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Functional effective Supra-national TB Reference Laboratory Network Dr Gavin Macgregor-Skinner Senior Laboratory Advisor (TB) USAID Washington

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Page 1: Functional effective Supra-national TB Reference …...Stockholm Zagreb SRLN – Functional, Effective • TORs – significant expansion • Roles and Responsibilities – technical,

Functional effective Supra-national TB Reference Laboratory Network

Dr Gavin Macgregor-SkinnerSenior Laboratory Advisor (TB)

USAID Washington

Page 2: Functional effective Supra-national TB Reference …...Stockholm Zagreb SRLN – Functional, Effective • TORs – significant expansion • Roles and Responsibilities – technical,
Page 3: Functional effective Supra-national TB Reference …...Stockholm Zagreb SRLN – Functional, Effective • TORs – significant expansion • Roles and Responsibilities – technical,

USAID TB Priority Countries

Category Countries

Focus Countries (20) (64% of global burden)

Afghanistan, Bangladesh, Brazil, Cambodia, Democratic Republic of Congo, Ethiopia, India, Indonesia, Kenya, Mozambique, Nigeria, Pakistan, The Philippines, Russia, South Africa, Tanzania, Uganda,Ukraine, Zambia, ZimbabweUkraine, Zambia, Zimbabwe

Other Countries (20)

Angola, Armenia, Azerbaijan, Bolivia, Djibouti, Dominican Republic, Georgia, Ghana, Haiti, Kazakhstan, Kyrgyzstan, Malawi, Mexico, Namibia, Peru, Senegal, Southern Sudan, Tajikistan, Turkmenistan, Uzbekistan

Countries in italics are High-Burden Countries.

Page 4: Functional effective Supra-national TB Reference …...Stockholm Zagreb SRLN – Functional, Effective • TORs – significant expansion • Roles and Responsibilities – technical,

USAID TB Funding Trends 1998 – 2008

$162$176

120

140

160

180

* Excludes Global Fund

0$10

$15$22

$56

$78 $74$84

$93$91

$92

0

20

40

60

80

100

Pre-1998199819992000200120022003200420052006200720082009

Page 5: Functional effective Supra-national TB Reference …...Stockholm Zagreb SRLN – Functional, Effective • TORs – significant expansion • Roles and Responsibilities – technical,

FY2009 = $176 Million

E & E, 7%

Asia, 30%

LAC, 6%

USAID TB Program Funding by Region

$53M

$13M

$11M

AFR, 29%

GDF, 8%

GH 19%

*Asia includes Central Asian Republics

$53M

$34M

$15M$50M

Page 6: Functional effective Supra-national TB Reference …...Stockholm Zagreb SRLN – Functional, Effective • TORs – significant expansion • Roles and Responsibilities – technical,

USAID’s TB Program Approach

• Focus on country level

• Concentrate resources in highest burden countries

• Support NTP strategic plans

• Ensure success of GFATM grants

• Leverage PEPFAR

• Standardized indicators to measure outcome• Standardized indicators to measure outcome

• Invest in the future – new tools

• Expand partnerships

• Global and technical leadership – active in STOP TB Partnership board and technical working groups

Page 7: Functional effective Supra-national TB Reference …...Stockholm Zagreb SRLN – Functional, Effective • TORs – significant expansion • Roles and Responsibilities – technical,

Lantos-Hyde Sec 3: USG TB Strategy requirements

“In support of the Global Plan to Stop TB, the

President shall establish a comprehensive 5-year

USG Strategy to expand and improve our efforts to

combat tuberculosis globally, including a plan to

support:

– The successful treatment of 4.5 million new sputum – The successful treatment of 4.5 million new sputum smear TB patients under DOTS programs by 2013, primarily through support for needed services, commodities, health worker training, and additional treatment through coordinated multilateral efforts; and,

– The diagnosis and treatment of 90,000 new MDR TB cases by 2013, and provide additional treatment through coordinated multilateral efforts.”

Page 8: Functional effective Supra-national TB Reference …...Stockholm Zagreb SRLN – Functional, Effective • TORs – significant expansion • Roles and Responsibilities – technical,

USG Global Health Initiative 2009-15

May 2009: President Obama announced the Global Health Initiative (GHI), a 6-year, $63 billion USG investment in Global Health beginning in FY2009

• $51 billion to build on the progress made in recent years against HIV/AIDS, tuberculosis and malaria

• $12 billion for maternal and child health, and neglected tropical diseases

• Increased attention to health systems strengthening and program integration

The TB strategy is a key component of this Initiative!

