World TB Day

Shrayan Mukhopadhyay

World TB Day is on 24th March. TB is a disease that kills many people in India. TB is curable but people still die due to lack of proper information and treatment. TB can be prevented if detected early. If a person has cough and if it continues for more than 2 weeks, the person is likely to have TB. He should visit the nearest hospital and take services from DOTS program. He should not delay because the bacteria can damage the lungs badly. World TB Day thus signifies the day when peple should stay fit and fine and cured from TB. It is also the day where various TB organizations and hospitals make the general public aware about symptoms and signs of TB. And if affected by TB they make people aware of the treatment and prevention of the disease. This is how the World TB Day is celebrated.

(Shrayan is a lad of 15 years, studying in tenth standard in Amity International School, Saket, New Delhi)

Making Family Planning Work in Afghanistan

Aftab Ahmed Awan, Pakistan

Afghanistan is a country ravaged by decades of war, internal conflict and strife. It is only in the last few years that a democratically elected government has been able to bring some semblance of stability in the different part of the country, though the situation still remains highly volatile.  The country is getting a lot of support from international community for the rebuilding of the infrastructure and systems which have been almost wiped out by continuous war like situation.

Though Afghanistan is going through a phase of rebuilding and restructuring, yet she still faces huge challenges in providing essential services to its citizens. These difficulties are caused by factors such as geographical remoteness, civil instability, the over-centralization of government, a lack of infrastructure such as transportation systems, and a lack of government resources, among others[1].

All the above mentioned problems have severely hampered the development process which almost stood still form many years in the past and started afresh only recently. The effects are manifest in the population statistics which are a real cause of concern for the development planners in Afghanistan. Using estimates derived from a number of recent surveys, the UN estimates the current Total Fertility Rate (TFR) at 6.6 children per woman and the U.S. Census Bureau estimates 5.7. Not only do these TFRs, as high as they are, represent quite a decline from the past, but the onset of decline has been quite recent. The real question now is: what about the country's demographic future? The UN has quantified the effect of such high TFRs in its constant-fertility projection. If the TFR remains at 6.6, by 2050 the country's population would reach 111 million and be growing at 3.6 percent per year, a rate that would double a population in 19 years[2].

Keeping in view the scarce resources and not so good economic condition, the Afghan government needs to strengthen the family planning and population planning programs in the country in order to check the alarming trends in population increase. However this a challenge as there are many obstacles in way of population planning programs because of typical socio-cultural and traditional tribal set up in Afghanistan. These challenges can only be overcome by bringing together all stakeholders on single platform.

Afghanistan can learn a lot from the other Muslims countries of Asia like Iran, Indonesia and Malaysia who have highly successful FP programs and have succeeded in overcoming the challenges caused by traditional and conservative interpretation of religion. In all these countries governments  initiated dialogues with religious scholars and convince them to look for reinterpretation of religion in the light of the changing requirements of modern times. Regular interaction of Afghan religious scholars with religious scholars of the above mentioned countries can be a right step in this direction. This interaction can be very helpful Afghan religious scholars and would help in overcoming the resistance which is mostly caused by narrow and traditional interpretation.

NGOs are also an important stakeholder and can play a very important role increasing effectiveness and efficiency of the family planning programs in the country due to their unique advantages. In all South Asian countries and similarly in neighboring countries of Pakistan, Bangladesh, Nepal and India, NGOs have emerged as alternate providers of public services, particularly within poor and rural communities.

Many lessons can be learnt from the neighboring country of Pakistan, which has successfully involved NGOs in the family programs to enhance the reach, quality and effectiveness of the service delivery. Pakistan is also similar to Afghanistan in many respects as both countries share similar socio-cultural background, traditions and the recent history of conflict. Though Pakistan has an area slightly bigger that Afghanistan and contains a population nearly six times the size Afghan population yet the challenges faced by both the countries are very similar. Many Pakistanis do not have access to government services, due different factors including geographical remoteness, lack of resources, lack of capacity in public sector and an ongoing conflict situation in northern areas of Pakistan. So the role of NGOs has increased manifold which have stepped up to fill the gap. NGOs have emerged as alternate providers of public services, particularly within poor, rural and hard to reach communities. The role of NGOs in provision of family planning services is even more prominent as NGOs have been involved in the family planning program since the beginning.

In Pakistan the early programs on family planning were started in late 1950s and early 60s. Provision of family planning services was started through setting up of FPAP which today in one of the largest organizations working in the sector of family planning[3]. NGOs have played a pioneering role in establishing family planning in all countries of South Asia and in setting the reproductive health agenda. NGOs have provided important clinical services, including contraceptive surgery. Apart from service delivery, there has been a considerable role for NGOs and CBOs in advocacy, BCC and community mobilization, where they have advantages. They have also been used as agents of information and advocacy to support the national program.  Some other roles of NGOs also include: ensuring quality of services being delivered, community mobilization, social Marketing and facilitators of Family planning education, training and linkages development.  

