Challenges in Tuberculosis Eradication - Literature review Example

Challenges in Tuberculosis (TB) Eradication National and international challenges in T.B eradication Health systems The recent universal plan has been formulated at a duration when it has been realised that if most of the health-related millennium goals are to be achieved, then constraints facing health systems must be overcome those that hinder quality, equity and access to quality care especially (Organization, 2009, 20). These factors are key, not only in T.B elimination, but on other transmissible diseases too. In strategizing and implementing DOTS programme and other approaches in the past few years, countries experiencing high T.B disease burden have reacted to their health systems, weaknesses and strengths. Most countries capacity to respond to T.B have been strengthened, but management resources and staffing showed a great variation and in several countries, these efforts are completely absent. New technologies in a number of countries allowed the capability of the public, community and private organizations to take part in expanded service delivery (Lönnroth et al., 2009, 62). New methods were discovered to overcome inadequacies in drug supply, access to laboratories and diagnosis, evaluation of results and basic information. However, even with all these efforts, it was impossible to reach all the needy patients. Human resources shortages in the health care sector remains one of the major challenges facing T.B eradication and attainment of Millennium Development Goals. It demands collective action in all the health systems levels, partnerships, programmes and global action. Health workforce crisis Human resource remains a crucial component of the health systems globally. Without these resources, public or individual interventions are futile. A wide scope of health personnel and allied fields take part in T.B control. Shortages in motivated staff and component staff are one of the key barriers in stopping T.B and achieving MDGs (Atun et al., 2010, 2172). H.I.V impact on health workforce worsens the crisis in Human resources, especially in the Sub-Saharan Africa. The global plan pays special attention to this problem and recognize that workforce weaknesses are rather complex requiring comprehensive, concerted approaches in curbing them. National plans to push for DOTS expansion and the cumulative strategies in stopping T.B in the next decade will take specific consideration of Human Resource base in particular country settings. In addition, they should be incorporated in the planning of a larger system, which will ensure that these constraints are acknowledged and effective opportunity utilization such as financing new health staff cadres and training initiatives. Lack of political commitment Stop T.B strategy and basic DOTS call for political commitment that is clear and sustained if both of the strategies re to be fruitful. Political commitment is essential in fostering international and national partnerships, which should be intertwined to plans and actions in the long term goal (Maher et al., 2007, 345). Strategic plans should focus on resolving financial and technical requirements and advocate for results and accountability at all heath systems levels including T.B-related indicators. If applicable, these political commitments should have national legislation backing. Lack of local partnerships makes it hard to improve care for T.B patients in terms of quality, access and equity. Inadequate financing. It is crucial to have adequate funding. Currently, there is acute inadequacy of resources, and there is a need for added effort in mobilizing required domestic resources, as well as universal resources. the global partnership and financial resources that are currently available for improvement of health systems, poverty reduction and control of diseases have provided for new opportunities of addressing T.B. the human resource department still experiences critical deficiency even with financing, and this impedes progress in many countries especially in Africa. Special efforts, such as effective strategic planning are required to ensure competent and adequate availability of human resources for particularly T.B care and general health care (Wang et al., 2007, 693). Lack of supervision and support for patients T.B services should address and identify contributory factors that stop or lead to interruption in treatment. Treatment supervision, such as included in “Direct Observation of Therapy,” ensures that patients remain adherent to treatment regimen and complete the treatment. This prevents drug resistance and ensures cure is achieved. Supervision should be conducted in a patient –sensitive and context-specific manner and is aimed at ensuring adherence of both the patients and the care providers (Lönnroth et al., 2009, 66). There are several barriers to supervised therapy such as geographical barriers and inadequate personnel, which contribute to the lack