A roadmap for eradicating TB

Over the past two decades, the world has made remarkable progress in the fight against tuberculosis (TB). However, TB is still a serious challenge from a global health and development perspective.  According to WHO, more than 10m people continue to fall ill with TB every year. More importantly, a heavy burden of TB is on poor, vulnerable and socially marginalized populations.

In this context, the strategic interventions primarily focus on a unified response to end all the sufferings by addressing social determinants of TB. However, in many low-income countries, there are still inadequate policies and strategies to support implementation of universal health coverage, social protection, and regulatory frameworks to prevent and end TB.

Nepal has set the goal to end TB by 2035. The first-ever prevalence survey in 2018-19 shows that TB incidence and prevalence in Nepal are 245 and 416 per 100,000 people, respectively with a majority of TB patients from productive age groups. Interestingly, the prevalence among men is more than in women. Considering this reality, Nepal’s strategic plan to end TB (2020/21-2025/26) offers fresh hopes to many TB patients in terms of an easy access to timely diagnosis, treatment, prevention and care.  

An ambitious plan

By 2025, the ambitious strategy aims to significantly increase treatment coverage, success rate, uptake of new diagnostics and new drugs, and reduce catastrophic costs. The strategic priorities primarily include integrated patient-centered care, treatment and prevention, multi-sector engagement, and research for creating synergies for a unified response. Putting patients at the heart of the delivery, the strategy calls for consistent actions to ensure early detection, treatment and prevention for all TB patients.

A recent review of the strategic plan to end TB suggests that there are significant gaps in strengthening prevention and treatment services, community engagement, multi-sectoral coordination and accountability in the federal context. While social protection services for improved service delivery are critically needed, the rollout of new tools and innovative digital technologies are crucial for an effective TB response. This will help ensure treatment for all people with TB, including the drug-resistant strain.

A priority agenda

Engaging the private sector is a priority agenda in TB response. However, there are limited interventions to strengthen implementation of the public-private partnership strategies at all levels. Experiences from Bangladesh, India and Myanmar suggest that non-governmental organizations can play a critical role in providing essential TB services at the community level.

Effective implementation of the strategic plan is crucial at the local level. Because of inadequately-trained human resources for TB services, it is a challenging task for local governments to provide quality TB services. Therefore, concerted efforts are needed to ensure supportive supervision, periodic review, monitoring and evaluation, and timely feedback mechanism for actions at the local level.   

Despite persistent challenges of ensuring human and financial resources, Nepal has implemented a TB-free initiative at the local level for enhancing political leadership and ownership in TB response. The scaling up of the TB-free initiative is critical to strengthen local health policies and harness the power of multi-sectoral engagement for timely notification, diagnosis, prevention, treatment and care.

Inadequate efforts

However, existing efforts are inadequate to enhance the capacity of local governments in participatory and inclusive planning of a TB-free initiative. More focus is needed in the area of ensuring meaningful engagement of TB patients so that their representation, voiced experiences, and choices of prevention, treatment and care are realistically addressed at all levels. While TB is heavily influenced by socio-cultural, economic and health risk-related factors such as undernutrition, diabetes, HIV infection, and smoking, multi-sector actions are needed to combat the epidemic.   

More importantly, there are high-level global and regional events that have significantly reaffirmed commitments toward ending TB. In Sept 2023, the political declarations adopted at the UN High-level Meeting on TB include commitments toward universal access to TB services in both high and low-burden countries, with time-bound targets of reaching, with health services, at least 90 percent of people with or at risk of TB between 2023 and 2027. Moreover, there is a critical need to increase investments, and fast-track the development and availability of new tools to prevent, diagnose and provide treatment for TB.  

Undoubtedly, TB is largely a social disease that poses significant development challenges. There are growing needs to reduce human suffering and the socio-economic burden of TB by providing mental health and social protection services at the community level. Toward this end, anthropology of infectious diseases is instrumental in understanding interaction among socio-cultural, economic, political and biological variables in prevention and treatment of TB.

In this context, it is evident that TB is disproportionately common among disadvantaged populations. From an anthropological perspective, the relationship between poor health and poverty is a consequence of biosocial and biocultural factors. Still, stigma and discrimination associated with TB is another challenge to provide necessary care and support in the families. Therefore, apart from TB prevalence surveys, it is equally important to better understand people’s indigenous knowledge, attitude and health–seeking behavior to prevent and provide treatment for TB in the communities.

Urgent action necessary

To sum up, urgent actions are necessary to ensure universal access to TB prevention, treatment and care at all levels. The strategic priorities must focus on multisectoral actions to address wider determinants of the TB epidemic and effective management of the co-morbidities. In addition, there is an emerging need to strengthen health systems for ensuring essential TB services during disasters and pandemics such as Covid-19. 

The author is a health policy analyst