Malawi needs to expand TB control interventions

Martin Chiwanda, CNS Correspondent, Malawi
The World Health Organization (WHO) says that Malawi must expand interventions to control TB as it is one of the developing countries with very high incidence of the epidemic. The Director of WHO Global TB Programme Dr Mario Raviglione, in an interview via a webinar hosted by Citizen News Service (CNS) and the International Union Against Tuberculosis and Lung Disease said that Malawi government needs to fully adhere to the new Sustainable Development Goals (SDGs) of which Goal 3 targets to ensure healthy lives and promote well-being for all at all ages.

The specific SDG 3.3 aims to ‘End the epidemics of HIV/AIDS, TB, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases’. Translated into numerical targets, this means that TB incidence and death rates should be reduced by 80% and 90%, respectively, in the next 15 years. The End TB Strategy of WHO has a longer timeline than the SDGs— up to 2035. Although the 80%/90% reduction represents milestones to be achieved by 2030 in the End TB Strategy, the targets to be achieved by 2035 are reduction of 90% in incidence and 95% in death rates. Dr. Raviglione lamented that  TB now rivals HIV/AIDS as the leading cause of death globally with an estimated 9.6 million TB cases and 1.5 million TB deaths worldwide every year.

While agreeing that developing countries like Malawi need international support to assist in the fight against TB, Dr. Raviglione advised that, “Malawi is one of the developing countries where the TB epidemic is not only a real  concern by itself, but is also very closely associated with HIV/AIDS co-infections. So a normal approach to tackle this problem will not work. There is an urgent need to expand interventions like early diagnosis of TB with drug-susceptibility testing, and systematic screening of contacts and high-risk groups”. “From my view, malaria and HIV/AIDS dominate in most of the projects submitted by the developing African countries to the Global Fund for financial assistance, while TB takes a backseat and is underrepresented. What is required is political commitment with adequate resources for TB care and prevention,” he explained. Dr. Raviglione said there is a need for Malawi to increase collaborative activities for management of TB and HIV co-morbidities as well as preventive treatment of persons at high risk.

Dr James Mpunga, Programme Director of Malawi National TB Control said that the fight against TB is going on well as the country has been able to reduce the number of TB cases and those diagnosed get treatment. He said that in the past they could not be very successful in the fight against TB due to paucity of funds for the programme. “Six to eight years ago we did not have enough funding to fight against TB in the country. For instance, only 50% of the annual health budget that we submitted would be approved and out of that, TB operations were given only 30%. But currently we have more resources from the Global Fund and I am sure of more successes as regards fight against TB,” said Dr. Mpunga. 

He said Malawi is expanding diagnostic and treatment sites at the primary healthcare level unlike the past when these facilities were available only in district hospitals. But he noted that still the country needs a lot more resources in order to meet the sustainable development goal of eradicating TB by 2030. “As Malawi we still need help as we would want to start searching for patients and not waiting the patients to come to the hospital. In fact currently we have 51 machines country wide, so we want more so that we can go flat out. “What we want is to go out in the community with the necessary diagnostic tools, screening people door to door, and not wait for the patients to come to the hospital. We also need to have more equipment and better technology than what we are using currently. Right now we have only 51 machines country wide, but we want more,” explained Dr Mpunga.

He further explained the need of having skilled staff as the fight against TB cannot be achieved without adequate trained staff. “While we are looking at having trained staff, the communities too need to be sensitized on TB so that together we can move forward. These things will need support from the Global Fund,” he said.  

Martin Chiwanda, Citizen News Service - CNSApril 4, 2016

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