Report of a WHO consultation meeting to enhance the engagement of communities, nongovernmental and other civil society organizations in implementing the End TB Strategy 11–13 November 2015 Addis Ababa, Ethiopia
© World Health Organization 2016 All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Design by North Creative, Geneva. WHO/HTM/TB/2016.01
Significant progress has been made in the global fight against tuberculosis (TB), especially during the past three decades. TB death rates have dropped by nearly half (47%) since 1990, and 43 million lives were saved between 2000 and 2014. The Millennium Development Goal (MDG) to halt and reverse TB incidence by 2015 was achieved. Yet, despite these critical gains, the progress made against TB is far from sufficient. TB is still a leading cause of death from infectious diseases. In 2014 alone, TB killed 1.5 million people, including 400 000 people with HIV infection. To further intensify the global TB response and to end the TB epidemic by 2030, WHO Member States endorsed the End TB Strategy in May 2014. On 11–13 November 2015, 90 community-based nongovernmental organizations (NGOs), other civil society organizations (CSOs) and more than 150 participants from 35 countries met in Addis Ababa, Ethiopia, to define steps to facilitate their implementation of the End TB Strategy. The meeting noted the tremendous progress made since the first WHO consultation with CSOs in 2010, which was called to collect evidence and experience for formulation of the End TB Strategy.
3
Participatory and inclusive process The content and conduct of the consultation were based on the results of a participatory, inclusive global online survey between July and August 2015. Nearly 800 NGOs and other CSOs – mostly national and indigenous organizations – participated in the survey; they suggested that the priorities for the meeting were capacity-building and technical assistance, advocacy and networking, and monitoring and evaluation.
Paradigm shift in the making The transition of the global development architecture from the MDGs to the Sustainable Development Goals (SGDs) heralds a new era in the global fight against TB. The WHO End TB Strategy targets are now included in SDG subtarget 3.3 to end the epidemics of AIDS, TB, malaria and neglected tropical diseases. This offers an unprecedented opportunity to galvanize TB prevention, care and control to end the global TB epidemic. Participants emphasized that TB must no longer be perceived and tackled as a narrow biomedical issue but as a global, essentially poverty-induced development challenge, and the opportunity offered by the SDGs should be seized. They also noted that, to end the TB epidemic, a multisectoral response is required at all levels, with enhanced engagement of all relevant governmental and nongovernmental actors, within and beyond the health sector. The participants further noted that the End TB Strategy, with its ambitious targets of reducing the incidence of TB by 80% and TB deaths by 90% by 2030 and eliminating the catastrophic costs for TB-affected households by 2020 captures this new paradigm and offers a mechanism for action. Dr Mario Raviglione, Director of the WHO Global TB Programme, said that the engagement of communities, NGOs and other CSOs was at the heart of the principles of the End TB Strategy, across its three pillars.
These priorities were used to organize panel sessions, group discussions and an interactive market place at the Consultation Meeting where NGOs and other CSOs presented their work and achievements in communities and shared their experiences and innovative approaches in communitybased activities. Participants also identified challenges and opportunities and jointly defined the steps necessary for their engagement in implementing the End TB Strategy. The participants also included representatives of national TB programmes (NTPs) and donors, including the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) and the United States Agency for International Development. The participants endorsed a Statement of Action (see hyperlink below) comprising 20 recommendations for enhanced NGO and CSO engagement in community-based TB activities and urging action to be taken by NGOs and other CSOs, governments and their NTPs, the Global Fund and other donors and WHO.
Investing in TB – great value for money The meeting participants deplored the fact that 4100 people lose their lives to TB every day. This is unacceptable in an era when almost all cases of TB can be diagnosed, treated and cured. They noted that TB diagnosis and treatment services offer the best return on investment: every US dollar spent returns US$ 30–40. The participants called on donors and governments to increase their investment in TB in view of this compelling economic return.
