World Bank Project China Fidelis Demonstration projects Mobilising funding for TB & Poverty

1. Are there effective, implementable strategies? • World Bank Project China • Fidelis • Demonstration projects • Mobilising funding for TB & Poverty

2. TBSA

3. WB programme since 1992 WB programme since 2002

4. The total amount of exempted expenses is only about 250 Yuan. (~ 14% of actual cost) • Repeated hospital visits and unnecessary tests • Liver protection drugs, liver monitoring and prolonged treatment

5. Conclusion • The reimbursement of diagnostic tests and free TB therapy supported by World Bank and DFID, can help to some extent reduce the financial burden for the patients and their family. • Current health financing policy is one of the main influencing factors of high TB related cost.

6. http://www.fidelistb.org/ Principles • Small projects of one-year duration (USD 150K-250K) • Local solutions to local problems • Encourage innovative ideas within existing programs • Focus on populations with limited access • Systematic monitoring and evaluation

7. Project implementation update • 32 contracts approved • 13 countries with at least one FIDELIS project • 15 of 32 projects in China or Pakistan • 24 of 32 in World’s six highest burden countries • 7 of 15 projects approved for an additional year

8. FIDELIS results Main outcome measure • Cost per additional weighted treatment success (AWTS) – target less than $80 USD • Difference between the number of treatment successes during the project and the previous year • Weighting based on proportion of new cases registered that have ‘limited access’ to care

9. Classification of access • If the total treatment delay (from symptoms to initiation of treatment) is 12 weeks or greater the person is classified as having limited access to health services.

10. Example: • For a US $200,000 projects that successfully treats 6,000 patients during the project with 80% designated as limited access and also successfully treats 3000 patients in the previous year with no reliable data on limited access proportions prior to the projects, cost per AWTS calculation would be as follows: • Previous year weighted treatment successes (WTS) = 3000 x 50% (assumption) x 1 + 3000 x 50% x 0.5 = 2250 WTS • Project year WTS = 6000 x 80% x 1 + 6000 x 20% x 0.5 = 5400 • AWTS for project = 5400 - 2250 = 3150 • Cost per AWTS = 200,000/3150 = US $63.49

11. FIDELIS results (to end 4th quarter, 2004) • Cost projections available for 21 of 32 projects • 8 of 21 projects have a projected cost lower $80 • 5 projects have projected costs between $80 and $150 • Few projects with high cost projections (e.g. $2 318)

12. FIDELIS (project-specific results) • Enhancing diagnostic services in urban slums in Africa

14. FIDELIS (project-specific results) • Enhancing diagnostic services in urban slums in Africa • Mobilizing junior high school students in Anhui, China to screen family members for tuberculosis

16. Attribution of ResultsTrend in non-project and project areas

17. FIDELIS (future directions) • Additional CAD 8 million from CIDA (initial $19 million) • ensure further funds for successful projects • allow further projects • Independent review to assess all projects • Documentation and publication of both successful and ‘unsuccessful’ approaches (sustainability?)

18. Demonstration projects • Engaging informal sector (LHL funded) – see REACH Presentation.

19. Ideas for mobilisingfunding for TB & Poverty • ?EU - EuropAid • ?Multi – country (regional) bid for Health Systems strengthening to GFATM • ?WB-Gates Global Health Equity Project • ?Japan’s Health & Development Initiative (USD 5 billion)