A World Free of TB Needs Free Diagnosis

1
A World Free of TB Needs Free Diagnosis

• The Global Plan states
• Every TB patient must have access to an
  effective diagnosis, treatment and cure.
• To fulfil this this house believes
• The TB Diagnostic Process Can and Should be Free
  for the Poor and Vulnerable
• Dr Noor Ahmed

2
TB is Closely Linked with Poverty

• Most TB patients are from poor households or
  vulnerable groups including internally displaced
  migrants refugees prisoners and confined
  population
• They become locked in a vicious cycle of poverty
  and disease
• Many cannot access quality care
• On average patients lose 3-4 months of work time
  an annual loss equivalent to loss of 20-30 of
  the family household income.  If a patient dies
  the family loses about 15 years of income
• If a wife develops TB it is not uncommon for the
  husband to leave her.  For female members of the
  family the stigma attaching to TB may prevent
  marriage.

3
Current Challenges for TB Diagnosis

• Quality of Care
• Poor quality diagnostic tools and approaches
  (e.g. smear microscopy) leads to poor diagnosis
  and missed cases
• Patients face long waiting times and delayed
  diagnosis
• Results in increased transmission.
• Threat of MDR TB
• Exacerbated by low quality diagnoses
• Equity in Access to Care
• Care is not available to all
• Unequal distribution of health services not
  based on need
• Social, cultural, geographic and economic
  barriers to care1
• Where treatment and drugs are free patients face
  high travel costs2
• Care is unavailable to those who need it but
  cannot pay but is available to those who can pay
  but dont need it.
• Social Determinants
• Poor living conditions, food availability and
  livelihoods opportunities promote the spread of
  TB and the numbers of people requiring diagnosis

4
TB suspect
5
Informal Providers
6
2
1
3
Non-biomedical hakims, homeopaths
Biomedical medical stores, unqualified
practitioners
Solo GPS
Initial Contact
NGO Clinic
Social marketing/ franchising NGO
Private Clinics/ hospitals
Government facility
Without lab
With lab
Referral to NGO community programme
Referral to public facility, LHW or NGO
Public TB system
Smear microscopy at clinic laboratory
Smear microscopy at clinic laboratory
Smear microscopy at other CBO/NGO or public lab
Smear microscopy at local private lab
Diagnosis
Reporting
Per public guidelines
Reporting Laboratory Data Collection Field
Officer/quarterly meetings Dissemination Field
Officer
Reporting Lab or social franchiser Data
Collection Field Officer Dissemination Field
officer and social franchiser
Referral forms given to providers
Reporting Laboratory Data Collection Field
Officer/quarterly meetings Dissemination Field
Officer
Funding
Public
Government provides resources as required for
microscopy, treatment and reporting
EDOH provides drugs and reporting forms to GPs
through social franchiser
EDOH provides drugs and reporting forms to
CBO/NGO who provide to selected informal providers
Govrnement provides resources for microscopy,
treatment and reporting
QA
QA from the EDOH/DTC. Laboratory QA from Field
Officers and Laboratory Supervisors
Public
Social franchiser conducts QA of GPs DOT.
EDOH/DTC, will also provide oversight, especially
in early stages.
CBO/NGO may be trained to provide supervision and
QA to informal private providers
QA from EDOH/DTC. Laboratory QA from Field
Officers and Laboratory Supervisors
5
Importance of Free TB Diagnosis

• Access to a good quality diagnosis is crucial for
  TB control
• The poor bear the greatest burden of TB but have
  the least access to a quality diagnosis
• Free treatment is enshrined in TB guidelines
  free diagnosis should also be given the same
  status
• TB Diagnosis should be available free of charge
  in all health care facilities .
• This free availability of diagnosis would ensure
  that barriers in access were effectively avoided