Update on TB Funding in India and National Strategic Plan
The Global Fund has been a significant partner in funding TB programs in India, with a focus on reducing the TB burden and preventing catastrophic costs. India aims to be TB-free by 2025 through strategic initiatives outlined in the National Strategic Plan (2017-2025). Domestic funding plays a crucial role, alongside contributions from the Global Fund, in supporting TB activities in the country.
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Update on TB Funding Request The Global Fund cycle (2024-27)
The Global Fund Portfolio in India The Global Fund has a sustained partnership with India since 2002. Disbursed US $2.74 billion grant so far for HIV, TB and Malaria disease programmes including US $ 1.05 billion for TB. India has contributed 93.5 mUSD so far as a donor to the Global Fund. For the current grant period April 2021-March 2024, the Global Fund has signed grant amount of USD 500 million( USD 280m for TB, USD 155m for HIV and USD 65m for Malaria programmes).
Vision: TB Free India On 13 March 2018, India committed to End TB by 2025, five years ahead of Global SDG target Global SDG TB Targets TB Free India Targets Indicators By 2025 By 2030 1. Reduction in TB mortality rate (compared to 2015) 90% 90% (3 per 1,00,000 population) 2. Reduction in TB incidence rate (compared to 2015) 80% 80% (45 per 1,00,000 population) 3. TB-affected families facing catastrophic costs due to TB 0% 0% (Zero catastrophic costs due to TB )
TB DISEASE BURDEN IN INDIA Estimated incidence rate of TB 196 / lakh population in 2022 Estimated TB cases in 2022 in India 27.70 lakh# Reported TB cases* 24.2 lakh (2022) 21.46 lakh (2021) 18.1 lakhs (2020) 2% HIV-Positive 33% Urban Children 6% Male 61% Female 39% 2.8% 58% Drug Resistant Rural 15-45 years (Age) 65% 9% Tribal #Source: India TB Report 2023 (https://tbcindia.gov.in/showfile.php?lid=3680) * Programmatic datac
NATIONAL STRATEGIC PLAN (2017-2025) Find all TB cases with an emphasis on reaching every TB patient in the private sector DETECT TREAT Treat all TB cases with high quality anti TB drugs BUILD PREVEN T Prevent the emergence of TB in susceptible populations and stop catastrophic expenditure due to TB by all Build & strengthen supportive systems including enabling policies, empowered institutions & human resources
Funding for TB & GF contribution in India Major source of funding is domestic All source converge into NSP 700 600 500 400 300 76% 76% 200 79% 62%% 80% 67% 100 0 2017 2018 Domestic 2019 2020 2021 2022 Donor/Other GF contribution for NTEP in FY (2021-24) is 23% (2068 Cr / 9124 Cr of the total 3 year budget for NTEP)
TB Global Fund Grant (Apr 2021-March 2024) TB Grant Principal Recipients TB Grant (2021-24)-PR wise Allocation under Global Fund (US$ 280 m) Government PR: DEA, MoF Non Government PR Implementation PR: CTD (Budget~ 80 USD m) (Budget~ 200 USD m) Input based grant Payment for Result based grant US $ 80 m, (29%) WJCF (USD 22.6 m) SR1: TISS (USD 4.09 m) US $ 200 m, ( 71%) SR2: NIRT (USD 9.25 m) UNION (USD 13.6 m) PLAN India (USD 6.47 m) CTD NGPR FIND (USD 37.1 m)
TB Grant Allocation for period Apr 2024-March 2027 Global Fund Allocation for period (2024-27) USD 4 m- Matching Fund Tofind and successfully treat the missing TB cases Malaria $ 65 m CTD $ 200 m TB-$ 280 m Conditional to investment of at-least equivalent grant funds towards private sector engagement NG-PR:$ 80 m HIV-$ 155 m HIV Malaria TB NG-PR Total TB Grant : 284 m $/ Rs. 2293 Cr.
