USAID-supported TB control activities in Mexico : final evaluation

Agency for International Development (USAID) provided technical assistance to the National Tuberculosis Control Program of Mexico based on a memorandum of understanding (MOU) signed in 1999 by Presidents Bill Clinton and Ernesto Zedillo and a strategic objective grant agreement (SOAG) in 2000. The strategic objective was to develop a sustainable and effective institutional capacity to diagnose, control, and monitor tuberculosis in target areas. USAID's commitment was approximately US$16 million; support started in 2004 and ended in 2012. The project aimed to increase political commitment to the TB program, increase use of laboratory-based diagnosis, improve directly observed therapy, and strengthen mechanisms to monitor program activities to reach 70 percent TB case detection and 85 percent cure rate. This evaluation aims to: (1) update the findings and recommendations from the 2010 evaluation of activities by USAID and the Tuberculosis Coalition for Technical Assistance (TBCTA); (2) document USAID's legacy in Mexico for TB control; (3) assess the sustainability of USAID investments in Mexico for TB; (4) identify priority activities at risk of not being continued after the phase-out of USAID support; and (5) recommend options for ensuring sustainability. The document also analyzes the past and current epidemiological situation of tuberculosis in Mexico and includes recommendations to USAID and to the National Tuberculosis Program (NTP) for future action to sustain gains and increase the impact of control activities on TB transmission, incidence, and mortality. The evaluators concluded that USAID cooperation had a major impact on the national capacity for TB control, disproportionate to the funds invested (~US$0.01 per capita per year). The main areas strengthened were: (1) the laboratory network; (2) human resource capacity at national, state, and district level; (3) the information system; (4) and MDR-TB diagnosis and case management. Technical cooperation accelerated DOTS implementation and increased political commitment at national level and in geographical areas in addition to the priority states. There were increased treatment success rates, and the strategic objectives of case detection and treatment success were achieved. In areas with direct support to service improvement, PP/PPM and ACSM, the detection of suspects and notification of smear-positive pulmonary TB cases increased rapidly. (Excerpt, modified)