of treatment adherence. Lack of access to treatment A blend of social, cultural, financial and physical barriers interact leading to poor access to treatment especially in developing countries. Keener attention should be paid to most vulnerable and poor populations. There are few treatment outlets in poor urban and rural settings (Storla et al., 2008, 15). In addition, there lacks legal and psychological support, gender considerations and advocacy activities. These factors are pronounced in the third world. These factors are to be addressed if the Stop T.B strategy is to yield substantial fruits especially in the developing countries. Priorities In many countries, health care has not been awarded top priority, despite this sector being demonstrated to impact the economy of a country directly. Generally, healthcare should be a priority of any one country (Maher, 2010, 15). In the healthcare team, T.B does not appear in the top priority of the centres. The T.B regimen takes up to an average of six months and is costly so primary prevention should be the goal of the healthcare. When the infection is not a priority, the health care team may be lax in prevention activities. Governance Health of the population has been demonstrated to be determined by governance of the country. A country with a stable governance normally will have a healthier population. Poor governance often jeopardizes health systems since most of the Legislations and policies are formulated by the government. Poor governance will translate to poor health Legislations and policies (Piot et al., 2007, 10). The decisions trickle down leading to poor health services delivery. T.B specific intervention requires a government action to back the health care efforts especially in resource allocation and dispatch. Lack of a medical personnel in the higher ranks of governance with a say in policy formation may be a major cause for this problem. Corruption Many developing countries are plagued with corruption, a major problem in all sectors of the country. Corruption hinders just distribution of resources, leaving gaps in resource distribution. When resources are allocated for health initiatives, corrupt officials greatly reduce the resources actually reaching the patients. Money allocated for strategies such as Stop T.B initiative may be squandered by selfish officials and severe the efforts to curb T.B. Corruption in the healthcare team leads to inadequate health care personnel and inadequate drugs, which adds to the difficulties facing T.B eradication (Squire et al., 2006, 957). Tuberculosis in the Millennium Development Goals Tuberculosis is now addressed under goal 6.c of the Millennium Development Goals (Organization, 2009, 23). It ascribes objectives to stop and reverse tuberculosis incidences. Undeniably, tuberculosis inclusion in the Millennium Development Goals has placed a disease that had been largely neglected on the political forum (Atun et al., 2010, 940). Governments are now accountable to halt tuberculosis spread. Since this development, significant progress has been realized with over 51 million cured cases since 1995 and a gradual decline in annual rates of incidences and total patients suffering from tuberculosis (Squire et al., 2006, 955). Conclusion. The Stop T.B strategy and DOTS initiative have proved beneficial in T.B fight. However, most of the countries especially African countries are experiencing acute difficulties in implementing these initiatives. Major contributing factors are bad governance, corruption, lack of comprehensive support system and inadequate health care personnel. The secret to overcoming these setbacks lies in full governmental and international partnership into a collective initiative in eradicating T.B for all populations. This approach proved almost 100 percent effective in polio eradication. References Atun, R., Raviglione, M., Marais, B., Zumla, A., 2010a. Tuberculosis control is crucial to achieve the MDGs. The Lancet 376, 940–941. Atun, R., Weil, D.E., Eang, M.T., Mwakyusa, D., 2010b. Health-system strengthening and tuberculosis control. The Lancet 375, 2169–2178. Lönnroth, K., Jaramillo, E., Williams, B.G., Dye, C., Raviglione, M., 2009. Drivers of tuberculosis epidemics: the role of risk factors and social determinants. Soc. Sci. Med. 68, 2240–2246. Maher, D., 2010. Implications of the global financial crisis for the response to diseases of poverty within overall health sector development: the case of tuberculosis. Trop. Med. Int. Health 15, 11–17. Maher, D., Dye, C., Floyd, K., Pantoja, A., Lonnroth, K., Reid, A., Nathanson, E., Pennas, T., Fruth, U., Cunningham, J., others, 2007. Planning to improve global health: the next decade of tuberculosis control. Bull. World Health Organ. 85, 341–347. Organization, W.H., 2009. Global tuberculosis control: epidemiology, strategy, financing: WHO report 2009. World Health Organization. Piot, P., Greener, R., Russell, S., 2007. 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