Page 9: Functional effective Supra-national TB Reference …...Stockholm Zagreb SRLN – Functional, Effective • TORs – significant expansion • Roles and Responsibilities – technical,

USG GHI Principles

• Implement a woman and girl-centered approach

• Increase impact through strategic coordination/integration

• Strengthen/leverage key multilateral organizations, global health partnerships, and private sector engagement

• Encourage country ownership and invest in country-led plansplans

• Build sustainability through health systems strengthening

• Improve metrics, monitoring, and evaluation

• Promote research and innovation

TB Targets:

Save ~1.3m lives by reducing TB prevalence by 50%

Treat 2.6m new TB cases and 57,200 MDR cases

Page 10: Functional effective Supra-national TB Reference …...Stockholm Zagreb SRLN – Functional, Effective • TORs – significant expansion • Roles and Responsibilities – technical,

USG TB Strategy Principles

• Country Ownership: USG will work with NTPs to support national strategic plans; foster sustainability through health systems strengthening

• Women-centered: Improve TB detection among women and innovate to reduce gender related barriers

• Integration: Improve coordination among USG health programs (link with HIV, PMTCT, IMCI)/non-health agencies and programs (link with HIV, PMTCT, IMCI)/non-health agencies and programs (education, finance, etc)

• Multi-lateral Engagement: USG participation in Stop TB Partnership, coordinate with GF, leverage key partners

• Metrics, Monitoring and Research: USG will assess outcomes and measure progress toward results through indicators, data sources and measurement; OR to create/test new approaches and translate into policy/ program; and invest in new drugs, tools, diagnostics

Page 11: Functional effective Supra-national TB Reference …...Stockholm Zagreb SRLN – Functional, Effective • TORs – significant expansion • Roles and Responsibilities – technical,

USG TB Strategy 2009-2014 - Laboratory

1. Strengthening laboratory systems

2. Increase TB diagnosis by scaling up a fully functional laboratory network with appropriate biosafety provisions

3. Scaling up to ensure that laboratory networks are fully functional, including trained human resources, biosafety measures, adequate equipment and supplies, and routine quality assurance

4. Introducing new and more effective diagnostic tools to accelerate detection of TB for all patients (including children), and for drug-resistant TB, by supporting upgrading of laboratory services, biosafety and laboratory capacity

Page 12: Functional effective Supra-national TB Reference …...Stockholm Zagreb SRLN – Functional, Effective • TORs – significant expansion • Roles and Responsibilities – technical,

Laboratory Systems

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Policies, Plans & Financial

Systems

Training & Human Resource

Systems

Polio, Measles, Influenza, Tuberculosis, Malaria, HIV/AIDS, Viral

Hepatitis, STDs, Animal diseases, Neglected Tropical Diseases

Laboratory Systems – integrated, functional, effective

Policies, Plans & Financial

Systems

Training & Human Resource

Systems

Policies, Plans & Financial

Systems

Training & Human Resource

Systems

Policies, Plans & Financial

Systems

Training & Human Resource

Systems

Policies, Plans & Financial

Systems

Training & Human Resource

Systems

Training & Human Resource

Systems

Training & Human Resource

Systems

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Laboratory Services

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Quality Management Systems

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Systems

Quality Management Systems

Systems

Biosafety Systems

Quality Management Systems

Systems

Quality Management Systems

Systems

Supply Chain Management

Systems

Systems

Specimen Transport &

Sample Referral Systems

Laboratory Information &

Data Management Systems

Equipment Procurement,

Validation & Maintenance

Systems

Systems

Page 13: Functional effective Supra-national TB Reference …...Stockholm Zagreb SRLN – Functional, Effective • TORs – significant expansion • Roles and Responsibilities – technical,

Kenyan Laboratory Strategic Plans and Policy

Page 14: Functional effective Supra-national TB Reference …...Stockholm Zagreb SRLN – Functional, Effective • TORs – significant expansion • Roles and Responsibilities – technical,

http://sites.google.com/site/glitblabnetwork/home

Page 15: Functional effective Supra-national TB Reference …...Stockholm Zagreb SRLN – Functional, Effective • TORs – significant expansion • Roles and Responsibilities – technical,

Locations of the SRL

PAHO AFRO EMRO EURO SEARO WPRO

Atlanta Algiers Cairo Antwerp Bangkok Adelaide

Boston Pretoria Barcelona Chenai Brisbane

Buenos Aires Bilthoven Hong Kong

Mexico Borstel Seoul

Santiago Gauting Tokyo

Guadeloupe London

Milan

Porto

Prague

Riga

Rome

Stockholm

Zagreb

Page 16: Functional effective Supra-national TB Reference …...Stockholm Zagreb SRLN – Functional, Effective • TORs – significant expansion • Roles and Responsibilities – technical,

SRLN – Functional, Effective

• TORs – significant expansion

• Roles and Responsibilities – technical, managerial

• Agreements – MOU, LOA, National Plans

• Mapping the network

• What is required? – Business Plan, Checklists

• Governance – clearly defined• Governance – clearly defined

• What is the budget? – line items, details, Year 1 to ?

• How does SRLN become sustainable?

• Accountability? – Auditing, Reporting

• Performance Indicators?

Page 17: Functional effective Supra-national TB Reference …...Stockholm Zagreb SRLN – Functional, Effective • TORs – significant expansion • Roles and Responsibilities – technical,

USAID TB Partners

• National TB Programs

• Local partners and NGOs

• Stop TB Partnership

• GDF

• WHO

• CDC

• TB CAP/TBCTA (KNCV, IUATLD, WHO, ATS, MSH, FHI JATA, CDC)• TB CAP/TBCTA (KNCV, IUATLD, WHO, ATS, MSH, FHI JATA, CDC)

• Gorgas (JHU and UAB)

• IUATLD

• Management Sciences for Health – Strengthening Pharmaceutical Systems (SPS)

• US Pharmacopea Drug Quality and Information (USPDQI)

• TB Drug Alliance

• TASC2 TB IQC and TB Task Order

• PATH, University Research Corporation and other international NGOs