Speech by Dr. Olivé on the occasion of World TB Day 2009
Dr Jean-Marc Olivé, WHO Representative to Viet Nam
For the past year, most key indicators used to measure progress towards TB control have either remained still or shown little or negligible improvement.
Measures to tackle the TB epidemic like Public-Private Mix, deeper community involvement, effective advocacy, communication and social mobilization campaigns, universal HIV screening for TB patients and TB screening for PLHIV, adoption of the programmatic management of MDR-TB have not yet fully materialized. So Viet Nam keeps producing 150,000 new cases of tuberculosis per year and 20,000 persons still die of TB every year.
The reasons for this apparent lack of progress are probably much more complex than a superficial analysis could lead to believe and are intrinsically entangled with the existing gaps in the functioning and coverage of the health system.
The TB prevalence survey carried out by the National TB Programme in 2006-2007 included data collection on health seeking behaviour of TB patients and has shown that only 40 percent of them had reported to any health facility for their condition. The remaining 60%, either because had no symptoms or had symptoms but sought no care, could not have been detected and treated by the health system, as TB detection, both worldwide and in Viet Nam, is based on patients reporting to a PHC unit for care (passive case-finding). Whereas still inadequate PHC services coverage could be probably blamed for undiagnosed TB cases in remote and mountainous areas, the figures above show very clearly the need for intensified engagements of the community and health care providers in the struggle against TB. To increase case detection the NTP and the Ministry of Health should speed up the adoption of effective contacts screening, as most cases of TB are concentrated within the same household, and support the involvement of the private and non-NTP hospitals in TB control, as the vast majority of patients who seek care for their TB symptoms do so by reporting first to either a private practitioner, a pharmacy or a general hospital. Unfortunately not all patients end up being treated in an NTP unit and even if that happens, it may be too late for the treatment to be effective. We need to ensure free access to TB medicine with full commitment of practitioners to ensure adherence to the regimen until treatment is completed.
Nevertheless, it would be unfair not to acknowledge the great efforts made by the Ministry of Health and the NTP in the past year. The year 2008 has been the year of the establishment of the Viet Nam Stop TB Partnership (by the way, still awaiting formal MoH endorsement) that has encouraged new stakeholders to become active partners of the NTP; 2008 has been the year of the new law on the notification of infectious diseases that, although still requiring a set of clear implementation rules, is a major step toward 100% reporting of TB cases by all providers; 2008 and early 2009 has seen NTP leading national and international partners engaged in the production of its application to Round 9 of the Global Fund, which will hopefully provide the much needed injection of new financial and human resources for the last rush against time for the achievements of the TB-related MDGs in Viet Nam. Again, we do acknowledge with great satisfaction all the activities carried out by the NTP and among others we are particularly pleased of the special focus given to the laboratory component of TB control with the introduction of the long awaited new system for external quality assurance of sputum microscopy which in turn will allow to introduce a simplified system of TB diagnosis.
We should also remind here the support WHO has given to TB control in Viet Nam and our firm commitment to continue providing such a support in spite of the turbulences of recession threatening development agencies and their work around the world.
As we speak, a delegation of the NTP is in Rio de Janeiro celebrating World TB Day with a large crowd of delegates attending the 3rd International Stop TB Partners Forum, a high level gathering aimed at voicing global concerns, attracting the attention of those who can help and create even stronger alliances between countries, bilateral donors, the UN system and the private corporate sector against TB.
The next week Viet Nam will be one of the countries represented in the MDR-TB Ministerial Meeting in Beijing, where a call for common and coordinated action against MDR-TB will be launched. This will translate, we are sure, in a renovated and consolidated commitment of the government against a potentially dreadful threat of global dimension.
Thanks for your attention.