However transparency has declined rather than improved

However, transparency has declined rather than improved. A recent analysis in the ranked PEPFAR as very poor—50th of 67 aid agencies worldwide. The report noted that, “PEPFAR does not disclose information on contracts to prime partners and sub-partners in a machine-readable and open format consistent with the US Open Data Policy.” Just a few years ago, countries met after the Paris Declaration on Aid Effectiveness and agreed to an Accra Agenda for Action that put public transparency at the centre of the global aid effectiveness project:
On Oct 1, 2013, WHO and global partners launched a roadmap to end tuberculosis deaths in children worldwide. The roadmap identifies key actions that must be taken, including increased and targeted research, partnerships between key stakeholders, and strategic economic investment. The roadmap also shows the crucial lack of global emphasis on tuberculosis prevention and treatment for one of the most vulnerable populations. This intervention comes at a pivotal juncture because rates of drug-resistant tuberculosis have been increasing worldwide, particularly in the WHO European Region, with severe implications for child tuberculosis morbidity and mortality. Globally, children younger than 15 years account for about 6% of the 8·6 million cases of tuberculosis, and about 5% of the 1·4 million deaths that occur annually from the disease. Children have been traditionally viewed to pose less of a risk for transmission than adults because they often have paucibacillary disease, which is also harder to diagnose with sputum smear microscopy, culture, and molecular tests. If tuberculosis is undetected and untreated, children are at high risk of death, especially in the context of multidrug-resistant and extensively drug-resistant tuberculosis. 15 of the 27 countries with a high burden of multidrug-resistant and extensively drug-resistant tuberculosis worldwide are in the WHO European Region, with 99% of the regional disease burden in 18 high-priority countries (Armenia, Azerbaijan, Belarus, Bulgaria, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, Romania, Russia, Tajikistan, Turkey, Turkmenistan, Ukraine, and Uzbekistan). 6% of the total estimated incidence of new and relapsed tuberculosis cases occurred in these countries (376 200 cases), in 2011, an estimated 23 000 children had tuberculosis, of whom nearly 5000 are estimated to have had multidrug-resistant or extensively drug-resistant disease. These estimates rna polymerase sharply with the fewer than 1000 cases of childhood tuberculosis that were detected and reported in these countries. In response to the alarming increase in multidrug-resistant and extensively drug-resistant tuberculosis in the WHO European Region, in 2011 the Consolidated Action Plan to Prevent and Combat Multidrug and Extensively Drug Resistant Tuberculosis (2011–15) was endorsed by the sixty-first Regional Committee for Europe, and implemented in all 53 member states. The plan includes essential milestones and activities for childhood tuberculosis, with the aim to scale-up access to treatment; prioritise childhood tuberculosis in member states\' national strategic plans; and develop a special response for diagnosis and treatment of tuberculosis in children, including identifying policies (or lack of policies) that contribute to underdiagnosis. The summarises data on national childhood tuberculosis policies collected by the WHO Europe task force for childhood tuberculosis from 15 (of the 18) high-priority countries that provided policy information from September, 2012, to January, 2013. At present, the 15 countries have policies that adhere to the 2006 WHO guidelines for childhood tuberculosis with regard to contact-tracing of close household contacts, detection with tuberculin skin testing, and provision of isoniazid preventive treatment for children with a close household tuberculosis contact. However, only eight countries have policies for contact tracing for children with a close non-household contact (as recommended by WHO for children younger than 5 years). Additionally, four countries recommend a multidrug-resistant tuberculosis treatment regimen only in children with bacteriologically confirmed multidrug-resistant tuberculosis. However, since bacteriological confirmation is often difficult in children, WHO recommends that, if active tuberculosis disease develops in children with a close contact with multidrug-resistant tuberculosis, a multidrug-resistant tuberculosis drug regimen should be promptly started. Although 11 countries have this policy in place, its efficacy is predicated on effective contact investigation. For children who are detected with active tuberculosis or are given preventive therapy for latent infection, several countries require hospital admission for either the initial 2 month phase or the entire length of preventive and active tuberculosis treatment (three and seven countries, respectively). However, admission of children to tuberculosis wards for an unnecessarily long duration places them at high risk of primary infection or reinfection with multidrug-resistant or extensively drug-resistant tuberculosis. Forthcoming updated WHO guidelines for the management of childhood tuberculosis will add clarity for countries about these and other issues, including detection with molecular diagnostics and use of paediatric drug formulations.