Launched in 2020, USAID’s Health Systems for Tuberculosis (HS4TB) project supports high TB burden countries with financing and governance strategies, tools, and approaches to achieve TB elimination goals. A five-year Task Order under an IDIQ, the project has been working in Bangladesh, Ethiopia, India, and Kenya, where it has supported policy reforms for increased and improved domestic contracting of TB services, greater domestic financing, and more efficient use of resources, while building in-country financial and managerial skills and leadership. HS4TB is also engaged in two global activities to strengthen sustainable financing for TB. Together, these interventions contribute to global efforts to meet the ambitious TB targets outlined in Sustainable Development Goal 3.
In Bangladesh, HS4TB is supporting the government to design and implement a pathway for government-funded procurement of TB services through competitive contracting with non-government entities. After conducting an assessment based on this framework, the project assisted the government to develop a roadmap for establishing domestic contracting and to define a regulatory pathway and plans for piloting. The early stages of this process were documented in a case study, technical highlight, and policy brief, with later documentation of stakeholder engagement. With the project’s assistance, the government is also finalizing a standard tender document for health services contracting and contracting training materials.
In Ethiopia, the project has leveraged ongoing health reforms to assist the national government in scoping a co-financing approach and improved domestic financing for essential health services, including TB. To date, this work has been documented in an inception report, a TB Domestic Resource Mobilization and Sustainability Roadmap, and policy briefs on the prospects for co-financing, and the implications for the TB program from the revision of the exempted health services package.
In India, HS4TB is working with the Central TB Division (CTD) and governments in eight states to improve government contracting of private sector agencies and network intermediaries providing TB support services. Expected outcomes include increased TB service coverage, increased responsiveness to program needs, and more timely contracting and payment processes. As a basis for this work, the project produced a report on best practices in contract management, and did a root cause analysis of payment delays. HS4TB also conducted an analysis of innovative financing options and is establishing a mechanism to help private TB contractors to access working capital.
In Kenya, the project supported the National Tuberculosis, Leprosy, and Lung Disease Program (NTLD-P) to: develop a TB financing roadmap; assess the planning and budgeting capacities of county-level TB coordinators; develop a capacity-building plan and related training modules for county-level TB resource mobilization; institutionalize a TB financial resource tracking tool at the county level (as documented in this evidence brief); and assess the potential for contracting out selected TB services to private organizations (resulting in this guide for conducting such a process). Bringing together all of these elements, the processes and prospects for implementing the TB financing roadmap were outlined in this reference document.
GLOBAL WORK:
HS4TB has published a technical report on the state of TB financing, the economic case for the TB response, and the interdependence between health and the economy.
HS4TB has conducted a study on current approaches to establishing the contracting of health services to non-state providers (by identifying promising legal, regulatory, policy, procedural and operational practices); this was then distilled into a policy primer. That policy primer will form the basis for a Joint Learning Network collaborative on contracting, in which countries can discuss how to establish, improve, or expand contracting for TB and other health-related services.
Finally, HS4TB is piloting a global TB Sustainability Index, a set of indicators on various dimensions of TB financing and governance that will help countries assess and ensure sustainable financing of their TB programs.