Beverly Collin: Being bold on a budget at Lille

After the initial orientation to the vast Union World Conference on Lung Health (Lille, France), I settled into a series of thought provoking sessions and symposia. There were big concerns linked to the current global economic crisis and the flatlining of funds for tuberculosis from international donors at at least two of the sessions I attended. I came away from both feeling perturbed by the dominance of “classic economic theory” creeping into the narrative, the scaling of money allocations dependent on gross national product, and continual reference to “value for money,” and “proof of efficiency.” It left me wondering where the principles of “health for all” and “rights to healthcare” fit into this framing of the problem. I was mildly reassured by presentations from China and South Africa (countries with a high tuberculosis burden, ranked second and third in the world, respectively); both had given consideration to the essential component of social support in their budget plans for scale-up of drug-resistant tuberculosis care.

In reality, the 14% of the total tuberculosis control budget that comes from international donors (90% of which is allocated from the global fund) has to meet the challenge of the STOP TB strategy as the 86% provision that countries themselves must make relies heavily on such subsidy in many cases. With the global fund replenishment proposals of round 11 due in March 2012, the sessions on global financing and financing for multi drug resistant tuberculosis in particular focused on what is required to sustain the funding for the “problem” of tuberculosis – it is notable that funders and policy advisors seem increasingly reluctant to refer to the global epidemic any longer as an emergency, as if changing the rhetoric modifies the size of the problem and lessens the urgency to save lives. Several speakers referred to the “time of plenty” when the global fund was developed as if the sentiment for wealthier countries to help alleviate worldwide medical crises such as HIV, multidrug-resistant tuberculosis, and malaria is contingent rather than principled.

Alongside the “value for money” rhetoric, the competing and welcome challenge evident throughout the conference was to be BOLD in addressing what is needed now to scale up to tackle drug resistant tuberculosis: to focus on children, case detection, and getting patients on treatment. This message is echoed in a booklet launched by Médecins Sans Frontières (MSF) at the conference – “Treating drug-resistant TB: What does it take?” The booklet shows how MSF and its partners in 14 projects from 12 settings have developed country adapted strategies that have enabled health practitioners to overcome the many difficulties in developing treatment programmes for drug resistant tuberculosis. We hope that our experience inspires others to get started- whether in just starting to treat one patient or in scaling up treatment across countries.

Whether being bold in stopping the deadly epidemic of drug resistant tuberculosis is compatible with “value for money” in international health remains to be seen. What is important is that international donors continue to support the global fund as it needs to continue to succeed in making up the difference between aspiration and reality.