TB control in complex emergency settings

1
TB control in complex emergency settings

• Akihiro Seita
• Salah Ottmani
• STB, EMRO/WHO

2
Complex emergencies in the world

• Nber of refugees and displaced people 20 million
  in 2004 (UNHCR)
• Complex emergency is not only refugees and
  displaced population.
• Complex emergency is "relatively acute situations
  affecting large civilian populations usually
  involving a combination of war or civil strife,
  food shortages and population displacement,
  resulting in significant excess mortality"
  (Salama P. et al, Lancet 2004 364 1801-13)
• Presently, more than 200 million people live in
  complex emergency settings

3
Complex emergencies in the world (continued.)

• Increase of communicable diseases because of
  inadequate shelter, poor access to water, poor
  sanitation, overcrowding and malnutrition
• Breakdown of public services (including health
  services), poor logistic network, ongoing
  conflict
• Complex emergency is not only refugees and
  displaced populations

4
TB in complex emergency settings

• TB increases (Caucasus, Iraq, Afghanistan)
• Existing TB control services usually collapse,
  NTP performance sharply decreases reduction of
  TB detection and TB cure (population mobility,
  defaulting)
• Various organizations provide health care
  services including for TB
• Poor coordination among NGOs

5
Constraints to implementing DOTS in complex
emergency settings

• Unstable government (Iraq) or no government
  (Somalia) ? poor or no MOH structures/services,
  therefore no/poor political commitment to control
  TB and weak NTP or no NTP anymore
• Health infrastructure weak or destroyed
  (facilities, equipment, human resources)
• Logistic operations difficult because of security
  issues
• Many NGOs which focus mainly basic health and
  urgent services with little priority for TB
• Choice of donors who may prefer spend resources
  on shorter-term programmes (more visibility)

6
Conditions to develop TB control in complex
emergency settings

• First of all there is a prerequisite
• No acute phase of emergency mortality lt 1
  death/10,000 pop./day
• Basic needs of the population are meet food,
  water, shelter, sanitation
• Essential clinical services including drugs and
  trained staff available
• Security and stability of population envisaged
  for at least 6 months
• TB-specific issues
• TB is an important health problem
• Lead organization (NTP, WHO, NGO) identified with
  full time TB coordinator with well-trained team
• Clear policy for TB control programme developed
  and responsibilities of parties defined
• Long-term commitment of all parties (MOU)
• Regular supply of drugs and lab material can be
  ensured
• Lab facilities able to perform SSE
• Funds available for minimum of 1 year of
  programme implementation

7
Keys steps to implement TB control activities in
complex emergencies settings

• Situation analysis and evaluation of capacity
• Confirm prerequisite criteria
• Mobilize/confirm political commitment and support
  from relevant authorities
• Ensure collaboration with NTP
• Establish CCM
• Define a clear procedures to manage TB cases
  (guidelines)
• Develop workplan and budget
• Identify procedures to refer severe TB cases

8
Keys steps to implement TB control activities in
complex emergencies settings (continued.)

• Define training programme
• Ensure QA for TB laboratory
• Establish monitoring and supervision system
• Ensure a drug procurement system
• Secure storage facilities for drugs and supoplies
• Recruit staff
• Implement training programme of staff
• Implement workplan
• Monitoring and evaluation