Friday’s symposium dealt with, “Saving lives in areas of conflict or disaster: partnering for results.” Dr. Eliud Wandwalo (MSH Tanzania) coordinated the session along with Morgan Richardson (USA). First up was Dr. Joseph Lou (South Sudan’s National Tuberculosis Program [NTP]), who explained the challenges that remain in the health facility infrastructure in his presentation entitled, Partnership for DOTS expansion in post-conflict situations: experience from South Sudan.
Following his presentation, Dr. Stephen Macharia (MSH TB CARE I-South Sudan) spoke about Integrating TB into primary health care in South Sudan: challenges and lessons learnt. His presentation clearly laid out the challenges that they have faced and what they have done so far to tackle them. Although they have renovated some health facilities, other factors, like lack of human resources and unsafe transportation, remain. Often times, an activity that should take only two days, takes up to one week, because of transportation issues (i.e. plane getting stuck in mud). Dr. Macharia also explained that there is still a lot of stigma around TB among health care workers, poor access to health services, and inadequate and poor quality of health services. He also mentioned that in order to access health facilities, sometimes people have to wade through water for up to two kilometers- this does not work well for constant supervision and monitoring.
About 75% of 1147 functional health facilities require renovation or reconstruction. Facility coverage on TB services is only 22% of 345 hospitals and primary health care centers. Most of the health facilities providing TB services are concentrated in the urban centers. Assessment conducted in 2011 showed that 46% of the functional health facilities meet minimum criteria to integrate TB services. This is an opportunity for TB services scale up in the country. Despite the challenges of human resources and infrastructure, minimum funds can be mobilized to refurbish health facilities and provide supplies to establish TB services. Training of existing health workers and community involvement is a key to integrate TB services into primary health care.
Moving from South Sudan to Afghanistan, Dr. Mohammad Khakerah Rashidi (MSH TB CARE I-Afghanistan) spoke about Community contribution in TB control in Afghanistan. There are roughly 24 million people in Afghanistan and it is one of the 22 high burden TB countries in the world. Dr. Rashidi explained that the female to male TB ratio is 2:1, thus, they trained 156 female health workers in their standard operating procedures (SOPs) and engaged 4,000 female community health worker (CHWs) in community-based Directly Observed Treatment, Short-course (CB-DOTS). They implemented this CB-DOTS approach by contracting with NGOs and holding raising awareness during community events. This resulted in improved surveillance (addition of indicators for females). The team also promoted a multi-sectoral organization approach to TB by involving the Ministry of Women’s Affairs and the Ministry of Education.
Although this is a success to be proud of, there are many challenges that remain: There is a lot of stigma and discrimination against people with TB in Afghanistan, as in South Sudan; females are rarely allowed to visit health facilities (a cultural issue); and there is poor TB treatment adherence. In addition, there is insecurity, lack of awareness about TB in children, poorly educated CHWs, no payment for CHWs (volunteers), and few people supervising and monitoring over 4,500 health posts in Afghanistan.
TB services must be supported by the communities they serve to attain sustainability. By actively engaging a diverse range of actors in TB control activities and dividing responsibilities clearly among them, programs can expand and strengthen their responses to difficult TB control challenges.
Swetha Desai, Project Specialist for TB CARE I and TB-IQC, contributed to the content of this story.