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Unified action: The only way forward to control TB

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Message Bobby Ramakant

"We simply must stop TB. This succinct but compelling message implies a shared responsibility for unified action at all levels, by health-care providers, national and international partners and communities to control and eliminate TB", said Dr. Samlee Plianbangchang, World Health Organization (WHO)'s Regional Director for South-East Asia.

The strong call for unified action at all levels to control tuberculosis is significant and echoes the responses to concerns raised by many other people on what should be done to improve TB responses in these times of global economic meltdown. At the first day of the 3rd Stop TB Partners' Forum in Rio de Janeiro, Brazil, a day before the World TB Day (24 March 2009) and a week before the high-level ministerial meeting on X/MDR-TB opens in Beijing, China (1-3 April 2009), the call for unified action at all levels from WHO regional office in South-East Asia, adds to underlining the urgency needed for TB control.

Progress in reducing the number of tuberculosis (TB) cases stands at a crossroads today. While over 87% of the two million TB patients in the South-East Asia Region are being treated successfully every year, multi-drug resistant TB (MDR-TB), TB-HIV co-infection and the global economic crisis pose a serious threat to the gains achieved so far.

For instance, the Global Fund to fight AIDS, TB and Malaria (GFATM) falls short by USD 5 billion of its 2009-2010 budget of USD 8 billion. Countries instead of keeping their promises to the GFATM, are instead disbursing many times more of bail-out money to banks (which banks are disbursing to their employees as holiday bonuses). It is clear that TB care and control is not yet a development priority for most countries - and the need to engage these stakeholders as equal partners was never so compelling.

Annually over 10% of the estimated 3.6 million people living with HIV (PLHIV) in the South-East Asia Region are likely to develop active TB. Hence, it is critical that both HIV/AIDS and TB control programs ensure that the benefits of expanding access to HIV counselling, testing and care, including access to antiretroviral therapy (ART), reach TB patients who also have HIV.

Levels of drug-resistance in TB patients in most parts of the South-East Asian Region are still low, at less than 3%, due to good implementation of basic directly-observed treatment short-course (DOTS). However, given the large number of TB patients, this represents over 150,000 new patients with MDR-TB every year. "Widespread unregulated use of anti-TB drugs outside of national programs is our major concern in the context of drug resistant TB," stressed Dr Plianbangchang.

Increasing investments in health-care systems are essential to ensuring that all TB patients have equitable access to free and quality care at all health care facilities at the primary level. What is also urgently required is that all health professionals, from both the public and private sectors, adhere strictly to internationally recommended standards for TB care, and that appropriate measures are duly implemented to contain unregulated use of anti-TB drugs to prevent the emergence of drug resistance.

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Bobby Ramakant is a development journalist and has been writing on development issues since 1991. Health is one of the key focus areas he writes on. He is also a World Health Organization (WHO)'s WNTD awardee for 2008
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