TB Funding Request (2024-27) Development Process Internal meetings at CTD level to deliberate NTEP priorities (Jan 2023) TB stakeholders consultations - at programme and CCM level to seek inputs for priorities for GF proposal (Feb 2023) Deliberations with NGPRs (approved by India CCM) to align interventions with programme priorities (Apr 2023) Comprehensive TB proposal development (April-May 2023) for submission in May 2023 window Re-initiation of EOI process by India CCM to select non- government PRs (July 2023) Recommendation of Non-government PR for TB by Screening Committee of India CCM (2nd week of Aug 2023) 9
Community Inputs for TB CTD led TB stakeholder consultation (virtual) held on 7th Feb and CCM led combined HIV, TB, Malaria stakeholders consultation held on 9th Feb 2023. TB community consultations: 18th April- Gangtok, Sikkim 20th April- northeast consultation at Guwahati, assam The key asks deliberated by community were presented at the national-level consultation on 24th April at New Delhi The final key asks were discussed virtually with the fourteen state-level networks and revised asks were shared with India CCM Secretariat proposals. led stakeholder regional for inclusion in 10
Existing vs New TB Grant under Global Fund Existing Grant (2021-24): USD 280 m New Grant (2024-27): USD 284 m NGPR-$ 80 m (29%) NGPR-$ 39 m (14%) CTD -$ 200 m (71%) CTD, $ 245 m (86%) GOVT. PR Central TB Division GOVT. PR Central TB Division 1. 2. 3. 4. 5. KHPT HLFPPT TISS SAATHI Doctors for You 1. 2. 3. 4. WJCF FIND India Plan India The UNION NG-PRs NG-PRs
SC Recommendation: TB Non-Government PR WJCF, FIND, PLAN and The UNION are focusing on scaling up TB Preventive Treatment, Active Case Finding, Laboratory strengthening and Supply Chain Management; 9 TB Non- Government PR recommended by SC WJCF These are already being undertaken by NTEP through existing structure (NTEP staff, AB- HWC, large lab network etc). The UNION FIND India In view of sustainability, interventions will be scaled up/ continued through NTEP only. PLAN India SAATHI TB NG PR proposed by MoHFW for 2024-27 grant cycle Operationally challenging to have 9 NG-PRs, with overlap of priorities/interventions amongst most partners. The Global Fund recommends having minimal NG-PRs KHPT HLFPPT Doctors for You Proposed NG-PRs have good track record of working in TB in the community at the grass root levels. TISS
TB Grant: Government Non-Government PRs (2024-27) Non-government Principal Recipients for TB proposed for India CCM concurrence TB grant (2024-27)- PR wise Allocation Government PR: CTD *Non Government PR (Budget~ 245 m $/ Rs.1977 Cr.) (Budget~ 39 m $/ Rs.314.7 Cr.) 14% Payment for Results Input based grant KHPT Linked to 3 Disbursement Linked Indicators SAATHI HLFPPT 86% Doctors for You Govr. PR NG-PR TISS
Central TB Division: Key Interventions for 245 m USD Programmatic management of TPT Drugs and diagnostics procurement Expanding the coverage of DR TB treatment SLD procurement Decentralization of Rapid Molecular diagnostics Chips/consumable procurement Strengthening TB surveillance District level Surveys Sub-national Certification US $ 55 m US $ 90 m US $ 10 m US $ 90 m Geography: Pan India Grant Modality: Payment for Results linked to 3 Disbursement Linked Indicators No. of persons initiated on TPT Treatment success rate of RR/MDR cases No. of total tests done through rapid molecular diagnostics
Key Procurements All Procurement are to be done by national programme All procurement will be done through CMSS As part of PFR modality, procurements will be done using domestic resources and subsequently will be reimbursed through the Global Fund as per DLI achievement Drugs/consumables, if available cheaper than the domestic market or is not available in the domestic market will be explored though GDF. 15
Non-Government PR Key Interventions (1/3) S. No Non-govt. PR & Budget Key Interventions Community Systems Strengthening through Panchayat Raj institutions Capacity building of Gram panchayat members and Urban local bodies Strengthening community engagement (training and capacity- building of TB champions, Strengthening TB Forums and survivor-led networks) Technical Assistance for Direct Benefit Transfers (DBT) across states Technical assistance for Pradhan Mantri TB Mukt Bharat Abhiyan to strengthen linkages between Ni-Kshay Mitra and patients Karnataka Health Promotion Trust (KHPT) (USD 15 m) 1 Technical Support to Increase uptake of pediatric TB diagnostics and treatment services in public sector Decentralised sample collection support and TB services through child health programs (RBSK, WCD, NRC) Private sector: Technical Support to PPSA & Partnership with IAP National /state level Training of Trainers, in collaboration with national and regional PCoEs Solidarity and Action Against the HIV Infection (SAATHI) (USD 9 m) 2 16
Non-Government PR Key Interventions (3/3) S. No Non-govt. PR & Budget Key Interventions ACF in vulnerable key population using mobile vans and deployment of AI-enabled hand-held X-ray devices Strengthening private sector engagement through corporate hospital and integrating online healthcare platforms Skill development for 9000 beneficiaries from TB in identified States Case finding and enabling early diagnosis by engaging AYUSH & informal providers Strengthening sample collection & transportation at service delivery level Hindustan Latex Family Planning Promotion Trust (HLFPPT) (USD 5 m) 3 To strengthen counselling skills of NTEP staff using patient centric -empathetic approach (STS, TBHV, DTO, MODTC, DPS, DPC and STLS) To develop a holistic, one window, end to end, state of the art and sensory Patient Support demonstration model in 4 states Tata Institute for Social Sciences (TISS) (USD 5 m) 4 17
Non-Government PR Key Interventions (3/3) S. No Non-govt. PR & Budget Key Interventions Hub & spoke model for DRTB care on Public private partnership mechanism To bring innovation for scaling up upfront NAAT testing for EP TB and Pediatric TB Active Case Finding through deployment of AI-enabled hand-held X-ray devices, Case finding and enabling early diagnosis by engaging AYUSH & informal providers Strengthening sample collection & transportation at service delivery level Doctors For You (DFY) (USD 5 m) 5 18
THANKS 19
