Breaking Silos: TB and Poverty

Bobby Ramakant, Rachael ThomsonSTOP TB Partnership TB and Poverty Subgroup

Poverty and health: the links

• Increased Personal and Environmental Risks

• Increased Malnutrition• Less Access to Knowledge,

information• Diminished Ability to Access

Care

• Diminished Quality of Life• Reduced Productivity• Diminished Household

Savings • Reduction in Household

Assets

The vicious circle:• Ill health leads to poverty• Poverty leads to ill health

What is poverty?

Poverty• is more than economic

poverty (living on ≤US$ 1 per day)

• encompasses lack of opportunities, voice and representation, and vulnerability to shocks

• is a major determinant of vulnerability to disease – especially TB

TB and Poverty– Poor and vulnerable people are much more likely to suffer from TB due to

socioeconomic factors – The poor face significant costs and delays in accessing TB services.

• In urban Malawi poorer patients face costs 6 times their monthly income to access a diagnosis from ‘free' facilities

• In rural Malawi this rises to 10 times– Case detection in many countries is low because the poor cannot access TB

services – The process of accessing care is impoverishing– The lack of diagnosis, treatment and cure means the burden of TB in their

communities continues to increase– Papers:

Kemp et al. Can Malawi's poor afford free TB services? Patient and household costs associated with a TB diagnosis in Lilongwe. Bull World Health Organ 2006; 85(8)

Nhlema-Simwaka et al. Developing a socio-economic measure to monitor access to tuberculosis services in urban Lilongwe, Malawi. IJTLD 2007; 11(1):65-71.

Hanson C. Tuberculosis, poverty and inequity: a review of literature and discussion of issues. 2002. Washington DC. World Bank

The relationship between poverty and TB

The poor have

• higher risk of infection

• higher prevalence of disease

• worse outcome of disease

The poor have greater health care needs

Active TB

Symptoms recognised

Health care utilisation

Diagnosis

NotificationInfected

Health system delay

Patient

delay

Conceptual framework for improved and early case notification/detection

Patient d

elay

What can we do?

Break Silos: work together

• Put health on the poverty agenda

• Put poverty on the health agenda

What is the TB and Poverty Subgroup?

• Subgroup of the DEWG of the STOP TB Partnership • Network of individuals and organisations interested in the needs of

poor and vulnerable populations with respect to TB• Led by a core team and supported by a secretariat funded since 2007Vision:• "A world where the poor and most vulnerable are protected from

TB and have easy and equitable access to quality care“Purpose:• To enable the STOP TB Partnership to achieve its global targets

and contribute to its poverty related mission statements.• To ensure that every TB suspect/patient has easy and equitable

access to effective diagnosis, treatment and cure.• To reduce the inequitable social and economic toll of TB.

TB & Poverty Subgroup Revised Objectives

• Support & Advocacy:– To establish a new Subgroup Secretariat in a low-income country that

organises communication, dissemination and meetings for the Subgroup – To actively promote the explicit acceptance that diagnosis of smear

positive TB disease is an international public good and should be provided free of charge for universal access in all health systems

– To identify additional and feasible entry points for TB control interventions addressing prevention and specifically social determinants of TB

• Research:– To promote implementation of the TBCAP patient-centered approach (Tool

to Estimate Patients’ Costs, QUOTE Tool, ISTC, Patients’ Charter) and indicators that NTPs can use to assess equity in access in relation to geographical, social/cultural, health system or economic barriers

– To ensure that the needs of the poor are met as new tools are developed and implemented, including work with Introducing New Approaches and Tools Working Group (INAT) and Treat TB.

• TB & Poverty Secretariat• TB & Poverty Subgroup Secretariat is housed in The Union South-East Asia

Office in New Delhi, India since September 2010 with a dedicated staff of one technical officer and one communication officer

• Activities carried out• For addressing poverty in TB control, a 2-day consultative workshop was

held in Delhi on the 29th & 30th October 2010.• It involved the NTP Manager from India, Nepal and Thailand, State TB

Managers from 8 poorest states of India, and partners for various other organizations like WHO, the World Bank, World Vision, GFATM Round 9 members, Media (CNS, Asia Tribune), National Partnership for TB care and control in India etc.

• Way Forward• Organize a Sensitization workshop for program managers in India on

Relationship between TB and Poverty• Regional workshop related to issues in Addressing Poverty in TB control• Coordinate with the ongoing Global Fund Round 9 civil society project in

India and identify opportunities in poor population

How can the subgroup help? Guidelines for NTPs

1. Identification of the poor and vulnerable groups in the country/region served by the national TB control programme

2. Identification of the barriers to accessing TB services faced by the poor and vulnerable groups in the country/region

3. Identification of potential actions to overcome the barriers to access

4. Identification of situations and population groups requiring special consideration

5. Harnessing resources for pro-poor TB services

6. Assessment of the pro-poor performance of the national TB control programme and the impact of pro-poor measures

http://www.stoptb.org/tbandpoverty/steps.asp

WHO/HTM/TB/2005.352May 2005