Annual Report 2008
GENERAL GRANT INFORMATION GENERAL GRANT INFORMATION
Country: Round: Program Coverage: Program Title: Grant Number: Principal Recipient: Program Starting Date: Program Ending Date: Global Fund Grant: Reporting Period: Reporting Date: Serbia 3 Tuberculosis Reducing the Burden of Tuberculosis on the Health Status of the Population of the Republic of Serbia SER-304-G02-T Ministry of Health of the Republic of Serbia 1 December 2004 30 November 2009 US$ 4,087,979 US$ 2,428,986 (Phase1), US$ 1,658,993 (Phase2) 12 months (from 1-Jan-2008 to 31-Dec-2008) 31 March 2009
THE OVERALL GOAL OF THE PROGRAM THE OVERALL GOAL OF THE PROGRAM
To reduce the TB burden in the country to 25/100.000 by the end of Program implementation through: 1. Strengthening the health care system for TB control; 2. DOTS implementation in 100% of the country; 3. Improvement of the TB control in specific high-risk population groups and prevention of emerging drug resistant cases.
PROGRAMMATIC REPORT FOR THE YEAR 2008 PROGRAMMATIC REPORT FOR THE YEAR 2008
Objective 1: Strengthening the health care system for TB Control Activity I.1 – Training of different categories of health staff involved in TB Control, including international exchange of experience and participation to different international seminars and workshops. In the fourth year of the Program implementation refreshment of knowledge and exchange of experience were provided through sustained activities: workshops on DOTS strategy implementation, annual TB meeting and international exchange of experience. Workshops on DOTS strategy implementation, established in 2007, were continued in 2008, using the same principal: through nine regional workshops, organized for three to four neighboring districts, specialists for lung diseases and laboratory workers from each of the 25 districts in Serbia were involved, ones during the year, in a round table analysis of TB control in their municipalities, districts and regions, exchange of experiences, sharing of the practices/challenges and bringing general conclusions on modalities for further improvement.
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(Related also to Activity II.3)
Third Annual Meeting on TB organized within the Global Fund granted Program was held on 5 November 2008. Giving opening remarks, Minister of Health of the Republic of Serbia pointed out that achievements must be used as a basis and motivation for advanced TB control in the country. Deputy Head of the WHO Country Office stressed that TB Program in Serbia is one of the best implemented in the European Region heading towards low TB incidence rate and achievement of the National Millennium Development Goals for TB.
Meeting was attended by 308 participants, the majority of them were from the health system, but there were also representatives of partner organizations, CCM and international organizations, as well as guests from neighboring countries who implement Global Fund funded TB grants. Following well accepted meeting concept applied in previous years, participants were able to hear and discuss about following: Achievements after four years of the TB Grant implementation, Challenges and plans for the period 2009-2105, Analysis of TB control in the country in 2007, Effects of rationalization of the TB laboratory network, First-line drugs management review and recommendations, Evaluation of supervisory visits to TB units, Determinants of TB surveillance, GLC application and Organization of the TB care in the light of health system reform. As in previous years, all participants received printed copies of the latest annual report on TB that is Report on TB in Serbia for the year 2007. During the course of 2008 Program Team took opportunities for international exchange of experience. One of the most beneficial meetings, attended by six team members (Project Coordinator, TB Expert Group Coordinator, Data Collection Officer, Laboratory Specialist, Drug Management
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Specialist and DOTS Plus Specialist), was The Fifth Balkan Meeting on Tuberculosis, organized by the WHO Regional Office in Banja Luka, Bosnia and Herzegovina, from 6-9 May 2008. Information and guidance provided during the Meeting about GLC application and performance of Drug Resistance Survey were immediately after integrated in Serbian GLC application which has been submitted in September and approved in November 2008, and later used for planning of the RCC proposal. Eighth WHO National TB Programme Managers Meeting and Wolfheze Workshop and National TB Surveillance Correspondents Meeting organized jointly by KNCV Tuberculosis Foundation, WHO and ECDC, held from 1 to 4 June 2008 in Hague, Netherlands, were attended by the Data Collection Officer. Scope and purpose of the meetings were: to review The Berlin Declaration on Tuberculosis and make recommendations on how to enhance its use as advocacy tool, to discuss interventions for TB control in different settings, their monitoring and evaluation, and to understand the new organizational set-up for coordination and assistance of TB surveillance in the Region and agree on future actions. TB Export Group Coordinator was invited to attend the Stop TB Partnership’s Meeting, Tuberculosis Technical Assistance Mechanism (TBTEAM), held on 13 October 2008 in Paris, France where she gave her