At the recent Delhi End TB Summit, Sudeshwar Singh, 40, a tuberculosis (TB) survivor, took to the stage to share his story, not just about the physical hardship of his diagnosis but also the stigma and fear that plagued his family and threatened to crush his spirit. Sudeshwar’s story, however, ends with a victory and a call for optimism for the fight against TB; he completed his treatment, and became an activist, raising TB awareness in his home state of Bihar.
The global community is coming together to tackle an ancient disease that still inflicts interminable human suffering. Globally, one person dies of TB every 20 seconds. While progress has been made over the past decade much remains to be done. Annually, there are still 10.4 million new cases and 1.7 million deaths. One of the key challenges is to find the 4 million missing cases, individuals who develop TB but are missed by health systems and continue to transmit the disease. With the global commitment to end TB, there is a renewed sense of hope in the battle against TB.
On March 24th the global community marks World TB day to commemorate the day in 1882 when Dr. Robert Koch discovered the cause of tuberculosis. At the time, the tuberculosis (TB) epidemic was raging out of control in Europe and the Americas, and this discovery paved the way for millions to be successfully treated. Today, TB remains a major public health threat with 4,000 lives lost daily to this highly curable disease. But this TB day stands out from previous ones.
The quest for an accurate, timely and affordable medical diagnosis remains elusive in many developing countries. In East Africa, laboratories are often poorly staffed; ill-equipped; and lack quality systems. Obsolete equipment clogs up limited space. Clinicians often resort to presumptive diagnoses rather than requesting lab confirmations. Individuals suffering from infectious diseases, such as tuberculosis, run the risk of going undetected and transmitting the disease to others, or being misdiagnosed, which in turn leads to compromised care and higher health care costs.
Many laboratories are not adequately prepared to respond during public health emergencies, yet their services are critical to detecting new pathogens and containing disease outbreaks.
World Laboratory Accreditation Day, observed recently, offers a good opportunity to draw attention to the critical role of laboratories in health, and the importance of accreditation in promoting quality. Accurate and reliable laboratory services are critical for conducting clinical diagnosis, guiding treatment, and responding to disease outbreaks. There’s a growing recognition of the importance of laboratory services, and several important initiatives have been launched, including the WHO-AFRO Stepwise Laboratory Improvement Process towards Accreditation (SLIPTA).
The scaling up of voluntary medical male circumcision, particularly in high HIV prevalence settings, is a highly cost-effective intervention to fight the epidemic—randomized controlled trials have found a 60% protective effect against HIV for men who became circumcised.
But, the supply of this medical service is just one part of the picture. Without active involvement from individuals and communities to deal with social and cultural factors that influence service acceptability, the demand for this common surgical procedure will be low.
Indeed, on a recent visit to Botswana, a country with high HIV prevalence and low levels of male circumcision, my World Bank colleagues and I had a good discussion with the National HIV/AIDS Commission about ways to address the low uptake of voluntary, safe male circumcision services in spite of a well-funded program by the government. It was obvious to all that if the demand for, and uptake of, this service were not strengthened through creative mechanisms that foster acceptance, ownership, and active participation of individuals and community organizations, the program would not help control the spread of HIV through increased funding of facilities, equipment, and staff alone.
So, what do we need to do to ensure that need, demand, utilization, and supply of services are fully aligned to improve health conditions?
Il y a quelque temps, je suis parti en mission visiter un nouvel hôpital au Lesotho. Je savais que cet établissement était destiné à accueillir des patients atteints de tuberculose multi-résistante et je sais aussi le lourd tribut que la co-infection VIH-tuberculose fait payer au pays. Je m’attendais donc à ce que les caractéristiques démographiques des patients correspondent à celle du VIH : essentiellement des patients jeunes, et de plus en plus de femmes.
Mais je n’étais pas préparé à voir deux familles entières, jeunes et vieux, hommes, femmes et enfants, confinées ensemble pour un certain temps, sous la surveillance de professionnels de santé veillant à ce que tous prennent bien leurs doses quotidiennes de médicaments.
Hace un tiempo, formé parte de una misión que debía visitar un nuevo hospital en Lesotho. Me advirtieron de antemano que el propósito de estas instalaciones era atender a las personas que sufren de tuberculosis (TB) multirresistente a los medicamentos, y conociendo la inmensa carga de coinfecciones de VIH y TB en el país, esperaba que el perfil demográfico de los pacientes fuera similar al del VIH: en su mayoría jóvenes y cada vez más mujeres.
Para lo que no estaba preparado era para encontrarme con dos familias enteras —jóvenes y viejos, hombres, mujeres y niños— confinados juntos en el futuro inmediato para ser observados por trabajadores de la salud mientras toman sus medicamentos diariamente.
A while ago, I was part of a mission to visit a new hospital in Lesotho. Warned in advance that this facility was intended to treat people with multi-drug resistant tuberculosis (TB)– and knowing the huge burden of HIV-TB co-infection in the country—I was expecting the patients’ demographic to match the profile of HIV: largely young and increasingly female.
What I wasn’t prepared for was the sight of two entire families—young and old, men, women and children—all confined together for the foreseeable future, to be monitored by health workers as they take their daily drugs.