T uberculosis is a global public health scourge. In 2014, 9.6 million people worldwide were estimated to have fallen ill with the disease, while 1.5 million died. In the WHO South-East Asia Region, which accounts for a high degree of the global TB burden, the disease killed around 4,60,000 people while 3,40,000 children contracted it. Though there has been steady progress in combating TB, it remains inadequate.
Beginning this year, an intensified battle has been launched against TB, which aims to change this. The “End TB Strategy” aims to reduce TB deaths by 95% and cut new cases by 90% by 2035, thereby creating a “region free of TB, with zero death, disease and suffering”. Though ambitious, this goal is achievable. The strategy rests on three pillars: the importance of integrated, patient-centered care and prevention; the need for bold policies and supportive systems; and the value of intensified research and innovation. This means governments must create and implement policies that address the social, economic and behavioural factors that affect TB care and control, and tailor these policies for society’s most vulnerable. In other words, it means better governance.
Governments must strive to ensure early TB diagnosis and treatment, while managing associated illnesses. They must also provide adequate funding for TB-related programmes and back them with unswerving political will. They must pursue research to gauge the effectiveness of initiatives they are undertaking, ensuring that public funds are used for the best possible outcomes. Importantly, governments must also alleviate the catastrophic expenses the disease inflicts on affected families – expenses that greatly diminish the incentive to seek care and stay the course of treatment. Poverty reduction, improved nutrition, and better living and working conditions will make a difference.
Still, increasing health coverage remains the single most effective tool for countries in the South-East Asia Region to end the TB epidemic. Inadequate access to healthcare services results in cases going undiagnosed, while weak, overstretched and poor health systems result in patients being unable to gain the care required to beat the disease. Countries in the region need to prioritise strengthening of health systems. By enhancing access to healthcare services and delivering the highest attainable standard of care, governments will increase their ability to prevent, treat and eradicate TB, as well as associated illnesses such as HIV/AIDS.
Civil society and community groups have a critical role to play in engaging with government to ensure that access to health care is increased and universal health coverage becomes a reality. Claiming the rights accorded to ourselves, our families and friends under the International Covenant on Social, Economic and Cultural Rights is a duty we must take seriously, and one that we must all make good on.
Beyond acknowledging the importance of increasing health coverage, ending the TB epidemic in South-East Asia – particularly its drug resistant strains – also demands greater cross-border cooperation. A number of the globe’s highest TB-burden countries are in the South-East Asia Region, which is also host to significant cross-border migrations. Enhancing TB prevention, care and control for people in all countries of the region means working in unison to develop frameworks that guide cross-border management of the disease and strengthen access to care and treatment for the vulnerable. To achieve this, visionary leadership is needed, as also a collective realisation that TB does not recognise national borders, nor does it care for citizenship categories.
(The author is Regional Director, WHO, South-East Asia Region)