contribution to the assessment of needs for technical assistance and mapping of partners. From 13 to 14 November 2008, TB Export Group Coordinator also participated at the International Conference “Challenges for the Future” Research on the HIV&AIDS, Malaria and Tuberculosis, organized in Brussels by The European Commission, Directorate General for Research, which gathered Leading scientists, research managers, decision-makers, funding agencies, representatives of relevant international NGOs, and significant number of representatives from disease-endemic countries. At the end of 2008, in December, another opportunity for learning and networking between Balkan and some other countries has been provided by the Global Fund at a Sub-Regional Meeting “Successes, Challenges and Prospects: Managing the HIV and TB Epidemics - Global Fund funded programs in the Balkans” held from 15-17 December 2008 in Przno, Montenegro. Project Coordinator, Operations Officer, Finance Officer, TB Expert Group Coordinator and Data Collection Officer actively participated in the official part of the Meeting and also used the time for exchange with counterparts from other countries and communication with the Portfolio Manager. Activity I.2 – Procurement of adequate equipment and reagents/consumables for the bacteriological laboratories. Introduction of liquid system for culturing opened the opportunity for more rapid and sensitive diagnostics of mycobacteria and led to the increase in isolation of non-tuberculosis mycobacteria. For that reason DNA strip hybridization tests for rapid identification of mycobacteria on species level and for rapid detection of multi-drug resistant M. tuberculosis were procured in 2008, together with necessary equipment for hybridization. Training on HAIN hybridization tests was organized in December 2008 in the National Reference Laboratory. In order to enhance culturing, the procurements of Löwenstein media base (for all culturing laboratories), disposable pipettes, laboratory reagents and 3 shakers were carried out. Activity I.3 – Procurement of small office furniture and PC computers with printer for the 25 district dispensaries for lung diseases and TB and Central Unit. This activity was completed during the Phase 1 of the Program.
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Activity I.4 – Development of a special drugs management system and a centralized tender and Activity I.5 – Procurement and continuous distribution of right amounts of first-line antiTB drugs. Procurement of the first-line anti-TB drugs, performed in August 2007, was the last procurement of first-line drugs financed from the Grant funds. At the end of 2008, the Health Insurance Fund (HIF), in cooperation with TB Program Team, prepared a public tender for the new procurement of the first-line anti-TB drugs to be launched at the very beginning of January 2009. Regardless of the fact that the national HIF will fund the procurement, the requirements in terms of quality assurance were set in line with the Global Fund’s QA policy. The drugs will be procured at the central tender for all TB patients in the country, with planned reserve. System of procurement and distribution will include all relevant health facilities, not only in the health system but also military and penitentiary system, which are also integrated in the TB recording and reporting system, thus enabling proper planning, procurement, distribution and maintaining of adequate stocks of first-line drugs. The drugs will continue to be delivered to all TB patients free of charge. Monitoring of drugs management has been continued in 2008 and will be sustained further on through verification of prescriptions and supervisory visits to TB units. Observations and lessons learned about drugs management were discussed at all workshops/roundtables on DOTS implementation organized in the course of 2008. The Annual Meeting on TB, in November 2008, provided First-line Drugs Management Review and Recommendations. Same practice will be sustained in following years. Objective 2: To expand DOTS to 100% coverage of the country Activity II.1 – Develop the national guidelines for bacteriological examination and quality control and train the staff according the guidelines. Refreshment trainings for the staff working in culturing and DST laboratories were continued at the National Reference Laboratory all through 2008 and this practice will be sustained. Registering of and reporting on laboratory results have been improved since computerized data collection system for the network of 28 laboratories was introduced in 2007. Establishing a software linkage between laboratory and TB data base was not possible in 2008 since there were no savings that could be used for this purpose. Therefore, this activity will be integrated in applications for the new grant funds. Automated liquid media system for rapid detection of growth of Mycobacteria was implemented at the National Reference Laboratory (NRL). DST for first-line anti-TB drugs using liquid media will be started after the end of renovation of NRL facilities. The Ministry of Health allocated UD$ 390.000 from the 2008 budget for the renewal of facilities of the National Reference Laboratory at the Institute for Lung Diseases and TB of the Clinical Center of Serbia. Renovation started in September 2008 and will be ended early in 2009.
