Health ministers commit to reverse the tide of lung diseases and NCDs

Shobha Shukla, Citizen News Service - CNS
The first press meet at the 47th Union World Conference on Lung Health, being currently held in Liverpool, saw the Ministers of Health from Philippines, Sri Lanka and Zimbabwe reflect on the successes and challenges of responding to the global epidemic of TB, tobacco related diseases and Non-Communicable Diseases (NCDs).

Jose Luis Castro, Executive Director of the International Union Against Tuberculosis and Lung Disease (The Union) set the ball rolling by saying that although the latest estimates of the global TB burden were very disturbing (10.4 million new TB cases and 1.8 million TB deaths in 2015), all is not lost. There is still hope to reverse the tide as we know what is to be done - business cannot be as usual. WHO's endorsement of the 9-month short regimen for MDR-TB treatment is one such positive step in the direction of meeting the global goal of ending TB by 2030. Countries will now have to start the process for its roll-out. Past experience has shown that it takes at least 1-2 years for a country to uptake a new approved drug regime.

Tobacco control

Dr Paulyn Jean B Rosell-Ubial
Dr Paulyn Jean B Rosell-Ubial, Health Minister of Philippines lauded the anti tobacco efforts of the recently elected President of her country,  Rodrigo Duterte. She shared that, “We have submitted to the office of the President early this month a draft on smoke-free public places for the entire country. In his earlier position as a Mayor of Davao, the President had implemented a very comprehensive 100% smoke-free ordinance in that province. Now he wishes to implement the same 100% smoke-free policy in the entire country. The Bill, which is still pending signatures, clearly defines the public places and designated smoking areas - but there will be no indoor designated smoking areas."

R. Senaratne
Sri Lanka
Rajitha Senaratne, Health Minister of Sri Lanka listed the strong tobacco control measures that Sri Lanka has implemented. "We were the first country in Southeast Asia to sign the [Framework Convention on Tobacco Control] FCTC. We already have smoke-free public places, recently increased taxation on cigarettes to 90%, and implemented 80% pictorial health warnings on tobacco packs. We are now bringing in legislation for plain packaging. Every action taken results in 4-5% decrease in the number of smokers. There is a strong anti-tobacco campaign in the country and awareness programme amongst youth is very successful. 86% of students agree that smoking is harmful and 96% believe that smoking should be banned. But chewing tobacco is still a big problem."

Ending TB by 2030

Sri Lanka: With a prevalence rate of only 65/100,000 and mortality rate of 5.6/100,000, the TB burden in Sri Lanka is not very high, said Senaratne.

There is 100% treatment coverage and an 85% treatment success rate. The Health Minister attributed this to the robust and free of charge public health delivery system of the country. The whole system is computerised and there are no drug stock-outs. Apart from having a very good network of health clinics for TB care and control, “We have recently set up 846 well-being centres in the countryside for control of NCDs. For the first time we have started health checkup systems - to check blood pressure, BMI, blood sugar, cholesterol, ECG, etc. We will now be opening district level centres, which will provide all higher level tests, except MRI and CT Scan. We have also set up 946 well-women clinics where apart from above tests, they are also tested for breast and cervical cancer”, said the Minister.

Philippines: It is one of the 9 high TB burden countries that has met the MDG target by bringing down TB incidence rate to 288/100,000, prevalence rate to 417/100,000 and TB mortality rate to 10/100,000 by 2015.

“In terms of meeting the Sustainable Development Goals (SDGs), Philippines is getting full government support. In April 2016, we passed an Act to establish a comprehensive action plan to eliminate TB. We are now in the process of crafting and implementing the rules and regulations of this law,” said Paulyn.

While Philippines is making all out efforts to eliminate TB, timely roll-out of new drugs and/or treatment regimens at the ground level remains a challenge. It can take 2-3 years for full roll-out of new drug regimens. Paulyn attributed this to the geographical constraints. Philippines has 7100 islands and many people do not have access to the internet. The geographic isolation of areas makes it challenging to train all the healthcare workers and put in place logistics management systems.

David Parirenyatwa
Zimbabwe: David Parirenyatwa, Health Minister of Zimbabwe, said that TB-HIV co-infection and MDR-TB is a huge problem in his country. Installation of GeneXpert has improved diagnosis. But the fight against TB is multisectoral and everyone has to be part of the efforts to eliminate it. Raising awareness in the communities about TB, as well as HIV/AIDS, is very important. This is where the role of parliamentarians comes in, he said. MPs are in direct contact with their constituencies and hence can empower and educate the public, so that people recognise the signs and symptoms of TB and go for diagnosis and then complete their treatment. Zimbabwe has introduced an AIDS levy, and part of this money goes for TB control, as TB is one of the most opportunistic infections in people living with HIV/AIDS. This has, to some extent, mitigated the funds shortage in TB sector. However he felt the need for an increase in the domestic health budget to reduce dependence on donor agencies for funds.

Philippines is slowly weaning away from international funding. In 2013 government allocation of about 1 billion pesos for TB control programme, covered 100% of the TB drugs needed by the country. But there is external budget support for MDR-TB programme. Currently, 80% of the TB budget is met by domestic funding and 20% by external donors. But the government hopes to finance 100% of the TB budget from domestic sources by 2020.

There is need to make optimal use of resources and overcome bottlenecks for further roll-out of GeneXpert to increase case detection, roll out of the new improved treatment regimens and drugs, as well as tackle NCDs, to meet the ambitious sustainable development goals.

Shobha Shukla, Citizen News Service - CNS
27 October 2016
(Shobha Shukla is providing thematic coverage from the 47th Union World Conference on Lung Health, Liverpool, United Kingdom, with kind support from TB Alliance (Global Alliance for TB Drug Development). Follow her on Twitter @Shobha1Shukla)