Despite the expansion of tuberculosis care in the Region, many tuberculosis patients still cannot access appropriate tuberculosis care. The case detection rate, which is the percentage of existing tuberculosis patients in the community that have access to and have been detected by the tuberculosis care services, is only 44% in the Region (table 1). Out of 565 000 cases in the Region, 280 000 cases were detected in 2005. This means that approximately 284 000 tuberculosis patients had no access to appropriate care in 2005. The global target is to detect 70% of the existing cases. The 44% regional detection rate is actually the second lowest among the six regions of WHO[1]. Only seven countries, Bahrain, Lebanon, Libyan Arab Jamahiriya, Morocco, Oman, Somalia and Tunisia, have reportedly achieved a 70% case detection rate.

Causes of low case detection, namely limited access to tuberculosis care, are complex. The quality of tuberculosis care is not always high in many countries. For example, laboratory diagnosis is not always extensive or accurate. This is because of incomplete development of the laboratory network and incomplete introduction of quality assurance systems. Health care providers in the public and private sectors are not fully involved in tuberculosis care. The Stop TB Strategy is not fully adopted by these care providers. Care for tuberculosis suspects is not well established yet. Many patients who have tuberculosis-like symptoms do not receive appropriate diagnostic care, and thus are not diagnosed as tuberculosis and do not receive tuberculosis treatment.

Complex emergencies are also an important challenge in the Region. Countries that suffer from a high burden of tuberculosis more are often those under conflict. Afghanistan, Iraq and Sudan have low case detection because in many areas of their countries, tuberculosis care is not accessible due to security issues. Access to tuberculosis care was also disrupted during the recent crisis in Lebanon.

More importantly, tuberculosis is not always regarded as a high priority in relation to other issues in the health sector, and is not recognized at present as a priority among many stakeholder groups including communities, nongovernmental organizations, donors, professional associations and societies of specialists, academia, mass media and policy-makers. National plans are therefore often limited to the national health programme, and are not inclusive of other key stakeholders.

Weakness in the health system does not allow the national tuberculosis programme to implement the Stop TB Strategy fully. This health system weakness extends to health care providers outside the national programme. Resource constraints, including human and financial, are limiting the capacity of countries to implement the Stop TB Strategy.

[1] The 6 WHO regions are: Africa, Americas, Eastern Mediterranean, Europe, South-East Asia, Western Pacific