One Project in Ethiopia Shows Us That Investing in Health Systems Pays Dividends 

Over the past five years, the Ethiopian government and MSH have been working shoulder to shoulder to improve and expand the country’s tuberculosis services with the goal of alleviating the burden of the disease.

If you wonder whether foreign assistance is money well spent, just look at the remarkable progress we’ve made in Ethiopia, where only a few years ago the stock out rate for TB drugs was as high as 20 percent. That number today is about two percent.

Our tuberculosis work in Ethiopia supported 55 million people between 2010 and 2016. During that period, we improved case detection, diagnosis, and treatment mechanisms; strengthened the laboratory capacity of more than 2,000 facilities to diagnose TB; improved the supply management of TB drugs; and trained tens of thousands of health workers at all levels of the health system.

The upside is not just the thousands of lives saved or improved, but the strengthening of a health system that is now better equipped not only to respond to TB, but also to other diseases, therefore helping the people of Ethiopia live healthier lives, contribute to their economy, and make their country a more stable and peaceful place to live.

“I started feeling this coughing… so I went to the health center and got tested. It was positive for TB,” says Grace*, a young Ugandan woman. She started on medicines, but after two months, she stopped adhering to treatment.

They told me to continue with the drugs for five more months, but I stopped.

I thought I was ok.

She started coughing again, went to the hospital, and was diagnosed with multidrug-resistant TB (MDR-TB). MDR-TB cannot be treated with two of the most powerful first-line treatment anti-TB drugs. Her treatment regimen? Six months of injections and two years of drugs.

Cross-posted with permission from Science Speaks Blog. [15]

The Value of Patient Support

Eight years ago Busisiwe Beko was undergoing treatment for multidrug-resistant tuberculosis (MDR-TB) when, after months of waiting to see a pediatric specialist, her daughter was diagnosed with the same illness. The five-month-old baby was admitted to a TB hospital where she would receive treatment for seven months; Busisiwe, however, was turned away due to lack of space. Today, both mother and daughter are healthy. And, their experience with MDR-TB didn’t stop at their cure. Busisiwe went on to join Médecins Sans Frontières [16] as a counselor for MDR-TB patients in her community, providing the support and medication counseling that she wished she had received during treatment.

Guaranteeing that patients have uninterrupted access to anti-tuberculosis (TB) treatment begins with national TB programs (NTP) making complex calculations about how many cases to expect in the future.  Vigilant stock management, accurate number of cases started on each type of treatment along with forecasting the expected number of patients that will be enrolled on treatment, are vital to ensure that medicines are available to all patients who need them.

To promote a systems-strengthening approach to TB medicines management, the US Agency for International Development [20] (USAID)-funded Systems for Improved Access to Pharmaceuticals and Services [21] (SIAPS) program developed QuanTB [22]—a downloadable, desktop tool that transforms intricate calculations into a user-friendly dashboard displaying key quantification and supply planning information.

Join Management Sciences for Health (MSH) at the 45th Union World Conference on Lung Health [27] (WCLH2014) in Barcelona, Spain, October 28 - November 1, 2014, as we launch our Quan TB 2.0 tool, highlight our latest Challenge TB win [28], and promote our work on HIV/TB integration [29]. 

MSH staff are presenting [30] 19 posters and 5 oral presentations and speaking at 5 symposiums and 1 workshop. We also will have a booth (#43 [31]) in the technical exhibition area. 

Azmara Ashenafi, a 35-year-old woman from the Amhara region of Ethiopia, was diagnosed with tuberculosis (TB) and placed on treatment. She was fortunate. Many people with TB are missed by health systems altogether. But Azmara’a treatment wasn’t helping. Despite taking medicine for months, her symptoms persisted and became more severe.

In many places, her story would have a sad ending—TB is one of the top three leading causes of death for women 15 to 44 in low- and middle-income countries [34].

But Azmara went to the Muja Health Center—one of over 1,600 supported by USAID's Help Ethiopia Address Low TB Performance (HEAL TB) [35] program, and where MSH has been training health workers to screen patients for multidrug-resistant TB (MDR-TB).

MDR-TB cannot be treated with the two most potent first line anti-TB drugs and infects 6,000 Ethiopians each year. To help curb the spread of the disease, health workers learn how to screen people in close contact with MDR-TB patients. All of Azmara’s family members were tested and both she and her three year old son Feseha were found to have MDR-TB.

I never thought that being sick with tuberculosis [40] (TB) for a decade would lead me to this purpose: being an advocate to fight and eliminate this disease--not just in my country, the Philippines, but all over the world.

I was recently invited by RESULTS Japan [41] to represent TB patients' perspectives in the call for continuous funding from the Japanese government to the Global Fund to Fight AIDS, Tuberculosis and Malaria [42] (Global Fund). The advocacy activities, led by Results Japan, were in support to the Global Fund Fourth Replenishment [43] which aims to secure financing for the years 2014-2016.

A version of this post originally appeared on the SIAPS program blog. [46]

"Health care is not about what doctors and nurses do in hospitals," said Dr. Sania Nishtar. "There are a range of different stakeholders that need to play their parts."

@SaniaNishtar" href="https://twitter.com/SaniaNishtar">Dr. Nishtar, keynote speaker at the "Engaging Pharmacists in TB Care and Control in Pakistan" stakeholders' meeting last week in Islamabad, Pakistan, highlighted the importance of involving all care providers in tuberculosis (TB) diagnosis and treatment. The meeting of key stakeholders included representatives from the Ministry of Health, universities, and pharmaceutical manufacturers, among others.

TB CARE I Indonesia [50], The Global Fund to Fight AIDS, Tuberculosis and Malaria [42], and Indonesia’s National TB Program (NTP) organized a mass-mobilization World TB Day event on March 24, 2013, called "Run 4 TB".

This 5K race drew thousands of runners, bikers, walkers, and observers.

(Photo credits: KNCV/TB CARE I)

On the eve of World Tuberculosis Day, Voice of America interviewed Dr. Stephen Macharia, the TB CARE I country director for South Sudan.

During the interview (transcript, PDF [53]), Dr. Macharia discussed the TB epidemic in South Sudan, TB CARE I project achievements, and the way forward for improving funding for TB services and multi-drug resistant TB (MDR-TB) control in fragile states, like South Sudan.

TB CARE I [54] is a USAID [55]-funded project, led by KNCV TB Foundation [56] with partners, including Management Sciences for Health [57].

Voice of America, the official external broadcast institution of the United States federal government, produces nearly 1,500 hours of news and programs each week for an estimated global audience of 123 million people.