4
Progress since the 2010 WHO consultation with CSOs The meeting in Addis Ababa was the second of its kind organized by the WHO Global TB Programme with civil society. In 2010, 38 organizations met at WHO in Geneva to discuss ways to strengthen the engagement of CSOs in global TB prevention, care and control. WHO was asked to provide policy and programme guidance for enhanced community engagement, promote standardized monitoring and evaluation of community-based contributions to TB control, broker partnerships with NTPs and offer training and technical assistance. WHO subsequently prepared the ENGAGE-TB operational guidance, implementation and training manuals to help NGOs and other CSOs to work better with NTPs, particularly in communities. WHO also established a global system to document and monitor the contributions of communities, with standardized indicators. The ENGAGE-TB approach was pilot-tested in five countries and then adopted for nationwide scale up in six additional countries. Several NGOs that were previously not engaged in TB have since innovatively integrated TB services into their community development programmes using the ENGAGE-TB approach.
that community health workers and community volunteers are essential for ending TB, as they perform a variety of activities that are responsive to the local context and need. She reported that health education, TB screening, referral for diagnosis and treatment support were essential components of her pro-bono activities in her community. Although she is not paid for her activities, she said “My efforts are very much appreciated and they consider me almost like a medical doctor and that keeps me going.” She highlighted the main challenges she faced: “Many of the TB sufferers I serve are poor and refuse to take their treatment with empty stomachs. I want them to recover from TB, so I sometimes give them money out of my own pocket to buy food.”
Ethiopia at the forefront Dr Kesetebirhan Admasu, Minister of Health of Ethiopia, who delivered the opening speech at the meeting, said that governments should recognize the role of community health workers as an integral part of national health strategies. He referred to his country’s experience in creating a positive impact through its Health Extension Programme that includes TB among its interventions. He said, “Wiping out the TB epidemic will be possible only with strong political commitment and the engagement of communities. That is why Ethiopia has made important strides in improving access to basic health services, through its Health Extension Programme, country-wide deployment of more than 40 000 health extension workers and the movement of 3 million women volunteers now working alongside the health extension workers.” He reported that Ethiopia has already embraced the targets of the End TB Strategy as part of its 5-year Health Sector Transformation Plan. “In addition,” the Minister of Health continued, “our universal health insurance scheme will remove the catastrophic costs associated with TB – another milestone target of the End TB Strategy.” Notwithstanding the country’s efforts, much remains to be done in the fight against TB: “We have implementation and funding gaps, and we need to find ways to achieve the same results at lower cost and to increase domestic resources.”
Dr Haileyesus Getahun, who coordinates community engagement in the Global TB Programme, reported on the progress made and called on participants to help WHO define the next steps for further strengthening and better engaging communities, NGOs and other CSOs in implementing the End TB Strategy. He said that the outcome of the meeting would inform national programmes, partners and donor organizations.
A community health volunteer opened the meeting The opening session of the meeting was attended by Dr Kesetebirhan Admassu, Minister of Health of Ethiopia, Dr Eric Goosby, United Nations Special Envoy on TB, Dr Mario Raviglione, Director of the WHO Global TB Programme, and Ms Mary Naukot, a community health volunteer from Isiolo, Kenya. Ms Naukot shared her experience and emphasized
5
Shared responsibility to end TB “We have the shared responsibility of ridding the world of preventable and curable diseases like TB and creating a world free of poverty and inequality,” said the United Nations Special Envoy on TB, Dr Eric Goosby, in his opening speech. He said that progress in achieving universal health coverage and alleviating poverty is urgently needed to end the TB epidemic. “It is both our shared responsibility and our right to build the road to ensuring a meaningful, comprehensive, inclusive, sustainable approach to achieving the goal of ending TB.” Dr Goosby stressed that NGOs and other CSOs should be the voice of TB patients, who often suffer in silence; they should turn former TB patients into local, national and global TB “champions”. “In the spirit of the Sustainable Development Goals, communities should be the first, not the last, in our efforts to end TB,” he concluded.
services in communities, and 4000 TB patients were newly identified and treated in 2013–2014. In the project areas, up to half of all TB cases were notified by community referrals, and up to 90% of patients received care in their communities. The ENGAGE-TB approach has been adopted and integrated in Burkina Faso, Côte d’Ivoire, the Democratic Republic of the Congo, Gabon, Ethiopia, Kenya, Malawi, Morocco, Namibia, South Africa, the United Republic of Tanzania and Zimbabwe. The total confirmed funding for scaling up integrated, community-based TB activities is US$ 15.6 million. In addition, up to US$ 16 million has been requested and will be confirmed as Global Fund grants are signed.
