Partnerships in tuberculosis control: Together we can!

One Swallow Cannot Make A Summer But Together We Shall Overcome
The theme of the recently concluded 42nd Union World Conference on Lung Health was ‘Partnerships for Scaling Up and Care’. The large number of delegates who attended this 5 day yearly event came from diverse fields - doctors, donors, governments, civil society, NGOs, advocates, affected communities and a host of other stakeholders. According to the dictionary ‘partnership is an arrangement where parties agree to cooperate to advance their mutual interests. Partnership means a formal agreement between two or more parties that have agreed to work together in the pursuit of common goals.’ But what did partnerships really mean to them in the context of the global health issues of lung health, especially tuberculosis. Here is a kaleidoscopic glimpse of the expectations and dreams of the participants:

In his inaugural address Prof S Bertel Squire, President of the International Union Against Tuberculosis and Lung Disease (The Union), affirmed “We are collectively interested in scaling up innovations, expertise, solutions and support to address health challenges in low and middle income populations - not just TB, or just HIV, or just asthma, or pneumonia or non-communicable diseases (NCDs) - but all of them. Our vision is health solutions for the poor. This is a huge responsibility which is shared by the large number of partners of The Union. Our vision is health solutions for the poor.”

“Governments and donors alone can’t solve the health care challenges facing the world today - especially as they affect the poor”, said Dr Nils E Billo, Executive Director of The Union. “Whether you look at the problem from the perspective of the global economic crisis or the greater demand for patients to have input into their care, it is evident that partnerships across the whole spectrum of stakeholders are required”.

According to Dr Billo: “We have to come away from a Partnership that deals only with TB, or only with HIV, or only with NCDs. In fact we need to think about collaborating across different health sectors and have a more holistic approach towards health, as all aspects of health, including stigma, are interrelated. We cannot work in isolation. If we want to scale up, we really need to continue and improve our partnerships across different areas of health. At the same time we have to make sure that we do not lose sight of the purpose of the program, otherwise everything will be too dispersed.”

Mikkel Vestergaard Frandsen, CEO and owner of Vestergaard Frandsen (a company focused on achieving the United Nation's Millennium Development Goals of eradicating extreme poverty, combating infectious disease and reducing global warming), in his inaugural lecture focussed on private-public partnerships. He felt that stand alone campaigns cannot work. Integration and fusion are important, as divorce (disintegration) between partners can make a millionaire out of a billionaire. He exhorted the private sector to come up with innovative interventions, and spoke about the health benefits of the integrated prevention campaigns of his company. One such partnership he had with the Ministry of Health in Western Kenya in 2008, wherein, “We achieved three goals – reducing malaria, diarrhoea and testing/counselling for HIV/AIDS through a single intervention. We designed a care pack consisting of a life straw water filter, and insecticide treated bed net, 60 condoms and some health education material. This was given free to anyone above 15 years of age, who volunteered to come for free HIV/AIDS testing services. We had tremendous success with a very large percentage of population testing for HIV/AIDS within a very short time, and at the same time getting access to malaria and diarrhoea prevention. There was stigma reduction too, as we had integrated a stigma related disease with two non stigma ones. This is the power and benefit of sensible partnerships.”

According to Dr Anne Detjen - “Partners mean all those who are involved. Partnership should be with the community, and community means the patients, the families of the patients, the community that they live in, and health care providers. Patients and doctors must form meaningful partnerships in the fight against TB. It is not only the governments’ National TB Programs, but also the NGOs (that are providing basic care and supporting the TB programs) who need to work together. Partnerships are often confusing for patients. So there has to be collaboration and a lot of communication between all these segments in order to work together and achieve together. Patients are partners and have the right to information, education and knowledge.

For Dr Nevin Wilson, Regional Director South East Asia Office of The Union, “Partnership is working together and sharing. Two or more people can sit together, look at the problem together and bring in their experiences together. When they use their joint efforts to help a third person (like the TB patient) the results are bound to be good. The idea is to reach out. One cannot reach out to everybody on one’s own. So we need to collaborate, cooperate, talk to each other, hear each other’s ideas and thus form partnerships. I cannot work alone. I need your help and you need mine. If I do not share with you and you do not want to share with me, then we are not working in partnership. The risk is that we will reduce our own efficiency and will also not be able to communicate with the community we want to serve."

According to Gilles Cesari, Singapore-based regional Director of The Union, “Partnerships mean working together and you cannot discriminate against people you work with. TB programs have overall been very centralized with the Ministry of Health/National TB Programs. But we need to involve the private sector too in the correct manner, so that they are able to report cases and follow guidelines as well as standard treatment parameters. It is equally important to involve communities, schools, donors and NGOs, not only for TB control but tobacco control also, which is so closely linked with health.”

According to Dr Ann Ginsberg, “we all need to work together—the people, the community, the advocates, the people who are implementing the current tools and the different groups which are trying to develop new tools. It has to be a combined effort of the governments and funders as well to engage and together we can do it.”

For Community representative Robert from Uganda, for partnerships to be meaningful we have to look at all players as equal partners, regardless of who they are. The community should be looked at more as partners rather than mere participants or patients. Partnership means involving them in all key projects. As of now there is very low participation of community as partners in TB control, and this is dangerous.

Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership would ideally like to see countries having partnerships around health issues and have a round table of partners. Not only must the Ministry of Health, but representatives from other government structures like the Ministries of Education, Social Affairs, Migration, and Human Resource (dealing with work force) should work in partnership. In addition to this, civil society and community representatives should be there with clear seats and clear empowerment, and given the right weight. We also need the private sector to be partners. I would say that partnership should represent entire society and we need to look at the whole health sector and not just TB. Also, mobilising the youth is absolutely essential. My message for the conference—there should be no more women and children and men dying of TB and this can be achieved by forging real and meaningful partnerships which include vulnerable populations.

So let there be many swallows for a summer sans tuberculosis and other health problems. Amen!

Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She is currently writing from the 42nd Union World Conference on Lung Health, Lille, France. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. Email: shobha@citizen-news.org, website: http://www.citizen-news.org)

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