Innovating for Impact: Strengthening Health Systems and Building Connections at the Union Lung Conference

When thousands of people from around the world come together for a common purpose, the energy is palpable. When that common purpose is to end the world’s leading cause of death from a single infectious agent, that energy has an urgency to it.  

At this year’s Union World Conference on Lung Health in Bali, Indonesia, nearly 4,000 lung health experts, health professionals, government officials, and activists gathered to present research findings, discuss experiences, and share best practices for fighting TB. Hosted by the International Union Against Tuberculosis and Lung Disease, the conference emphasized innovative strategies, research advancements, and community-driven solutions. 

MSH President and CEO Marian W. Wentworth led a delegation of 30 team members from around the world. They represented the more than 200 MSH staff who work to end TB. With the conference taking place in their home country, the USAID BEBAS-TB project team, led by MSH, was well represented—comprising over half of MSH’s delegation and offering numerous presentations about their work. 

New Technologies Offer Hope

MSH Principal Technical Advisor for Laboratory Systems Dr. Alaine Umubyeyi Nyaruhirira and USAID BEBAS-TB Chief of Party Erik Post moderated a panel on diagnosing TB through stool-based testing, which has been recommended by WHO as a first-line diagnostic for detecting TB in children. They introduced participants to an existing informal community of practice where countries conducting stool-based testing exchange challenges and lessons learned. Countries in Africa already implementing stool-based testing shared practical experiences from planning, introduction, and scale-up. Health professionals from Nigeria, who have introduced the practice in their routine approach, and Malawi, where it is in the first phase of scale-up, shared their experiences on moving beyond initial implementation to routine use. Eswatini’s success using stool samples for targeted next generation sequencing was also shared. This new method of testing is one of many exciting new technological approaches to predicting, detecting, and treating TB that conference participants and exhibitors discussed during the five-day event.  

Dr. Nyaruhirira credits global attention and funding for diagnostics for driving a busy pipeline of new ways to diagnose TB and new drugs in development to treat it. But, she adds, “Lab capacity must be strengthened and ready to support the deployment of these new technologies.” 

The Effects of Conflicts and Other Shocks 

Increasing patients’ access to early diagnostics and treatment is a key component of the approach taken by the USAID Eliminate TB Project in Ethiopia, led by MSH. To do so, the project focuses on expanding and improving laboratory services through state-of-the art WHO-recommended molecular rapid diagnostic tests, such as those done with GeneXpert machines. This sophisticated equipment delivers results in a matter of hours rather than the weeks needed to process microscopic tests, thereby enabling earlier treatment for patients, minimizing backlogs, and increasing efficiency at high TB burden facilities. 

The results have been impressive. But what happens to hard-won gains when regional conflict, drought, or another crisis disrupts the health system? MSH Ethiopia staff are uniquely positioned to discuss such scenarios, given the recent upheaval in various regions of the country due to successive periods of conflict.  

They brought their insights to the Union Conference in presentations that discussed mentoring health workers by phone in the Amhara region, partnering with the private sector to transport specimens for testing in conflict-affected areas, and ensuring data quality, among other topics. We continue to collect data from the USAID Eliminate TB project that may inform TB prevention and control efforts in fragile settings. Work from USAID’s AFIAT project in Afghanistan, led by MSH, on the importance of actively screening household contacts of people diagnosed with TB and the role of a shorter treatment regimen in the treatment of multidrug-resistant TB was also presented.  

The Value of a System-Wide Approach

Strong health systems are essential to helping countries maintain positive health outcomes in the face of conflict and other shocks. That’s why the USAID BEBAS-TB project, which uses such a strategy, had so much to contribute to this conference. They partner with local governments to hold active case finding events that target individuals vulnerable to TB and are pivotal in fighting the disease, especially uncovering latent asymptomatic cases.  

From integrating TB and diabetes screenings to engaging frontline community health volunteers to supporting survivors after they are cured, the USAID BEBAS-TB team shared best practices with their MSH colleagues and other conference attendees.   

Funding for the Future 

Financing options for TB work in countries looking to move away from donor funding is sometimes overlooked in discussions about TB, but it’s an area where MSH is fostering innovation.  In Bangladesh, India, Kenya, and Ethiopia, USAID’s Health Systems for Tuberculosis (HS4TB) project has collaborated with countries burdened by high TB prevalence. HS4TB has helped these countries mobilize additional domestic funding and outsource TB services to private-sector entities and nongovernmental organizations to improve service delivery and expand access to TB testing, treatment, and prevention. In the last year, HS4TB has also launched two global initiatives. The TB Financial Sustainability Index is a self-assessment tool to help countries identify both challenges and opportunities for sustainably financing efforts to end TB. The Collaborative on Contracting Organizations for Health-Related Services brings together 40 health sector leaders from 12 countries for practical peer learning on effective government-led contracting. 

Making Important Connections 

The Union Conference provides a snapshot of where we are in the fight against TB and how far we still have to go. It gave our project staff, who are normally geographically dispersed, a chance to connect and share knowledge across programs. We also connected with current and potential partners and explored possibilities for deeper collaboration. Staff who attended report that they are coming away energized by the conversations they had and with a renewed commitment to this fight moving forward. 

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