"The Big Issues" focus on matters that concern us. These sessions begin with a short presentation from an invited speaker, followed by a time of discussion. A series of questions will be posed, and by the end of the session some recommendations will be developed. As well as views from participants at the conference, we will also include your responses received by e-mail from all over the world!
Please read the following introductory notes, and then send us your ideas by e-mail. Click on
My Ideas after each section to send an e-mail response.
Dr Dirgh Singh Bam
Nepal National Tuberculosis Programme (NTP)
NGOs and governments have complementary strengths and weaknesses. The ability of NGOs to act swiftly in times of need, to mobilise community resources, and to help communities identify their own needs and respond appropriately, is matched by the government's ability to mobilise extensive resources, and it's long term commitment to health care services. In this session we will hear from two speakers - Mr Elgin Saha, Director of HEED Bangladesh, and Dr Dirgh Singh Bam, Director of the Nepal National Tuberculosis Programme. Their observations, from two perspectives and two countries, will shed light on this area!.
Are the roles of NGOs and governments always complementary?
Why do relationships sometimes become strained?
If so, what can be done?
How can NGOs and governments improve co-ordination?
Mr Aidan Keyes
South Africa National Tuberculosis Association (SANTA)
People with TB often live at the margins of society. Health care services are frequently ill equipped to reach and support such people, and as a result, the people who need care the most, are least likely to get it. The TB Care Committee is a network of agencies working in TB control in South Africa. Ms Ria Grant will discuss this issue, and look at ways of overcoming barriers to care for deprived communities. Mr Aidan Keyes will describe the strategy now adopted in South Africa to fight TB, and the relationship between SANTA and the national government.
What are the main barriers to care for disadvantaged people?
How can NGOs and governments ensure that services reach deprived communities?
What specifically can NGOs contribute to this area?
As AIDS cases rapidly increase in Asia, many countries turn towards community and home based care for people with HIV and AIDS. The AIDS pandemic also has considerable implications for existing TB control programmes in Asia. AIDS and TB care strategies are closely linked, with people in the community and family providing care and support. The linkage is even stronger, as the two diseases are often found together in the same patient. To what extent then do treatment, care and support strategies for the two conditions relate?
Can planning for home and community based care of people with AIDS (PWA) learn
anything from care of patients with TB, and vice versa?
How can we integrate HIV care into the DOTS strategy for TB patients?
How can we provide proper treatment for TB patients through existing AIDS care
systems?
Dr Mohammed Akhtar
Britain Nepal Medical Trust (BNMT)
The global target of a cure rate of 85% is still a distant dream for many programmes. However, there are several programmes which have managed to achieve this target, and are now looking at ways of increasing case finding as the next step. Britain Nepal Medical Trust are such an organisation, and have made attempts to find the "missing" patients in several remote hill districts of eastern Nepal. Dr Mohammed Akhtar, TB Co-ordinator of BNMT, will describe their programme, and the results they have obtained.
Who are the missing patients?
Is there a role for active case finding?
What strategies are appropriate for active case finding?
What can NGOs contribute in this area?
Analysis of case finding statistics in most developing countries shows that the majority of patients registered for treatment are men. This may be because women get TB less than men, or because they are denied diagnosis and treatment. The BRAC programme in Bangladesh works with female health volunteers, and is therefore well equipped to answer some of the questions relating to gender and TB. Ms Elizabeth Fair will present the results of their research, and discuss some important questions relevant to this topic.
Is the gender difference the same across all countries?
Do women get TB less than men?
Are women denied diagnosis and treatment?
If so, why?
What can NGOs contribute in this area?
Mr Virendra Lal Karn
International Nepal Fellowship (INF)
The declining prevalence of leprosy world-wide has led many organisations to reconsider the role of leprosy control programmes. With fewer patients to diagnose and treat, it will become more and more difficult to sustain such programmes. However, there will still be an ongoing need for leprosy control activities for many years to come, and for rehabilitation work for even longer. Many countries have combined their leprosy and TB programmes, whereas in others TB has been combined with other communicable disease control programmes, such as HIV/AIDS, or with Respiratory Disease Control. The previously independent INF TB and Leprosy projects were recently combined as one project in the Mid West Region of Nepal. Mr Virendra Lal Karn of the INF TB Leprosy Project will describe the process, and identify some of the issues involved.
Should TB and leprosy programmes be combined?
Is this true in all situations?
What are the advantages and disadvantages?
What can NGOs contribute in this area?
This is your opportunity to discuss an issue that you feel hasn't been dealt with properly yet. What about multi-drug resistant tuberculosis? Or issues of sustainability and funding for NGO programmes? We received many ideas for topics to be discussed in the conference, but it would have taken a full week of meetings to cover all of them! During this session we will have two rooms available for participants to get together and discuss issues of their choice. You can join in too! Identify an issue and give us some of your ideas. We will announce it, and if there are other people interested then they will get together and come up with some difficult questions, interesting ideas, good discussion and profound thinking!