Dia Mundial de Luta contra a Tuberculose - 24 de março
24/03/2006  Só em inglês. Every year 2 million people die from Tuberculosis, 90% of whom are in developing countries, and 1.5 million in Sub-Saharan Africa.From July 2005 the Global Fund Angola is implementing a project against TB in Angola, in collaboration with the Ministry of Health and the Italian NGO Doctors with Africa, Cuamm.
Mensagem do Secretário-Geral da ONU, Kofi Annan http://www.unangola.org/impset.asp?id=28
Tuberculosis is a forgotten disease. Every year 2 million people die of TB, 90% of them living in developing countries, and more than 1.5 million in sub-Saharan Africa. Approximately 2 billion people, 1/3 of the world’s population, are infected with the macrobacteria that causes TB. To sustain a political commitment by national governments and mobilization of additional resources each year the 24 of March is celebrated as World TB day.
The Global Fund, the Fund created by the G8 in 2001 to finance a dramatic turn-around in the fight against AIDS, tuberculosis and malaria, is supporting the national TB Control Program in Angola through a project started in 2005, set to end in 2010. The tuberculosis component within the framework of the Global Fund’s (GF) intervention in Angola will amount to USD $9 million over five years. Other donors also support tuberculosis treatment and care, include USAID and the World Bank through the HAMSET programme.
“Our goal – explains Mario Cooper, coordinator of the technical Unit VIH, SIDA, TB in Global Fund - is to strengthen the National Plan against TB. In these months we could assist to improve the National Plan of Action; the Angolan government is promoting a DOTS strategy (Directly Observed Treatment Short-Course) and more and more patients infected with TB now have access to efficient diagnosis and treatment. But the lack of structures for TB control still represents a huge hindrance to implementing the TB control strategies. There are not enough hospitals, lots of them are without laboratories and the TB ward, remains without electricity, water, and sometimes without a roof.”
Therefore, the Global Fund TB component in Angola will engage in the next 5 years to achieve these 5 objectives: training new technicians at the national level; training for nurseries; logistic experts and supervisor at municipal and provincial level; construction of health units particularly in the municipalities; implementation of Information, Education and Communication (IEC) on TB in Angola; and finally, to set up recording and report systems enabling outcome-based assessment. To reach these goals, Global Fund is working with an Italian NGO, Doctors with Africa Cuamm (Medici con l’Africa Cuamm), which has been engaged with the programme for 2 years.
According to data collected by Cuamm, in Angola during 2005 the number of individuals with Tuberculosis was more than 36,000. 16,000 of those individuals had an active form of TB. 10% were children with extra-lung and no infective TB. In the capital, Luanda, the detection has shown a steady increase, in line with the growth of population, the worsening conditions of life in the slums, and improved systems of detection linked to the strong expansion of treatment via DOTS. The number of new TB cases detected has increased from 140 per 100,000 inhabitants in 2001, to 180 in 2003 and the proportion of municipalities to which the system has been successfully extended has increased from 44% in 2001 to 67% in 2004.
The DOTS programme should be made an integral health system activity with nationwide coverage, thus anchoring TB activities across all levels of the health system at all levels, including provincial and municipal health facilities. DOTS strategy consists of five elements: sustained political commitment; access to quality-assured TB sputum microscopy; standardized short-course chemotherapy to all cases of TB under proper case-management conditions; uninterrupted supply of quality-assured drugs; and the recording and reporting system enabling outcome assessment. The effective expansion of DOTS demands a multi-sectoral and sustained response to address the social and environmental factors that increase the risk of developing TB.
“The project is being conducted in 11 of the 18 provinces of Angola,” explains Stefano Santini, doctor and project manager of Cuamm. “In July 2005 we assumed the priorities of GF project and we started implementing the project. First of all, in these 6 months we organized 6 courses for logistic experts and nurseries from Luanda to Benguela, Lubango, Malange, Uige and other cities”.
To strengthen the ability and the accuracy of the supervision process, Global Fund through Cuamm, is promoting a standard information system for detection and treatment in all countries participating in GF activities and, at the same time, it is organizing training to improve capacities of analysis and control. “Sometimes,” continues Santini, “the information that we receive from the small centers are uncorrected. For this in our courses we try to teach the right way to collect the data, to prepare statistics, and, finally, to interpret the situation of TB at local and national levels. We would like to prepare not only technicians, but at the same time, people who are really aware that their job can save lives; for this they have to work with competence. We are visiting each province every 3 months and we are preparing a report with descriptions and evaluations of the activities, written with experts of the National Direction Plan against TB.”
To provide for the expansion of treatment via DOTS to the entire country by 2007, to ensure that 70% of cases are notified and 85% cured Angola needs new health units, new laboratories, and new wards for TB patients. “For this our budget goal is US $700,000. That is US $60,000 for each province. We are working on rebuilding and renovating old buildings and old laboratories. At the same time we are trying to build and open new small structures in the field. This is really a difficult task, because of the lack of infrastructure and above all, because it is not easy to find nurses or doctors available to work in the field, far from town, without water and electricity. In Luanda,” says Santini, “we have just built 3 centers, in Benfica, Cacuaco and Sanbisanga. Before the end of this project we will open 17 new centers.”
In Angola most of men and women have a prejudice against TB. “One cough more, or one kilo less, and you have your label, you are a sick one. And, if you are sick, you are poor. This is the common idea,” explains Joseph Nsuka, director of Luanda Tuberculosis and Leprosy Screening. “Because of this, lots of sick people don’t want to come into heath units and pick up the medicines. They are ashamed; they feel the prejudice of their families, of their friends.”
For this reason the Global Fund/Cuamm TB project has another goal, the implementation of an IEC strategy on TB in Angola. “On the theoretic level,” ends Santini, “we are preparing a key study in 5 provinces, to explain how TB is considered. On the social level, we are encouraging communities to get involved in social education activities; with a budget of US $200,000 we will pay for performances by Angolan actors and actresses on Tuberculosis. With them we wish to explain what TB is, what everyone has to do to defend himself from TB, and what the patients can and cannot do in their daily lives.”
Useful links
Global Fund
www.theglobalfund.org/en
Medici con l’Africa Cuamm
www.cuamm.org
Stop TB
www.stoptb.org/
WHO
www.who.int/
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