Tuberculosis: Our Impact

 {Photo credit: Hatoluf Melkamu}Temesgen Zewdu visits Keta Health Center to pick up his TB medicines and care for the plant dedicated to him.Photo credit: Hatoluf Melkamu

Betiglu Legesse is always trying to ensure that the patients he cares for stay on their tuberculosis (TB) treatment from beginning to end. It’s a challenge: In 2020 alone, more than 60 of his patients stopped their treatments, often due to many interplaying factors, such as forgetfulness, length of the treatment itself, fear of side effects, and a long distance to the health facility. Betiglu works as a TB focal person at the about 50 kilometers east of Ethiopia’s capital city, Addis Ababa.

 {Photo credit: MSH staff}Internal displaced people being screened for TB, COVID-19, and HIV in 1 of the 10 centers for internally displaced people in Mekelle, Tigray.Photo credit: MSH staff

The major conflict in Ethiopia’s Tigray region is affecting the functionality of the region’s health system, impacting everything from human resources to infrastructure. TB services are no exception. TB client follow-up has been disrupted, and many facilities have been damaged, including laboratory diagnostic equipment like microscopes and GeneXpert machines. The capacity to ensure service continuity and collect monitoring and evaluation data has been compromised.

Women wait to receive services outside a health center in Tanzania. Photo Credit: Brooke Huskey/MSH

In January 2020, the Tanzania Ministry of Health, Community Development, Gender, Elderly, and Children (MoHCDGEC), in collaboration with the World Health Organization and the Technical Support Services Project (TSSP), identified the need for a national health cross-cutting dashboard that would allow for more efficient reporting from the District Health Information Software 2 (DHIS-2), which is the national health information data repository. We spoke with Isaelly Nagunwa, Strategic Information Advisor, Management Sciences for Health (MSH) TSSP, and Claud John Kumalija, MoHCDGEC Head

A Jinja Regional Referral Hospital staff member receives redistributed TB medicines from Lira Regional Referral Hospital.Photo credit: Benjamin Atwine/MSH

Multidrug-resistant tuberculosis (MDR-TB) is a critical public health problem in Uganda, where the prevalence of MDR-TB in 2015 was an estimated 1.6% among newly diagnosed TB cases and 12% among previously treated TB cases. Uninterrupted access to treatment is necessary to prevent a more serious form of MDR-TB, ensure that the treatment works, and help prevent drug resistance. However, the months-long treatment, plus side effects such as nausea and vomiting, causes some patients to abandon the regimen.

 The USAID SAFEMed Activity in Ukraine launched an innovative public private partnership to improve the distribution of antiretrovirals for HIV and TB medications.

The rates of HIV and TB in Ukraine are high, yet some regions lack access to enough medicines for these and other conditions. The country has the second-largest HIV epidemic in Eastern Europe and Central Asia. Tuberculosis, which is the leading cause of death among infectious diseases in Ukraine, is especially dangerous due to the high estimated number of patients with multidrug-resistant TB.

MSH was formed in May 1971 by Dr. Ron O’Connor to focus on supporting countries as they strengthen their health systems and the local ownership needed to achieve sustainable change. In 2021, we are celebrating our five decades of health impact. But we are not going to celebrate this anniversary by reflecting on the past. We want to focus on the future of global health – the Next 50 Years.We turn 50 during a time when, due to the COVID-19 pandemic, the importance of global health is on everyone’s mind and impacting everyone’s lives.

 {Photo Credit: Gwenn Dubourthournieu}National Health Insurance System (NHIS) desk of the National Hospital of Abuja, Nigeria.Photo Credit: Gwenn Dubourthournieu

Nigeria, like many other low- and middle-income countries, suffers from systemic weaknesses which cripple its health care system and leave many without adequate access to health services or care. With support from the Global Fund, the MSH-led Nigeria Resilient and Sustainable Systems for Health (RSSH) project is working with Nigeria's Center for Disease Control, the Department of Health Planning Research and Statistics (DHPRS) at the Federal Ministry of Health, and the National Product Supply Chain Management Program to strengthen and expand the capacity of its national and state-level health systems. One way that RSSH is supporting Nigeria in providing quality health care, especially for those most in need, is through its state-level interventions around public financial management, the state health insurance scheme, and organizational and labor market assessments.

 {Photo credit: MSH staff}Pharmacists at KIU Teaching Hospital view data in the Pharmaceutical Information PortalPhoto credit: MSH staff

Until 2012, Uganda’s public health supply chain was uncoordinated because the information needed to estimate quantities of essential medicines and health supplies was not readily available. A national centralized platform to track routine monitoring of stock levels, share information to support data-driven decisions, and provide accountability of funds and commodities did not exist. Without knowledge of stock levels, funding could not be properly allocated to procure needed commodities.

 {Photo credit: MSH staff}A district TB and leprosy supervisor conducts supportive supervision.Photo credit: MSH staff

According to the National population based TB prevalence survey, each year, 87,000 Ugandans develop tuberculosis (TB), a preventable and curable disease. Strides have been made to notify more cases. In 2019, the National TB and Leprosy program notified 61,372 cases, leading to a 76% (61,372/80,412) treatment success rate. This was a huge improvement, with a 53% treatment success rate reported three years earlier.Many patients go untreated due to poor health-seeking behavior and limited access to health services.

{Photo Credit: Warren Zelman}Photo Credit: Warren Zelman

As a country with high rates of tuberculosis (TB), Ethiopia is working to expand services and improve TB case finding. However, engagement with private clinics has been limited at primary- and medium-level care clinics, leading to less than 20% of all TB cases being reported (NTP 2018 Report). Under the TB REACH Project, funded by the Stop TB Partnership, MSH is working in partnership with the Amhara Regional Health Bureau to address gaps in private-sector engagement and build the capacity of private health providers in TB service delivery within the densely populated region. Markos Tamrat, a clinical nurse working at Medhanialem Medium Clinic in Bahir Dar, shares his story.

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