“The ENGAGE-TB approach has achieved more and better collaboration between NGOs and other CSOs and governments. It has enabled many more NGOs to integrate community-based TB activities into their work,” said Mr Thomas Joseph, one of the architects of WHO’s ENGAGETB approach, in his presentation.
Innovation in Engage-TB: kitchen gardens The ENGAGE-TB approach shows the way Community engagement in TB covers a wide range of activities for the detection, referral and treatment of people with drug-susceptible, drug-resistant and HIV-associated TB. To enhance community engagement in TB, better identify and treat people with TB and engage more NGOs and other CSOs, WHO launched the ENGAGE-TB approach in 2012. This innovative initiative provides practical guidance to NTPs, NGOs and other CSOs on (1) integrating TB activities into other health and non-health community activities; (2) collaboration between NTPs, NGOs and other CSOs; and (3) close alignment with national systems, particularly in reporting and monitoring community contributions so that they are duly recognized in national TB data. ENGAGE-TB pilot projects have been implemented in the Democratic Republic of the Congo, Ethiopia, Kenya, South Africa and the United Republic of Tanzania. Eight million people have been given access to TB prevention and care Mr Alphonce Blaise Otiato of the Grassroots Poverty Alleviation Programme in Kenya, an ENGAGE-TB partner, described the successful integration of TB services into its livelihood programme for fishing communities. “We are integrating TB into our activities because people can get cured. But our big aim is to eliminate poverty. There is no point in curing our people from TB if they go back into poverty and sooner or later suffer from TB again. Therefore, we not only engage in TB advocacy, screening, treatment adherence, case finding or referrals, but also incentivize our fishermen to establish kitchen gardens.” The initiative helps to sustainably improve the livelihoods and nutrition of current and former TB patients and their families. Although the TB services that the programme now offers to fishing communities is only a pilot project, it has already had a positive impact: 275 new TB patients have been notified. The kitchen gardens project has also had successful results: 96 TB patients are engaged in the project, most of them among the most vulnerable, including children and people living with HIV.
6
National TB programmes should open their doors To achieve the targets of the End TB Strategy, NTPs will have to reach out to NGOs and other CSOs to encourage them to integrate TB into their work, in order to increase the number of organizations involved in TB work at community level, to reach as yet unreached populations and groups. Systematic collaboration and cooperation between NTPs and NGOs is essential. Useful lessons can be learnt from NTPs that have already increased their collaboration with NGOs and other CSOs through the ENGAGE-TB approach.
Integrating TB into screening for cervical and breast cancer Mr Ademe Tsegaye of CUAMM (Doctors with Africa) described integration of TB prevention and care into the screening programme for cervical and breast cancer in Ethiopia. Community volunteers are teaching communities the symptoms of TB and referring presumptive cases to nearby health posts. They hand out colour cards to patients, who pass them on to health extension workers when they are referred to health centres. “The cards help monitor community-based TB care and also incentivize community volunteers to do a good job, as we can trace back how many people with presumptive TB each of them referred,” Mr Tsegaye explained. The project is successful: 46 health extension workers were trained in integrating TB into cervical cancer screening; 174 presumptive TB cases were identified by community volunteers, and more than 18 000 people were reached with information, education and communication materials. He concluded, “TB activities can be integrated into other projects without significant additional cost.”
Dr Susan Gacheri of Kenya’s NTP shared her experience of intensified collaboration with NGOs and other CSOs. “We benefit immensely from jointly planning and implementing TB activities. It is possible for NGOs, CSOs and the Government to sit down and work together.” The enhanced collaboration has contributed significantly to national TB control by reaching new populations and increasing case finding and notifications. “NGOs and other CSOs are providing much needed care and support to communities, which our Government alone would not have been able to do.” Given the success and positive experiences of NGOs and other CSOs in the ENGAGE-TB approach, the participants concluded that such innovative projects should be replicated and adopted in all high-TB burden countries, thereby strengthening community engagement and reaching all those in need of effective TB care. They stressed that NTPs should be receptive to such collaboration.
