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Who should pay the bill for stopping TB?

The World Health Organization (WHO) reported today that the amount of funding for TB in the 22 countries with the highest burden has more than doubled since 2002. At first glance this seems like great news but closer analysis of the data shows that we still have a long way to go to fully fund the global TB response.

Most of the new money that has gone into TB over the past few years has actually been for just two countries - South Africa and the Russian Federation (in response to MDR-TB). If you take those two countries out of the equation, the funding gap for TB is still large and increasing annually.

The WHO predicts that there will be a US$1.6 billion gap for 2009 and US$3 billion for 2010. In the African region there are massive funding gaps preventing the scale up of TB-HIV collaborative activities, and in the Western Pacific and South East Asia regions further resources are needed for MDR-TB activities.

Domestic resources have been increasing and account for around two-thirds of TB funding globally. It is hoped that a large proportion of the funding gaps for middle-income countries will be filled from national budgets. For low income countries, which collectively account for half of the total funding need for TB, the roles of international donors and mechanisms such as the Global Fund are as crucial as ever.

The WHO estimates that 11 percent of all government health expenditure in Africa already goes towards fighting TB (compared to 2.6 percent in Eastern Europe) so in the short term, it is not realistic to expect African governments to invest much more in TB. It is therefore up to the donor community to step up to the plate and support low income countries to fully fund their national TB plans.

The donor contribution needed to support low income countries is around US$1 billion per year. Compare that to the US$5 billion provided by donors for HIV each year or the trillions found to bail out banks and the task is not as impossible as it may seem.