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Mexico
>> Regional Overview >> Mexico Overview Activity Data Sheet
PROGRAM: Mexico
TITLE AND NUMBER: Sustainable and Effective Institutional Capacity Developed to Diagnose, Control and Monitor Tuberculosis in Target Areas, 523-008
PLANNED FY 2001 OBLIGATION AND ACCOUNT: $3,991,000 (CSD)
PROPOSED FY 2002 OBLIGATION AND ACCOUNT: $4,000,000 (CSD)
STATUS: Continuing
INITIAL OBLIGATION: FY 1999 ESTIMATED COMPLETION DATE: FY 2004Summary: Tuberculosis (TB) continues to be a major public health problem in Mexico, with 23,000 new cases officially reported in 1997, mostly among Mexicans 15 to 44 years of age. The increase in reported new cases is due to increased emphasis on the disease at the Federal Secretariat of Health, an improved system of case notification, and increased awareness by medical personnel since 1996. Cases are most prevalent in less well-off states and in areas where internal migration overwhelms the state health secretariat's ability to deal with the disease. Patients often wait for diagnosis and treatment until the advanced stages of their disease, serving as sources of infection for the rest of the population.
Tuberculosis in Mexico has implications for the United States, including migration of infected individuals to U.S. border areas and beyond, the difficulty in identifying these individuals and ensuring continuity of treatment, and the risk of an epidemic facilitated by HIV/AIDS, as seen in Brazil. The six Mexican states along the U.S. border report approximately 20% of the nation's cases and have morbidity and mortality rates higher than the Mexican national average.
Reduced incidence and transmission of TB cannot be achieved solely through prevention and control activities among the U.S./Mexico border populations. Infected persons arrive in the border areas daily from the southern part of the country where economic and social conditions favor continued TB transmission. Effective tuberculosis control includes a strong political commitment and appropriate direction from the national and state levels; appropriate standards, technical norms and procedures; rapid expansion of directly observed therapy strategy (DOTS) to all health jurisdictions; and an efficient monitoring and evaluation system.
Key Results: USAID will continue to improve national and local commitment to tuberculosis control; increase the use of laboratory-based diagnosis to identify tuberculosis cases; improve treatment through directly observed therapy; and improve epidemiological surveillance mechanisms.
Performance and Prospects: USAID and the Mexican Secretariat of Health signed the Tuberculosis Strategic Objective Grant Agreement on August 21, 2000. USAID will partner with U.S. government agencies, international health organizations, non-governmental organizations (NGOs), and the Mexican National Tuberculosis program to administer direct observation of a complete six-month short-course therapy to all new tuberculosis patients, upgrade laboratory capacity, provide staff training, and improve treatment monitoring. The activity will also strengthen national and international referral systems. The states selected for initial project implementation are Baja California, Sonora, Chihuahua, Coahuila, Nuevo León, and Tamaulipas on the northern border; Chiapas, on the Mexican border with Central America; and Jalisco, Veracruz, Michoacán, Guerrero, Oaxaca, and San Luis Potosí.
In 2001, early project implementation includes: research on all aspects of Mexico's national tuberculosis program including treatment, laboratory management, and epidemiological surveillance; promotion of inter-institutional collaboration among public and private sector service providers; purchase of laboratory equipment for the priority states; development of a national tuberculosis management information system; and evaluation of border TB epidemiological surveillance systems.
FY 2002 plans will most likely include promoting continued collaboration, resources, skills, and information among key stakeholders in the public and private sectors; implementation of an education campaign to encourage people with symptoms suggestive of pulmonary tuberculosis to seek prompt and appropriate medical care; continued training of medical and paramedical personnel in DOTS; creation of regional training centers; improved DOTS services for special populations including migrants, indigenous people, migrant farm workers, and those with HIV/AIDS, malnutrition, diabetes, and addictions; and research of possible alternative methods of providing DOTS, especially in remote areas.
FY 2001 funds will finance the following key basic interventions: improved national and local political and administrative commitment to a tuberculosis control program ($680,000); increased use of laboratory-based diagnosis to identify tuberculosis cases ($720,000); improved directly observed therapy (DOTS) meeting strict case definitions ($1,520,000); and improved mechanisms for monitoring program activities ($560,000). A portion of the FY 2001 budget ($500,000) will fund USAID-managed audits and evaluations and program management. Planning for FY 2002 funds follows roughly the same proportional breakdown and funding amounts.
