Tuberculosis care is expanding everywhere in the Region. All countries have been using the WHO-recommended tuberculosis control strategy, DOTS (Directly Observed Treatment Short-course), for several years. Tuberculosis care according to the DOTS strategy is available widely: the population covered by DOTS is actually 97% in the Region. Seventeen (17) countries in the Region have 100% DOTS population coverage. The other countries also implement DOTS widely (81% in Afghanistan, 87% in Iraq, 91% in Sudan and 93% in Yemen) except for the United Arab Emirates (20%).

Good tuberculosis care is available in areas implementing the DOTS strategy. Patients suffering from tuberculosis can receive diagnostic services at microscopy laboratories. In 2005, 276 144 tuberculosis patients were diagnosed in the Region (table 1), including 110 030 patients with infectious, smear positive tuberculosis. Once diagnosed, patients can receive standardized treatment of 6 to 8 months with the help of treatment supporters. The quality of treatment is good because the majority of tuberculosis patients under treatment are cured. Of the detected cases in 2004, 83% of those who received treatment were cured.

Table 1. Notified tuberculosis cases, case detection rate and treatment success rate in countries of the Region, 2005

In the past 10 years (1996–2005), 2 million tuberculosis patients were detected and cured in the Region. This was a tremendous support to overall health and economic development in countries of the Region.

Tuberculosis care is also expanding to meet the different, emerging needs in the community in the countries of the Region. This has been done through adaptation of the new Stop TB Strategy developed in 2006 (figure 2). The Stop TB Strategy is a comprehensive set of tuberculosis care activities based on DOTS. The Strategy consists of six components: pursuing expansion of high-quality DOTS activities; addressing MDR-TB, HIV/TB and other challenges; contributing to health system strengthening; engaging all care providers; empowering people with tuberculosis, and communities; and enabling and promoting research.

Figure 2. The Stop TB Strategy 

Countries have been pursing expansion of high-quality DOTS activities in several ways. Laboratory quality has been improved via establishment of a laboratory network with quality assurance. The national reference laboratory of Egypt was designated as the regional reference laboratory for tuberculosis in order to support countries. A regular supply of high-quality tuberculosis drugs is ensured through the support of the Global TB Drug Facility (GDF). The GDF provides tuberculosis drugs to 10 countries in the Region. Monitoring and evaluation of tuberculosis control has been improved through introduction of an innovative computerized system (e-nominal registration system, or ENRS). ENRS has been introduced in Egypt, Jordan and the Syrian Arab Republic.

At the same time, care for those suffering from multidrug resistance is expanding. Egypt, Jordan, Lebanon, Morocco and Tunisia are implementing the global strategy on multidrug resistance set by the Green Light Committee. Countries of the Gulf Cooperation Council also provide care for drug-resistant patients. Care for tuberculosis suspects (i.e. patients who have tuberculosis-like symptoms) has been improved through introduction of the Practical Approach to Lung Health (PAL) in five countries. Collaboration with health care providers is being promoted. Six countries carried out an extensive national situation analysis to develop national collaboration strategies.

To help scale up tuberculosis care in countries, the regional plan to Stop TB was developed as part of the Global Plan to Stop TB 2006–2015. The plan aims at achieving Target 8 of the Millennium Development Goals by 2015[1]. The plan is based on the new Stop TB Strategy, and outlines priority activities. As indicated in the plan, in the next ten years an estimated US$ 3.1 billion will be needed to expand, scale up and accelerate efforts to Stop TB in the Region.

This scale-up cannot be achieved through the work of the national tuberculosis programmes alone. National tuberculosis programmes need to be further strengthened and supported. Additional partners, resources, expertise and active community involvement are urgently needed to help address the challenges facing tuberculosis control in the Region in an effective and sustainable manner.

To address these needs, an initiative to establish an Eastern Mediterranean Partnership to Stop TB (EM Partnership) is under way. A preparatory committee was formulated by the WHO Regional Office for the Eastern Mediterranean and met for the first time in January 2007 to plan the establishment of the partnership. The EM Partnership will be a key player in providing support to national partnerships and in ensuring the achievement of the global targets for tuberculosis control and the tuberculosis-related target of the Millennium Development Goals.