Civil Society Perspectives on TB Policy in Bangladesh, Brazil, Nigeria, Tanzania, and Thailand

Published by the Open Society Institute (OSI)'s Public Health Watch project, this 296-page resource is part of a series of reports designed to highlight how social mobilisation can be an important communication strategy for addressing the fact that tuberculosis (TB), HIV/AIDS, and poverty combine to cause almost 2 million preventable deaths every year (data on estimated global TB burden among high-burden countries, 2004, are provided here). For the TB Monitoring Project, Public Health Watch civil society partners in Bangladesh, Brazil, Nigeria, Tanzania, and Thailand prepared assessments of national TB policies based on a standardised questionnaire, incorporating multiple opportunities for dialogue and exchange with a range of policy actors during report preparation.

Released to coincide with the 2006 World Conference on Lung Health in Paris, the series intends to demonstrate that health experts and policymakers alone cannot effectively combat TB. The thrust of the compilation report summarised here ("Civil Society Perspectives on TB Policy in Bangladesh, Brazil, Nigeria, Tanzania, and Thailand") is that community participation and public awareness - which have lent vital support to the fight against HIV/AIDS, according to OSI - have (wrongly) been excluded from efforts to control the spread of TB.

An opening section of the resource culls out common themes from the 5 country-specific reports which follow, highlighting examples from each context to illustrate the themes. In short, researchers all found low levels of awareness of the basic facts about TB and TB/HIV co-infection among political officials and the general population, including within high-risk groups such as people living with HIV/AIDS. Widespread ignorance of how TB is spread and the fact that the disease can be cured contribute to high levels of stigma and discrimination against people living with TB. Media coverage of TB is limited, and national TB programmes (NTPs) generally lack strong communications strategies and staff with the experience and skills to interact effectively with the press. Due to a lack of information, stigma, and the prohibitive cost of care, many patients do not seek or fail to complete TB treatment, the reports find.

In this context, author Ezio T. Santos-Filho calls for public engagement to heighten awareness and mobilise research, prevention efforts, care, and funding. While civil society engagement in the design, implementation, and evaluation of TB policies at the national and international levels has been minimal, there have been some fresh attempts to stimulate greater activity in this area - and illustrations are provided within each of the country reports. To cite one example on a global level, the author notes in the overview section that the World Health Organization (WHO) Stop TB Department has begun to collect information on advocacy efforts in high-burden countries and has promised to establish a working group that includes community participation to develop indicators for more detailed reporting on communications and social mobilisation activities as well. The Stop TB Partnership has also welcomed several community-led initiatives such as the creation of a community task force to ensure representation of people living with HIV/AIDS and/or TB in all of its decision-making structures.

In short, the examples shared in this compilation report endorse the strategy of seeking the input from the communities and populations most affected by TB when engaging in advocacy around this disease. According to Santos-Filho, "these voices - those of patients, health workers, community volunteers, and other members of civil society - are vitally important because they offer first-hand experience on the gaps between policy and practice, the social and economic impact of the disease, and - on a more hopeful note - successful interventions that should be replicated or scaled up."

Click here for the full report in PDF format.

Click here to access each of the individual country reports.

Click here to download a Portuguese-language version of the Brazil report in PDF format. The Bangladesh, Tanzanian, and Thailand reports will soon be available in Bangla, Swahili, and Thai, respectively.