World TB Day 2007: TB Anywhere Is TB Everywhere
World Tuberculosis Day, commemorated on March 24, encourages awareness of the international health threat presented by tuberculosis (TB) and recognizes the collaborative efforts of countries involved in fighting this infectious disease. MSH contributes to worldwide efforts to combat TB by engaging communities to improve their management systems and leadership skills, which are essential to effective TB control.
The Dominican Republic has one of the highest incidences of TB in Latin America, and inappropriate or incomplete pharmaceutical treatment contributes to the country's prevalence rate of multi-drug resistant TB (MDR-TB). But MSH’s RPM Plus program is helping to change that by helping to ensure that treatment regimens are easier to adhere to and more affordable. RPM Plus helped change therapeutic regimens in the Dominican Republic from complicated multi-pill treatments to simpler fixed-dose combinations (FDCs), and by purchasing these medications through the Global TB Drug Facility mechanism, the cost of the types of medications used by a majority of patients dropped from US$155 to an estimated US$20 per treatment regimen.
RPM Plus also implemented a pharmaceutical management information system (PMIS) in the Dominican Republic that was pilot-tested in two areas and scaled up to the rest of the country by the end of 2006. The PMIS revealed that health facilities and provincial warehouses often did not have the minimum stock of appropriate TB medication; further investigation indicated that shortages occurred because the government regularly paid high prices for medication that could be more affordably procured from international markets.
The Dominican National Tuberculosis Program is also facing management challenges that impact the diagnosis and treatment of HIV/TB co-infection, the treatment of MDR-TB, the procurement of second-line TB medicines, and the administration of financial resources provided by USAID and the Global Fund. With the support of the Global Fund, RPM Plus organized a national workshop to address these challenges and to empower local health authorities to improve their leadership and management skills. The workshop yielded positive results:
- Using the Management and Organizational Sustainability Tool, attendees and facilitators identified five priority management areas to address.
- Participants developed a detailed action plan to address these priorities during 2006, including standardized procedures for the new working areas incorporated into the TB program.
While there is still much work to be done, health leaders in the Dominican Republic now have additional tools to help them confront TB in their country and the confidence and leadership skills to guide their action plans to completion.