By:
WHO Representative – Dr Arvind Mathur
Coordination, collaboration, and cooperation are critical mantras for accelerating ending tuberculosis (TB) in Timor-Leste. The clock is ticking to end TB in this young nation with 1.3 million, which sees an average of 6400 new TB cases every year.
Timor-Leste has a massive TB burden because of the continuing high transmission rates and impact on the productive population that leads to slow economic growth and pushing families into greater poverty. By the end of 2019, the estimated TB mortality rate in Timor-Leste was reported as 88 per 100,000 Population- the second highest in the world. Due to the current State of Emergency (SoE) from the Covid-19 pandemic, a decline in TB case notification is expected because currently TB is diagnosed only when sick people visit the health facilities. As people are now confined to homes, there could be a delay in diagnosing TB and disruption in treatment services which may result in an increase in the number of cases, deaths, and catastrophic costs for families and further spread of the disease if immediate actions are not taken.
Such a situation calls for concerted and joint accelerated efforts drawn from the global, and regional strategies and coordinated implementation at the country level. The launch of the revised National Strategic Plan (NSP) 2020-24 developed with WHO technical support lays the ambitious vision for ending TB in Timor-Leste with a multi-sectoral and health system strengthening approach. It’s clear that “Business as Usual” would not result in achieving the goal of Ending TB and call of the hour is effective and efficient implementation of the National Strategic Plan to fast-track the nation’s vision to ‘End TB’ in the next five years.
Finding and treating TB remains the fundamental pillar of TB prevention and care, but this very step requires extensive planning, strategizing but importantly partnerships, multi-sectoral coordination and resource sharing for health system strengthening. These key actions are essential to ensure easy access to tools for early diagnosis and ensure that the network of volunteers and health workers are supported for active TB screening and providing preventive treatment as per the NSP 2020-24. Optimizing current tools such as rapid tests and modified treatment regimens, and universal health coverage will reduce the TB incidence rate by 10% by 2025. However, the steepest rate of decline is possible by introducing the new drugs and treatment regimens for active TBand tuberculosis preventive treatment (TPT).
We must seize the opportunity for community and community-based services to support and strengthen all actions from active screening to service delivery in an integrated and collaborative way within the existing health systems. Partnership and integration with other sectors like Maternal & Child Health (MCH), National Immunization, Non-Communicable Disease, and Saude Na Familia programmes, with its potential outreach component, offers an excellent opportunity for collaborative, integrated and patient-centred care and services which is one of the main pillars of End TB Strategy and updated National Strategic Plan.
The End TB Strategy milestones for 2020 and 2025 – reducing the number of TB deaths by 35%, 75%, 90%, and TB incidence rates by 20%, 50% and 80% respectively by 2020, 2025 and 2030- the SDG target can be achieved if diagnosis, treatment and prevention services are provided within the context of envisaged Universal Health Coverage (UHC). And if there are multisectoral action and accountability to address the broader determinants that influence TB epidemics and their socioeconomic impact. Robust health system and commitment to UHC remain the foundation of any disease-specific program- Strategic Plan for Ending TB is an opportunity to advocate for renewed thrust on primary health care and institutionalization of Human Resource Development.
Timor Leste is certainly and strategically positioning its TB program as people centric as during the recently held country dialogues with crucial community representatives and other stakeholders; bold strategic actions were agreed which include: intensified TB control efforts through better community response and engagement, shift from passive to active case detection by going from house to house; provision of transport support to visit households for TB symptomatic screening, sputum collection as needed; implementing household contact tracing and providing preventive treatment. Engagement of faith-based organizations (FBO)/ Church networks in the TB response planning and implementation will help in addressing stigma associated with the TB. These measures are of immediate importance and need to be implemented universally and urgently by all partners to avoid preventable deaths and save lives. Reducing risk factors like smoking, drinking alcohol, diabetes, and HIV infection that require multi-sectoral actions will further reduce TB mortality and morbidity. Multisectoral actions within the context of Universal Health Coverage are essential for ending TB as it requires addressing the social determinants of health such as poverty, safe housing, and malnutrition.
Let me reiterate TB is both preventable and curable. Investing in TB is a great value for money as for every US Dollar invested in TB, the return gain is 43 US Dollar. Given such high return, it would be prudent to advocate for higher allocation for domestic resources too for ending TB a reality in the Timor Leste.
The end is in sight, but we all need to join hands as the time is for concerted, cohesive, and collaborative actions to fast track progress in ending TB in Timor-Leste. As a reliable and trusted partner, WHO is committed to extending high-quality technical aid and partner with all stakeholders in supporting the Ministry of Health and people of Timor-Leste in realizing their vision of Ending TB in next five years.
24th March 2021