Strategic approach to maintain appropriate tuberculosis control activities in countries affected by the Asian tsunami disaster
WHO is playing a major role in tackling health problems resulting from the natural disaster in South East Asia. The Maldives, India, Indonesia, Sri Lanka and Thailand are the most affected countries.
Significant efforts were developed to control tuberculosis (TB) in these countries over the last decade where national health authorities have shown a clear political commitment to implement and expand the DOTS strategy. At the moment, the focus is, rightly, on the urgent health conditions for survivors and rebuilding the most basic health infrastructure. In this emergency or acute phase, TB infrastructure and resources are being put to use, meeting these immediate priorities. These resources will re-focus on TB control once basic primary health services are up to speed. On top of the emergency, relief and rehabilitation funding requested, support for the re-establishment and strengthening of TB control efforts will be an additional requirement.
Before the disaster, WHO in collaboration with other partners, ensured there was technical support and mobilized funding resources at the international level. As a result, DOTS population coverage had significantly progressed and TB case detection and cure had improved. However, this progress may not only be compromised by the disaster but also be set back many years. Rough estimates suggest that up to ten thousand TB patients might be directly affected by the consequences of the tsunami. Due to the collapse of health services, many TB patients may be unable to be located and thus remain untreated. In turn, many TB suspects may not be investigated and could continue to infect others.
Strategic approach to support tsunami-affected countries
The WHO Stop TB Department is undertaking the following actions in tsunami-affected countries:
- Establish a task force for TB control and provide support, as required, to WHO's South East Asia Regional Office (SEARO).
- Provide full assistance and support to the Health Action Crisis Department and Communicable Disease teams, based in WHO's headquarters in Geneva, and to the Emergency and Humanitarian Action Department in SEARO, New Delhi.
- Provide support to WHO offices in affected countries
- Develop a WHO Stop TB plan of action to assist the Regional Office and affected countries.
- Ensure coordination with international organizations involved in TB control in affected countries
- Develop and issue documents on TB and TB control situations, targeting international organizations involved in health issues in affected countries
- Finalize and issue the new edition of the WHO guidelines on TB control in refugee and complex emergency situations
- Through WHO country offices, collaborate with and support the national health authorities of affected countries in adapting, developing and implementing strategic approaches for TB control in affected and non-affected areas
- In collaboration with WHO regional and country offices, provide assistance and support to tsunami-affected country national TB programmes (NTP) to adapt their strategic plans, taking into account the potential impact of the tsunami on TB control for the coming years
- Support NTPs to mobilize funds for TB control within the framework of the international movement for relief in the tsunami-affected countries
Potential impact on TB control in tsunami-affected countries
The WHO Stop TB Department is concerned by the potential consequences of the tsunami on TB transmission, disease development and potential drug resistant development. In the immediate emergency and relief phase, the following areas pose particular risks for TB control in tsunami-affected countries:
- Crowded living conditions of displaced populations: The prevention of over-crowding in camps is a priority in the acute phase as well as the prevention of malnutrition both of which increase people's susceptibility to infection.
- Interrupted drug supply to patients: This may include difficulty in tracking and continuing treatment for mobile populations, e.g. in camps, and can result in the development and spread of drug-resistant TB.
- Access to drugs in affected areas: Patients who were on anti-TB treatment in the tsunami-affected areas are likely not to have access to any appropriate drug distribution system, given that most of the health infrastructure is totally destroyed
- Access to drugs in non-affected areas: The distribution system of anti-TB drugs and supplies implemented by the NTP, and vital to the continuation of TB control services, is likely to be disturbed in the non-affected areas where the existing health infrastructure has in many cases been overwhelmed by the additional and urgent workload
- Inappropriate drugs administered: TB patients who were on treatment in NTP services before the disaster may receive inappropriate anti-TB drug prescriptions from other health care providers not trained in DOTS.
- TB service providers: Increased challenges of coordination when multiple TB service-providers are involved - NTPs must have the support they need in order to assure this vital function continues.
- NTP management: Members of the central units of NTPs may be assigned to other managerial tasks related to the health emergency situation. This is likely to disturb, or even stop, the managerial activities of the NTPs particularly in the regions unaffected by the tsunami where the majority of TB cases are located.