HIV, TB & Malaria
Field Experiences From Bangladesh, Bhutan & Nepal

The Global Fund Supported Programmes
With the Technical Assistance of WHO/SEARO

Goal Six of the Millennium Development Goals (MDGs) specifically seeks to combat HIV/AIDS, Malaria and Tuberculosis. These are the diseases that affect some of the most vulnerable communities and poorest regions in the world.

Department of Communicable Diseases, WHO/SEARO, initiated the process of capturing the real life human-interest stories of the people who are directly related with the Global Fund supported programmes in three countries, namely Bangladesh, Bhutan & Nepal. The current series, 'Voices From Communities: HIV, TB & Malaria, Field Experiences From Bangladesh, Bhutan and Nepal', emerged from this. All three countries have full-fledged national programmes under HIV/AIDS, TB and Malaria and launched important initiatives to tackle these three diseases with financial support from the Global Fund for AIDS, TB & Malaria (GFATM) and the continued strategic technical assistance of the World Health Organization (WHO).

The future has its challenges, but the experiences of the recent past should help Bangladesh, Bhutan and Nepal consolidate on the gains made and learn from success stories in the South East Asia Region.

Netting Malaria in Nepal
By Pamela Philipose

Kavre, a mid-hill district in central Nepal, is full of wheat fields. Idyllic as the scene may be, Kavre is one of the 13 districts in Nepal that is malaria-prone. In many ways, a district like Kavre tests the effectiveness of Nepal's oldest health initiative, the National Malaria Programme, and the results are for everyone to see: From a previously high risk district, Kavre at present is in malaria low risk. This achievement is mirrored at the national level. Nepal had achieved the malaria control target set for 2015 under the Millennium Development Goals by 2010 itself. A functioning basic health system, ably supported by Community Health Volunteers; technical support from the World Health Organization; and financial support from the Global Fund have made the difference.

* Says Dr G.D. Thakur, National Manager, Malaria, "We have a three-pronged strategy: One, the provision of essential drugs in the endemic belt as well as the rapid diagnostic test. Two, malaria surveillance. Three, the continuation of use of bed nets, along with indoor residual spraying."

WFS REF NO:NEPK314H           1,550 words           Photographs Available

Net Working In Rural Bangladesh For Malaria Control
By Pamela Philipose

Bangladesh has witnessed a remarkable decline in malaria deaths. A network of civil society organisations, in partnership with the Government of Bangladesh, has been a major factor for this turnaround, combined with careful strategising on reaching health care to the communities in rural areas most vulnerable to malaria. The approach demanded careful planning, understanding sleeping patterns for effective bed net distribution, augmenting existing microscopy facilities, and recruiting an additional 13,000 local health volunteers trained to test for malaria and to dispense medication.

* Says Dr A. Mannan Bangali, National Professional Officer, Vector Borne Diseases, WHO Bangladesh, "The programme has been able to penetrate every corner of the country, even in places where it can take you two and a half days to reach from Chittagong."

WFS REF NO:BANK307H           1,550 words           Photographs Available

Bhutan's Malaria Cure: Early Diagnosis and Treatment
By Aditi Bishnoi

Asha Rai, 30, hails from Zomlethang village in Sarpang district, barely 40 kilometres from India's northeastern state of Assam, and Bhutan's malaria hotspot. Fortunately Asha, and others in the local community, are particular about following the instructions of the health workers, who visit their village from the nearby Gelephu hospital, as part of the Information Education Communication (IEC) activities on keeping the surroundings clean and free of stagnant water. But the future holds many challenges. Apart from concerns like the long-term sustainability of activities like the distribution of LLINs, there is the worry that in-migration could lead to drug or insecticide resistant malaria. But tiny Bhutan knows that while it cannot insulate people from getting the disease, it can certainly prevent them from succumbing to it.

* According to Tobgyel Drukpa, Senior Programme Officer, Vector-borne Disease Control Programme (VDCP), Department of Public Health, Bhutan, "The LLINs are a real breakthrough. Thanks to the Global Fund we have been able bring them in."

WFS REF NO:BHUK228H           1,600 words           Photographs Available

Controlling TB: Nepal Shows The Way
By Miriam Fisher

About 10 months ago, Anu Marhatta, 19, who lives in Balaju, had a bout of fever along with a cough. Two months later it was clear that Anu had developed Multi Drug Resistant Tuberculosis (MDR-TB). It turned her happy world upside down. Tragic though Anu's case is, her country - which gets 48,766 new cases of active TB every year - fortunately has one of the best run TB programmes in South Asia. There's 100 per cent national DOTS (Directly Observed Treatment, Short course) coverage; all systems and counselling services are working well. And with Nepal becoming the first country in 2006 to adopt WHO's Stop TB, initiatives to manage the new challenges in the treatment of the disease have been initiated.

* Says Dr Kashi Kant Jha, who heads the National Tuberculosis Centre (NTC), "We have already started MDR / XDR management in Nepal. The biggest gap is the lack of a central chest hospital. However, we aim to establish one at the central level, linked to hostels catering to the entire country."

