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A partnership in pictures: our tribute to China and Ghana teams

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Our China and Ghana teams. From left: Dr Gifty Antwi, Professor Harry Tagbor, Professor Xiaolin Wei, Sunny Zou, Zhitong Zhang, Simin Deng


Earlier this year the COMDIS-HSD team said goodbye to two highly-valued and long-standing partners, Global Health Research and Development (GHRD) in China and Centre for Global Health Research (CGHR) in Ghana.
These partners have made an exceptional contribution to our work to improve health service delivery for malaria and multi-drug resistant TB, as well as reducing antibiotic over-prescribing – a serious and urgent issue worldwide, but especially in China.
Click here for our photo tribute sharing some of the many highlights and impacts of our work with the China and Ghana teams.

 

World TB Day 2017: why we're leaving no-one behind

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ARK Foundation and COMDIS-HSD team members join thousands on the World TB Day 2017 rally through the streets of Dhaka, Bangladesh


World TB Day is always a big date in the COMDIS-HSD calendar. This year, the ‘Leave no-one behind’ theme had particular resonance with our research. It gave us a global platform to promote our work to tackle the stigma, social isolation and mental stress associated with TB and multi-drug resistant TB (MDR-TB) treatment.
To mark the day, and the week leading to it, COMDIS-HSD and our partners ARK Foundation (Bangladesh) and HERD (Nepal) took part in a range of activities to show solidarity with the global TB community and engage new audiences in our research.
HERD: Giving a voice to those at the heart of TB control

HERD’s World TB Day 2017 special series report; a detailed insight into TB in Nepal and some of the hidden voices in frontline TB care


In their special series report, HERD highlighted some of the myths and challenges that surround TB and its treatment in Nepal. The report captures first-hand stories from individuals closely connected to the disease, either as patients, volunteers or health workers.
Jog Bahadur Gurung, a community volunteer at the directly observed treatment (DOT) clinic in Tanahun District, shared his thoughts about the need to educate all patients about the disease:
‘I have served more than 3,000 patients and am proud of playing a small hand in their lives. I found that illiterate patients did not have any idea about the disease while the literate were aware to some extent.’
Kamala Wagle is a Public Health Nurse Officer and Drug-resistant TB Programme Co-ordinator at the National Tuberculosis Centre. She feels that social media has a key role to play in changing attitudes:
‘There has been a difference in the attitude of people towards TB treatment. They used to hide the disease and now they come for test even if a minor problem is noticed. Even the attitudes of health workers have changed. Social media has played a very important role.’
Reaching all target groups remains a challenge, says Kamala, adding: ‘We need to introduce decentralised programme packages as most of the programmes are only concentrated in Kathmandu or major urban areas. There is a need to expand awareness programmes and conduct sensitisation programmes through media.’
The vital role of the media was reinforced in another HERD World TB Day media perspectives report, featuring the views of 6 Nepali journalists and media professionals. Asked to reflect on the role of the media in reaching unreached populations, there was broad agreement that the media is key to better dissemination of health education.
‘To curb the disease, it is important to focus on strengthening media’s role as a trusted agency to impart health education,’ says Anil Nyaupane, Editor in Chief, Swasthya Khabar Patrika.
Krishna Adhikari, Nepal Television (NTV) reporter, Nepalgunj, adds: ‘One way of ensuring services reach the unreached is effective mobilisation of Female Community Health Volunteers (FCHVs), teachers and cured TB patients for distribution of TB drugs.’
According to Krishna, this would give patients easier access to medication and help ensure patients completed their treatment.
ARK Foundation: We need to treat the public as our partners
The ARK Foundation team took to the streets of Dhaka once again on World TB Day, joining around 4,000 people linked to National TB Control Programme (NTP) partner organisations.
20,000 TB factsheets were also produced and circulated to hospitals, clinics and health centres in Dhaka city.
ARK researcher, Deepa Barua, reflected on the day, saying:
‘We’ve come quite far over the years. The NTP along with its partners have played the most important role in fighting TB. However, it is vital that we involve the public too. When we say “Unite to End TB”, it can’t just be unity between the NTP and the partners. It will have to be unity between the NTP, their partners and the people.
‘The NTP knows its role, the partners know their roles, it’s now time for us to join hands with the public to make them aware about theirs, and help them realise what they can do to end TB.’
Other resources we shared on World TB Day 2017

COMIS-HSD e-news special edition showcasing some of our recent TB and MDR-TB research


