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TB and poverty
HDN Key Correspondent


"TB and poverty go hand-in-hand, sometimes we do not know which causes the other," said Riyas Musa Ahmed from the National TB Program of Afghanistan. Ahmed is in New Delhi to participate in the Second Stop TB Partnership Forum.

He is not alone in voicing his concern about the suffering inflicted upon hapless victims by these two deadly killers. Now more and more people are talking about the linkages between TB and poverty. It has come to be identified as one of the core issues that remain to be addressed, leading to a consensus that TB control must find a central place in poverty reduction strategies.

It was the Prime Minister of India, Mr. Atal Bihari Vajpayee who set the ball rolling this week during his inaugural address to the Stop TB Partners Forum in Delhi. He reminded participants that conditions associated with poverty - such as overcrowding and malnutrition - lead to increased vulnerability to TB. Pointing to the silent spread of the disease Vajpayee said that it wrecked lives and livelihood.

Over the past two years the relationship between TB and poverty has been explored in depth. It is clear that poor people face specific difficulties in accessing health services and experience long delays before diagnosis of TB can be made. These access delays are costly for the patients and lead to further TB transmission. They are a major part of the impact of TB as an impoverishing disease.

Dr. Anhari Achadi, Advisor to the Ministry of Health and Human Services of Indonesia says 17% of people in his country live in abject poverty. He laments that the awareness level of these poor people about TB (and other health conditions) is abysmally low. Even if they know that someone in their family has TB, they do not know that facilities exist for free treatment of the disease. Unfortunately these people are trapped in the vicious cycle of poverty, ignorance and suffering.

Santa Raye who works as an IEC Consultant with DAN-TB in Orissa State of India says, "Eighty-five percent of the TB cases that my project has been providing DOTS services to live below the poverty line - with a daily income less than a dollar per day." Her mantra for reaching the poor is simple: "Generate a demand for TB treatment from within the community."

Dr. Karam Shah, National Manager of the TB Program in Pakistan says that in his country TB control is part of the Poverty Reduction Strategic Plan (PRSP). The PRSP initiative targets rising population, illiteracy and infectious diseases together.

In Bangladesh one of the largest NGOs in the world, BRAC, which has devoted itself to work related to poverty alleviation and empowerment of the poor, joined hands with national tuberculosis control program over ten years ago. Dr. Faruque Ahmed, Director Health and Nutrition at BRAC added that trained female community workers are playing a pivotal role in TB care.

"So as to increase the access of the poor to DOTS services sputum collection has been decentralized and female workers who earlier used to provide micro credit to poor women are now also doubling up as DOTS providers," he explained. "This has reflected in a gradual increase in detection rate and a high cure rate for TB."

In Peru, nearly half the population - or 6 million people - live in extreme poverty. The country has a high TB burden and cured TB patients have come forward and developed networks to support other TB patients.

Across the globe communities are clearly trying to develop pragmatic local responses and some of them are already showing signs of success.

The formal and informal discussions at the Delhi Forum endorsed the need to carry forward the agenda of TB and poverty. The Coordinating Board of the Stop TB Partnership has approved the setting up of a Network for Action on TB and Poverty to become a platform for innovative implementation and sharing of experiences. Furthermore the Network aims to be the catalyst for expansion of best practices, as TB control activities extend and further adapt the DOTS strategy to better meet the needs of poor.

The identification of poverty alleviation as a key element in TB control has helped to bring forward once again the human face of TB.

HDN Key Correspondent
Email: correspondents@hdnet.org


Source: STOP-TB eForum 2004: stop-tb@eforums.healthdev.org