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This renewal will significantly improve working conditions and staff safety, as well it will enable further enhancement in quality assurance. Activity II.2 – Implement the quality control /quality assurance visits for laboratories. Within the regular quality assurance program, in 2008 the National Reference Laboratory (NRL) conducted 30 visits to peripheral laboratories in the TB laboratory network. Number of laboratories performing bacteriological diagnosis of TB in the course of 2008 has been reduced from 41 to 37 labs. In accordance with the program of rationalization of TB laboratory network, from the year 2005 total number of TB labs has been reduced for 40%. Number of laboratories performing only microscopy significantly decreased – for 78% (from 18 labs in 2005 to 4 labs at the end of 2008). Microscopy and cultural examination were performed by 25 laboratories at the end of 2008 that is 26% reduce in comparison with 34 labs in 2005. Some progress has been made in reducing the number of DST laboratories, with decrease of only 20% there were still 8 operational DST laboratories at the end of 2008. Therefore, in 2009 most efforts will be addressed to rationalization of DST laboratories in order to have 1 national and 3 regional DST laboratories in the country. Out of the total number of laboratories, 25 have been included in external quality assessment program of smear microscopy for acid fast bacilli by rechecking of randomly selected smears. Correct results were found in 24 laboratories while one laboratory failed because of the high proportion of false positive results. Following interventions were required: repeated training for the laboratory staff, strict following of given recommendations as well as monthly re-checking of smears in the NRL. The NRL for Mycobacteria in Belgrade has performed successfully proficiency testing on M. tuberculosis drug susceptibility testing organized by Supranational Reference Laboratory for Mycobacteria in Borstel. All 76 results (19 strains, 4 drugs) were correct for the 4 drugs: Streptomycin, Isoniazid, Rifampicin, and Ethambutol. NRL carried out quality assurance program for DST in 3 regional laboratories and the results will be available at the beginning of 2009. MDR strains were retested to first-line anti-TB drugs and tested to second-line drugs in the Supranational Reference Laboratory. Results were used for the preparation of the GLC application which was submitted in September 2008. Activity II.3 – Establish a regular system for supervision and monitoring to the peripheral level TB Units. Fourth round of supervisory visits to TB units was concluded in 2008. Altogether 68 visits were performed: 63 to TB units in the health system, 2 to military system facilities, 1 to Special penitentiary hospital and 2 to institutions for mentally disabled.