Possible Adjustments to Plans: Because the key Mexican counterpart staff has been retained by the new Fox administration, USAID sees no immediate changes from previously agreed upon approaches and priorities.
Other Donor Programs: These include the Pan American Health Organization and the National Committee for the Fight Against Tuberculosis and Respiratory Diseases. Japan, under the Common Agenda framework, has agreed to provide $800,000 over four years for equipment and technical cooperation complementing USAID's program.
Principal Contractors, Grantees or Agencies: Local partners include the Mexican Federal Secretariat of Health along with the secretariats in 13 states; the Institute of Epidemiological Diagnosis and Reference; the social security program; and the Social Security Institute for state employees. U.S. contractors/grantees are to be determined.
Mexico 523-008
Performance Measures:
Indicator FY97
(Actual)FY98
(Actual)FY99
(Actual)FY00
(Actual)FY00
(Plan)FY01
(Plan)FY02
(Plan)Indicator 1: Proportion of tuberculosis cases cured NA NA 75 83.9 90 90 90 Indicator 2: Percent of tuberculosis cases detected NA NA 41 47.5 80 80 90 Indicator 3: Number of tuberculosis laboratories in the priority areas participating in the Institute of Epidemiological Diagnosis and Reference's quality assurance program NA NA 80 90 90 90 95 Indicator 4: Number of inter-institutional meetings convened at the national level with representatives from each of the major health systems involved in tuberculosis prevention and control NA NA 0 0 1 4 4 Indicator Information:
Indicator Level (S)or(IR) Unit of Measure Source Indicator Description Indicator 1: SO Percent Epidemiologic Surveillance Information System, Epi-TB Number of cases cured divided by number of cases who finished treatment. A key indicator of the effectiveness of a DOTS program is cure rate. This measures the percentage of cases bacteriologically confirmed by positive smear microscopy at diagnosis that successfully convert to negative bacteriology at the conclusion of their treatment. Indicator 2: SO Percent Epidemiologic Surveillance Information System, Health Secretariat Epidemiology Department Number of cases of tuberculosis notified divided by the amount of cases expected. Indicator 3: IR Percent Institute of Epidemiological Diagnosis and Reference reports Percentage of laboratories with quality control programs. The National Institute of Epidemiological Diagnosis and Reference (INDRE) has a quality assurance mechanism to evaluate the performance of TB laboratories performing smear microscopy and culture identification. This mechanism helps to ensure that laboratories are performing at an acceptable level in support of the diagnostic efforts of TB clinics. FY2000 data is for the Health Secretariat only. Indicator 4: IR Number Meeting notes Number of inter-institutional meetings. A key element of the DOTS strategy is political/administrative commitment. This indicator will measure concrete evidence of the national, state and local governments' commitment toward effective tuberculosis control and prevention activities based on the DOTS strategy. Meetings will be held to discuss progress, identify problems, propose actions to resolve problems, delineate next steps and develop consensus. U.S. Financing
(In thousands of dollars)
Obligations Expenditures Unliquidated Through September 30, 1999 0 DA 0 DA 0 DA 160 CSD 0 CSD 160 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 INL 0 INL 0 INL 0 DFA 0 DFA 0 DFA Fiscal Year 2000 0 DA 0 DA 3,840 CSD 300 CSD 0 ESF 0 ESF 0 SEED 0 SEED 0 INL 0 INL 0 DFA 0 DFA Through September 30, 2000 0 DA 0 DA 0 DA 4,000 CSD 300 CSD 3,700 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 INL 0 INL 0 INL 0 DFA 0 DFA 0 DFA Prior Year Unobligated Funds 0 DA 0 CSD 0 ESF 0 SEED 0 INL 0 DFA Planned Fiscal Year 2001 NOA 0 DA 3,991 CSD 0 ESF 0 SEED 0 INL 0 DFA Total Planned Fiscal Year 2001 0 DA 3,991 CSD 0 ESF 0 SEED 0 INL 0 DFA Future Obligations Est. Total Cost Proposed Fiscal Year 2002 NOA 0 DA 0 DA 0 DA 4,000 CSD 4,000 CSD 15,991 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 INL 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA
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Last Updated on: May 29, 2002 |
