Economics & Development

Ratings of the Southern Africa Tuberculosis and Health Systems Support Project for Southern Africa were as follows: outcome was satisfactory; Bank performance was satisfactory; M&E quality was substantial. Regional investments generated economies of scale and synergies, demonstrating the value of a coordinated approach and careful selection of regional coordinating organizations such as the East, Central and Southern Africa Health Community and the African Union Development Agency New Partnership for Africa’s Development with clear roles. Empowering countries to innovate and share good practices through centers of excellence and communities of practice built a regional pool of experts and strengthened ownership. Health systems and multisectoral approaches to tuberculosis and occupational health proved highly effective and created public health assets useful for broader disease control and preparedness. Tuberculosis control is inherently challenging and requires coordinated action across the care cascade, continual training and mentoring on best-buy interventions and new technologies, and stronger tracking tools to identify and correct bottlenecks. Operational research underpinned evidence-based design by documenting good practices, bottlenecks, and progress and by guiding scalable solutions. Strong partnerships minimized duplication and maximized impact, with interministerial platforms and private sector collaboration yielding tangible results despite higher coordination costs. Planning for sustainability from the outset is essential to ensure continued staffing, equipment maintenance, and operating budgets after project closure. Key recommendations are to expand regional investments to other public health priorities, including noncommunicable diseases, alongside pandemic preparedness through programmatic approaches; use tuberculosis outcomes as proxies for health system performance and progress toward universal health coverage; systematically apply the World Health Organization Multi-Sectoral Accountability Framework to enhance accountability across public, civil society, and private stakeholders and to advance the Regional Private Sector Engagement tuberculosis action plans; strengthen metrics to evaluate the impact of investments, including assessing training outcomes on provider knowledge and practice and measuring response speed and effects on case fatality during public health events; and request governments to provide modest counterpart funding from inception and increase it progressively to bolster sustainability of investments.