World TB Day: An opportunity to galvanise united action to end the disease in Rwanda

On the occasion of World Tuberculosis Day celebration today, it is important to reflect on the 2017 theme: “Unite To End Tuberculosis” and its implications for ending transmission of the deadly disease in Africa and Rwanda in particular. Tuberculosis (TB) is a deadly but preventable and curable disease which is caused by a bacterium called Mycobacterium tuberculosis that affects the lungs. TB causes ill-health in millions of people each year and in 2015, it was one of the top 10 causes of death from infectious diseases worldwide, for the first time ranking above HIV. The factors that facilitate the transmission of the disease include; overcrowding, malnutrition, weakened immune system due to HIV infection, smoking and harmful use of alcohol. Globally, good progress has been made since 1882 when a German scientist, Dr. Robert Koch discovered the cause of the disease. Rapid diagnostic tools, more effective medicines and treatment procedures have been developed. Furthermore, a comprehensive global “End TB” strategy has been formulated and is being implemented as a means of realizing the related targets of the Sustainable Development Goals (SDGs). Rwanda, through its Ministry of Health, has adopted these new strategies and made good progress in its quest to reduce transmission of the disease. Through the provision of facilities for diagnosis, treatment and prevention of the disease, attainment of high treatment success rate of over 90 per cent and reduction of financial barriers to access the appropriate care and treatment, the country is on the verge of halting the occurrence of the disease. This is by all means an enviable achievement on a continent where many other countries have faltered. These achievements provide a solid foundation and momentum for attainment of the health SDG goals, which has ending the TB epidemic as one of its targets. Ending the TB epidemic is interpreted as achieving 90 per cent reduction in TB deaths, less than 20 cases of TB per 100,000 population and no financial hardship for any family as a result of TB by 2030. Consistent with Rwanda’s track record of good achievements under the MDG era, the country is no doubt uniquely placed to be among the pathfinder countries to attain the End TB targets. This would however require additional investment in the following areas: First, the country needs to apply the lessons learnt and success factors from attainment of the health related MDGs such as proactive and accountable leadership, decentralization, implementation of high-impact interventions and policies and use of home grown solutions such as the “Umuganda” (Community Work), “Imihigo” (Performance Contract), “Umushyikirano” (National Dialogue) and others to accelerate TB prevention and control. Second, it is critical to scale up universal health coverage which would ensure that every Rwandan irrespective of their place of abode have access to full complement of TB preventive, diagnostic and treatment facilities with no financial hardship especially to vulnerable populations such as children, the elderly, people living with HIV, prisoners and others. Third, in the context of rapidly changing international aid, predictable and sustainable funding is required to ensure adequate and uninterrupted supply of TB diagnostics materials and essential medicines thus there is the need to increase domestic funding to safeguard the achievements made so far. Fourth, strengthening of the laudable community-based health initiatives in the country to facilitate more community participation, ownership and actions to increase the geographic coverage of TB interventions. Lastly and importantly, the government should continue its efforts to improve the Social Determinants of Health (SDH) which are the conditions under which people are born and in which they live. Thus, poverty reduction, expansion of the existing social protection measures and safety nets, improved housing, education and reduction of environmental pollution all of which are challenges to prevention and control of the disease should be addressed as adjunct to the public health interventions. The theme of the 2017 TB Day is therefore very instructive and one that inspires a call for concerted efforts from all stakeholders to achieve Rwanda’s vision of a TB-free country. Continuous political goodwill is needed to ensure that the required financial and human resources for TB prevention and control are available to the national TB programme; academic institutions should engage in further research into innovative home-grown strategies for ending the scourge. Uniting against TB calls for collective action from the social sector to address the SDH and implement the national TB policy and strategy. National and international NGOs and CSOs need to support community and health-facility based interventions. WHO through its headquarters, regional office for Africa and Rwanda country office supports it’s Member States including Rwanda to; develop regional and national TB policies, strategies and standards, to strengthen national TB programmes to enable the country to attain its TB targets among others. Within the overall framework of the One UN, WHO Rwanda is committed to sustain its support to Government of Rwanda in its quest to reach zero TB cases in the country. Together we can and let us “UNITE TO END TB” in Rwanda ensuring that we leave no one behind! The writer is WHO Representative to Rwanda

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World TB Day: An opportunity to galvanise united action to end the disease in Rwanda