7
Integrated patient-centred care Integrated patient-centred care and prevention, the first pillar of the End TB Strategy, requires diagnosis of TB and starting treatment as soon as possible to prevent infection of others. More, better-quality clinical care and prevention services should be readily accessible for all TB patients. Ms Lana Syed of WHO’s Global TB Programme discussed the components of the Strategy’s first pillar. The roles and responsibilities of community health workers and volunteers must be enhanced to provide TB prevention, diagnosis and treatment services sensitively in response to patients’ educational, emotional and material needs. Their engagement ensures that people with TB can easily access good-quality diagnosis, full treatment and good care services and that children and people living with HIV are given preventive treatment. All populations that need these services should receive them and also the services they require for co-morbid conditions, through an integrated system as close as possible to a “one-stop shop”.
Social support is essential for high-quality TB care Dr Lusine Kocharyan of the Armenian Red Cross Society described the successful outcomes and lessons learnt in the management of multidrug-resistant TB (MDR-TB). While the proportion of MDR-TB among new TB cases in the country is 9.4%, the proportion of MDR-TB among re-treated cases is alarmingly higher, at 43%. An additional challenge is the fact that 20% of all TB cases are detected among migrants. Dr Kocharyan emphasized the importance of providing social support to TB patients and their families and assisting people who have been made vulnerable by harsh socioeconomic conditions. The assistance has three components – support, education and empowerment – and has been offered to MDR-TB patients in Armenia since 2008. The organization also prepares representatives of TB-affected communities for advocacy and involvement in developing national strategic papers. As a result, stigma and discrimination have decreased. She shared important lessons learnt, including the greater sustainability of initiatives through community participation. While progress has been made, stigmatization remains a challenge.
New and better TB drugs are needed The presentation of Ms Phumeza Tisile, a representative of the South African NGO TB Proof, received particular attention. A survivor of extensively drug-resistant TB (XDR-TB), the young woman narrated her painful 5-month experience and her deteriorating health before her case was correctly diagnosed as XDR-TB. A side-effect of the drug she received resulted in loss of hearing, and the treatment was also very expensive, because of patent laws. Through international donor support, however, Ms Tisile was given the expensive treatment and received a hearing device implant.
Participants pointed out the challenges to high-quality, integrated, patient-centred care, which include inadequate political will to build CSO capacity in TB services and lack of integrated technical assistance and training. The opportunities identified include the creation of peer support groups (e.g. mothers) to increase the capacity to support special groups (e.g. women and children), increasing the basic knowledge of health workers about TB and integrating TB into the training of community health workers and community volunteers active in HIV and mother and child health. Participants shared innovative approaches in advocacy and networking, such as involving patients and ex-patients and disseminating information on patient rights.
8
Referring to her manifesto on drug-resistant TB, “Test Me, Treat Me”, Ms Tisile reminded participants that TB will be ended only if the diagnosis and treatment of drug-resistant TB become universally accessible, treatment regimens are improved with new, more affordable drugs, and financial support from donors is prioritized.
Universal health coverage, social protection and poverty alleviation are fundamental for TB control Progress towards universal health coverage is fundamental for effective TB care and prevention and for ultimately ending the epidemic. People at highest risk for TB often face the greatest financial or legal barriers to care. The End TB Strategy calls for the elimination of catastrophic costs to patients and their families. TB should be addressed through a “health-in-all-policies” approach, said Ms Diana Weil, coordinator of WHO’s Global TB Programme, who presented the core components of the second pillar of the End TB Strategy. TB must be part of the poverty reduction agenda and of work on universal health coverage and social protection, including measures to improve food security, cash transfers, transport vouchers, housing support, disability grants and income-generating activities. NGOs and other CSOs have an important dual role to play: advocating for the creation of such schemes and also implementing social protection or poverty alleviation schemes in their communities. For sustainability, they can help advocate for coverage of TB affected persons under general government schemes that are likely to be financed and institutionalized. The participants noted that NGOs and other CSOs provide diverse social protection and poverty alleviation services, which are tailored to local settings, to address lack of education, food or money among patients and their families. Many NGOs and other CSOs have established various forms of savings and credit cooperatives that help TB patients to pay for food and treatment and provide compensatory financial support when they can no longer earn income because of their illness.
