a) Treatment Failure & The Problem of Non Adherence
AU : Kumaresan JA, de Colonbani P & Karim E
TI : Tuberculosis and health sector reform in Bangladesh
SO : INT J TB & LUNG DIS 2000, 4, 615-621
DT : Per
AB :

Bangladesh is the most densely populated country in the world, with 122 million people. In spite of many challenges such as poverty, illiteracy, political instability, natural disasters, the national population and health programmes have made significant progress in the recent decades. In 1977, the annual incidence of all TB was 246 / 100,000 population; death due to TB was 68,000 in the whole country. The annual risk of infection was estimated to be 2.2% with an annual decline of 1%. In 1965, the TB services were organized into 44 TB clinics and 12 TB hospitals situated in different districts of the country.

In 1975, the health and population sector, with the international assistance had been successfully implemented, but the philosophy of fourth population and health project (FPHP) was project oriented and had several weaknesses i.e., centralized authority, delays in fund release, etc. In 1998 the GOB changed its policy to sector wide management known as Health and Population sector programme (HPSP). This involves strengthening the management capacity of the Ministry by integrating the two wings of health and population control. The reforms were made to address the inefficient, fragmented and duplicated services provided by the project oriented approach. The essential service package will receive 60% of the total funds. The five areas identified are reproduction, child health care, communicable disease control, curative care and behaviour change communication. TB & leprosy services were identified as important programmes within the communicable diseases.

The NTP organized within the FPHP provided effective TB control services within the existing health care system in Bangladesh. In 1992, Government of Bangladesh (GOB) adopted the WHO recommended World Bank sponsored DOTS programme. Will the integrated approach in fifth HPSP, the priority and commitment given to TB will be sustained? Having reached high cure rates, the NTP needs to reach out to private practitioners and other academic institutions. This needs monitoring of the changed strategy and reformed sectoral approach through indicators such as case detection and cure rates. Many challenges are foreseen in the transition period of implementation of HPSP. The essential programmes should be further integrated for their sustainability and participation by the NGOs, community and the private practitioners should be strengthened.