Tuberculosis

Tuberculosis, once treatable and manageable, has risen to the surface as an intractable global health issue. Each year, 2 million people, 98 percent of who are from the developing world, die from the disease. Our response to this serious health threat and the growing problem of multi-drug resistant (MDR) tuberculosis began in Kosovo in 2001. Since then, tuberculosis treatment has become a critical activity in Pakistan, where we continue to use WHO’s Directly Observed Therapy, Short-course (DOTS) protocol, which mitigates the development of MDR tuberculosis. Our tuberculosis programming is community-driven and results-focused and seeks to:

• Mobilize communities for improved health
• Build the capacity of public health facilities to respond to the epidemic

What We Do

Education and community mobilization are among the most basic and vital approaches in addressing any health issue. Our efforts in this area are driven by community organizations themselves. We build relationships with community organizations and form coalitions that meet regularly to discuss goals, methods and progress. As a result, communities are able to form their own solutions and set their own achievable goals for tuberculosis (TB) case detection and cure rates. Through school and community center awareness sessions, advocacy meetings, debate and art competitions, radio talk shows and public service announcements, awareness is raised, stigma is reduced and communities become involved in delivering patient care.

Equally important to responding to tuberculosis is the presence of well-trained and adequately numbered public health staff. Through training and technical mentoring, medical officers and other government health staff become adept at internationally accepted DOTS, a protocol deigned integral by the World Health Organization to stemming the spread of this infectious disease. Our programming focuses on strengthening existing public health systems, rather than establishing parallel systems, which allows activities to continue long past the end of projects. When programming ends, activities are integrated into normal public health system operations, also strengthening local ownership.

Where We Work

To date Mercy Corps has implemented more than 148 community health programs in 32 countries around the world. Here is a sample of some of our programming on tuberculosis.

Worldwide, 2 million people a year die from tuberculosis, a contagious but curable disease. The World Health Organization's 2007 Global TB Report ranked Pakistan as the 7th-highest burden country in the world. The bacterial disease kills 62,000 people here each year, and only 27 percent of the cases are detected. Mercy Corps is working to change this and our efforts have led the Government of Pakistan to publicly recognize us as a leading partner in the fight against tuberculosis. We have been running TB programming in Pakistan since 2005, working in the rural mountainous regions of Baluchistan and Sindh Provinces, where some of the hardest hit populations reside. Our work there focuses on mobilizing communities, particularly the most vulnerable members of women and youth 15-25 years of age, to seek and complete treatment and to support others in doing the same. We also increase the capacity of government health facilities through specialized health staff trainings and technical mentoring. We use large-scale social marketing campaigns to increase tuberculosis awareness and have implemented a total of 2,715 Advocacy, Communication & Social Mobilization activities to reach over 500,000 people in Pakistan since programming began.

Historically, a major setback in stemming the spread of TB has been the emergence of drug-resistant strains of the disease when patients fail to complete their full treatment regimens and it becomes immune to the original antibiotics. This has led the WHO to recommend the DOTS approach, which calls for a treatment supporter who encourages the patient to complete treatment. Mercy Corps uses the DOTS approach in all of its Pakistan TB programming and is improving and strengthening the treatment-supporter model here by forming coalitions of small, grassroots organizations and asking members to volunteer as treatment supporters.

One of our mandates is to help the most vulnerable members of society. Due to cultural norms, access to health care is particularly difficult for women in Pakistan and the stigma associated with a TB diagnosis is very high. We employ health workers to communicate TB- related messages directly to women during person-to- person interaction, motivate them to seek early medical help and support them to assure treatment completion.

Health service strengthening in Pakistan has enabled 65 diagnostic centers to offer quality TB care, resulting in greater case detection, reduced prevalence and the prevention of further transmission. Because of this, we are realizing enhanced productivity and social well being for approximately 6.5 million men, women and children.