Missed opportunities for NGOs not engaged in TB Mr Manoj Kumar of Plan International, an NGO that is not engaged in TB in Ethiopia, described his organization’s health interventions for women and children, the WATCH project. In seeking to contribute to the MDGs, the project supported existing Government health systems and reinforced Government ownership and community mobilization initiatives to increase awareness of issues in maternal, newborn and child health and gender equality.
The NGO has made important achievements in improving health facility infrastructure, referral systems and the skills and efficiency of health workers through technical and refresher training. Nevertheless, Mr Kumar noted that his NGO is missing opportunities: “We want to make our responses more effective and increase our impact. We are currently not engaged in TB in this country, but we have a good opportunity for integrating TB into our maternal, newborn and child health programme.”
Minimum package for NGOs not engaged in TB The diverse presentations at the meeting – from NGOs and other CSOs that had either successfully embarked on ENGAGE-TB projects or were still not engaged in TB but were interested in doing so – prompted animated discussion in plenary. Several organizations proposed that a minimum package of requirements and processes be defined for introducing TB prevention and care services into their work. The participants reached consensus that a standard minimum package of capacity, tools and services should be identified so that NGOs and other CSOs are sufficiently equipped for successful engagement in TB activities. Based in Thailand, the NGO TB/HIV Research Foundation mobilized local funds to engage “Volunteer Ladies against Tuberculosis” – senior women of good socio-economic status, who raise funds in their communities or donate their personal money to support very poor TB patients and help them to feel not alone. The volunteer ladies visit the houses of TB patients; as many patients are isolated from their communities because of their disease, the visits of the volunteer ladies help to reduce stigma and discrimination. The volunteers donate food to the patients and encourage them, often eliciting tears and smiles at the same time.
9
The Japan–Nepal Health and Tuberculosis Research Association realized the importance of social protection for TB patients who are poor and cannot secure a meal a day during their costly treatment. The NGO therefore initiated the Volunteers Trust Fund, which provides nutritious food for poor and extremely poor TB patients. It gives priority to people who are not eligible for the public nutrition allowance provided by Nepal’s NTP because they do not fall into the defined patient categories. The Volunteers Trust Fund uses part of its assets to provide transport and refreshment for volunteers who visit communities to follow up patients – a successful way to maintain the motivation of volunteers.
Research critical to break the TB trajectory Breaking the trajectory of the global TB epidemic and achieving the ambitious targets of the End TB Strategy will require intensified research and innovation. Participants noted that the way in which TB is currently prevented, diagnosed and treated should undergo a revolutionary transformation. Better diagnostics are crucially needed, including new point-of-care tests, safer, easier, shorter treatment regimens and safer, more effective treatment for latent TB infection. The slow decline in TB incidence globally and the persistent threat of MDR-TB both highlight the critical need for new, effective TB drugs and vaccines. The participants noted that NGOs and other CSOs have important roles to play in advocacy, sharing innovative approaches to documentation and participating in setting priorities for TB-relevant research and development, particularly at national level.
The participants shared information about opportunities for advancing universal health coverage and social protection schemes, including making better use of the untapped potential of local social institutions that are not yet engaged in community-based TB activities. Countries could build on the existing infrastructure of NGOs and community organizations working in social protection to integrate TB control. Future needs were identified, such as linking larger NGOs and other CSOs with local organizations, mobilizing resources from the private sector and establishing a virtual hub for information on social protection experience and tools.
Roles of NGOs and other CSOs at national level • active advocacy and participation in national TB research networks; • advocacy for the development and implementation of country-specific TB research plans; • advocacy for government-sustained public funding of TB research; • participation in monitoring implementation of national TB research plans; and • strengthening community engagement in research (e.g. design and conduct of clinical trials and use of results).
Rights-based approach – the way forward Participants stressed the importance of looking at TB through a “human rights lens”. An example presented at the meeting was that of ActionAid Malawi, which uses a human rightsbased approach, basing its activities on the three pillars of solidarity, community empowerment and campaigning. Ms Marta Khonje said, “In preparing for this conference, I learnt that TB involves three areas of concern: inequality, the poorest and most vulnerable people and loss of income due to treatment.” Integrating TB into the work of ActionAid Malawi would result in a number of synergies. “People have the right to health, and therefore TB is also a human rights issue. We have to empower the people so that they are able to monitor and evaluate their health services. And we need more evidence-based advocacy at all governance levels.” She concluded, “Without ending TB, we cannot end poverty, and that is violation of a human right.”
