Tuberculosis Monitoring

Although TB is curable, nearly two million people die each year from the disease. The WHO estimates the global incidence rate of TB is growing at nearly 0.4 percent annually, resulting in more than 8.5 million new infections per year. Deadly drug-resistant strains and HIV co-infection are fueling TB epidemics. TB is the leading cause of death among AIDS patients.

The world community has undertaken a series of Global TB Commitments (pop-up window) to guide an effective response to TB and to share responsibility among the 22 high-burden countries that are most affected by tuberculosis, the Group of 8 (G8) major donor countries, multilateral organizations, and the private sector. These international commitments include the Amsterdam Declaration to Stop TB, the Washington Commitment, and the UN Millennium Development Goals. All of these commitments reaffirm the World Health Organization’s principal TB-control strategy: DOTS, which comprises the following five elements:

1. Sustained political commitment;
2. Access to quality-assured TB sputum microscopy;
3. Standardized short-course chemotherapy to all cases of TB under proper case-management conditions;
4. Uninterrupted supply of quality-assured drugs;
5. Recording and reporting system enabling outcome assessment.

The Open Society Institute is a member of the Stop TB Partnership, a global consortium of organizations working to ensure implementation of the Amsterdam Declaration and to reduce the burden of TB around the world.

Public Health Watch partners with civil society organizations in five of the 22 high-burden countries to monitor national efforts to control TB and TB/HIV co-infection. Public Health Watch reports will also examine the extent to which international TB control efforts—including the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) and bilateral funding programs—complement national government efforts in these five countries.

Public Health Watch researchers work from a single methodology that enables in-depth qualitative assessment of government policy against international TB-control standards and commitments. Reports are compiled on the basis of desktop research as well as extensive consultation, interviews, and review by local organizations and health policy actors. The aim is to produce independent reports that enjoy a high level of consensus from governmental, nongovernmental, and international TB actors and are thus seen as a constructive contribution to the policymaking process. The reports complement and expand upon the official monitoring reports produced by governments and by the WHO.

Please see Monitoring Concept for more background on the Public Health Watch’s approach to monitoring.

TB Country Profiles

Public Health Watch is currently working in the following five of the 22 high-burden countries: Bangladesh, Brazil, Nigeria, Tanzania, and Thailand. Country profiles for all 22 countries are available on the World Health Organization website at http://www.who.int/tb/publications/global_report/2004/annexes/en/.

Bangladesh

Bangladesh bears the highest absolute number of TB cases (active and latent) in the world. According to the World Health Organization, Bangladesh faces obstacles in health care staffing, monitoring and evaluation, ineffective decentralization, management constraints, and incomplete drug distribution. Yet, Bangladesh is well known for its vibrant and flourishing civil society sector.

Public Health Watch partners with BRAC, a multifaceted nongovernmental organization with over 26,000 regular staff and 34,000 part-time teachers that is active in all of Bangladesh's 64 districts. BRAC is committed to alleviating poverty and empowering the poor through its micro-credit, health, education, and training programs. BRAC already has extensive experience in tuberculosis control. The lead researcher is Afsan Chowdhury, Director of Human Rights and Advocacy at BRAC.

Brazil

Brazil is the only high-burden country in Latin America. According to the WHO Global Tuberculosis Control 2005 Report, one of Brazil's greatest challenges is its variability in DOTS coverage. Since 2002, health care has been largely decentralized, resulting in a lack of standardization in services.

Public Health Watch is working with Ezio T. Santos Filho, a lawyer and longtime HIV/AIDS and TB activist with extensive experience in communications and social mobilization.

Nigeria

Nigeria has the highest number of new TB cases in Africa and ranks fourth in the world among countries with the most new TB cases. The WHO has identified the withholding of government funds and a lack of political commitment as major obstacles to TB control.

In Nigeria, Public Health Watch is collaborating with Journalists Against AIDS (JAAIDS). JAAIDS Nigeria is a media-based nongovernmental organization working in the field of HIV/AIDS and development. Its primary mission is to contribute to the prevention, care, and control of HIV/AIDS in Nigeria by providing innovative communication interventions that will facilitate positive behavior change to reduce the spread of HIV/AIDS. JAAIDS is taking a lead role in incorporating TB advocacy and communications into their work on HIV/AIDS. The primary Public Health Watch researcher in Nigeria is Olayide Akanni, senior program officer at JAAIDS.

Tanzania

Tanzania has a well-developed primary health system compared to many countries in sub-Saharan Africa. However, the estimated number of TB cases has continued to rise since 1996, due in large part to the HIV epidemic. Constraints to TB control include a lack of local capacity for diagnostic centers and health care workers as well as fees for patients attending health care clinics.

Public Health Watch is partnering with Media Bank, a group of media, communication, and advocacy professionals committed to the use of media to address development, health, and human rights. The lead researcher is Jamillah Mwanjisi, director of Media Bank.

Thailand

Like Brazil, Thailand has a relatively strong health care system and has achieved some success in addressing HIV/AIDS, but it has a growing problem with multidrug-resistant tuberculosis and TB/HIV co-infection. Challenges in Thailand include lack of program management, weak supervision and monitoring, inconsistent quality of DOTS, and uncertain provincial commitment to financing and reporting.

Public Health Watch is partnering with Amara Soonthorndhada, associate professor and deputy director of the Institute for Population and Social Research (IPSR) at Mahidol University. Dr. Soonthorndhada is part of a group of faculty conducting research and providing training and technical support on issues of population, development, health, and other social issues in Thailand and other countries.