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Major conclusion at the end of the fourth round of supervisory visits was that there is a trend of enhanced DOTS implementation in the country, as a result of: High bacteriology confirmation of pulmonary TB; Decreased number of unknown results of laboratory tests; Full adherence to treatment regimens and categories of TB patients; Implemented infection control measures; Accurate TB recording and reporting; Acquired skills for analyzing and evaluating TB data and applying corrective measures. It is noticeable that medical staff has enriched their knowledge, improved behaviors, modified attitudes and enjoy more confidence of their clients. Motivation for enhancement of everyday practices corresponds to enlarged opportunities for learning and implementing the knowledge with available tools and resources. A good basis for advanced TB control interventions has been set out, so the next focus will be on: o o o o o o o o o o Increase of treatment success; Analysis of death outcomes (“died from” and “died with” tuberculosis); Contacts investigation; DST testing performed in 3rd level laboratories for all new culture positive patients; Rationalization of TB diagnostic procedures; Increasing capacities of local medical staff for planning orders of first-line drugs; Consultation about TB treatment in children; Strict DOT for institutionalized mentally disabled people with TB; Improved reporting on treatment outcomes for TB patients in military and penitentiary system; Extra-pulmonary TB management.
With the purpose to attain the highest possible level of services in TB control and full implementation of DOTS strategy in the country, in addition to supervisory visits, workshops/round tables on DOTS implementation were organized for pulmonologists and laboratory workers in the course of 2008, as already mentioned under Activity I.1. At all nine round tables, local practices, results and operational aspects of the health care in TB control have been discussed and topics of interest for the next meetings.
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Activity II.4 – Implement a computerized data collection system based on the WHO recommended forms (including the training of staff). In 2008, the computerized system for TB data collection and processing was fully operational. All data collection points were working properly. As in two previous years, collected and processed data were printed in the form of the annual report – Report on TB in Serbia for the Year 2007, which was presented at the Annual Meeting on TB, in November 2008 and distributed to all the participants. Preliminary data analysis for the year 2008 showed the total of 1,742 notified TB cases, giving the rate of 24/100,000. There were 1,606 new pulmonary TB cases, out of which number 70% bacteriology confirmed. As for treatment success, out of 2,059 TB cases registered in 2007, there were 905 new sputum smear positive pulmonary cases: 704 were cured and 40 had treatment completed, giving the success rate of 82%. There were 2% of patients died from TB, 4% died with TB, 4% defaulted, 2% failed, 2% were transferred out and for the rest (4%) results of treatment are still unknown. Comparing the results of the impact and outcome indicators for the year 2008 with preceding years, continuous progress can be noticed. Considering intended yearly targets, notification rate of 24/100.000 versus 28/100.000 targeted, case detection rate of 103% vs targeted 81% and treatment success of 82% vs targeted 86%, the numbers clearly confirm sustained improvement of TB control in Serbia. Bacteriology confirmation of pulmonary TB cases is also continuing to improve: in years 2005, 2006 and 2007 confirmation rate was 58%, 67%, 72.5% respectively, reaching 80% in 2008. Ongoing on-site and on-line support to data entry points enabled further decrease of missing data (for example percentage of unknown initial culture results in 2005, 2006, 2007 and 2008 was decreasing from 16%, 10% and 6% to 4%, respectively) making the data more complete and comprehensive. As mentioned in previous chapter II.3, every workshop/round table on DOTS implementation starts with data presentation and data related discussion as well as a discussion on enhancement of data collection and management. Additional funds are needed for three key activities in relation to data collection: upgrade of the existing software system in order to enable entry and analysis of data on drug resistant TB, linking of the software for TB data collection with laboratory data collection and training of the new staff involved in data collection and processing as a replacement of retired ones. Activity II.5 – Develop and implement health education strategies for TB patients and general population based on the findings of KAP surveys. In 2008 continued regular activities on education of TB patients and their families by medical staff, celebration of the World TB Day, distribution of information given through national and local media and through the website of the Program “Control of Tuberculosis in Serbia” www.zdravlje.sr.gov.yu and website of the Ministry of Health www.zdravlje.sr.gov.yu . On the occasion of the World TB Day 2008 the press conference was organized on 24 March 2008, with participation of the Minister of Health, Deputy Head of the WHO Country Office, Program manager and Head of National TB Committee. The Minister of Health presented TB control in Serbia in comparison with Berlin Declaration. WHO representative stressed that TB does not respect boundaries and that all people can act to stop TB. Impacts of the Global Fund supported TB Program were presented by the Program manager and the comparison of TB
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control in Serbia with European countries were made by the Head of the National TB Committee. Besides taking part at the press conference, in reporting about World TB Day 2008 journalists could rely on the press releases of the Ministry of Health, WHO Country Office and on Program website information. They were also able to report about raising awareness activities of the Red Cross of Serbia in Belgrade and all over Serbia, organized on the occasion of the World TB Day. Control of Tuberculosis in Serbia website www.tbc.zdravlje.sr.gov.yu will change the domain in 2009 to www.tbc.zdravlje.gov.rs . It will continue to provide most relevant information related to the Program implementation, news, PDF versions of all printed publications important for medical staff and information for TB patients.
