President Obama and US Partnership with Muslim Countries

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President Obama was just in Istanbul talking about the importance of partnership and collaboration with Muslim countries. One way he could give this idea some real substance would be to work with these countries to address their TB epidemics and to make sure the Global Fund has the resources it needs.

That’s the hope expressed by Pakistan’s Minister of Health and by one of Pakistan’s top experts on TB, Dr. Arshad Javaid , who I had a chance to interview on March 25 at the Stop TB Partnership Forum in Rio de Janeiro, Brazil.

TB is Pakistan’s leading cause of death among infectious diseases, and TB is the 5th leading cause of death in Afghanistan (where nearly 70% of notified cases are among women). In fiscal year 2007 only about one-tenth of one percent of US aid to these countries was for TB control.

TB is also a major killer in Indonesia and Bangladesh (as well as in India and Nigeria, which have large Muslim populations).

Interview with Dr. Arshad Javaid
Professor of Pulmonology, Dean and Chief Executive
Post Graduate Medical Institute
Hayatabab Medical Complex, Peshawar

David Bryden
Infectious Diseases Center for Global Health Policy and Advocacy
Stop TB Partnership Forum, Rio De Janiero, Brazil

David Bryden:

Thank you for taking the time to have a few words with us about the situation in Pakistan regarding tuberculosis. Please tell us about your experience in this area.

Dr. Javaid:

I am a professor of pulmonology, so chest diseases like TB are always an area of my interest. Besides my duties as a professor, I am always involved in the national TB program in one capacity or another. Presently I am the President of Pakistan Chest Society, which is a partner of the national TB program. We are helping the program by developing guidelines, giving technical support, and providing training and lecturing. I am here on behalf of the National TB Program to deliver a lecture on some of the program’s initiatives.

David Bryden:

Can you tell us about some of the progress that Pakistan has been made regarding TB?

Dr. Javaid:

As you know, Pakistan is a large country with a population of around 165 million people. Pakistan until 2001 did not have any effective TB program, but, since the Islamabad Declaration, Pakistan has made tremendous progress.

They have achieved some of the targets set by the WHO. Pakistan achieved 100% DOTS coverage in 2005 and then the target of 70% case detection rate was achieved in 2008. And, we have also achieved the 85% cure rate success in 2007.

So, this is only in the last 4-5 years that all of this progress has been achieved, and, as I was mentioning to you, although DOTS was achieved throughout the country by 2005, we have struggled to achieve the case detection rate to close to 70%, and this is where the public-private partnership comes in.

David Bryden:

Can you explain this partnership and how it is helping to advance case detection?

Dr. Javaid:

Yes, in 2005 public and private sector collaboration was introduced because Pakistan has a very large private sector. According to one survey, 70% of patients have their first encounter with a private practitioner, so unless we brought the private sector into the TB program we would not have been able to succeed.

This private-public mix is the story of Pakistan. There are a lot of models that have been tried, but one of the most innovative and successful models was social franchising, in which the program is franchised to a NGO called Greenstar and they are the link between the general practitioners and the patients. And, of course the national TB program supports that initiative by providing drugs and diagnostic services, and in the last year 2 years the contribution of this initiative to total case reduction is about 15%.

But, unfortunately, one thing that we are a little bit worried about is that it is resource intensive initiative. It needs a large amount of community health officers and who work between the doctor and the patient and they are paid.

David Bryden:

Was this backed by the Global Fund?

Dr. Javaid:

Yes, this program has been supported by the funding from Global Fund round 2 which has now finished. We are a bit apprehensive. We have to sustain this initiative to maintain 70% case detection throughout the country and for that reason we desperately require more partner support for the national program of TB of Pakistan.

David Bryden:

Are you applying for more resources from the Fund to expand this work?

Dr. Javaid:

Yes, Pakistan has put in an application for Global Fund round 9 to support this. This initiative has shown great success, but it has still not been expanded throughout the country. I think if we are able to sustain and expand it we are going to achieve the millennium development goal of 2015 by reducing prevalence and mortality.

David Bryden:

Your TB application in Round 8 was approved, but my understanding is that this will be cut by 25% in the second phase of the grant, that is, in year three, unless the gap in contributions to the Fund is rapidly filled. How will that affect the fight against TB?

Dr. Javaid:

Pakistan’s TB program is fortunate in that we have good political commitment at all levels and Pakistan government itself has contributed a lot of money to TB. But, we still need support from donors. The achievements I have told you about are mainly through support of partners and to be honest we still need a lot of support to sustain what we have achieved. Pakistan is a difficult country because it’s a huge country with a lot of poverty and faces serious resource constraints.

David Bryden:

Do you think that working on TB might be a useful way in which the United States could intensify collaboration and partnership with Pakistan and other Muslim nations?

Dr. Javaid:

Absolutely. As you realize, in developing countries and in Pakistan in particular, the US needs to enhance its reputation. While some of us know very well that USA has helped us significantly and throughout, still the perception among ordinary people is not very positive about the United States. I think that it will be through an intervention like this, which would touch the ordinary person, that America could enhance its reputation. I think TB would be the one area in which we would like to see the United States come up to our expectations and help us, so that we can have a better relationship and the United States can improve its image. We know this would build good will and friendship and help build stability.

David Bryden:

What about in other Muslim countries?

Dr. Javaid:

Yes, the four big Muslim countries where TB is a major problem are Indonesia, Bangladesh, Pakistan and Afghanistan. These are the four places where support for TB programs would be a very relevant thing to do.

David Bryden:

Thanks for taking some time to discuss this.

Dr. Javaid:

Thank you.

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