Infographic: We’re leaving no-one behind
COMDIS-HSD e-news: Special edition for World TB day 2017. Subscribe to our e-news.
Policy brief: Improving treatment for MDR-TB patients – lessons from Shandong province, China
Research brief: Women and their mental and social wellbeing during multi-drug resistant TB treatment in Nepal
Research brief: Improving access to TB care for garment factory workers using public-private partnerships in Bangladesh
 
 
 
 
 
 

Blog: Talking to Parliament about the women and girls agenda in the fight against malaria

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Christian Rassi


Christian Rassi talks about his recent presentation in Parliament on our study exploring the barriers to uptake of intermittent preventive treatment of malaria in pregnancy (IPTp) in Uganda.
Malaria in pregnancy is a good example of how health programmes need to take gender into account. Pregnancy is one of the main risk factors for malaria and malaria infection during pregnancy is typically prevented and controlled through routine antenatal care, which is obviously a gender-specific care delivery mechanism.
On 14 March, I had the opportunity to present the study at a meeting in the UK Parliament to mark World Women’s Day and Women’s History Month. The meeting was hosted jointly by the All-party Parliamentary Groups on Malaria and Neglected Tropical Diseases (NTDs) and on Population, Development and Reproductive Health. Mine was one of three presentations which looked at how the development community addresses the women and girls agenda in the battle against malaria and NTDs.
Presenting to parliamentarians in a high-income country is a very different experience compared with the meetings and discussions we normally have with policymakers in the countries where we conduct our research. The focus was much less on the specific details of the intervention and its potential scale-up, and more about demonstrating the value of small-scale implementation research and illustrating the importance of addressing gender-specific barriers to service delivery.
As well as being an excellent opportunity to raise the profile of Malaria Consortium and COMDIS-HSD, the presentation also helped promote awareness of operational research and gender issues among stakeholders in high-income countries. Several representatives from DFID were in the audience when I presented and the malaria focal person made a very positive comment about the study.
On a personal level, having the opportunity to address parliamentarians in such a grand and historical place as Westminster Palace was of course a very exciting experience. I also couldn’t resist having my photo taken with Big Ben in the background…
Christian Rassi is COMDIS-HSD Project Co-ordinator with Malaria Consortium

 
 
 
 

Putting the power and politics into health systems research: reflections from RinGs

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Health Systems Global has opened a call for ideas on the theme of the 2018 Global Symposium on Health Systems Research, to be held in Liverpool, UK. Recognising this as great opportunity to help shape dialogue and debate on global health over the coming years, the team at RinGs (Research in Gender and Ethics) has been blogging about the need to frame the next symposium around power, politics, equity and rights.
In this recent blog, RinGs team members Kate Hawkins, Sally Theobald, Rosemary Morgan and Linda Waldman were joined by COMDIS-HSD’s Helen Elsey to offer these key questions to help shape the Liverpool agenda…
‘As RinGs is a project that works primarily on gender and ethics, we were delighted that the 2016 Health Systems Global Symposium included a stream on these issues. This meant that gender and ethics were more prominent in 2016 than in previous years. We were also excited by the focus on intersectionality and believe that this is an area that should not be discarded as we move forwards.
There are several areas where critical reflection is necessary and where we need to begin to try to address persistent and challenging questions:
Rights and justice
The right to health is the foundation of health systems strengthening. Key issues and questions include:

  • How has the right to health been actualised in policy, practice and legal challenge?
  • How does the right to health interact with other rights, eg those of women and children?

Inequity, gender and intersectionality
Intersecting forms of inequity shape the way that health systems are conceptualised, which issues rise to prominence, and the importance and investment afforded to different challenges. How social stratifiers, such as gender, race, age, class, (dis)ability and/or sexuality, intersect creates different experiences of privilege and disadvantage, leading to vastly different health needs, experiences and outcomes. Key issues and questions include:

  • Social determinants of health continue to drive inequities in health and well-being. How are health systems responding to these up-stream issues?
  • Risk factors driving both communicable and non-communicable diseases are disproportionately experienced by the poorest. How can approaches to prevention respond to intersectionality without stigmatisation?

Participation and voice
Participation is a key component of people-centered health systems. If we are going to achieve people-centered health systems, a range of diverse people need a voice and active role in health systems and health systems strengthening. Key issues and questions include:

  • How can community inclusion, involvement and leadership shape health system strengthening?
  • What methodologies have broadened our understandings of people-centred health systems?

