TB case detection, cure rate way below 2005 target
THERE have been a number of articles on tuberculosis (TB) in The National in recent weeks and I would like to make a few comments.
TB has been in this country for many years and yet it is still a major public health problem.
Nothing has been done by the Health Department and the Government to control this curable disease.
In 1997, the department introduced a directly-observed treatment short course (DOTS) strategy on a trial basis in the National Capital District (NCD) and Lae.
It was hoped that the National TB Programme would adopt the strategy and eventually extend it to other provinces.
This has not happened and there are several reasons for this.
First, there is only one officer responsible for the programme for the entire country at the national level.
More than 80% of the provinces do not have a provincial TB officer.
A good number of doctors and health extension officers have been trained in TB control either locally, in Japan or Vietnam over the last 10 years, yet when they return, they do nothing, leaving a handful of untrained nurses and staff to do the work.
Why waste resources on training doctors and HEOs overseas?
Second, since the DOTS programme was introduced, all the focus from the National TB Programme office has been in the NCD and Lae. Only recently was the programme extended and strengthened in a few provinces such as Milne Bay, Madang, East Sepik and Eastern Highlands.
Therefore, the statistics being reported under the DOTS programme do not represent the true picture of the TB situation in PNG.
While other programmes such as HIV/AIDS, EPI, malaria, etc, are being strengthened in a big way in many provinces, I do not see any reason why it has taken more than a decade for the DOTS strategy to be implemented throughout the country.
Third, it seems that the World Health Organisation (WHO) has taken over the responsibility of the Government in implementing the National TB Programme.
While I appreciate the work of WHO in supporting the programme, its staff have gone beyond their boundaries of technical advice and support (as a technical agency) to supervising hospitals, health centres, aid posts and even TB patients.
That is the job of health workers in the provinces and statistics.
The effect is that, health workers relax and say: let them do it because they have taken over our responsibilities.
Moreover, I have learnt that the Government, with assistance from WHO, has signed a grant agreement with Global Fund for AIDS, TB and malaria.
The funds will be used to implement the National TB Programme in a phased manner.
However, much of these funds will go to a number of non-governmental organisations (NGOs) and organisations operating in Port Moresby.
Instead of giving the money to these organisations, I think it should be managed by a credible fund manager or channelled through the Government financial system so that it can be used to improve the TB facilities and build up the capacity of health workers in all districts to implement the programme.
Why give the money to organisations which have not in any way been involved in TB control, or which have not had their hands dirty with TB germs in this country?
I am sure many hands went up when they heard about the huge funding coming our way.
What about sustainability?
Finally, the National TB Programme planned to cover the entire country, achieve 70% case detection and a 85% cure rate by 2005.
It is now 2008 and we have not achieved the case detection and cure rate targets in even one province.
With Global Fund’s assistance, we may achieve some results. However, after four years, the programme will go back to square one when the NGOs use up what has been given to them.
At the end of the day, we may not have achieved our goals.
The Health Department should create additional positions for TB at the national level.
The provincial administrations should also create positions for TB control officers and TB laboratory officers in all provinces and districts.
Use the grants from Global Fund, AusAID and the Government to train these officers and provide the necessary logistical support for them to implement the programme based on the national guidelines.
If we do this, I am hopeful that we will achieve the targets in the next five years and go on to sustain it even when the Global Fund assistance is used up.

GK, Port Moresby
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