NGOs and other CSOs were also encouraged to conduct more research themselves. One meeting participant noted: “Doing research is not only for the upper-class university professor. You all as NGOs can easily engage in research by simply documenting which of your interventions work and how. I encourage you all: do more research, especially on social protection schemes and their impact.” Concrete examples of how NGOs and other CSOs can intensify research and innovation were presented. Dr Alwyn Mwinga of Zambart said that her organization had found that intensified research activity helped the NGO to become an important technical resource and partner for the NTP . Dr Anne Detjen of UNICEF stressed the importance of research to address the challenges of diagnosing, preventing and treating childhood TB.
ba
Monitoring and evaluation: essential ingredients Meeting participants noted the numerous challenges of documenting and monitoring community TB activities, including lack of standardization and an established system and the different reporting requirements for different donors. Participants emphasized the importance of closer collaboration among NGOs and their networks as well as with governments to facilitate the monitoring and evaluation of community activities. A number of possibilities were described, such as standardized online training and online platforms for information sharing.
share powerful messages to galvanize stronger political will at all levels of governance. Effective, innovative strategies for reaching communities should be scaled up quickly, building on existing structures.
Reflections of NGOs and other CSOs on the WHO consultation “I feel embarrassed that my organization has not yet incorporated TB in its work, although TB integration is feasible and much needed. I will go back home now and do as much as I can to integrate TB into our work.” (Several NGOs not yet engaged in TB) “We have learnt about so many valuable community-based strategies. This meeting will contribute to better access to health services and the provision of social protection schemes.” (ANK, Kenya, currently not engaged in TB) “This consultation inspired me to go back and encourage all my NGO colleagues to start working on TB and help end TB.” (LABENA, Sudan, TB-engaged NGO)
Enormous untapped potential for integrating TB Participants recognized the enormous untapped potential for integrating TB services into existing community work in various sectors – by sharing best practices and applying them to TB activities and by integrating them into other health and non-health activities. Integration of TB care into programmes for HIV infection and maternal, newborn and child health and working with vulnerable groups like children, women, miners and prisoners is essential. Integration into existing projects of NGOs and other CSOs will not add significant cost and can contribute to TB prevention and care. Empowerment of communities emerged as an important element of all the pillars of the End TB Strategy. Communities must be better sensitized and made more aware about TB so that they can demand better access, availability and affordability from local health services. Participants said that current and former TB patients should have a stronger voice, and “champions” should be identified and encouraged to
bb
Conclusions and action to be taken Read the Statement of Action: http://apps.who.int/iris/bitstream/10665/199333/1/WHO_HTM_TB_2015.30_eng.pdf?ua=1