Objective 3: Improve the TB Control in specific high risk groups and drug resistant cases
Activity III.1 – Needs assessment followed by active case finding for slum dwellings, refugees and IDPs camps and institutions with mentally disabled people and Activity III.2 – Health education sessions with distribution of food and hygiene kits. After the Knowledge-Attitude-Practice (KAP) survey conducted in 2005 which resulted in TB education strategy, the Red Cross of Serbia was sub-contracted, late in 2005, for performance of education and active TB case finding in Roma slums and camps for refugees and internally displaced people (IDP). Basic premise for conducting these interventions/operational research was that Roma living in slums, refugees and IDP are more vulnerable to tuberculosis. At the beginning of 2008 the analysis of the data collected during the active TB case finding was completed. Camps for refugees and IDP: According to the latest data available in 2008, around half a million of refugees and IDP live in Serbia. Although the majority of collective centers and camps were closed down in recent years, there were almost 8,000 people still living in collective centers and camps. Active screening and education on TB in collective centers and camps for refugees and IDP were carried out in 2006. Activities were performed in 75 centers/camps in 40 cities and towns with total number of 7,363 persons. Education on TB included 6,870 people (93%) out of which number 5,583 were older than 14. Screening on TB, conducted as a symptom-based case finding, included 6,677 persons (91%), out of which 623 (9%) symptomatic persons were referred to TB units for diagnostic tests. Diagnosis of TB was confirmed in 2 cases. Calculated incidence rate was 30/100.000. Conclusion: TB incidence rate 30/100.000 found in collective centers and camps for refugees and IDP in 2006 was almost the same with the national TB incidence rate 29/100.000. General access to health care services was very good and included active approach of the medical staff and civil organizations. There is a trend of closing down of the collective centers and camps for refugees and internally displaced people as a result of their integration in the society.
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Roma living in slums: According to the latest 2002 census 180.000 Roma was living in Serbia, while estimated actual number is around 500.000. Active screening on TB in Roma slums has been conducted in 2006 and 2007 as symptom-based case finding among adults and tuberculin testing among children age up to 14. In parallel, education on TB has been provided, followed by distribution of motivation parcels. Education on TB and active case finding included 122 Roma slums in 3 cities and 11 towns with estimated total number of 41.012 inhabitants. During 2006 and first half of 2007 in total 14.941 adult Roma attended educational sessions followed by distribution of motivation parcels. Red Cross activists interviewed 14.815 adults about symptoms. Among those referred to local TB dispensary for diagnostics 8 new TB cases were found, making incidence 54/100.000 that was twice as in general population. Screening of latent TB infection among children by performing tuberculin tests included 8.172 children age up to 14. Only one TB case was detected which makes specific age group incidence of 13/100.000. Isoniazid chemoprophylaxis was given to 15 children.
