategies and the needs for each WHO Region including ours, and the International Standards of Tuberculosis Care which identifies a set of frameworks for patient-centered care for tuberculosis. Many of you have also national multi-year strategic plans for tuberculosis control, which is your national guiding principle.

Partnerships are the important supporting mechanism. Some of you have already started Stop TB National Partnership. In this regard, I am pleased to inform you that the Regional Office is also planning to launch a Stop TB Regional Partnership. The Regional Partnership aims at brining political, technical and financial support from within and outside of the Region so as to ensure sustainability to all our efforts for tuberculosis control in the Region.

Ladies and Gentlemen,

I have referred to the three questions of the meeting: namely “Have you achieved the global targets for tuberculosis control?” “Why our case detection is low?” and “How to improve our activities?” These are very important questions to respond to during this 11th meeting. Without extensively discussing these questions, we will never move forward. The meeting’s programme is therefore developed along with these three questions and sessions are prepared to address these questions extensively.

I assure you, you will have a very busy coming three days. Please remember that I cannot emphasize more about the importance of this meeting. I am very keen to hear from you, at the end of the meeting, how you responded to these questions. I wish you all the success in your work during the meeting and a pleasant stay in Cairo.

Thank you for your attention.