NGOs and civil society organizations have many advantages over the public and private sector which can contribute in enhancing effectiveness, efficiency and reach of the FP program. The foremost advantage which the NGOs and CSOs enjoy is their capacity to work at the grassroots level at very low costs. Since most of the NGOs have strong community linkages and presence, therefore they find it much easier to work at the community level and to overcome barriers and resistance which is often faced by public or private sector. Moreover, they often operate without a lot of overheads which keeps their cost very low which is a very important factor in resource constraint situations.

The slightly informal structure of NGOs gives them a flexibility which the public sector often lacks and which is of utmost importance in socially and culturally sensitive programs. They can adopt and review their program according to the changing ground realities. They do not have to go through the bureaucratic channels to review and redesign their program to meet the needs of community. This reduces the time required for taking necessary decisions and for taking prompt actions when required. Since most of the NGOs have to report back to donors and government and go through the rigorous audits conducted by donors and governments, they have to maintain high levels of transparency and accountability which is another argument for employing NGOs in FP programs. Of course, there have been studies and researches which prove that NGOs have proved more effective in implementing FP program because of higher quality of services, high rates of success, better outcomes, presence of more female workers and their capacity to scale up when pilots have proved successful[4].

However this does not mean that there are no disadvantages or challenges while working with NGO. There are several challenges which should be considered before going ahead with the decision. It is a common issue that most CSOs and NGOs have limited resources and sustainability problems, and do not have the capacity to locally raise funds for themselves. There exists a certain amount of distrust for NGOs among stakeholders due to the religious and cultural norms and they are often seen as working on foreign agenda which leads to unfavorable working environment for NGOs. NGO have also been criticized for their heavy reliance upon donors and sustainability issues of the projects. NGOs have also suffered in recent times because of the shifting trends of donor funding and lack of focus on FP. In the last decade or so the funding for FP program has declined considerably which has adversely affected the effectiveness or FP program and has resulted in stagnant indicators like unmet need and CPR.

Despite the above mentioned disadvantages and drawbacks, NGO remain the most important stakeholders in FP and population planning programs. No FP program can succeed without active and meaningful participation and support of NGOs in Afghanistan or for that matter anywhere else. This fact has been proven time and again through many studies. Learning from the experience of Paksitan with similar challenges and factors can be very helpful for the success of FP program in Afghanistan. This can be done through exchange visits, brining technical expertise from region or through involving NGOs from other countries of the region for capacity building of NGOs and civil society organizations in Afghanistan. 

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[1] (Evaluating NGO Service Delivery in South Asia: Lessons for Afghanistan: Laura Antuono, Chris Meeks Melissa Kay Miller, Jean Rene Watchou, Robert M. La Follette School of Public Affairs University of Wisconsin-Madison, 2006)

[2] http://www.prb.org/Articles/2009/afghanistan.aspx

[3] http://www.icomp.org.my/new/uploads/fpconsultation/Pakistan.pdf

[4] Evaluating NGO Service Delivery in South Asia: Lessons for Afghanistan; Laura Antuono, Chris Meeks, Melissa Kay Miller, Jean Rene Watchou, Prepared for Workshop in Public Affairs, International Issues Public Affairs, 2006

Fund to fight key diseases running low

RICHARD FEACHEM, SAN FRANCISCO, USA

 A study just published in the Lancet, a British medical journal, found that malaria killed 1.2 million people in 2010. That is nearly double the World Health Organization’s official estimate.

 Compounding this tragic news is that the Global Fund to Fight AIDS, Tuberculosis and Malaria — the largest and arguably the most effective financier of malaria control — is running out of money. It has suspended new grants until 2014 — grants that would have provided millions of families with protective bed nets, life-saving medicines and vital health-care services.

 Unless we make a concerted and immediate effort to support the Global Fund, the tremendous gains it has made in the past decade will be lost. The United States should convene an emergency donor meeting to address the Global Fund’s resource gaps and ensure that it can operate at full capacity.

 Ten years ago, HIV/AIDS, tuberculosis and malaria were crushing burdens on development, killing over 6 million people a year and draining billions of dollars from the global economy. In the developing world, HIV was a death sentence. Only about 50,000 Africans were on anti-retroviral treatment. After five decades of spotty results, aid was still primarily directed by Western technocrats with little accountability for results.

 The Global Fund was created in 2002 to change all of this. It had two fundamental goals: to mobilize massive new resources against HIV/AIDS, tuberculosis and malaria, and to shatter old development-assistance models by being transparent, accountable and demand-driven. On both, the Global Fund has been an unambiguous success.

To date, the Global Fund has disbursed $15 billion to programs in 150 countries. These grants have provided 230 million insecticide-treated bed nets and 170 million antimalarial treatments. While the new data have counted adult malaria deaths, increasing the total number of deaths reported, it also shows that these investments have saved more than half a million lives. Taking everything into account, malaria deaths actually decreased, from 1.8 million in 2004 to 1.2 million in 2010.

 Global Fund investments have also provided antiretroviral treatment for 3.3 million people living with HIV/AIDS. Nearly half of all people currently on AIDS treatment in low- and middle-income countries depend in some way on the Global Fund to stay alive.

