PROGRAM Stop TB in Ukraine with financial support of the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GF)

Reducing the TB burden in Ukraine through expanding and enhancing access to high-quality TB services
  

The Proposal from Ukraine to the GF (http://www.fdu.org.ua/en/cat/364) was submitted on 1 June 2009.
The Cooperation Agreement (http://www.fdu.org.ua/en/cat/364) between Ukraine and the GF was signed on 10 December 2010.
The program was launched on 1 January 2011.
Program implementation timeline: 2011-2015.
Main program sub-recipients:
• All-Ukrainian Centre on TB Control under MOH of Ukraine
    http://www.tbc.gov.ua/
• State Penitentiary Service of Ukraine
    http://www.kmu.gov.ua/punish/control/uk/index
• International HIV/AIDS Alliance in Ukraine 
    http://www.aidsalliance.org.ua/
• Representative office of PATH in Ukraine
    http://www.path.org/
• Red Cross Society in Ukraine
    http://www.redcross.org.ua/

 
Main program partners:
• Ministry of Health of Ukraine
    http://www.moz.gov.ua/ua/portal/
• Committee on HIV/AIDS and other Socially Dangerous Diseases Control
    http://www.stop-aids.gov.ua/
•  Yanovskiy Phthisiology and Pulmonology National Institute
    http://www.ifp.kiev.ua/
• All-Ukrainian Network of People Living with HIV/AIDS
    http://www.network.org.ua/
 

Main program objectives:
1. To improve TB diagnostics by optimizing the laboratory network at the public and penitentiary establishments.
2. To improve access to high-quality services for people that, for whatever reason, have limited access to TB health services.
3. To strengthen the capacity of the Ukrainian health system to respond to TB by improving the governance (leadership, monitoring and evaluation, human resource development) necessary for the successful delivery of the TB program.
4. To increase overall access to TB diagnostics, treatment and care through awareness raising, mobilization of political support and reduction of stigma.

Program history:
The Foundation for Development of Ukraine jointly with the Ministry of Health of Ukraine in 2009 submitted the Proposal for the TB component of Round 9 to the GF. It was the fourth attempt of Ukraine to secure financing for anti-TB measures. In March 2010, the GF decided to provide funds to Ukraine for fighting the TB epidemic, according to the submitted Proposal.
Ukraine and the Global Fund signed the Grant Agreement on 10 December 2010.

The allocated funds shall be used to fight the TB epidemic in Ukraine. The Foundation for Development of Ukraine is the main Grant recipient. Along with the main recipient, the program provides for involving five key sub-recipients that, in their turn, are going to work jointly with their own partners all over Ukraine. 

Program budget:
Total for five years:                                                     USD 94, 862.399
including:
for Year 1 –                                                                   USD 16,475,244
for Year 2 –                                                                   USD 13,184,070
Total for Phase 1 –                                                        USD 29,659.314


  

Regional coverage:
In 2011 (Year 1), program activities are planned in 6 regions:
- Kiev
- Donetsk Oblast
- Dnepropetrovsk Oblast
- Kharkov Oblast
- Nikolayev Oblast
- Lvov Oblast

The plan is to provide help and support to all the regions of Ukraine over five years of the Grant implementation, from 2011 to 2015.

 
Proposal summary:
Ukraine submitted its Proposal to the GF in 2009. This Proposal provided for the amount of USD 103,459,619 for a five-year period to support the important and necessary measures to control the epidemic of tuberculosis (hereinafter referred to as TB) in Ukraine.
The main objective of this Proposal is reducing the TB burden in Ukraine through expanding and enhancing access to high-quality TB services.
The deficiencies of the existing TB control system in Ukraine mostly affect vulnerable and low-income population groups. After the first pilot DOTS programs had been implemented in Ukraine in 2001, the government took serious steps to redirect the TB diagnostics and treatment system on basis of the Stop TB strategy, including the fundamental structural changes in the TB control system.  At present, the DOTS strategy has been fully approved and makes up the basis for the State TB Program for 2007-2011. USD 241,708,253 was allocated from the state budget to implement this program. In general, the government recognizes that implementation of the new system involves certain difficulties: in the course of transition the country needs substantial additional financial and technical resources that exceed the state budget capacity. Through this Proposal, the National Tuberculosis and HIV/AIDS Council expects to secure the financing that is going to become a catalyst for successful transition of Ukraine’s healthcare system to the modern TB control model. The general strategy of the Proposal provides for simultaneous reforming of all the key areas of TB control system:

Objective 1: To improve tuberculosis diagnosis by optimizing the TB laboratory network in the civil and penitentiary facilities
Recognizing the fundamental role of reliable and accessible diagnostics, this objective focuses on the establishment of a high quality TB laboratory network.
SDA Improving diagnostics: Under this SDA, support will be provided to implement the government endorsed consolidation of the TB laboratory network, aiming for a reduced number of TB laboratories that are fully equipped and integrated into a tight quality assured network under leadership of a strong National Reference Laboratory, and with support from a Supranational Reference Laboratory. At each echelon of care, laboratories are clearly associated with the corresponding diagnostic and treatment functions of corresponding health facilities.

Objective 2: To improve access to high quality services for people who, for whatever reason, have limited access to TB services
Recognizing low detection and cure rates in Ukraine, this objective focuses on improving quality and acceptability of TB care in a patient centered approach.
SDA Quality DOTS: Focus on capacitating TB and primary health care services to better respond to the particular needs of populations with limited access, by introducing a case management approach to TB care throughout the continuum of care cycle from diagnosis to completion of the continuation phase. Particular emphasis is on strengthening decentralized and integrated TB care down to the Primary Health Care level (including outreach to the patients’ home where necessary).
SDA: MDR-TB: Systematic reorganization and roll-out of MDR-TB treatment according to international  standards to 15 high burden oblasts in Ukraine, and enrolling up to 5 560 patients per year in MDR-TB treatment in the civil and prison sector. MDR improvement is based on a concerted introduction of quality assured laboratory  support, training, GLC drug procurement and infection control measures including the necessary infrastructure upgrade (ventilation, UV decontamination) 
SDA TB/HIV co-infection: As a complementary effort to TB/HIV funding received through GFATM Round 6, efforts to scale up addressing the TB/HIV co-infection through increased TB/HIV coordination; TB case finding, TB infection control, to increase preventive treatment and HIV test coverage, and to introduce harm reduction services in TB settings.

 
Objective 3: To strengthen the capacity of the Ukrainian health system to respond to TB by improving the governance (leadership, monitoring and evaluation, human resource development) necessary for the successful delivery of the TB program
Under this objective activities are proposed that will together help to strengthen key elements that make up the foundation of the National TB Program:
SDA Leadership and governance in TB control: Activities to build capacity among TB program managers at national and regional levels and regional TB/HIV councils; organization of regular National TB conferences.
SDA HSS Monitoring and Evaluation system; Support to building capacity of government funded TB M&E units in all regions and the generation of relevant strategic information.
SDA HSS Workforce: Development of a comprehensive national strategy on human resources for TB. Revision of TB education in 43 pre- and post graduate academics institutions to prepare shift from ad-hoc to regular training. Adaptation of PAL clinical standards of care and preparation of national plan for PAL introduction. Strengthening of the National TB Center role in coordinating all TB related training efforts in Ukraine.

Objective 4: To increase overall access to TB diagnosis, treatment and care through awareness raising, mobilization of political support and reduction of stigma
SDA ACSM: Develop and implement a coordinated national ACSM strategy at the national level and in all oblasts; mobilize and build capacity  among NGOs and community leaders for greater involvement in the TB response; advocate and to reach out to groups with limited access; increase public awareness and stimulate political will and resources allocation for TB programs at all levels; address TB-related stigma and discrimination in the health care system and in the society; and reach out to vulnerable groups to stimulate them seek access to care and expand the reach of TB services by involving new partners.

It is expected that the combined activities funded by this proposal will complement the ongoing National TB Program, allowing Ukraine to achieve its 5- year targets to increase to 70% case detection rate and 80% treatment success rate. The objectives and activities described in this proposal follow  the STOP TB Strategy, and are directed to increasing its efficacy and account for weaknesses identified in the previous GFATM Round 8 Proposal. In particular, they reflect commitment of the government to address structural issues identified in past evaluations as well as results from recent gap analyses and will complement efforts supported by other donors in the TB and TB/HIV field, including USAID projects, the World Bank loan, private philanthropy (Charity Foundation “Development of Ukraine”) as well as GFATM Round 6 activities.

Indicators/program results (http://www.fdu.org.ua/en/cat/364)
Grant management scheme (http://www.fdu.org.ua/en/cat/364)

The list of TB-related legal acts subjected to expected amendments by the interagency group has been fixed (List of documents).

Drafts of documents:
Text of the new law draft 

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