 Evidence and information
Knowledge is power, and information and evidence are not politically neutral building blocks of the health system. Key issues and questions include:

  • In an era where censorship, post-truths and alternative facts increasingly pose a threat to science, how have health systems researchers responded?
  • Why is there so little support for qualitative research in the world of global health and what can we do about this?
  • How can we better ensure that knowledge is communicated beyond the ‘ivory tower’ to the communities, practitioners and policy makers who need it for decision making?

Money and control
Those who hold the purse strings can determine how money is spent and who benefits from investments. Key issues and questions include:

  • What are the potential avenues and political roadblocks to ensure financing for Universal Health Coverage?
  • What role is there for public-private partnerships in ensuring that patients are protected and practice is ethical?

Solidarity and resistance:

  • Can an approach to health systems strengthening build on ‘planetary health’ thinking to prompt new ways of tackling old problems?
  • Many settings are experiencing conflict, economic and environmental instability, and migrant crises leading to the mass movements of people. How can we can ensure that health systems work across borders?

The 5th Global Symposium on Health Systems Research provides an opportunity for health systems researchers to come together and critically examine the ways in which power and politics shape research and research institutions, and explore how we, as a community, can ensure that good health is attainable for everyone.’

 
 
 
 
 

COMDIS-HSD attracts global audience for our antibiotic findings in Vancouver

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hsr-2016-logo

  • ‘We need to be cautious not to romanticise communities as resilient, when what they are doing is coping in difficult situations.
  • ‘Health systems resilience needs to be qualified by an explicit focus on equity and social justice, and support the empowerment of the most vulnerable.’

These were among the key reflections to emerge from the Fourth Global Symposium on Health Systems Research and welcomed by our COMDIS-HSD delegates who joined thousands at this key date in the global health calendar.
Held in Vancouver earlier in November, HSR 2016 took place over a packed 5 days of formal sessions, oral presentations, skill building events and social media sharing. COMDIS-HSD partners from ARK in Bangladesh, GHRD in China and Malaria Consortium took a frontline role, giving well-received presentations on 3 of our projects to improve rational prescribing and effective use of antibiotics.
ARK’s Dr Rumana Huque described our study to promote appropriate prescribing of antibiotics in children under 5 by health workers at community clinics in Bangladesh. The study shows that using specially-adapted job aids and interactive training, community health workers can correctly prescribe antibiotics in 89% of cases. See her full presentation here.
Dr Huque also told delegates that this, like all COMDIS-HSD research, follows the embedded approach – involving the Ministry of Health and other stakeholders right throughout the study design, implementation and subsequent national scale-up. Delegates learned that 1,200 doctors and 14,000 community health workers have now been trained to use the Integrated Management of Childhood Illness (IMCI)-based job aid and ‘how to diagnose and treat’ guidelines.
Delegates and world experts responded enthusiastically to a presentation on our work to reduce irrational antibiotic prescribing among children with upper respiratory tract infections (URTIs) in rural China.

GHRD Programme Manager Zhitong Zhang presenting at HSR 2016 in Vancouver

GHRD Director Zhitong Zhang presenting at HSR 2016 in Vancouver


GHRD Director Zhitong Zhang set the scene by informing delegates that antibiotic consumption per capita is 10 times higher in China than the United States. He went on to describe how our multi-faceted intervention package – including evidence-based guidelines, peer review of prescriptions and health education materials – has been effective in reducing antibiotic prescribing for childhood URTIs in China’s rural primary care facilities. Our full study and detailed data is due to be published shortly.
Helen Counihan, Technical Director of Malaria Consortium, spoke about our work in Zambia to assess the capacity of community health workers (CHWs) to diagnose and prescribe for pneumonia in children under 5. She shared encouraging findings that show CHWs are capable of correctly measuring respiratory rates and providing appropriate treatment – with high agreement between their decisions and those of experts.
Summing up after the presentations, COMDIS-HSD partner and session chair, Professor Xiaolin Wei, said: ‘Participants praised our trial in China, which reached 30% reduction of absolute antibiotic prescribing rates.
‘But across all our antimicrobial resistance (AMR) study settings, there are commonalities we can all learn from:

  • it is crucial to develop guidelines for clinicians (either doctors, nurses or community health workers) and build training and evaluation into the process of care;
  • and while there are huge challenges, it is not as difficult as we often anticipate to reduce antibiotic use using relatively cheap and cost effective interventions.’

