The objective of fidelis is to support innovative tuberculosis control activities in order to increase case detection of new smear positive cases of tuberculosis, while maintaining high cure rates within the DOTS Strategy. fidelis is especially for people who would not otherwise receive modern TB treatment (people with limited access to health services).
fidelis is based on the belief that solutions for addressing the constraints to DOTS expansion lie within affected communities themselves. By funding and carefully tracking the results of these initiatives, fidelis encourages, enhances, and promotes TB control strategies and will thus serve as a stimulus for, and promoter of, innovative ideas that have been pioneered in the communities most affected by the disease.
fidelis expects these innovative approaches to be highly cost-effective, sustainable within the local context using indigenous materials and personnel and be capable of demonstrating independently verifiable results.
fidelis arose from discussions in the Stop TB Partnership including especially the DOTS Expansion Working Group (DEWG) and Public-Private Mix Sub Group (PPMSG).
- Applicants: Stop TB Partners, Governments, and Non Governmental Organizations are eligible to submit proposals
- Development Partners: the Canadian International Development Agency has provided initial funding for fidelis. fidelis will seek to attract further donor support to TB programs by creating investment opportunities for projects that are delivering results demonstrated to be cost-effective
- Host: The International Union Against Tuberculosis and Lung Disease (The Union) houses the program staff of fidelis
- The primary focus of fidelis is people with limited access to health services and proposals will be evaluated with this in mind. Nevertheless, credit is also given for other successfully treated patients
w A Proposal Review Committee (PRC), independent of The Union, reviews each proposal assessing its technical merits, the capacity of the proponent to achieve the results, and the financial competence of the proponent. fidelis screens proposals to determine which are eligible and the Proposal Review Committee determines which to recommend for funding.
w Proposals considered for funding are those between US $150,000 and US $250,000.
In order to be considered for funding, proposals have to meet the following basic conditions:
a) The country in which the project is to be carried out has a GNI of US $1000 or less as judged by the World Bank[1]
b) The country in which the project is to be carried out is deemed by the World Health Organization[2] to have a high burden of tuberculosis or a compelling case of high or intermediate level of burden of tuberculosis is made in the application
c) The cost in the first year to fidelis per additional (estimated) weighted treatment success must be below US $80 and must be assessed as credible[3] (see DEFINITIONS)
d) The country in which the project is to be carried out is applying the DOTS Strategy, as judged by the World Health Organization[4]
e) The project is consistent with the policies of tuberculosis control of the country in which it is undertaken
f) The applicant must demonstrate the capacity to carry out the proposed work
g) The applicant provides convincing evidence that the project can be administered according to plan
h) The project would not go forward without fidelis resources
Priority for funding among proposals deemed by the Proposal Review Committee to be of high quality and to meet the objectives of fidelis is given for those with:
a) a lower cost per weighted treatment success (see DEFINITIONS)
b) a larger number of additional cases cured
c) clear evidence of complementarity to existing health services and TB control efforts and for which the probability of sustainability within the existing system is judged to be highest.
d) the highest numbers of additional treatment success among people with limited access to health services (see DEFINITIONS)
e) convincing evidence that the innovations developed will be taken up into routine practice within the community
fidelis negotiates contracts with successful applicants based on the recommendation of the Project Review Committee, disburses the funds and monitors the implementation of the project.
An Independent Results Assessment Group, independent of the applicant, the donor, the Proposal Review Committee, and The Union, will carry out an evaluation of the results of the project.
First phase independent verification will take place around 18 months after the start of the program. The Independent Results Assessment Group will evaluate the results with a focus on cost per additional weighted treatment success (see DEFINITIONS).
[1] World Bank Year in Review. Annual Report 2002 http://www.worldbank.org/annualreport/2002
[2] WHO Report 2002. Global Tuberculosis Control. Surveillance, Planning, Financing. WHO/CDS/TB.2002.295, p 11
[3] The cost threshold is based on the KNCV figure of 60 Euro per treatment in their public statement of March 21st, 2002. See also ‘Executive Summary for the Economics of TB Drug Development’ costing figures from pg.8. It should be noted that these figures refer to the full treatment cost rather than the additional cost that may be required to successfully treat an additional patient (e.g. using enablers). The focus of fidelis is on cost-effective initiatives that seek to build upon existing components by achieving additional TS for less than the full patient cost.
[4] WHO Report 2002. Global Tuberculosis Control. Surveillance, Planning, Financing. WHO/CDS/TB.2002.295, p 10