Conclusions: TB incidence rate in Roma slums in Serbia is higher than the national, still it is below the highest district incidence rate. Results are indicating that it is more reasonable to perform active case finding/contacts tracing in the settlements with confirmed and emerging TB cases. Raising the level of knowledge about TB and rights on free of charge diagnostics and treatment is particularly important among Roma living in slums with registered TB cases. Providing support to Roma people to obtain personal documents and health ID and support to Roma people with TB during the continuation phase of the treatment is essential for prevention of TB spreading in Roma settlements. Plan of action should be prepared and implemented in coordination with the Red Cross of Serbia, Roma NGOs, Roma mediators, relevant civil organizations and local stakeholders. New funds should be raised and allocated for these interventions. Activity III.3 – Integration of TB Control in Prison in the NTP – training of staff involved in TB Control in prison. As described in previous annual report, in order to achieve full integration of TB control in prisons into the National TB control system, TB Program activities conducted in penitentiary system have gone beyond the solitary capacity building of prison medical staff. Supervisory visits reports confirmed that starting from 2007 penitentiary system was completely integrated in overall national TB control system, as described under Activity II.3. Having in mind that tuberculosis is globally one of the most frequent health problems in prisons
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and that disease spreading is not only a threat to prisoners and prison staff but also to direct and indirect contacts outside the system, active screening on TB in penitentiary system was completed in 2007 and the analysis of the results was available in early 2008. The purpose of this operational research was twofold: to determine burden of tuberculosis in the penitentiary system and to introduce chest radiograph screening for all inmates entering the system. Active tuberculosis case finding has been conducted from 2006 to 2007 in all prisons in Serbia. It was performed by chest radiography for prisoners and prison staff, on voluntary basis. Coverage was 50% of prisoners and approximately 25% of employees. Chest radiography included 5.438 persons: 4.428 prisoners and 980 employees. Additional diagnostic procedures were performed for 87 persons. In addition to 5 registered tuberculosis cases 20 new cases were detected, 18 among prisoners and 2 among employees, none among females. Tuberculosis was most frequent in age group 50-55. Incidence rates found among prisoners 408/100.000 and employees 204/100.000 were significantly higher than in general population 29/100.000. Tuberculosis prevalence in prisons was 564/100.000. Conclusions: The burden of tuberculosis on prisoners is fourteen times higher than on general population in Serbia. Single independent predictor for detection of new tuberculosis cases among prisoners is duration of imprisonment. Starting from 2007 chest radiograph screening has been introduced as a standard procedure for all inmates entering the penitentiary system. There is a need for repeated periodical active case finding among long term inmates and prison staff. Funds should be raised for such activities. Activity III.4 – Create special teams in charge with diagnosis, follow-up and treatment of drug resistant cases and un-interrupted second line drugs supply. Even before entering into the Phase 2 of the Grant implementation, in November 2006 started the activities related to setting out a system for control of drug-resistant TB cases in the country. In his second GLC pre-application visit to Serbia, conducted in May 2008, WHO temporary adviser for MDR-TB, Dr Manfred Danilovits, verified that the country has met all the recommendations given in his first GLC pre-application visit report, in February 2007. Having reviewed Dr Danilovits’ second field visit report (enclosed to this Report), in July 2008, the WHO Office in Copenhagen informed Serbian TB Program Team that the first due date for submission of the GLC application is 20 September 2008. The GLC application has been submitted, in accordance with the WHO notification, on 19 September 2008 (application enclosed to this Report). Submitted Project of treatment of MDRTB patients was for 5 years and for cohort of 100 patients (45 known and 55 new cases expected in next 5 years). Considering low MDR-TB prevalence, 45 cases in 2008, fast track procedure has been required. The GLC approved Project of treatment of MDR-TB patients in Serbia on 26 November 2008 (Letter of Approval enclosed), thus the Letter of Agreement between the GLC and the Ministry of Health of the Republic of Serbia, as responsible administrative authority for the Project, has been signed on 23 December 2008 (enclosed to this Report). To conduct procurement of the second-line anti-TB drugs through the GLC mechanism, TB
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Program Team and the MoH need to undertake necessary actions in accordance with the national legislation and to coordinate with all relevant stakeholders in order to provide un-interrupted procurement of the drugs in next five years period of time, having in mind the fact that this Global Fund’s grant is ending on 30 November 2009. In addition, since MDR TB management is first on the list of TB priorities, in order to provide funds for procurement of second-line drugs after 2009 and for all needed interventions in relation to drug resistant TB management, the country is going to apply for the new grant funds through the RCC, as invited by the Global Fund on 1 December 2008. Having in mind the time needed for necessary preparations in the country and a standard lead time of approximately 5 months for the drugs to be delivered to the country through the GLC mechanism, there are low prospects that the Project of treatment of MDR-TB patients will start before October 2009. For the above explained reasons targets set for 2008 in connection with MDR-TB management were achieved/overachieved later (as “Training of TB specialists and nurses on MDR-TB” which had to be rationally postponed) or were not achievable at all (as “Number of MDR-TB patients enrolled on MDR-TB treatment” and “Number of people with MDR-TB receiving food and hygiene parcels”).