COMDIS-HSD delegates also engaged in the work of RiNGs, a cross-research programme consortium group that focuses on gender and ethics in research. Our team participated in workshops on gender analysis, as well as critical discussions on intersectionality and rights-based research.
Leeds-based COMDIS-HSD researcher Rebecca King said: ‘These events reminded me of how critical it is to engage with gender and other inequities throughout the research process and to take into account multiple perspectives.’
Reflecting on HSR 2016, COMDIS-HSD Consortium Manager Anthonia James said: ‘This year’s symposium was full on but incredibly energising.
‘The concluding statement from the event highlights that resilient and responsive health systems are ones which provide integrated, people-centred services, with primary health care as the frontline. Integrated services that are delivered as part of routine primary care are at the centre of everything we do at COMDIS-HSD and that puts us in an exciting position going forward.’
Find out more:

Real people, real stories: how digital storytelling is supporting NCD work in Swaziland

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Left to right: Annastesia Mims, US Peace Corps volunteer; Phumaphi Mamba, educator for CANASWA; Dumsile Mavuso, founder and director of Diabetes Swaziland


Our partners at Good Shepherd Hospital in Swaziland are using digital storytelling to improve awareness and education about non-communicable diseases (NCDs).
Working closely with the newly-formed Swaziland NCD Stakeholders Alliance, COMDIS-HSD is supporting a project to develop digital storytelling as a low-cost, effective way to educate patients and health professionals.
Our COMDIS-HSD partners are capacity-building across the Alliance’s 12 member organisations. The team is coaching healthcare advocacy staff on the use of video, pictures, voice and music to tell real life stories of patients who live with illnesses such as diabetes, hypertension, cardiovascular disease and mental illness.
Importantly, the workshop focused on low-tech solutions using photos, short video clips, basic audio and PowerPoint rather than expensive camera equipment and editing software.
As well as educating communities about NCDs, participants learned how stories can play an important part in counselling and reassuring newly-diagnosed patients. They can also be powerful tools in persuading fundraisers and stakeholders to invest in prevention and support for these conditions.
According to Annastesia Mims, Peace Corps volunteer working with our COMDIS-HSD team to lead the project, digital storytelling could have particular resonance in-country:
‘In Swaziland the use of digital storytelling is emerging but there is room for greater work. We have a large number of people that can be seen as expert patients; those that have been diagnosed with certain conditions but show a positive manner in the way they handle it.
‘A story can depict a message of hope and perseverance and this is something that the Swazi people can relate to.’
The one-day workshop covered the key principles of digital storytelling, reminding participants that stories should be short, honest, personal and focused.
Participants also learned about the practical process of developing their stories, including the use of ‘story circles’ to help patients and carers share their experiences in a supportive, non-judgemental environment before moving onto scriptwriting and storyboard stages.
One participant said: ‘The workshop has outlined the effectiveness of digital storytelling and it has filled the capacity gap we have as organisations to move into collecting patient stories.’
Another participant added: ‘Although digital storytelling is something new for me, it is one of the best ways of reaching our communities.’
See some of the detailed resources shared at the workshop on our website:

The work is part of our wider study to decentralise NCD treatment, particularly for diabetes and hypertension, from Good Shepherd Hospital to a network of community clinics. While there are still issues to address, such as drug availability and the provision of doctor-led outreach care, the study is showing encouraging preliminary results with clinics coping well with decentralisation.

Our tribute to Sylvia Meek: inspiration, powerhouse and dear friend

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Sylvia Meek , Malaria Consortium's Global Technical Director and member of COMDIS-HSD's advisory group and executive committee for many years.

Sylvia Meek , Malaria Consortium’s Global Technical Director and member of COMDIS-HSD’s advisory group and executive committee for many years.


