Message from the Regional Director
In 1999, following a 40% rise in TB cases over six years, the World Health Organization declared a “tuberculosis crisis” in the Western Pacific. Governments responded with an accelerated expansion of DOTS, the WHO-recommended TB control strategy.
Ten years later, TB control is stronger than ever in the Western Pacific Region. DOTS can be found even in the most remote areas. Case detection has soared to 78%, and more than 90% of cases are successfully treated.
Despite these gains, a long road lies ahead. Every day, 5000 people newly develop TB in the Region, while multidrug-resistant TB (MDR-TB) and the TB-HIV co-infection are growing threats.
Our available tools work, but they are not enough. To progress, we must think bigger and look beyond DOTS to the actual setting in which TB programmes operate — national health systems. We must connect the dots from the branches of TB programmes to their roots within health systems.
Currently, effective TB control is constrained by health system weaknesses: chronic staff shortages, low access to quality care; and poor links between service providers. The resource gaps and inequity in TB care are often huge.
Consider MDR-TB. How can we tackle it when most laboratories lack sufficient numbers of skilled technicians and even the tools to identify cases? The risk of an uncontrolled MDR-TB epidemic compels us to take action.
Ongoing health sector reforms may well affect how TB control is planned and delivered. They also offer opportunities. The time to act is now.
To begin with, governments must ensure TB treatment is entirely free of charge. So often, patients must pay for needless extras. For the sake of global health, governments must take on this responsibility.
Financial mechanisms are needed to support this, such as subsidies for facilities diagnosing and treating TB. Increasing coverage of health insurance will alleviate costs for the poor, who often pay huge out-of-pocket fees.
Engaging all care providers is also critical. The private sector and hospitals, both public and private, remain the weakest link in the chain of TB control. We need to connect the dots between them and TB programmes. Collaboration is critical.
Health systems must respond to the needs of TB control. In doing so, the benefits — better laboratory infrastructure, skilled staff, quality service delivery and equitable access to services — improve both health systems and TB control.
Delivering TB care through strong health systems has far-reaching rewards, even contributing towards poverty alleviation. Ultimately, investments in health become investments in national development. It is time to think big and take a holistic, systems approach to TB care. We need to stretch our vision, from programme to system. TB and health systems – let’s connect the dots!
Dr Shin Young-Soo
WHO Regional Director for the Western Pacific