Tb financing in bi h current situation and challenges to foster budgets in countries transiting out of the global fund undp

TB financing in BiH: current situation and challenges to foster budgets in

countries transiting out of the Global Fund

Introduction

• Population: 3,829 mil.• Unemployed: 552.363• GDP per capita: 4.656 USD (103. WB)• 13 Health Funds (without state level HF) • 2 entity MoHs, 1 DH BD and 10 Cantonal MoHs• Out of pocket health expenditure 97.3%-96.3%

Before Global Fund

• Started in 2006 with HIV R5 supported grant, followed with TB R6 supported grant late 2007

• 2007 Number of TB cases registered in BiH 2.373• Incidence: 53/100.000• Low DOT coverage, Insecure funding for TB drugs• Weak network of laboratories• High number of persons without health insurance• Unavailable data on HS financial contribution

Before Global Fund

• Without:• proper infection control measures in laboratories

and TB departments• proper laboratory equipment • Isolation rooms for MDR patients• Insecure procurement of TB drugs• Weak support to target population • Weak NVO/CSO activities

Global Fund support

• Developed and approved Tuberculosis Programme (FBiH and RS)

• Education of health professionals all over the country (doctors and nurses)

• Engaged NGOs to support health system to provide access to hard to reach population

• Organized screening for target population and access to health service (without health insurance-HS cover)

• Excellent expert and technical support

Global Fund support

• Strengthen network of laboratories with new technologies and equipment (maintenance and diagnostic tests)

• IC measures, rehabilitation of TB wards by GF, maintenance by HS

• Established isolation rooms and laboratories according to international standards

• Strengthened lab network provides fast diagnostic results, established QA/QC system with SNRL

WHO Country data on financing - 2013These data were unavailable before 2012

Finance profile

Funding

2011 2012 2013 2014 2015* 2016* 1490 1420 1261 1190 1160 1131

8,139,550.00

11,845,869.13

12,893,073.08

10,173,162.00

8,813,206.46 8,813,206.46

2,652,552.41

3,577,193.52

5,393,118.00

2,160,423.00 1,518,843.00

778,805.00

Funds used for Tuberculoses control Programmes in BiH (all sources in BiH),

*forecast for 2015&2016

BiH kontribucija (USD) GF kontribucija (USD)

Funding (%)

2011 2012 2013 2014 2015* 2016*

75% 77%

71%

82%85%

92%

25% 23%

29%

18%15%

8%

Share of expenditure of BiH Health Care System and Global Fund in the period 2011 - 2016

Procentualno učečće BiH Procentualno učečće GF

HSS

• Hospital costs ( including human resources)• Maintenance of equipment (old)• Maintenance of equipment and rehabilitated premises• IC measures• Drug procurement & management• NGO support• E-data base maintenance and upgrade• Diagnostic costs

Road to success

2007• Number of TB cases 2.373• Incidence 53/100.000• Without: active screenings,

NGO/CSO support, laboratory network

• Limited access to HS without health insurance

• Payment of services for suspects

2013• Number of TB cases 1.261• Incidence 46/100.000• Regular active screening, NGO

involvement, strong laboratory network with rapid results

• Access to HS and HI• No payment of services for

suspects

Road to success

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

500

1000

1500

2000

2500

3000

3500

4000

4500

TB case notification in BiH Estimation of number of TB cases at 2,5% decreasing rate annualy

Benefit gained through GF support in terms of decline of TB burden in BiH in the period 2007-2017

Positive impact

GF• Mechanisms• Monitoring and evaluation• High standards of

performance evaluation• Partnership of GO and

NGO

BiHPartnership of all stakeholdersStrong Public Health systemExchange of experienceStrong commitment to project aimAll as ONE

Comparison of TB prevalence and incidence

2013

Indicator Prevalence Incidence

EU

Slovenia 9.2 7.5

Croatia 18 13

Hungary 29 18

Romania 123 87

Bulgaria 37 29

non-EU

BiH 69 46

Serbia 28 18

Montenegro 25 21

Macedonia 25 17

Albania 27 18

Current budgets for health

• May 2014 Floods• Lack of investment for prevention activities, DOT

coverage and food/hygienic packages• Weak, but with funds for hospital costs,

diagnostic (-), HR (-)• Planning for drugs• Funds for NGOs from MHRR (Roma Action Plan)

To be continued…..

• SAT/DOT• NGO activities (prior analyze of new needs)• Improved cooperation between NGO/CSO and

PHIs• Treatment and quality diagnostic services• Screening• E-reporting

Chalanges

• To identify method for procurement fo FLDs and SLDs

• Surveys• Annual meetings of all NTPs• DST coverage rate

Thank you for your attention!