Joint Report on the Results of the Parallel Performance Audit - Prevention and Treatment of Tuberculosis

Tuberculosis is one of the most dangerous and widespread infectious diseases worldwide. According to the World Health Organization (WHO) data of 2018, about 10 million people worldwide were infected with tuberculosis, of which 1.5 million died.

According to the economic analysis conducted by the international company “KPMG”, the world economies are losing an average from 0 to 2% of their GDP per year due to the damage caused by the spread of tuberculosis. In Western European countries, where the prevalence of tuberculosis is less than 10 per 100,000 people, the economic effect is negligible, while in African countries, where the prevalence is more than 200 on average, the loss is up to 2%.

The fight against tuberculosis is a challenge for humanity. This disease mostly affects low-income vulnerable groups and increases inequality in society. Therefore, the fight against tuberculosis is one of the important components of the sustainable development goals.

Azerbaijan, Georgia and Ukraine, along with other UN countries, share the SDG objectives, including eradication of TB by 2030.

The fight against tuberculosis has a specific “The End TB” strategy, which is adopted by WHO and is shared by all participant countries.

The prevalence of tuberculosis in these countries is still high compared to many European countries, therefore, there is still significant potential for improvement.

Drug-resistant TB is a significant problem on global, regional and country level as well. SAI-s of Azerbaijan, Georgia and Ukraine report the high rate of drug-resistant TB cases. In general, WHO explains this trend with two reasons: first, improper management of TB treatment, and second, therefore, an increased risk of spreading of the relevant form of TB.

The combination of the above factors entailed the parallel performance audit of anti-TB measures presented in this joint report.

The scope of the parallel audit mainly covered 2016-2019 period and was determined as follows:

Early detection and preventive measures of TB;
Proper treatment of TB infected patients.

The parallel audit placed a particular emphasis on auditing government policies and measures to implement the Sustainable Development Goals (SDG 3- Health and Well-being).

This Joint Report is based on common findings and conclusions from national audits conducted by the SAIs of the Azerbaijan, Georgia and Ukraine.

The SAIs of Azerbaijan, Ukraine and Georgia report some common shortcomings in TB prevention and treatment management systems, which hinder the process of achieving SDG goals and eradication of TB by 2030, specifically:

Shortcomings in state policies – Unrealistic goals and indicators; Lack of action plans and efficient coordination of public entities;
Lack of medical personnel (doctors; epidemiologists) – shortcomings in distribution and efficiency of medical personnel that hinder the early detection of disease and proper coverage of the contacts of the TB patient. Epidemiologic studies are performed with a delay that impacts the spread of disease.
Lack of qualification and trainings for the medical personnel that cause problems in prevention and treatment of TB.
Weaknesses of primary healthcare system (PHC) in detection of high risk groups and early diagnosis of TB;
SAIs specially report highest MDR TB infection rate. The treatment of MDR TB is more time-consuming, expensive and, at the same time, less effective. The main factors contributing to the low treatment effectiveness include failed or interrupted treatment. Accordingly, SAIs report that treatment mechanisms are not efficient enough and further improvements of treatment processes are necessary.
Lack of public awareness and stigmatizations of disease;
Problems of infrastructure – Lack of anti-TB facilities and equipment;

SAIs issued specific recommendations to the auditees (Public Entities), concerning:

Improvement of state policies, strategies and actions plans;
Improvement of TB detection procedures – epidemiologic database and epidemiologic procedures;
Proper distribution of medical personnel;
Effective trainings for medical personnel (especially PHC personnel);
Strengthening the PHC role in TB management (detection of high risk groups and early diagnosis);
Improvement of the treatment mechanisms to decrease MDR TB rate;
Increase public awareness about the TB;
The proper, optimal and efficient distribution and equipping of anti-TB facilities.

National audit reports include country specific findings and recommendations that are shortly discussed in next sections of the joint audit report.