The question of universal access for TB patients

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This live blog is from the Pacific Health Summit in Seattle, a three-day meeting that opened Tuesday night. Its focus is the global response to multidrug-resistant tuberculosis.

Mario Raviglione, director of World Health Organization's Stop TB Department

Mario Raviglione, director of World Health Organization's Stop TB Department

In the world of HIV/AIDS, a long rallying cry has been universal access for treatment.

Now it’s coming to the world of TB – and likely for other illnesses and conditions.

That was the message today from Mario Raviglione, director of the World Health Organization’s Stop TB Department at a session at the Pacific Health Summit.

“We are dealing with a big issue over universal access because it is going to come – there is international pressure,’’ Raviglione said.

“… This concept was restricted to the HIV/AIDS community before but now is being expanded to cover a number of other health burdens. The evolution of this concept could go into TB, malaria, maternal health and child health,’’ he said.

But Raviglione and others cautioned that moving toward universal access raised a number of complicated issues. The one issue discussed in depth today was whether to abolish user fees.

In Rwanda, the government opposes user fees because it wants to move toward sustainability of the system eventually without donor support and also because it also wants to make sure that its health system is not overwhelmed by a flood of patients. In a trial program when user fees were abolished, according to one participant at the conference, there was a tripling of patients seeking health care.

But another participant asked: “Access to what? All too often when we have services accessible, we might be worse off than before’’ because of too few health workers and poor facilities.

Carol Nawina Nyirenda of the Community Initiative for TB, HIV, and Malaria in Zambia

Carol Nawina Nyirenda of the Community Initiative for TB, HIV, and Malaria in Zambia

Carol Nawina Nyirenda of the Community Initiative for TB, HIV, and Malaria in Zambia said that user fees provided minimal support to the health system. “But where I come from, 50 cents is a lot of money to many people,’’ she said.

She also raised the issue of other hidden costs such as transportation and lost time at work because of long waits in clinics and hospitals.

Dr. Jeremiah Chakaya, chief research officer at the Kenya Medical Research Institute, agreed that user fees were only one part of a puzzle in trying to expand health care to as many people as possible.

“I return to my village often,’’ he said. “In my village, we have a dispensary, but everytime I am there I run a clinic in my house. I bring something to measure blood pressure, and I check blood-sugar levels. The big problem is hypertension, and they are not getting that service in a local area. The nearest place is 40 kilometers away. The issues here are really complex, involving human resources, what kind of equipment is there, and what types of services people are expecting.’’

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