Growing call to translate commitment to action for a TB-free world

Shobha Shukla, CNS (Citizen News Service)
"... Nobody is immune to tuberculosis (TB), including those in the first world countries. More than 20% TB cases are linked to smoking globally. We are aware of our responsibilities and reducing deaths from TB, as well as from CVDs, is one of our country’s priorities. Only with coordinated and concerted action will we be able to defeat TB. I hope this meeting will boost the quality of life and healthcare globally..." so said Vladimir Putin, President of the Russian Federation at the World Health Organization (WHO)'s "Global Ministerial Conference: Ending TB in the sustainable development era: A multi-sectoral response" held in Moscow recently.

Although a concern for all people and a global threat to health, TB inflicts a disproportionate burden on some of the largest lower-middle and middle-income countries and their most vulnerable populations. Building on the experiences of these countries in transforming challenges into opportunities is key to ending TB.

Here are the insights shared by some of the participants (in alphabetical order of names):

  • Aaron Motsoaledi, Minister of Health, South Africa:
Governments are responsible for the health of their people which can be fulfilled only by provision of adequate health and social measures. Some key interventions are (i) Patients must be at the centre of the  response; (ii) Strengthen screening and diagnostics—especially for miners, healthcare workers, pregnant women (iii) Innovative R&D for diagnosis of latent TB, shorter TB regimens and preventive formulations; (v) Robust and reliable data to monitor progress.

  • Antônio Carlos Figueiredo Nardi, Vice Minister of Health, Brazil:
Key actions are (i) Integrated, patient centred care and prevention (ii) Bold policies and supportive systems (iii) Intensified research and innovation.

  • Erica Lessem, Project Director, Treatment Action Group (TAG):
We call to (i) Create innovative collaborative financing mechanisms to fast track development and uptake of new tools; (ii) Triple TB R&D funding; and (iii) Ensure community participation, equity, transparency, accessibility, availability, affordability, quality of treatment and care.

  • Isaac Adewole, Minister of Health, Nigeria:
The President’s wife herself is a TB ambassador. Key action points taken in Nigeria are (i) PHC revitalisation reforms geared towards achieving universal access to quality healthcare services, including TB; (ii) accelerating TB case finding through innovative strategies, like Wellness on Wheels campaign for bringing TB diagnosis to the doorstep of people; (iii) National Council of Health (NHC) resolution on mainstreaming of TB case finding and management at every primary healthcare centre PHC, including private health facilities. Licences of private practitioners are not renewed if they fail to comply with the national TB guidelines.

  • Jagat Prakash Nadda, Minister of Health and Family Welfare, India:
India’s National Strategic Plan 2017-2025 to control TB is based on the 4  pillars of detect, treat, build and prevent. A TB Research Consortium has been formed. USD 3 billion have been made available from domestic funding to fight TB. High priority is given to reaching the unreached; caring for patients in private sector, active case finding, social protection and nutritional support to needy patients. Every district has a GeneXpert machine.

  • Li Bin, Minister in Charge of the National Health and Family Planning Commission, China:
3 key action points are (i) Improve TB prevention and control and service delivery system (ii) Improve medical care and security and reduce patients’ financial burden (iii) Multi dimensional health promotion to raise public awareness about TB prevention and control.

In China, 500,000 volunteers are spreading knowledge about TB—75% population is aware of it. There has been a 3.2% drop per year in TB incidence in China. Challenges are poor diagnostic coverage and inadequate safeguards for patients.

  • Piyasakol Sakolsatayadorn, Minister of Public Health, Thailand:
Universal health coverage (UHC) alone is not a panacea for all health problems. In Thailand, which achieved UHC several years ago, 70% of the presented TB patients receive treatment with a 75% success rate. This means only 53% active coverage. Also only 70% of HIV positive TB patients receive ART and 20% of relapsed cases receive drug susceptibility test.

So apart from UHC, we need systematic approaches led by committed champions to ensure sustainable successes. Thailand has formulated a systematic approach called PROP: P = political commitment (policy power) to ensure adequate resources and inter-sectoral actions with clear targets;  R = research and development (power of wisdom), through a TB Research Network to develop and mobilise all technological interventions, including genetic technologies for early diagnosis and effective treatment; O = ownership of the movement against TB by all, (social power), through strong community engagement for effective prevention, early diagnosis and treatment adherence for a successful treatment; the last P = persistent actions by champions from all walks of life to link all the powers to form a Super Power for sustained active case finding and high cure rate with zero stigmatisation.

  • Puan Maharani, Coordinating Minister for Human development and Culture, Indonesia:
Key actions taken by Indonesia are (i) Establishment of district based public private mix centres; (ii) Improving TB programme management and community access to quality TB care; (iii) Strengthening of TB prevention and risk factor control through ‘Healthy Lifestyle Movement’

  • Saira Afzal Tarar, Minister of State for National Health Services, Regulations and Coordination, Pakistan:
As of now Pakistan is treating 300,100 TB patients, and missing out on 100,000 of them. There has been an important policy shift in support of developing a patient centred approach in the healthcare system of the country. The Health Ministry is exercising its role through improved co-ordination with the provinces to generate multi-sectoral response and enhanced domestic funding for TB. Governments’ ownership of the programme is necessary. Nations need to stand on their own feet and stop depending on donors. There has to be political commitment by way of increased resource allocation.

  • Dr Tedros Adhanom Ghebreyesus, Director General of WHO:
The cut cry of sustainable development goals is to ‘leave no one behind’ and yet of the estimated 10 million who were infected with TB in 2016 we left behind more than 4 million TB patients who did not know they have the disease. Stigma and discrimination are the main blocks in reaching the unreachable populations. All countries must (i) expand access to prevention and treatment services within the context of UHC; (ii) ensure sufficient and sustainable financing for the TB response; (iii) invest urgently in R&D; and (iv) work together across sectors to put an end to TB once and for all.

Political attention is very vital, but it is not enough. Commitment must translate into action. Investments in stronger systems built on people centred primary care are the best way to promote health, prevent disease, boost health security and drive inclusive economic growth.

Shobha Shukla, CNS (Citizen News Service) 
25 November 2017
(Shobha Shukla is the Managing Editor of CNS (Citizen News Service) and has written consistently on health and gender justice for several years. With support from the Global Alliance for TB Drug Development (TB Alliance) this article is part of her in-depth thematic coverage of the "WHO Global Ministerial Conference: Ending TB in the sustainable development era: A multisectoral response". Follow her on Twitter @Shobha1Shukla or visit www.citizen-news.org)

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