Acknowledgements Overall organization of the meeting: Miriam Faid, Haileyesus Getahun, Thomas Joseph and Lana Syed under the overall guidance of Mario Raviglione, Director of the Global TB Programme Administrative and secretarial support: Rosalie Edma Chairs: Mohammed Abdel Aziz, Lucy Chesire, Charlotte Colvin, Haileyesus Getahun, Eric Goosby, Daniel Kibuga, Phangisile Mtshali, Mario Raviglione and Jintana Yanai Chairs, rapporteurs and secretariat for group discussions: Lucy Chesire, Vivian Victoria Christiaens, Md Akramul Islam, Thomas Joseph, Lilian Kimani, Rebecca Matheson, Lana Syed, Ezra Tessera, Diana Weil and Christine Whalen Speakers: Kesetebirhan Admasu, Anne Detjen, Susan Gacheri, Haileyesus Getahun, Eric Goosby, Thomas Joseph, Martha Khonje, Lusine Kocharyan, Manoj Kumar, Alwyn Mwinga, Mary Naukot, Alphonce Blaise Otiato, Mario Raviglione, Lana Syed, Phumeza Tisile, Ademe Tsegaye and Diana Weil Participants: Alawia Abdelgadir Osman, Mohammed Abdullahi Mohammed, Tumusiime Abel, Abdulai Abubakarr Sesay, Lilian Achieng Ouma, Sandro Accosi, Esther Mary AcengDokotum, Kesetebirhan Admasu, John Stephen Agbenyo, Bedru Ahmed, Monisola Elizabeth Ajiboye, Berhanemeskal Assefa, Mohammed Abdel Aziz, Sanni Babatunde, Oluseyi Babatunde Oyebisi, George Bakaswa, Ulo Benson Otieno, Nick Blok, Moffat Bubelwa Tambwe, Bekele Chaka, Lucy Chesire, Vivian Victoria Christiaens, Renia Coghlan, Charlotte Colvin, Dominique De Santis, Bilal Derso, Anne Detjen, Kidist Dimore, Svetlana Doltu, Jorge Domingos, Rosalie Edma, Ismael Hassen Endris, Hailegnaw Eshete, Imlak Lemma Eshetu, Emmanuel Etim, Miriam Faid, Amha Fantaye, Pasquale Farese, Lelisa Fekadu, Daniel Fiseha, Susan Gacheri, Hammond Gatumo, Linda Geddes, Tsegaye Geremew, Etshegenet Getachew, Haileyesus Getahun, Adnan Ghani, Peter Gondwe, Eric Goosby, Ram Sharan Gopali, Elena Graglia, Kassa Hailu Ketema, Thomas Heller, Lilian Ishengoma, Shayla Islam, Md Akramul Islam, Thomas Joseph, Therese Kabale Omari, Irene Kamau, Joel Kangangi, Judith Kateule, Eshetu Kebede, Fikreab Kebede, Tadele Kebede, Yared Kebede, Adugna Kebede Yimam, Dilshat Khaitov, Talha Khan, Khin Swe Win, Martha Khonje, Daniel Kibuga, Lilian Kimani, Fatou Kiné Wathie, Mersha Kinfe, Larissa Klazinga, Lusine Kocharyan, Manoj Kumar, Andargachew Kumsa, Michelle Lafay, Hailemariam Legesse, Wendy Le Marquand, Timpiyian Leseni, Nathalie Likhite, Sarmwai Luangjina, Jacques Lubangu Lumenge, Marta Lunardi, Blantina Mabuela, Martha Malolela, Fabio Manenti, Nicolas Nkiere Masheni, Rebecca Matheson, Joel Mayowa, Haile Mekdes, Jimma Mekonnen, Tesfaye Melaku, Eshetu Mengistu, Gennet Mengistu Almaw, Serena Menozzi, Ashenafi Mitiku, Serafina Mkuwa, Ahmed Mohammed, Hailu Molalign, Yvonne Morgan, Irene Mpho Kwape, Phangisile Mtshali, Maluta Patrick Mugwedi, Haile Mulugeta Wuhib, Margaret Mungai, Alwyn Mwinga, Zahran Mohamed Nassor, Mary Naukot, Kassahun Negash, Katherine Ngo, Peter Ngo’la Owiti, Assumpta Ngozika Reginald, Simon Nguye, Diane Nguyen, Lerato Nkhetse, Ntambwe Dike Ogechi Obioma, John Ole Paitah, Alphonce Blaise Otiato, Maurizio Paganelli, Ishmael Qawiy, Jaliath Rangi, Mario Raviglione, Mtanios Saade, Moussa Sarr, Marco Scacchetti, Yesmisrach Seifu, Syed Karam Shah, Meshesha Shewarega, Million Shibeshi, Ruth Sila, Fasil Solomon, Sotheariddh Sorn, Lana Syed, Nesanet Taffese, Ezra Tessera, Phumeza Tisile, Taye Tolera, Ademe Tsegaye, Sentayehu Tsegaye, Haile Tsigie, John UmoOtong, Diana Weil, Christine Whalen, Hanna Woldegebrial Kifletsion and Jintana Yanai Meeting report written by: Miriam Faid and Haileyesus Getahun with contributions from Lana Syed and Thomas Joseph. This consultation meeting was financially supported by Bristol-Myers Squibb Foundation Secure the Future.
Annex Consult the Marketplace Overview: http://www.who.int/tb/areas-of-work/community-engagement/who_ngos_consultation_nov2015/en/
bc