FIFTY-FIRST WORLD HEALTH ASSEMBLY Agenda item 20
WHA51.13 16 May 1998
Tuberculosis The Fifty-first World Health Assembly, Aware that tuberculosis is strongly associated with social and economic inequalities, especially those related to low income and gender; Aware also that tuberculosis remains one of the most important causes of death in adults despite the existence of the highly cost-effective strategy known as “directly observed treatment, short course (DOTS)” to control the disease, and that poor treatment and inadequate control of anti-tuberculosis drugs will result in the development of drug-resistant strains that may make tuberculosis incurable; Recognizing that the already serious situation is worsening in many countries that have been slow to implement the strategy, and that in some the disease is rapidly spreading owing to HIV infection, itself facilitated by sexually transmitted diseases; Convinced that tuberculosis can be controlled using the DOTS strategy even under difficult conditions, although the strategy presupposes strong political commitment; Appreciating WHO’s leadership in persuading more countries to adopt the DOTS strategy (from ten in 1990 to nearly a hundred in 1997); Acknowledging that many countries will achieve the global targets for the year 2000 set by resolutions WHA44.8 and WHA46.36; Concerned that most of the countries with the greatest disease burden will be unable to meet the targets; Aware that the delay in introducing the DOTS strategy will lead to significant increase in tuberculosis prevalence and cause millions more preventable deaths, 1. URGES all Member States: (1) (2) to give high priority to intensifying tuberculosis control as an integral part of primary health care; to improve social and economic conditions for vulnerable groups in their communities;
(3) to ensure before the year 2000 the effective introduction of the strategy known as “directly observed treatment, short course (DOTS)” as an integral part of primary health care if it has not yet been implemented; (4) to monitor implementation of the strategy and establish an effective disease surveillance system;
WHA51.13
(5) to take the necessary steps, especially in those 17 countries with the highest burden of disease that are not expected to meet the targets by the year 2000: (a) to improve and sustain political commitment at national and local levels;
(b) to review the constraints faced in meeting the targets, if necessary with support from WHO, development agencies or nongovernmental organizations; (c) to meet the targets through implementation and expansion of the DOTS strategy;
(d) to develop a detailed plan to meet the targets as soon as feasible after 2000, clearly specifying the type, amount and phasing of support to be provided by their governments, WHO, donors or nongovernmental organizations as appropriate; (6) to coordinate the observance of World Tuberculosis Day on 24 March of each year as an opportunity throughout the world for organizations concerned to raise public awareness of tuberculosis as a major urgent public health problem and for countries to assess progress in tuberculosis control; 2. CALLS ON the international community, organizations and bodies of the United Nations system, donors, nongovernmental organizations and foundations: (1) to mobilize and sustain external financial and operational support;
(2) to encourage cooperation from other organizations and programmes for health systems development, and prevention and control of HIV/AIDS and sexually transmitted diseases and lung diseases; 3. REQUESTS the Director-General: (1) to use all appropriate existing fora where Member States, including those 17 with the highest burden of disease, may present problems faced in implementation of the DOTS strategy and other strategies in order to overcome these problems and mobilize external technical, financial and other support needed; (2) to encourage the accessibility of poor countries to an adequate supply of good quality medication and diagnostic equipment; (3) to encourage the establishment of networks for the surveillance of multidrug resistance at country level or in groups of poor countries; (4) to encourage research to ensure sustainable, cost-effective programme implementation, as well as action to prevent multi-drug-resistant tuberculosis, including the development of tools to monitor multidrug resistance, and to develop new tools to supplement the DOTS strategy (including vaccines); (5) to intensify collaboration and coordination with UNAIDS and other programmes and agencies;
(6) to take all possible steps to maintain WHO’s regular budget contribution for global tuberculosis control; (7) to keep the Executive Board and Health Assembly informed of progress.
Tenth plenary meeting, 16 May 1998 A51/VR/10
2
=
=
=