Bangladesh
Tuberculosis (TB) is a major public health problem in Bangladesh. In 2008, the
World Health Organization (WHO) ranked Bangladesh sixth among the world’s 22
high-burden TB countries. In 2006, there were an estimated 350,641 new cases,
157,773 of which were sputum smear-positive (SS+) TB cases, and more than
70,200 were TB-related deaths. TB mortality in Bangladesh is 33 percent higher
than the Southeast Asian region average. Bangladesh’s National TB Control
Program (NTCP) began implementing DOTS (directly observed treatment, short
course) in 1993. DOTS coverage reached 100 percent in 2006.
While the treatment success rate is fairly high at 92 percent, around one-third of
the cases are undetected, resulting in a larger number of undiagnosed and
untreated cases that spread the disease further. Full implementation of DOTS by
all public health facilities, private sector providers, and nongovernmental
organizations (NGOs) is not yet realized. Given that private practitioners and
NGOs provide a major portion of health services, implementation of DOTS by
NGOs and within the private health care system is paramount. Although
Bangladesh is a low-HIV/AIDS-prevalence country, the NTCP is introducing more
collaborative TB-HIV/AIDS-related activities as well as managing multidrug-resistant
(MDR) TB. The Green Light Committee (GLC) has approved the
treatment of 700 MDR-TB patients over five years; patient enrollment will begin
soon, with plans for the enrollment of up to 1,500 patients.
USAID Approach and Key Activities
USAID is helping to fight TB in Bangladesh by supporting the goals outlined in the
NTCP’s five-year strategy for 2006–2010, which include expanding and enhancing
DOTS, strengthening health systems, empowering people with TB, and reducing
the risk of TB in populations most at risk of acquiring HIV/AIDS. USAID will focus
on improving the quality of DOTS, as this is critical to sustaining current
achievements, increasing case detection rates, and preventing the further
development of drug-resistant TB. USAID will continue to strengthen and improve
the quality of DOTS services provided by USAID-supported NGOs. Between 2002
and 2005, USAID funding for TB programming in Bangladesh averaged almost
$800,000 per year; this more than doubled to $1.7 million in 2007 and further
increased to $3.67 million in 2008. USAID assistance includes the following
activities:
- Increasing availability of drugs for the treatment of TB by building capacity
for supply chain management and procurement practices
- Developing and maintaining coordination between relevant authorities and
NGOs by ensuring information sharing among partners
- Intensifying urban DOTS expansion and enhancement (urban case
detection rate lower than rural areas) with increased numbers of
community volunteers
- Supporting the expansion of TB lab services by strengthening the regional
lab network and improving MDR-TB detection
- Providing quality assurance services to decrease the error rate in
diagnosing TB
- Ensuring appropriate care for TB patients by strengthening referral
networks and referral health centers
- Establishing better outreach to populations at risk for acquiring HIV/AIDS
through referral links between clinics providing TB and HIV/AIDS services
- Supporting and conducting behavior change and communication activities, such as health education sessions, advocacy
meetings, distribution of educational materials, and observation of national and international TB days
- Developing new tools and approaches to increase case detection rate through support for operational research on
laboratory activities and field work
USAID Program Achievements
Since the initiation of support, USAID has developed excellent collaboration and coordination with the NTCP and has generated a
large amount of support for NGOs. Recently, USAID facilitated the expansion of a Memorandum of Understanding between the
NTCP and its partner NGOs, thereby sustaining the strong collaboration between the government and NGOs. USAID program
achievements in 2008 include the following:
- Provided quality control of laboratory services
- Trained 965 medical personnel in standard clinical training for TB-related services
- Provided DOTS at 56 clinics, detecting 5,000 new SS+ cases
- Established one external quality assurance center for 12 microscopy centers in Dhaka
- Conducted a situation analysis of DOTS service delivery and identified gaps and needs of the program
- Developed a curriculum and implemented quality, supervision, and monitoring activities at selected sites
- Supported the NTCP in the development of a DOTS-Plus pilot project to manage 700 patients with MDR-TB, which was
approved by the GLC
- Assisted the NTCP in operationalizing the public-private mix (PPM) DOTS strategy, provided support to develop the
PPM strategy of the Global Fund to Fight AIDS, Tuberculosis and Malaria, and supported the updating of the PPM-DOTS
technical guidelines
- Drafted three TB laboratory training modules, focusing on technical aspects and requirements for appropriate diagnostic
facilities, and internal and external quality assessments
Case Detection and Treatment Success Rates Under DOTS
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Note: DOTS treatment success rate for 2006 will be reported in the 2009 Global Report.
Source: Global Tuberculosis Control: Surveillance, planning, financing:WHO Report 2008. |
Partnerships
Forming partnerships has been one of the most important elements in combating TB in Bangladesh. In addition to USAID, international collaborators that have invested in efforts to improve the TB situation in Bangladesh include WHO, the Asian Development Bank, the Bangladesh Rural Advancement Committee, the Damien Foundation, the Global TB Drug Facility, and the
Canadian International Development Agency. To fill the gaps in program interventions and resources, Bangladesh has received
three rounds of grants from the Global Fund to implement a number of TB activities. In Round 3 in 2004, the country received
$42.5 million; $43.3 million in Round 5 in 2006; and $5.7 million in Round 8 in 2009. Ten of the USAID-supported NGOs
received Global Fund support, extendable through 2011, based on satisfactory performance. With this support, NGOs will
strengthen DOTS implementation in urban areas, involve the private sector more closely, conduct advocacy and mobilization
campaigns, and develop TB-HIV/AIDS collaborative activities.
January 2009
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