We were very saddened at COMDIS-HSD to hear about the death of our dear friend and colleague Sylvia Meek, Malaria Consortium’s Global Technical Director. She had an enormous presence within our consortium and her loss has been felt greatly among us. For over 10 years, Sylvia mentored and advised us with a clarity and insight that we all admired.
Prof Xiaolin Wei, the director of our research in China said, “I am so sorry to hear about Sylvia’s death. Sylvia has been one of the best friends, leaders and mentors for us at COMDIS. It is such a big loss to us both emotionally and professionally.”
Her guiding hand was a sentiment echoed by Dr Amir Khan, director of our partner organisation in Pakistan: “We will always remember Sylvia as a source of inspiration and guidance for the public health work that we have done during the last decade.”
Sylvia played an important role in our Consortium Advisory Group and Executive Committee. Prof Tony Harries, our Advisory Group Chair, said: “It was always a great pleasure to have Sylvia at the annual CAG meetings – she was always very informative about her subject areas, gave very sensible advice on strategy and direction and was at the same time very nice and always friendly. We will miss her.”
Even in the last 18 months, when she wasn’t able to travel to our annual meetings, her wisdom and sharp insight cut through our discussions to remind us that we had to focus, to be inclusive, to work together; all this over Skype or speakerphone. Her presence was palpable no matter the distance.
Prof John Walley, Co-Director of COMDIS-HSD worked with her for over a decade. “Sylvia was a powerhouse behind the control of malaria. My favourite memory was, at our annual partner meeting near Athens, we visited a temple and sat on a beach, and tried not to talk about work. She was a lovely warm person, so much fun to be with, and a dear friend.”
Personally, I feel very privileged to have known and worked with Sylvia, she was an inspiration. It doesn’t seem right that someone with such an exceptional contribution to make should be taken from us. She was so dedicated and COMDIS-HSD has been lucky to benefit from her expertise. I’ll miss her guidance and ability to keep us on the straight and narrow – she always had a gentle way of challenging issues and presenting a different perspective. She leaves a huge gap in so many ways, which I feel sure cannot be filled. The scholarship set up in Sylvia’s honour by Malaria Consortium is a very fitting tribute to a woman with such vision and passion. We’ve lost a unique and special person and she will be truly missed. We offer our sincere condolences to her family, friends and colleagues.
Anthonia James, Consortium Manager, COMDIS-HSD.
On behalf of COMDIS-HSD partners and friends.
To donate to the Sylvia Meek Scholarship for Entomology, please visit this site set up by Malaria Consortium: https://www.justgiving.com/Malaria-Consortium. If you wish to leave a message of condolence for Sylvia, please send these to messagesforsylvia@gmail.com. These will be seen by Sylvia’s family and Malaria Consortium.

Text message pilot boosts antimalarial uptake among pregnant women in Uganda

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A pregnant woman receives her IPTp drugs from a health worker in West Nile, Uganda

A pregnant woman receives her IPTp drugs from a health worker in West Nile, Uganda


Daily text messages reminding health workers to encourage pregnant women to take their antimalarial drugs are helping to significantly improve uptake of the treatment in Uganda.
The text message pilot is part of a wider project being led by COMDIS-HSD partners, Malaria Consortium. The project aims to identify and address the factors that prevent women from receiving and taking the proper preventive malaria treatments during pregnancy.
Malaria in pregnancy poses substantial risks to mother and unborn child, including maternal anaemia, stillbirth, miscarriage and low birth weight – a leading cause of child mortality. The World Health Organization (WHO) recommends intermittent preventative treatment in pregnancy (IPTp). This is a full therapeutic course of antimalarial medicine given to pregnant women living in areas of moderate or high transmission, regardless of whether or not they are infected with malaria, to prevent malaria infections.
However, our research in Uganda has found mixed knowledge among health workers regarding IPTp guidelines, as well as the fact they do not always offer IPTp or encourage women to take it.
Designed to complement the standard training on malaria in pregnancy, the text message intervention involves sending daily reminders to health workers for five weeks, summarising the key points of the training.

  • 6 months after the training, health workers who received training plus text messages had a better recollection of IPTp guidelines than health workers who had received only training.
  • In health facilities where health workers received the text messages, the coverage among women of the third and fourth IPTp doses was almost double that in health facilities where the text message system was not implemented.

Based on these promising results, the Ministry of Health in Uganda, which has been involved in the design and implementation of the study, has decided that instructions on sending text message reminders should be added to the national malaria in pregnancy training guidelines.

World TB Day 2016: What we’re doing at COMDIS-HSD to End TB

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One of our series of Tweets to showcase our TB work on World TB Day 2016

One of our series of Tweets to showcase our TB work on World TB Day 2016


This year the World Health Organization (WHO) is calling on countries to ‘Unite to End TB’. Ending TB by 2030 is a target of the Sustainable Development Goals and a programme priority for COMDIS-HSD and our partners.
More than 4,000 people lose their lives each day to this leading infectious disease. Many of the communities that are most burdened by tuberculosis are poor, vulnerable and marginalised.
WHO has highlighted some important progress in the 30 countries with the highest TB burden. It says that a number of countries are strengthening the strategic agendas of their TB programmes by adopting newer tools, extending access to care and linking with other parts of government to reduce the financial costs for patients.
At COMDIS-HSD we are contributing in all these areas and on World TB Day 2016 we’re taking the opportunity to share more widely some of our research and key findings:
Video briefings

Blog

Research evidence

A patient featured in HERD's special series on TB: "I have not only been helped economically but psychologically too."

