External Review of National Response to TB control


Prevalence of Tuberculosis (TB) in Sri Lanka is low in comparison to other countries in South East Asia (SEA). Multi-drug resistance levels and incidence of TB-HIV are also low. Key achievements of the National TB Programme are that both case detection and treatment success global targets have been reached and sustained mainly due to good implementation of Directly Observed Treatment Strategy (DOTS). The overall default rate has dropped to over 12% to 6% within five years due to intensified default tracing efforts involving all the categories of health staff at field level.


An external review of the National response to TB control was organized with the following objectives:


1.      To identify the accomplishments of the national response to TB by reviewing the activities of the National Programme for TB & Chest Diseases (NPTCCD), other Government organizations and non-government organizations especially in areas related to TB prevention and management from last review conducted in December 2006


2.     To evaluate the progress of implementation of tuberculosis control activities in access to DOTS and involvement of other sectors in DOTS, quality assurance of diagnostic services, drug procurement and management, advocacy, communication and social mobilization, management of multidrug-resistant tuberculosis and HIV-related tuberculosis interventions


3.      To provide recommendations to further strengthen TB control.


The review team comprised of experts from International Union for Lung Diseases (UNION), Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), Global Drug Facility (GDF) & World Health Organization (WHO).


The team observed considerable progress in TB control in the country since the last review in December 2006.


Most importantly they are:


         Active follow-up on the recommendation of the last review mission.

         Technical support has been utilised to review and revise the recording and reporting system, to strengthen laboratory and drug procurement practices and services and initiate implementation of DOTS Plus and the management of MDR TB with support from the Green Light Committee (GLC);

         Programme guidelines to guide implementation of DOTS Plus, management of HIV -TB patients and the laboratory network for assuring quality of sputum microscopy, culture and drug sensitivity testing (DST) are in an advanced stage of development and will be finalized shortly;

         Greater involvement of the civil societies, other public sectors, private sector and academia in TB prevention and control activities through GFATM project;

          Availability of quality drugs through the Global Drug Facility (GDF). Measures have been taken to strengthen Procurement Management System relating the TB drugs.


Main recommendations to further strengthen the National TB response are:

-         strengthen TB surveillance, specially expanding the quality laboratory services and data management system

-         early implementation of the DOTS Plus programme in the country to manage MDR TB

-         further strengthen human resource capacity at central as well as district level