Three ways we're helping to end TB by 2030
One of the most common first symptoms of tuberculosis (TB) is a persistent cough. For many people, a cough is not reason enough to leave their daily routine to go to the doctor. And for most of these people, going to the doctor means taking a full day off work, travel and treatment costs more than they can afford.
Dr Rahma Omar, Regional TB Coordinator for Amref Health Africa in Zanzibar, Tanzania, says this barrier causes many cases to go undiagnosed, and they continue to spread TB throughout their communities.
“Most patients come to the hospital very late,” she says, “and due to that, we have a significant number of deaths from TB.” Tanzania ranks among the 30 highest TB-burdened countries in the world with an estimated TB prevalence at 295 cases per 100,000 population.
This diagnosis delay is one of the biggest challenges to achieving the Sustainable Development Goal (target 3.3) to end TB by 2030.
We know that the only way we can tackle this is by designing solutions that are tailored to the unique needs and characteristics of the communities we serve across Africa to make sure we are reaching everyone with TB education and services.
Amref works with communities across several African countries, including in Zanzibar, to develop innovative, people-centred methods to detect cases early, diagnose them quickly, and treat them fully. Here are three of these innovations.
Innovating to detect TB early
“Community health workers should be the center of everything in health service provision.” Dr Rahma Omar
Community health workers (CHWs) – those community members who are nominated by their communities to be trained and serve them as health workers – are on the frontline providing regular health information and services to every house assigned to them.
Yet, many CHWs are not paid for their work, and many lack up-to-date training. Our programmes to tackle to TB burden in African communities harness the power and responsibility of this steadfast workforce.
In Ethiopia, Kenya and Zambia, our GSK-supported programmes train CHWs on prevention, diagnosis and management of TB. Thanks to the training, 97% of Kenyan and 93% of Ethiopian health workers trained through the programme can now effectively diagnose and manage TB (and malaria) compared to 70% (Kenya) and 63% (Ethiopia) before the programme began.
In Zanzibar, Tanzania, the 25 CHWs trained through the current USAID-funded programme can reach about 120 people each per month. Zanzibar has a population of 2 million people, so to achieve the target of reaching everyone with TB education rapid scaling is needed. The programme has established school health clubs in each target area’s secondary school to train secondary school pupils on TB symptoms. These students are then equipped with TB information posters that they take home to deliver information to their own families, and the neighbouring 2-3 households. Dr Rahma Omar says this approach has already seen results: “School health clubs is not a new concept, but we considered that since most CHWs only have a primary level of education, secondary school pupils are an untapped resource for us to reach more people with essential health information. This also builds a volunteering, community spirit really early, helping us to create a sustainable community health workforce of the future.”
One-stop-shop for free-of-charge, rapid diagnosis and treatment
“Malaria in Zanzibar is nearly controlled. I believe having a mobile TB clinic here in Zanzibar will also help eradicate TB.” Dr Rahma Omar
Most people at high risk of contracting TB are low-income. They rely on daily wages to meet their basic needs of shelter and food. Motivating them to recognise that their persistent cough could be sign of TB infection and to go to a health facility to get it diagnosed is very difficult. It would require them to take a day off work and not take any earnings home that day. This is simply not an option for many people.
In Tanzania’s mainland, Amref has deployed End TB mobile clinics which serve as a one-stop-shop for free TB services. In the space of about 40 minutes, someone with suspected TB symptoms can be screened, diagnosed, started on treatment and connected to a community health worker and their closest facility to ensure they follow through with treatment.
This is game-changing in the efforts to end TB. Each mobile clinic can reach about 400-500 people per day with these free services, ensuring that people do not have to choose between their health and their livelihoods.
Treatment for the impact on health, life and livelihoods
TB is a disease which does not only have medical symptoms; the effects of TB stigma and myths can be felt in a patient’s family and social life, and it can also impact their livelihood. This is why the solutions we design with communities respond to their own experiences of TB and its effects and address their unique needs and challenges.
In Zanzibar, our end TB programme integrates anti-stigma and discrimination through every activity, to ensure that patients, their families and communities are getting accurate information about the disease to prevent patients being isolated or stigmatised.
It also integrates entrepreneurship training for TB survivors who have been negatively affected by TB stigma—some of whom have self-isolated for years following their recovery, wrongly believing that they cannot return to normal life.
Entrepreneurship training allows them to learn new skills to set up or expand an existing small business to earn them steady income. This income is vital not only during treatment to cover travel costs to health facilities, or cover the cost of the extra food needed for TB patients on medication, but also in the post-recovery phase to ensure that patients have a stable entry back into their regular routine.
Find out more
Read more about how we are helping to bring critical TB care to more communities.
All images (c) Sam Vox / Amref Health Africa
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