Triumphs and challenges of the tuberculosis programme in Bangladesh
Even though Bangladesh has made impressive headway in combating TB, some challenges still remain in the way of making the country completely free of the disease
World TB Day has been observed on 24 March every year since 1882, when Dr Robert Koch discovered the cause of tuberculosis. World TB Day is one of the eight official campaigns for global public health marked by the World Health Organization (WHO). The day is designed to raise public awareness regarding the burden of tuberculosis and remind us of the importance of the collaborative and continuous effort to eliminate the disease.
WHO estimates that out of the 10.6 million people who fell ill with TB in 2021, 1.6 million died. This data indicates that TB is a global burden and needs attention if we want to achieve the "End TB" goal — a world free of TB with zero deaths, disease, and suffering due to the disease by 2035. The motto this year, "Yes! We can end TB!" aims to encourage high-level leadership and commitment, increased investment, innovation, and multisectoral collaboration to combat the TB epidemic.
The theme is highly aligned with the "End TB" strategy, as the health system cannot achieve the goal alone; instead, it needs strong political commitment, robust multisectoral collaboration, and an innovative approach to implementing the tuberculosis programme successfully.
Bangladesh has achieved considerable success in tackling the disease through continuous efforts by the National TB Programme (NTP), NGOs, and development partners. TB diagnostic and treatment services are available from all divisional levels to upazila levels, free of cost. NTP has achieved significant milestones in tuberculosis treatment success for all forms of the disease over the last few years.
Moreover, the NTP is expanding its capacity to test patients rapidly for drug-resistant tuberculosis. At the same time, the implementing partners have countrywide mobilisation and awareness programmes on tuberculosis and provide comprehensive services to community members.
Most notably, Bangladesh has a comprehensive National Strategic Plan (NSP) for TB Control (2021-2025), and it describes the key interventions and detailed action plans to enable the NTP and its partners to achieve the End TB Strategy's milestone for 2025.
Even though the tuberculosis programme has reached these important milestones, TB is still a public health problem in Bangladesh. According to the WHO's latest global TB report, Bangladesh is one of 30 countries with a high tuberculosis burden. The most evident challenges are financial constraints, a lack of skilled human resources and a lack of capacity to ensure quality TB services at all levels. Though the government provides free services like TB-DOTS (Directly Observed Therapy), insufficient screening is still a concern in treating tuberculosis patients.
TB case diagnosis and management in hard-to-reach areas still need to be improved. Monitoring the tuberculosis programme to ensure quality service is a major challenge in these areas. Moreover, equipment maintenance at all levels is a major concern, especially the maintenance of the GeneXpert machine. Getting the required cartridge to keep the machine functional has proven to be quite challenging.
The upcoming years are critical as Bangladesh's economy is expanding and external funding will decrease upon the country's LDC graduation. Therefore, securing funds to tackle the rising TB issues could be tricky.
Given the constraints in terms of funding and the expertise of NGOs to implement the tuberculosis programme, a comprehensive health system and available infrastructure would be assets. The government must utilise the optimum advantages of mobile and digital health technology through innovation to detect TB cases, as most people have mobile and internet access. Proper utilisation of the community health infrastructure and health workers could be the torchbearer to managing the TB case.
Now is the time to work on the problems that have been identified and need to be solved in a holistic way, with as much help as possible from all stakeholders based on their experience and knowledge. Most importantly, the government needs to realise that poor people are disproportionately affected by tuberculosis.
Therefore, free tuberculosis services need to be ensured in the hard-to-reach areas where the service has yet to be ensured comprehensively. Though the burden of TB is higher among men, women have less access to tuberculosis services and face social barriers, including stigma and domestic hurdles; a gender-transformative tuberculosis response is needed to tackle this issue. At the same time, it is expected to ensure quality service to achieve the target.
The government of Bangladesh is committed to continuing the tuberculosis control activity to achieve the End TB goal and to sustain the ongoing services with the support of NGOs and development partners.
However, considering the country's economic transition, the financial strategy needs to be more strategic as the global fund will be decreased. Therefore, local resource mobilisation and expansion of the government fund would be required.
Monaemul Islam Sizear is a Technical Advisor at the Health System for TB. He is also the Organising Secretary at the Public Health Foundation Bangladesh. Email: sizear.monaemul@gmail.com
Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.
