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Opportunities

Opportunities. From: Disease specificity and verticality Standardised interventions Short term orientation Emphasis on product/ targets. To: Integrated/ Horizontal linkages Flexibility/context sensitivity Longer term objectives/sustainability Emphasis on process.

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Opportunities

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  1. Opportunities

  2. From: Disease specificity and verticality Standardised interventions Short term orientation Emphasis onproduct/targets To: Integrated/ Horizontal linkages Flexibility/context sensitivity Longer term objectives/sustainability Emphasis on process Shift in Perspective for Infectious Disease Control(Porter et al 1999 Health Policy and Planning 14: 322-328)

  3. From: Limited to health sector Focus on individual ‘risk’ Operating without reference to global processes Working on behalf of populations To: Linking multiple sectors Understanding social vulnerability: risk in the context of everyday life Taking globalization as referent and context Working in partnership with communities Shift in Perspective for Infectious Disease Control(Porter et al 1999 Health Policy and Planning 14: 322-328)

  4. Tuberculosis Control as an example

  5. Historical decline of TB, 1840-1960 400 Phase 4 Phase 1 Phase 3 Phase 2 Antibiotic era Segregation of poor consumptives in enlarged and improved workhouses infirmaries 300 Systematic segregation of consumptives, rich and poor, In hospitals and sanatoria Koch’s discovery Standardised notification rate 200 100 Initial effect of segregation of poor consumptives in work house 0 1860 1880 1900 1920 1940 1960 1840 Year Source: data derived from various sources including T. McKewon. The modern rise of population, London: Edward Arnold 1976.

  6. TB & Poverty overlap Source: World Economic Forum, 2005

  7. Risk factors for TB From Lonnroth K et Al. Global epidemiology of tuberculosis. Seminars in Respiratory and Critical Care Medicine, 3 March 2008

  8. WHO-recommended Global Strategy to Stop TBand reach the targets for 2015 • Pursuing quality DOTS expansion and enhancement • Political commitment • Case detection through bacteriology • Standardised treatment, with supervision and patient support • Effective drug supply system • Monitoring system and impact evaluation Additional components 2 Addressing TB/HIV and MDR-TB 3. Contributing to health system strengthening 4. Engaging all care providers 5. Empowering patients and communities 6. Enabling and promoting research Stop TB Department

  9. Global TB Control Targets: the theory • 2015: 50% reduction in TB prevalence and deaths • 2050: elimination (<1 case per million population) • 5-10% declining incidence per year: • 70% detection rate • 85% successful treatment

  10. Global TB Control Targets: the reality Case detection rate • 61% globally in 2006 • 46% in Africa • 52% in European/Eastern Mediterranean regions • 2/3 of missing cases are in China, India, Africa Treatment success rate • 84.6% globally • 70% in Eastern Europe • 76% in Africa

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