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Uganda Failing to Control TB

Wambi Michael

BUDUDA, Uganda, Sep 29 2010 (IPS) - John Mahanga sits on his hospital bed, coughing persistently. The 42-year-old has been suffering from tuberculosis (TB) for the past three years. He has been in treatment for it, but repeatedly stopped taking medication when he felt better. Doctors have now diagnosed him with multi-drug resistant (MDR) TB.

“I did not see why I should continue with the drugs when the cough had cured and I had gained weight,” says Mahanga, who has been admitted to Bududa Hospital in eastern Uganda. He did not know that a course of TB treatment needs to be seen through to the end to be effective.

Mahanga’s story is not unusual in Uganda, which ranked 15th on the World Health Organization’s (WHO) 2008 list of the 22 countries with the highest TB burden. Currently, about 16 percent of TB patients default from their treatment, according to the national health department.

Lack of awareness is not the only the reason for the country’s struggle to get TB under control. Many patients default from treatment because of the difficulties in reaching clinics for follow-ups and check-ups, or because the needed drugs are out of stock, health experts say.

MDR TB has become a serious problem in the country, because there are few treatment options for those patients who have become immune to regular TB drugs. These patients then become a dangerous source of infection to others, explains Dr Martin Okot, senior TB consultant at the national referral hospital at Mulago.

TB was declared an emergency in 2005, and though the government has dedicated 38 percent of the health department’s budget towards fighting the epidemic, little progress has been made in curbing it.

Uganda’s health services detect just over half of all TB cases, according to the country’s Ministry of Health, which is far below the WHO target of 75 percent. Uganda has only achieved a 68 percent treatment success and thereby falls short of the WHO target of 85 percent.

“The situation is worrying,” notes WHO country representative in Uganda, Dr Joaquim Saweka.

Health experts believe the strategy has fallen short because one important component is missing: while government focused on increasing the number of clinics for TB diagnosis and treatment, not enough money was made available to procure the drugs and roll out education campaigns within communities throughout the country.

“The programme failed because of inadequate funding that was needed to support national supervision and community awareness,” confirms Rosette Mutambi, executive director of the Uganda Health Consumers’ Organisation.

Saweka says that Uganda needs to rigorously implement the STOP TB Strategy, the WHO model for treatment and control of tuberculosis, which includes universal access to drugs and monitoring of adherence to treatment in the community.

This means that public health workers hold education sessions within communities to provide TB patients as well as other community members with information about how to prevent, detect and treat the disease.

“Community and family members can help identify TB and encourage anyone who has a cough for more than two weeks to go for screening,” says Dr Francis Adatu, national TB and leprosy programme manager. Adatu says the National TB control programme has already made an effort to popularise treatment services at small health centres, emphasising that TB is curable.

Until the structural problems of the public health system are fixed, Uganda will have to place its bets on prevention, Adatu says. Educating communities plays a major role in early detection of TB, making it possible to limit the the spread of the disease. And patients who receive treatment early, respond to treatment better.

Government is aware of the problem. The Minister for Primary Health Care, James Kakooza, told IPS he will ensure that TB detection services, drugs and standardised registers to monitor treatment progress will be made available to all citizens.

But to do this, he relies on the financial support of donors like the Global Fund to Fight AIDS, TB and Malaria as well as the United States President’s Emergency Plan for AIDS Relief (PEPFAR), Kakoza admits.

Like the country’s supply of antiretroviral medicine, TB drugs are 95 percent donor-funded in Uganda.

In 2008, USAID gave Uganda $2.2 million for TB programmes, while the Global Fund has approved nearly $8 million. But since then, the flow of financial support has ebbed.

Kakooza says the Ugandan government has applied for additional funds from those donors, but did not want to disclose how much money had been requested. He was also unable to comment on if and when the funds will reach the country.