TB Week: Integration, involvement, a “holistic” approach key to linking women and tuberculosis care

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When a week of events focusing on the worldwide impact of tuberculosis brings together a group to talk about women’s health and diplomacy, it needs to be a broad-based group, and it was.

For a start, the talk at the Washington Club in Washington, DC was sponsored by The Center for Global Health and Diplomacy, PAHO, the Pan American Health Organization, the U.S.-based PATH and Aeras, the Netherlands-based KNCV Tuberculosis Foundation, and the Johnson and Johnson pharmaceutical company. In addition to the representatives from the sponsoring organizations, the panel included representatives from Kenya, Peru, Columbia, Guyana, the Philippines, South Africa,  USAID and from the BD global biotechnology company.

The questions they discussed were linked, providing in their ordering, their own answers: What role does global health diplomacy play in setting priorities in women’s health and in achieving results?  What are the priorities in women’s health? And, of course, how can maternal and child health services advance tuberculosis care and control?

From this diverse group came shared answers: Health system strengthening is key, but not enough, they agreed. Integration of services that takes a holistic approach to women’s health, including screening for infectious diseases with reproductive health care is vital. In addition, they need to be responsive to social realities as well as health conditions.

Sharon D'Agostino Ariel Pablo Mendez

Sharon Kathryn D’Agostino of Johnson and Johnson, with Ariel Pablos-Mendez of USAID

“Systems need to be reorganized so out of pocket spending is not a burden,” said Ariel Pablos-Mendez of USAIDS Global Health Bureau, who pointed out that paying for health services “has become the number one cause of impoverishment.”

Tuberculosis programs also highlight the importance of health settings that provide comprehensive services, so that patients are not forced to travel from one distant clinic to another for care, a common cause of treatment default.

Integration of knowledge and resources also was key to another  question: how can public-private partnerships make the most of global health diplomacy to move efforts addressing tuberculosis prevention, case-finding, treatment together with broader issues of maternal and child health? The answers from industry representatives: Their networks, their extensive work with governments, their positioning to see worldwide what programs work and what don’t,  all can make a contribution to building health systems that serve not just to reduce deaths, but to enhance well being.

mildredfernando

Mildred Fernando

From first-hand experience, in turn, Mildred Fernando of the Philippines gave an example of how public outreach to private endeavors could improve care, on a local level. Fernando, who had told the story of her 10-year battle with extensively drug resistant tuberculosis in a USAID-sponsored discussion Monday, noted part of it in answer to this question. She originally sought treatment through a private practice physician she said, and it was only after two years of treatment that a culture of her sputum was examined and showed that her disease was resistant to most of the treatments she had been receiving. There needs, she said, to be coordination between private doctors and public programs handling tuberculosis.

This, in turn, brought the discussion to its pivotal point, addressed by Simon Isaacs, representing Aeras, a nonprofit organization collaborating with public and private partners to develop new tools against tuberculosis.

Simon Isaacs

Simon Isaacs

“Bold endgames are exactly what we need,” he said, noting that ambitious goals had been discussed. Then he added this caveat: “We simply do not have the tools right now to adequately address tuberculosis.”

The most commonly used tool used now in resource poor settings to diagnose the disease, he pointed out, is a century old, developed around the same time the Wright brothers were building their first airplane. Trying to conquer the disease with antiquated tools, he said, would be “like asking the Wright brothers to fly to Mars.”

A robust pipeline of treatments exists, but it is not enough, he said. “We need more focus on research and development. We need more focus on tuberculosis overall.”

And that would require the one element missing from the panel of government, private and civil society representatives: an engaged populace. “We’ve never moved the ball forward without a constituency that is truly engaged.”

And while private enterprise would help, he said, “we need a significant amount of government funding, and we need the people to rise up and ask for that.”

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