   Further, its grants have let health officials treat 8.6 million cases of tuberculosis, saving more than 4 million lives. Thanks in large part to these efforts, the number of tuberculosis deaths has reached lowest point in 10 years.

   Through all of this, the Global Fund has remained true to its founding principles. Grant recipients — not donors — lead the process of identifying and addressing national health challenges. Civil-society groups, public officials and the private sector are equal partners in developing sound proposals and implementing effective programs. Scores of sensitive documents are published online, including extensive and detailed financial information.

 This is why the Global Fund’s model has been consistently validated by diverse organizations. Just last month, Publish What You Fund, a project of the nonprofit Global Campaign for Aid Transparency, ranked the Global Fund second among 58 donors surveyed for its commitment to transparency. And last year, the Global Fund earned top marks in the Department for International Development’s aid review for its “excellent track record for delivering results” that provided, “very good value to the … taxpayer.”

 The news of malaria’s revised death toll, and the striking downward trend in annual deaths, show that we need the Global Fund now more than ever. Yet instead of planning to end malaria, we are praying that our families and friends survive the next rainy season.

 Instead of creating the AIDS-free generation that President Obama envisions, we face scenarios in which millions now on treatment may be left for dead. Instead of modeling the elimination of tuberculosis, we are worrying about the rising tide of drug resistance.

   It is time for governments to take an honest look at their foreign-aid programs. They would be hard-pressed to find a better return on investment than what we have seen from the Global Fund. After 10 years, the Global Fund has unequivocally proven to be responsive, innovative and highly effective in its approach to aid. The United States should convene an emergency donor conference to mobilize new resources for the Global Fund. This is an investment we must continue to make.

 

Richard Feachem M.D.  is director of the Global Health Group at the University of California at San Francisco and formerly the founding executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. This article of his ran in the Provincial Journal and Richard is kind enough to allow this article to be posted in the Universal Health Blog.

Is Polio really gone from India?

Congrats India for remaining without reporting of any confirmed polio cases for one long year. This is indeed a mammoth achievement in the history of polio eradication in India.

India’s success should not be doubted because of the strong AFP (Acute Flaccid Paralysis) surveillance system that the country has been able to establish for years. It is very unlikely to miss a single AFP or polio case now due to a surveillance network that each and every public health professional of India should feel proud of.

But ‘no polio case for a year’ doesn’t indicate we, as a country has acquired the much-awaited ‘polio-free’ status.  A couple of more years with no polio cases will definitely justify our eligibility for the polio-free certification. But the next two years, will definitely demand the highest level politico-administrative commitment and the maximum operational level hard-work to ensure the polio virus no more exits in the environment of the country.

One of the most important aspects of the final phase of polio eradication should be making all-round efforts to strengthen Routine Immunization coverage, especially in the traditional polio-reservoirs of the country like UP and Bihar together with high quality supplementary immunization rounds (Pulse Polio).

Getting over the polio-fatigue is one of the most challenging jobs at the field operation; especially to keep the front line workers on their toes in each and every future Pulse Polio round is really tough in a war spanning for more than 18 years.  The motivational communication should categorically include high level appreciation to push the polio virus in the corner followed by the ardent appeal to erase it from every nook and corner of the country in the next couple of years.

 I strongly feel the frontline workers should be also given a much better remuneration now to extract the best possible services from them in the ground during the final assault against polio.

Cross-border surveillance and immunization should be collaborated with the neighbouring countries. This is one of the key areas that must be given all due importance and attention. There are instances where polio hit back an already polio-free country being exported from the neighbours.

Continuing advocacy with the neighbouring nations for concomitantly maintaining high quality immunization activities within their territories is equally critical to prevent any polio spillage across the borders that might put water to all the eradication initiative and achievements made so far.

If we can’t take precautions from all possible angles the victory over polio might be further delayed.

After all it is also the matter of survival for the virus so winning never remains an easy process.

Sugata M, Universal Health

WHO's updated policy for TB/HIV Collaboration

This important new policy emphasizes the need to maximise the delivery
of a range of medical and preventive interventions that are simplified, practical,
streamlined interventions that save lives:

Routine HIV testing for TB patients, people with symptoms of TB (TB suspects), and their sexual partners or family members; The use of a simple clinical algorithm for TB screening for PLHIV   that relies on the absence or presence of 4 symptoms: current cough, weight loss, fever and night sweats, to identify people living with HIV eligible for at least 6 months of isoniazid preventive therapy (IPT) or for further diagnostic investigations for TB. Provision of co-trimoxazole, a cost-effective medicine to prevent against lung or other infections for all TB patients who are infected with HIV; Starting all TB patients with HIV on ART as soon as possible (and within the first 2 weeks of starting anti-TB treatment) regardless of immune system measurements; HIV prevention in TB patients: Evidence-based methods to prevent the acquisition of HIV for TB patients, their families and communities Infection control in PLHIV From: Universal Health