SUMMARY OF PROGRAM INCOMES AND EXPENDITURES SUMMARY OF PROGRAM INCOMES AND EXPENDITURES FOR THE YEAR 2008 FOR THE YEAR 2008
All remaining Grant funds approved by the Program end date have been disbursed to the PR by the 5 September 2008. The amount of US$ 617,966 was originally budgeted for the Year 4 of the Grant implementation and actually US$ 510,749 was spent (US$ 509,309 is total program expenditure and US$ 1,440 is total conversion fee for the year 2008). Variance of US$ 107.217 is a result of modification of the work plan after each reporting period, as explained in Progress Updates No 12 and 13. In addition to the regular yearly budget for TB, the Ministry of Health of the Republic of Serbia allocated US$390.000 from the 2008 budget, for renewal of the National Reference Laboratory facilities. Statement of sources and uses of funds and statement of expenditures for the year 2008 are an integral part of the independent auditor’s report enclosed to this report.
OVERALL REMARKS OVERALL REMARKS
The Global Fund’s TB Grant had significant impact on national commitment to TB control and programmatic management of tuberculosis, which resulted in constant decrease of TB notification rate in Serbia from 2003, when the Round 3 proposal was prepared, up to 2008. As it can be seen from the table below, TB notification rate already surpassed targeted Program Objective.
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Year 2003 2004 2005 2006 2007 2008 2009
No of cases 2791 2649 2366 2150 2050 1775 target
TB incidence (per 100.000) 37 35 32 29 27 24 25
Regardless of the relatively small Global Fund’s share in the total available funds for TB in Serbia, from 1 December 2004 up to present (presented in the table below), the GF’s Grant enabled performance of key interventions which were essential for establishing a firm basis for the programmatic TB management.
Total 5 years budged $76,716,612 $4,087,979 $80,804,591 95% 5%
Investments in TB Serbia Nominal value Domestic
Year 1 (2005) $10,791,884 $1,337,023 $12,128,907 89% 11%
Year 2 (2006) $13,073,078 $1,091,963 $14,165,041 92% 8%
Year 3 (2007) $15,446,017 $1,032,533 $16,478,550 94% 6%
Year 4 (2008) $17,237,619 $378,480 $17,616,099 98% 2%
Year 5 (2009) $20,168,014 $247,980 $20,415,994 99% 1%
G. Fund Total amount Domestic G. Fund
% of Total
Once the basis has been established, the whole range of new scopes of work and challenges started to open. After four years of TB Program implementation, there is a need for scale up activities and expansion of scope, in order to sustain TB notification decrease and reach low incidence rate for European Region (under 20/100.000). Moving from DOTS to STOP TB strategy requires increased financial investments. Although national investments in TB control are annually increasing, they are not sufficient to enable all activities related to further strengthening of the health care system and are even more insufficient when it comes to the broader package of interventions which should strengthen TB control in key affected populations. In order to cover the financial gap between needed and available funds, the country took the opportunity to apply for the new grant funds through the last wave of the Rolling Continuation Channel and will also take the opportunity to apply for the Round 9.
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