ISRAELI COMPLIANCE WITH THE BERLIN DECLARATION ON

UNCLAS TEL AVIV 000250 SIPDIS C O R R E C T E D C O P Y - - CHANGE REF(A),TEXT ADDED PARA 1, 6 SENSITIVE SIPDIS DEPT FOR EUR/PGI TESSLER AND OES/IHB LAURITZEN CAIRO FOR ESTH AMMAN FOR ESTH E.O. 12958: N/A TAGS: TBIO SENV WHO IS EG JO SUBJECT: ISRAELI COMPLIANCE WITH THE BERLIN DECLARATION ON TUBERCULOSIS REF: A) 08 STATE 6989; B) 07 STATE 1228 ¶1. (SBU) Summary. In response to Department inquiry (ref A),Israel appears to implement a model DOTS program, and observes Berlin Declaration commitments fully. The Ministry of Health (MOH) continues t assess Israel's successful National Tuberculosis Control Program (NTP). Israel is a signatory of the Berlin Declaration and WHO considers Israel a success story in its ability to diagnose, treat and follow up TB patients. While Israel has much it could teach to other countries about managing TB through a strong public health structure, the MOH Director of NTP is frustrated by the lack of contact with his Egyptian counterparts. End Summary. ¶2. (U) Between 1989 and 1995, the absolute number of TB patients in Israel nearly quadrupled, from 133 cases in 1989 to 500 cases in ¶1991. This was mainly due to mass immigration from high and moderate TB-prevalent countries, namely from the Former Soviet Union (FSU) and Ethiopia. During the early 90's, Israel was experiencing the impact of having-along with many other countries during the 1980's-prematurely dismantled its TB treatment infrastructure. In addition to a lack of health care workers experienced in managing TB patients, laboratory services were not defined, suceptability testing was not done routinely, drug supplies were erratic, and second-line drugs to deal with TB drug resistant strains were essentially nonexistent. Further fragmentation occurred as a result of a decentralization of care from the MOH to four Israeli HMO's. ¶2. (SBU) In 1995, a new National Tuberculosis Program (NTP) was recommended and then launched in April of 1997, ten years before the signing of the Berlin Declaration on TB. The goal of the new program was to locate the disease in Israel, reduce and eliminate morbidity, and engage all health care workers in Israel in achieving the task. The program incorporated the five elements of the Directly Observed Treatment (DOTS) strategy recommended by WHO: 1) political commitment; 2) laboratory diagnostic facilities; 3) DOT of all patients; 4) a consistent drug supply; and 5) a permanent reporting system. ¶3. (U) The political will to implement the NTP was evidenced by legal changes, new administrative directives and medical guidelines, and the establishment and funding of a National TB Unit (the Department of Tuberculosis and AIDS, known as DTA). The MOH chose to limit TB treatment to nine designated centers using only 'DOT' to ensure expertise and to allow concentration of resources. Two national reference laboratories were selected to process all specimens from patients followed at the TB centers, to assure consistency of testing quality. This required some creativity allowing for financial incentives to improve compliance. ¶4. (U) The DOT strategy in Israel is followed for the entire duration of treatment, not just for the initial 2-month period as in other countries. Limiting treatment to a few sites assures a larger number of patients per physician, which in turn allows for the accumulation of experience and motivation that helps treat difficult patients (resistant TB cases-). The DTA has added a network of social workers in an attempt to deal with such cases. ¶5. (SBU) A central supply agency delivers a regular supply of all TB drugs, and the DTA maintains a reserve cache of all drugs to ensure non-interruption of supplies. TO enhance case tracking, TB notification to the MOH through District Health Offices was made mandatory for both physicians and laboratories. ¶6. (SBU) In 1999, 86 percent of Israel's TB cases were of foreign origin, both recently arrived and some from years earlier, including a very small WWII Holocaust survivor group. In response to Deparmtne inquiry (ref A),Israel appears to implement a model DOTS program, and observes Berlin Declaration commitments fully. Israel appears to implement a model DOTS program, and observes Berlin Declaration commitments fully. Admittedly their outreach program to other countries and international TB programs is weak; however, MOH Director of International Relations, Alex Leventhal, expressed readiness to share the GOI's experience with other countries, and is willing to do so within its financial capability. Currently, there is good inter-regional cooperation on TB between Israel, the PA and Jordan. He expressed continuing frustration with the on-going lack of cooperation by his neighboring Egyptian counterparts, which has also been expressed by the Public Health Service with respect to Avian Influenza cooperation. MORENO