Framework for conducting reviews of tuberculosis programmes

Overview

The review of a formal national tuberculosis (TB) programme (or the efforts that countries make to control the disease regardless of the existence of a formal “programme”) is an important exercise to evaluate the implementation and impact of TB prevention, care and control. It should be jointly undertaken by the government together with the relevant national and international partners that are involved in TB efforts.

A TB programme review assesses the performance of the strategy implemented to fight TB and identifies the strengths and weaknesses of interventions that have been put in place. An appropriate review must, then, describe specific recommendations on the strategic orientations that need to be adopted and developed to overcome the gaps identified in the way that TB prevention, care and control are being implemented. These recommendations provide the foundation for improving the strategy adopted to control TB and for revising or developing a national strategic plan. Moreover, the review of a TB programme provides an important opportunity to advocate for TB prevention, care and control among policy makers, to strengthen the engagement of national health authorities and key stakeholders, and to enhance the mobilization of resources from both domestic and international sources.

The first WHO guidelines on how to review a TB programme were published in 1998, and were designed to support the assessment of, and improvements to, the implementation of the DOTS strategy. Since then, there have been major evolutions in the WHO strategy for prevention, care and control of TB. Important new interventions have been defined, developed and implemented: for example, collaborative TB/HIV activities and the programmatic management of drug-resistant TB. Therefore, this new guidance takes into consideration all strategic approaches that are part of the current WHO strategy for TB control. In 2013, WHO began developing a post-2015 global tuberculosis strategy. Thus, this guidance will be further updated once the new strategy is fully translated into operational language.

The main purpose of this document is therefore to provide guidance on how to organize a review of a national TB programme. It identifies the keys steps needed to plan and prepare the review and specifies how to carry out field visits. It also describes the process of using the findings of the field visits, formulating recommendations and developing a review report. The document also includes, in annexes and in web-based format, checklists that can be adapted and used to assess key areas of TB prevention, care and control such as TB surveillance system, the management of the TB programme, and the process of TB case finding.

We strongly encourage national TB programmes, as well as agencies and organizations involved in TB control, to use the guidance included in this document to organize and implement the national programme reviews they are planning. The outcomes of the reviews should significantly contribute to improving the TB control situation in countries, revising or developing high-quality national strategic plans, and mobilizing the required resources.

Dr Mario Raviglione

Director, Global TB Programme

World Health Organization

French Version