Ways and Means
Bricks or Scaffold? Working with the health service
Dr Neil Hamlet
International Nepal Fellowship (INF)
One approach to NGO involvement in TB control is to support the implementation of diagnostic and treatment services through the integrated primary health care infrastructure. Working with government health services brings it's own particular joys and sorrows, and Dr Neil Hamlet, director of the Tuberculosis Leprosy Project of the International Nepal Fellowship will share some of these with us. The TLP supports TB and leprosy control services in one of the most remote and disadvantaged regions of Nepal. How can an NGO support the government, without taking over completely? Should excellent services be compromised for the sake of sustainability? Dr Neil Hamlet will cover these issues and several others in this session.
Working at the Grass Roots; Community based TB Control
Mr Akramul Islam
Bangladesh Rural Advancement Committee (BRAC)
The Bangladesh Rural Advancement Committee is widely recognised as one of the most experienced NGOs involved in community based rural development in South Asia. For many years BRAC has been involved in TB control, with an approach that is truly community based, involving female health volunteers. BRAC have recently seen an increase in this involvement as the revised NTP has expanded in Bangladesh, and continue to achieve remarkable results. But is this sustainable? Is TB control an expressed need of communities? What levels of support do volunteers need? Akramul Islam will present the experience of BRAC in community based TB control, highlighting some of the lessons learnt.
Changing Faces, Changing Roles; NGOs, NTPs and the Private Sector
Dr Klaus Jochem
Nuffield Institute for Health (NIH), UK
The dynamics of health sector reform, changing priorities in health care, emerging and re-emerging diseases, and demographic and epidemiological trends, are all combining to change the shape of traditional disease control programmes. How will this affect TB control? What is the potential role of the private sector? How can NGOs and NTPs learn to develop closer links with the private sector? These questions, and others, will be considered by Dr Klaus Jochem of the Nuffield Institute for Health, Leeds University.
Life In the City; Urban TB Control
Dr Bhawana Shrestha
German Nepal Tuberculosis Project (GENETUP)
The German Nepal TB Project is a joint initiative between the Nepal Anti TB Association and Kuratorium Tuberkulose in der Welte. GENETUP was the first organisation in Nepal to introduce DOTS, and has achieved remarkable results with an intermittent drug regimen. Their clinic is located in urban Kathmandu, where most of their patients come from. Dr Bhawana Shrestha will present their results, and describe some of the issues involved in providing services in an urban area.
People On the Move; TB Control in refugees
Dr Santa Tamang
Save the Children Fund UK (SCF UK)
Nepal provides a temporary home for refugees from several countries, with the largest group of over 80,000 coming from Bhutan, and living in camps in the Eastern Region of Nepal. Save the Children UK is responsible for health care services in the camps, and has established an excellent TB control programme. As the number of refugees world-wide increases, TB is also a growing concern in this group of people. Dr Santa Tamang will describe the SCF programme and discuss some of the issues involved in providing TB control services to refugees.
Centres of Excellence? Hospital based TB Control
Dr Andrew Edwards
United Mission to Nepal (UMN)
TB control provides an excellent example of the interdependence of curative and preventive health care services in disease control. Prevention IS cure, and a good TB control service relies on a combination of diagnostic and treatment services. Historically, these have often been based at TB clinics or general hospitals, and in many countries these institutions continue to treat a large proportion of patients with TB. Cure rates are sometimes poor though - often because the hospital is unable to routinely follow up late patients in the community. Patan hospital is an urban district hospital run jointly by the United Mission to Nepal and the government of Nepal, and provides treatment for the majority of TB patients in the Lalitpur district. Dr Andrew Edwards will describe the treatment services at Patan, and show how good results can be achieved in a hospital with links into the local community.
By the People, for the People; Patient's Organisations
Ms Anne Horgheim
Norwegian Heart and Lung Association (LHL)
The Norwegian Heart and Lung Association began as (and still is) a patients organisation to provide support for people with TB. Over the years, changing patterns of disease in Norway have led the organisation to expand its area of concern, but it remains firmly committed to TB control, and supports activities in several developing countries. LHL is unusual in that it remains an organisation of patients - people suffering from a disease who have organised themselves to fight their disease. Is this a potential model for other countries? Are there similar models in developing countries? What can we learn from the experience of LHL? Ms Anne Horgheim has worked in Nepal and Norway, and will describe the work of LHL.
Doing DOTS; Experiences with supervised treatment
Dr Ian Smith
United Mission to Nepal (UMN)
The directly observed component of DOTS is perhaps the most contentious aspect of the revised strategy for TB control. Health workers and patients alike find it difficult to understand why someone has to supervise treatment. Is it necessary? Why supervise treatment? Who can supervise treatment? These and many other related questions will be dealt with in a presentation which will also include a look at some models for DOTS in developing countries. Come prepared to share your own experiences of DOTS!
Voices to the Poor, Voices for the Poor; Advocacy and Health Education
Voluntary Health Association of India (VHAI)
Tuberculosis is a disease of disadvantage and neglect. Governments (and many NGOs!) have neglected TB for far too long. Perhaps because TB is a disease of the poor and marginalised it has failed to attract the attention of policy makers. Perhaps too because it has been with us for so long; familiarity breeds - not contempt - but apathy. Both advocacy and health education are essential strategies to overcome this complacency and ignorance. Those in power need to know that TB can be controlled, and those without power need to know that it can be cured. The Voluntary Health Association of India has a long history of involvement in these areas and will describe the advocacy and education activities of the VHAI relating to TB control, highlighting some of the lessons learnt.