Public health is a foundation for prosperity and sustainability, and this is true for every country. A world that is out of balance in matters of health is neither stable nor secure.

The current situation with COVID-19 demonstrates to the international community, governments, and activists very tangibly that the fight against infectious diseases knows no borders, and provides a number of lessons about how we should respond to such challenges. One of the lessons learned is that global public health becomes a united front in the fight against disease when countries are confronted with a sense of urgency to act.

Over the past 200 years, tuberculosis (TB) killed at least a billion people, more than have died from malaria, smallpox, HIV/AIDS, cholera, plague, and influenza combined. These deaths and new infections come more than 130 years after a cure for the disease was discovered and yet, TB remains one of the top 10 killers from infectious diseases globally.

In 2018 alone, TB claimed the lives of 1.5 million people globally. In the same year, 10 million people developed active TB. Of those 10 million, 7 million are known to health systems and on treatment; the rest are not. About 3 million people with TB are not registered by healthcare systems, they do not have access to the services and care they need, they might not even know they have TB. As a result, each person will potentially infect 15 people during their lifetime.

How can we ensure universal TB care coverage?

TB is a silent and slow killer and, as such, the general population and those in power do not see its real danger. However, on September 26, 2018, the first-ever United Nations High-Level Meeting (UN HLM) on TB was held to accelerate global efforts in ending TB by 2030 and reach all affected people with prevention and care.

Today there is a vital need to accelerate the sense of urgency recalling commitments made by Heads of States in the political declaration on TB adopted at the UN HLM. Many countries are taking actions to reduce socially-determined TB gaps but much more remains to be done. There is a pressing need to fulfill the commitment call for substantial scale-up of funding with overall global investments reaching at least US$13 billion a year by 2022[1] to ensure universal access to timely and qualitative diagnostics and care, effective treatment and support.

What is the global financial gap to fully meet TB needs?

Health is central to sustainable development of the countries and inadequate funding for TB impacts not just health, but other aspects of social and economic progress as well.

The financial sustainability of the national TB response in the Eastern Europe and Central Asia region, as well as globally, is under pressure due to the transition from major donors’ funding and limited domestic budgets to ensure the comprehensive coverage and further scale up of access to quality people-centered TB care. Without an increase in funding, the annual global gap to fully meet TB needs will widen to US$ 5.4 billion in 2020 and to at least US$ 6.1 billion in 2022[2].

What role can civil society and affected communities play in TB fund allocation?

Increasing the share of national funding for TB and ensuring that these funds are allocated and used effectively, equitably, and efficiently is key to reaching TB targets from the UN HLM and the United Nations Sustainable Development Goals (SDG). Civil society organizations (CSOs) can help achieve this objective by calling on governments to allocate sufficient funds into TB and into health programs in general to achieve universal health coverage. One of the tools vital to this work is TB budget advocacy[3]. This means that civil society and communities working in the area of TB undertake specific well-conceptualized strategic activities to influence government decisions on allocating and implementing TB public budgets and the provision of services, and may play a watchdog role to enhance the transparency and accountability of the government and its respective agencies.

Decisions on public resource allocation deeply affect the most at-risk people in society, often those living below the poverty line. They often come from vulnerable communities in the most critical need of public health services, and they are the people who experience most of the barriers in access to care, including human rights violations. It is critical to have their voices heard in order to find solutions on how to better address individual and community needs at all stages of TB care and remove the gaps, and yet they lack power in the decision-making process on what quality TB care should look like. TB budget advocacy should empower the most-at-risk and marginalized groups for meaningful participation in the TB budgeting process and to ensure equity in accessing TB resources. It can also help civil society find out when resources are not being spent as intended, not being spent efficiently or are not reaching disadvantaged groups.

How to move closer to UN HLM on TB and SDG goals?

The agreed goals of the UN HLM Declaration on TB and SDG by 2030 will remain a distant dream if those most in need are deprived from access to quality TB care because they cannot afford it.

On the World TB Day TBEС calls for increased international solidarity to address health issues within global security agenda and urges countries to strive reaching allocations to health of 9,9% GDP[4] annually in line with agreed targets of the UN HLM Political Declaration on TB[5] and the Sustainable Development Goals[6].

Sufficient health financing alongside with the focus on equity in access to quality health services and universal protection against financial risks will ultimately contribute to the goal of ending Tuberculosis. Universal health coverage can only be achieved with elimination of catastrophic costs in TB –  financial burden on families and individuals caused by out-of-pocket expenditures and loss of income.

It’s time to make a difference for people with TB in the real world, right now.

[1] https://www.who.int/docs/default-source/un-high-level-meeting-on-tb/unhlm-tb-web-flyer-120×120.pdf

[2] https://apps.who.int/iris/bitstream/handle/10665/329368/9789241565714-eng.pdf?ua=1

[3] https://www.tbcoalition.eu/wp-content/uploads/2020/03/A-Guide-for-TB-Budget-Advocacy_ENGL.pdf 

[4] https://www.who.int/features/qa/sdg-price-tag/en/

[5] http://stoptb.org/assets/documents/global/advocacy/unhlm/UNHLM%20budget%20break%20up%20-%20November%202019.pdf

[6] https://www.un.org/sustainabledevelopment/health/

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