USAID

In recent years, commitments from the government and major donors have led to improved tuberculosis (TB) control in Indonesia, with reductions in both prevalence and incidence. The nation’s economic status has also improved; however, this has caused many donors to reduce their contributions to the nation’s health programs.  Compounding this financial challenge is the rising prevalence of drug resistant strains of TB that further tax the health system with the cost of expensive services and medicines needed to care for these patients.

Management Sciences for Health (MSH) under USAID’s TB CARE I project, is assisting the Ministry of Health’s National TB Program (NTP) to develop ways to increase domestic financing for Indonesia’s TB control initiatives. Possible solutions include: increased contributions from national health insurance and government budgets, corporate social responsibility programs, and improvements in cost-effectiveness and efficiency.

Rwandan physicians receive continuing professional development. (Photo credit: C. Tran Ngoc/MSH)Rwandan physicians receive continuing professional development. (Photo credit: C. Tran Ngoc/MSH)

Maintaining state-of-the-art skills and knowledge is crucial for physicians. But in most developing countries, the lack of structured or ongoing educational activities has pushed medical doctors to travel abroad to benefit from the most recent expertise.

To solve that problem---and improve Rwanda's health system---the Rwanda Medical Council (RMC) launched the continuing professional development program in 2011. The continuing professional development sustains practitioners' knowledge through workshops, seminars, practical sessions, and research.

The USAID Integrated Health Systems Strengthening Project (IHSSP), led by Management Sciences for Health, provided technical and financial support to the RMC for the implementation of the continuing professional development program by developing strategic and monitoring and evaluation plans, helping to run an office, accrediting health professional societies as continuing professional development providers, and preparing the national sensitization campaign.

Karen Chio of MSH developed the K4Health Blended Learning Guide in collaboration with Liz McLean of MSH and Sara Mazursky and Lisa Mwaikambo of JHU-CCP (2013).Karen Chio of MSH developed the K4Health Blended Learning Guide in collaboration with Liz McLean of MSH and Sara Mazursky and Lisa Mwaikambo of JHU-CCP (2013).

Cross-posted with permission from the K4Health blogK4Health is a USAID project, led by Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs (JHU-CCP), with partners FHI-360 and Management Sciences for Health (MSH).

Mildred shares her story of surviving XDR-TB at an event honoring "TB Champions" in DC; Ambassador Goosby listens. {Photo: E. Delmotte/MSH.}Photo: E. Delmotte/MSH.

Mildred Fernando lives and works in the Philippines for the USAID-funded, MSH-led, Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program. Mildred spoke at several World TB Day events in Washington, DC, including at a senate briefing and an event honoring TB survivors and advocates (watch video). The interview below first appeared on the SIAPS blog.

It all began in November 2001 for Mildred Fernando when she was diagnosed with tuberculosis (TB), a preventable and curable disease which caused the death of 1.4 million people in 2011. She was only 19 years old, working on completing her last semester in college when she contracted TB from her father who sadly succumbed to it two years later.

 {Photo credit: Stephen Macharia/MSH.}Santo (right) and his father (left) share how Santo was finally diagnosed and treated for TB after being incorrectly treated for malaria for over two months.Photo credit: Stephen Macharia/MSH.

After South Sudan gained independence from Sudan in 2011, disagreements over oil-sharing between the two nations caused fighting and high economic inflation in certain regions. Desperate for security, over 110,000 Sudanese refugees escaped to South Sudan and now reside in camps in Maban County.

Bounj Hospital: Diagnosing and treating residents and refugees

These refugees, and the county’s 40,000 residents, are served by Bounj Hospital, the only TB diagnostic and treatment center in the district. This hospital is currently treating 75 patients for TB, 56 of whom are refugees.

The USAID-funded TB CARE I South Sudan project is helping to build the hospital staff’s capacity in TB treatment and infection control, despite the challenges the health workers face. Led by Management Sciences of Health in partnership with the National TB Program (NTP), the TB CARE I project team has trained over 200 health workers in TB diagnosis and treatment.