WFS REF NO: NEPK222H           1,500 words           Photographs Available

Bangladesh's Prescription: Mobilise Doctor In The TB Battle
By Pamela Philipose

The shadow of tuberculosis has long lingered over Bangladesh and today it ranks sixth among the 22 high TB burden countries of the world. Its big achievement is in ensuring almost universal access to TB diagnostic and treatment services. While the Directly Observed Treatment, Short Course (DOTS) has the potential to bring TB levels down drastically, ensuring the better management of DOTS remains a challenge, partly because the traditional medical approach to TB was very different. There was a need, therefore, to ensure a greater involvement of individual doctors, hospitals and colleges in this effort. Several steps taken to ensure this are making an impact today and Bangladesh has been able to achieve 100 per cent health coverage of those living with tuberculosis.

* Remarks Dr Mosaddeque Ahmed, Line Director, National TB Control & Leprosy Elimination Programme, "Clearly, Bangladesh cannot afford to neglect TB control. As a programme person, our challenge is to reach out to the affected community, so that no one afflicted by this disease is left behind."

WFS REF NO: BANK214H           1,500 words           Photographs Available

Free Treatment, Complete DOTS Coverage:The TB Success Story
By Aditi Bishnoi

Like all South Asian nations, tuberculosis is a major threat in Bhutan, but fortunately it has a well established network of health facilities that provides free care and covers 90 per cent of the population. In a one-on-one, Dr Ugen Dophu, Director, Public Health Department, Ministry Of Health, Bhutan, shares the secrets of the programme's success, the special initiative to tackle the disease among the productive age group of 15-49 years, and the challenges it faces - like the shortage of trained health workers to monitor DOTS treatment in rural areas and a lack of state-of-the-art lab facilities. Steps to address these vulnerabilities are already underway in the form of organising regular and rigorous training for frontline health workers and other initiatives, all with technical assistance from the World Health Organization and the financial support of the Global Fund.

* Observes Dr Ugen Dophu, Director, Public Health Department, Ministry Of Health, Bhutan, "Bhutan has 29 hospitals, 187 Basic Health Units (BHUs) and 440 outreach clinics and lab facilities. Unfortunately, we cannot expand like other South Asian countries. Training a laboratory technician for highly technical tests like sputum microscopy takes a lot of effort and money."

WFS REF NO: BHUK207H           1,500 words           Photographs Available

Playing Cricket, Singing Songs: Breaking The Silence On HIV In Nepal
By Sudeshna Sarkar

Hope and faith - that's what Bishal Manandhar, an events manager with the Kathmandu-based organisation, Faith, and a former Injecting Drug User (IDU), represents to the youth of Nepal. He may have done drugs for 19 years, but today this thirty-something is guiding young addicts out of their private hell, using creative outlets like songs, videos and art competitions for kids. Helping to break the silence, reach out, spread awareness on HIV/AIDS and introduce interventions among the most-at-risk population is the Nepal HIV/AIDS control programme. It is a strategy that is helping Nepal to address the HIV/AIDS concern more effectively.

* Notes Dr Krishna Kumar Rai, Director, National Centre for AIDS and STD Control, Nepal, "We work with civil society groups providing comprehensive care packages for them, including awareness programmes and needle exchange programmes."

WFS REF NO: NEPK131H           1,3800 words           Photographs Available

When Imams Join The Battle Against HIV/AIDS in Bangladesh
By Pamela Philipose

Despite the low prevalence of HIV/AIDS in Bangladesh, there is evidence to suggest that infections are rising within the most-at-risk communities in the country, whether they are injecting drug users or migrant workers. The need for raising awareness on HIV/AIDS is, therefore, paramount, and is one of the concerns that the Global Fund To Fight AIDS, Tuberculosis and Malaria, which has been lending financial support to the National AIDS/STD Programme since 2004, wants to address. An innovative effort that is presently being funded involves religious leaders propagating key messages on HIV/AIDS prevention and the need to end the stigma associated with the disease.

* Says Imam Toslim Uddin, "After receiving orientation on HIV/AIDS from Padakhep, I have held discussion with many youngsters in my mosque. They demand educational materials and want to know more."

WFS REF NO: BANK125H           1,400 words           Photographs Available

Facing Up To HIV In Shangri-la
By Aditi Bishnoi

'Let's Stop HIV'; 'Use Condoms. Always'; Get Tested - Ask your Village Health Worker or Visit Your District Hospital': messages like these are common across Bhutan - in schools, community halls, health centres and even at restaurants and bars. To secure 'Shangri-la' from one of the most stigmatised diseases of modernity, the National AIDS Control Programme is focused on "prevention and getting the basic messages out there to the people". Statistics show that young people between 15 to 29 years account for 50 per cent of the infected population. And Global Fund's boost has helped initiate outreach efforts for this at-risk group. Awareness-building is a major tool for now. Considering the conservative nature of the Bhutanese society, in a major breakthrough, the small but compassionate group of counsellors - 40 countrywide - has brought together 15 HIV positive people to form an informal peer network.

* According to Kinley Dorji, Global Fund Coordinator with the Ministry of Health, "We have already trained around 700 teachers in life skills on HIV/AIDS and they in turn teach it to the students."

WFS REF NO: BHUK117H           1,400 words           Photographs Available


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