A patient featured in HERD’s special series on TB: “I have not only been helped economically but psychologically too.”


In addition to their ongoing TB research, our partners are also taking active parts in this year’s World TB Day activities. HERD Nepal is taking the TB message out to the community by sharing material and talking about the stigma related to TB. See their full report of the day’s activities in Nepal.
HERD have also produced a special series of articles and insights celebrating Nepal’s efforts towards tuberculosis control, particularly over the last 10 years.
The series includes some interesting personal perspectives from policy makers, medical practitioners and patients about how they view TB interventions and services.
One patient featured in the series was diagnosed with MDR-TB but was concerned that she could not afford the lengthy 20-month treatment. However, doctors referred her to a facility where she is receiving free MDR-TB treatment and hostel accommodation.
“I have not only been helped economically but psychologically too. When I first came here, I was not sure what was going to happen but with the constant support from the staff and other patients, I realised I was in safe hands. Now I am confident I will stay here and receive the treatment and return home fully recovered from the disease.”
In Bangladesh, ARK Foundation joined up with their partners at the National TB Control Programme, marching with banners in the lively World TB Day rally in Dhaka.
The ARK team take to the streets of Dhaka with their End TB message on World TB Day 2016

The ARK team take to the streets of Dhaka with their End TB message on World TB Day 2016


The day’s activities were covered by a number of electronic and print media. Dr Md Quamrul Islam, Director of Mycobacterium Disease Control (MBDC) and Line Director of TB and Leprosy thanked all partner NGOs for their active participation in observing World TB Day 2016.
 

Dr Rumana Huque talks about the challenges of providing free TB treatment for factory workers

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A Directly Observed Treatment corner in a garment factory in Bangladesh

A Directly Observed Treatment corner in a garment factory in Bangladesh


On 24th March, it will be World TB Day. Under the National TB Programme (NTP), we can all make use of free TB diagnosis and treatment. But uptake to this free service is surprisingly slow. Why is this?
My personal view is that there are still many myths that we have to overcome, the biggest one being that TB cannot be cured. This is simply not true: TB is 100% curable, and each and every one of us can have free treatment if we go to any of the NTP clinics for diagnosis and treatment.
If you work in a factory that is part of the Bangladesh Garment Manufacturers and Exporters Association (BGMEA), then their doctor or paramedic can test you for free, without you losing your pay or having to stop work for treatment. However, not all factories are part of BGMEA, and we at ARK Foundation know the challenges of trying to persuade employers to invest in diagnosis and treatment for their staff.
When we conducted research, with the help of the BGMEA factories, we found that factory managers were reluctant to allow workers to visit TB diagnosis centres during working hours, and also reluctant to allow their staff to continue working once they were diagnosed with TB. In some factories, even the workers were uncomfortable accepting their colleagues back into the workplace.
We also found that some medical staff based in the factories thought that keeping up-to-date treatment records was time-consuming, and factories without medical facilities struggled to organise the referral mechanism that we were proposing, and struggled to maintain records.
All these challenges still exist, and do not help the cause of fighting TB. What did we do to tackle these challenges? We held orientation and educational activities for a large number of workers to challenge the stigma and myths surrounding TB. Most importantly, we gave them information on how they can get free diagnosis and treatment, and we persuaded factory managers that it was in their best interests (and ultimately more profitable) if they didn’t sack workers who were diagnosed with TB, but instead let them continue treatment while working for them.
Our project had a 100% success rate; everyone who worked in the BGMEA factories who was diagnosed with TB went on to complete their treatment and is 100% cured.
So what can we take away from this? My view is that providing workplace TB control depends on the management’s good understanding of what it takes to control TB in the workplace. Management also need to commit to allowing workers diagnosed with TB to continue to work in their factories and visit diagnosis centres during working hours.
Our experience of working with BGMEA factories can easily be replicated in other business sectors. However, national policies and funds should be mobilised to provide encouragement and support. Armed with this evidence, the NTP is in a strong position to initiate relationships with trade associations to help the workers and managers of Bangladesh control TB.
Dr Rumana Huque is Executive Director of ARK Foundation in Bangladesh.