TB CARE I also teaches the health workers how to educate their patients about TB infection control and provides the trainees with regular supportive supervision and mentorship.

Dr. Jonathan Quick, President and CEO of MSH, tours with Dr. Christian Nzitimira, director of Kibagabaga Hospital in Rwanda. {Photo credit: Jon Jay/MSH.}Photo credit: Jon Jay/MSH.

In a postoperative ward of Kibagabaga Hospital, the district hospital serving Rwanda’s capital city of Kigali, Eric Bizimana sits up in bed. Bizimana, 25, had sought care after severe pain in his right leg forced him to stop work as a barber. He was diagnosed with a bone infection called osteomyelitis. Antibiotics alone couldn’t clear the infection. Without an operation to remove the diseased bone, Eric faced the possibility of losing his leg.

Eric was one of the 40 patients who enter Kibagabaga for surgery every day. In Rwanda’s tiered healthcare delivery system, patients are referred from local health centers up to the district hospital when their conditions require more complex care. Most babies are delivered at health centers, for example, but a woman suffering complications or who was expected to need a C-section would be referred to the district level.

Patients wait in a well-ventilated area outside the TB clinic in Homa Bay, Kenya. {Photo credit: A. Kwiecien and A. Salakaia / MSH.}Photo credit: A. Kwiecien and A. Salakaia / MSH.

The state of tuberculosis (TB) is in a tug-of-war as current challenges threaten to undo past successes. One of the primary hurdles currently facing TB prevention and cure is the emergence of strains that are resistant to at least two of the most effective medicines (rifampicin and isoniazid).

So-called drug-resistant (DR)-TB arises when patients are unable to complete a full-course of appropriate, high quality anti-TB medicines. As compared with the 6 month treatment regimen for drug-sensitive (DS)-TB, DR-TB requires 18-24 months of treatment with medicines that are less effective, can cause sometimes severe side effects, and can cost up to 300 times more.

Marie Madelaine Thomas receives antiretroviral therapy through an SDSH-supported clinic. Since August 2012, SDSH has provided ART to more than 3,665 individuals.

Grace Tsawe owns a prayer camp in Ghana's Lower Manya Krobo District. She recovered from TB, and uses her experience to encourage others to be tested and treated medically for TB. {Photo credit: B. Adusei/MSH.}Photo credit: B. Adusei/MSH.

Tuberculosis (TB) control in Ghana is challenging: detection of TB cases is low, and TB mortality rates high. In many communities, like Lower Manya Krobo District, these challenges are compounded by the popular belief that TB is a spiritual disease. Many Ghanaians who contract TB seek healing in prayer camps and shrines, rather than going to health facilities for testing and treatment. By the time these patients seek medical care, it often is too late to recover and avert death.

Lower Manya Krobo District has over 93,000 residents, and a high incidence of TB (209 cases per 100,000 people in 2011). The district is also home to many of the nation’s mushrooming prayer camps, where local healers provide daily services for ill residents. There are 50 prayer camps in Lower Manya Krobo District---and only 18 health facilities.

Grace Tsawe owns a prayer camp in this district, and she usually sees over 100 patients on her main clinic day.

{Photo credit: Katy Doyle / MSH.}Photo credit: Katy Doyle / MSH.

Stop TB in my lifetime.

This global call to action---the Stop TB Partnership's theme for March 24, World TB Day 2013---is as relevant now as it was over a hundred years ago.

Progress toward reducing the global burden of tuberculosis (TB) has been impressive in recent years: TB mortality has fallen by 41 percent since 1990.

Yet, TB remains one of the world’s leading causes of death, killing more than 1.4 million people per year, including 70,000 children. In 2011, 600,000 people died of TB in Africa alone---including many people with HIV.

Low detection rates, new strains of multidrug resistant TB (MDR-TB), high prevalence of HIV/TB co-infection, and risk of TB among diabetes patients---nearly 10 percent of TB cases are linked to diabetes, add to the challenge of TB control, especially among the poor and most vulnerable.

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