The Gambia

The DOTS strategy has been introduced in The Gambia in 1985 and over the years the program has matured. In 2009 tuberculosis (TB) diagnostic and treatment services are provided at 23 health facilities, including NGO, faith based and private clinics. Directly observed treatment (DOT) is offered at the Basic Health Services (BHS) and through community based DOTS. WHO estimates the burden of TB in The Gambia as follows: 4,415 all forms TB (rate 258/100,000), PTB+ 1,936 (113/100,000).

INDICATOR	YEAR	DATA
Population	2008	1.6 million
Gross Domestic Product (GDP) per capita	2007	1,225 US dollars
Human Development Index (HDI) + ranking	2007	0.456 = position 168 out of 182
Human Poverty Index (HPI) + ranking	2007	40.9 = position 123 out of 135
Total number of TB patients all forms (% smear positive)	2008	2107 (68%)
Case Notification Rate per 100.000 population	2008	127
Case detection rate new smear-positive TB	2008	48%
Percentage adult TB cases HIV-positive	2008	16%
Number of MDR-TB cases found	2008	Unknown
Treatment success among all TB patients	2007	84%
Strategic partners of KNCV Tuberculosis Foundation		MoHSW, Global Fund, WHO, GDF, NLR, MRC

Role of KNCV Tuberculosis Foundation

KNCV Tuberculosis Foundation has supported the Gambian National Leprosy and Tuberculosis Control Program (NLTP) since 1985. CIDA funding for technical assistance (TA) was available for the period of 2003-2006. Since 2006 the TB program is financially supported by the GFATM (5th round) and by KNCV through DGIS funds.

KNCV is supporting the program through regular country missions, continuous backstopping and with specific technical assistance for Global Fund Round 5 implementation. NLR funds selected leprosy control activities.

Achievements

A new Tripartite Agreement (KNCV/NLR/GAMBIA GOVERNMENT AGREEMENT) was signed (including budget for the 1st year) at the beginning if 2009. A mission by two KNCV consultants took place in January 2009 (PM, IL) and focused on HRD and supervision aspects. KNCV assisted with TA the development of a TB Strategic Plan 2008-2012, which eventually was printed end 2009, unfortunately with considerable shortcomings.

The recording and reporting forms need also adjustment to match WHO recommended formats (including more data on case finding and TB/HIV collaborative activities). KNCV further funded training of Cuban doctors in TB control that improved their diagnostic capacity and contributed to training new laboratory staff allowing expansion of diagnostic facilities. NLR funded the revision of the Leprosy Manual. At the end of the year an exploratory mission (RV) looked at the coming year.

Next steps

Two country visits are planned for 2010 with specific TA for further developing a Human Resource Development (HRD) plan as a part of the new Strategic Plan for TB Control, including improved supervision. Focus on adaptation of R&R for better M&E and supervision. Hospital DOTS Linkage and improved TB/HIV collaboration is needed too. Support for the laboratory network, both for sputum smear and culture and DST; assess and further develop community DOTS for early case detection and DOT.