Translating Tuberculosis (TB) prevention science into a community health system issue: A convenient pathway to achieving universal health coverage in Uganda

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As we mark the world TB day themed “End TB Now” a stream of various factors need to be considered beyond the usual statistics. Well aware that the TB infection is one of the major public health problems in Uganda, the infected and affected population, sometimes will not mind of prevalence and incidence rates but the role they play in controlling the epidemic. Unfortunately, for long a time, TB has remained medical and only the medical works will always interpret the diseases making it extremely complex for the local person /citizen to meaningfully contribute to the control mechanisms. Citizens have maintained the receiving attitude which compromises the level of involvement; that we receive knowledge, treatment, counselling and care by the health workers and so what else is required?

By health systems concept, it will demand that individuals, communities and the general public plan, produce, monitor and design alternative health interventions for their own health outcomes and wellbeing; a move that will transit in similar pathway to the principles of universal health coverage of population coverage, financial protection  and equity. The principle of Equity is where everyone in the affected population will be reached with services that meet the aspirations and needs of citizens. This will stimulate and guarantee meaningful participation that is based on their capacities to influence the state to take action that address their concerns. This is also in line with the primary health care system which people centred health care where the needs of the people are put at the centre of health care  and taking charge of their own health system (WHO 2008). Therefore, the  design of TB interventions premised on people centeredness approach will  harnesses the population capacities for diseases prevention and organised around people not the disease and  ensure that TB services respond to people’s voices and meets their needs and aspirations.

How does it become a convenient path way to universal health coverage?

It’s imperative to appreciate the initiatives by Government (MoH) and other partners for reaching the various milestones in the prevention of TB in Uganda; including policies, standards, technical and operational guidelines setting, procurement and regular distribution of drugs and supplies and Partner coordination among others. Even during this year’ celebrations I am assured of the status update and awareness creation of how the regions and country rank in terms of TB incidence and prevalence and cannot recite it in this article. However, the missing link is particular to community empowerment and participation, advocacy and communication and integrating private health care providers

Participation is a product of empowerment and this affects the way citizens exercise their roles in disease prevention and ensuring the general wellbeing which is health in totality; and empowerment will involve a process through which individuals or organized groups increase their power and autonomy to achieve certain outcomes they need and desire (Eyben2011).It supports disadvantaged people to gain power and exert greater influence over those who control access to key resources for TB control and prevention. It will enhance the capacity of people to ensure that they take control of their own resources and actions that impact their lives in achieving the highest attainable quality of life as defined by WHO. Not until citizens are empowered to  influence public decisions  and separating responsibilities by individual societies that TB prevention science will be understood;  and facilitate the path to enjoying and  upholding  the principles of human dignity, equality and equity at all level  and  conveniently lead to achieving universal health coverage in Uganda . Meaningful and effective participation of beneficiaries in policies and programme development is central to ensuring voice and accountable which is part of the “Supporting Policy Engagement for Evidence Based Decision making” (SPEED) project on Universal health coverage implemented in partnership with Makerere School of Public Health.

As we celebrate World TB day, let us re-direct our subsequent steps towards achieving Universal Health Coverage as the ultimate goal for the Health Sector Development plan 2015/2016-2019/2020.Universal health coverage is the process of  ensuring that all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services(WHO 2012).In this regard, TB services need to shape around  the following pathway for universal health coverage:

  • Integrate the Rights Based Approach into the TB programming the will facilitate citizen empowerment participation and stimulation of their voice for quality TB services. It will promote collective responsibility and engagement which in turn minimise the dependence of medic-patient syndrome. It will also allow for citizen participation in decision making on their health and service delivery, discern good quality care, and demand accountability from providers of care (Williamson .l 2014).
  • Build strong linkages among private and public health service providers, community for improved capacity to carry out TB case finding and holding. This can be done by identifying community linkage facilitators from among the private care providers and offer them capacity to conduct TB case identification, referral to public health care facilities and accredited private facilities, reporting and follow up. This is will outlive the TB DOTs policy of 2005 of which the gaps in it can be bridged. Different actors will provide health education on TB patients’ rights and responsibilities as well as counselling.
  • Encourage show casing on TB prevention mechanisms by the different affected population groups and communities which  promotes learning and exchange of people centred intervention  .It can be useful in informing the subsequent interventions. Feedback and redress mechanisms

will be established and the level of engagement ascertained.

TB prevention will then be translated and viewed by community members as a right as well as a responsibility that promote the general wellbeing of society as product not only as health outcome. Therefore community participation and prevention should inform priority setting in UHC agenda because the biggest burden of TB morbidity and mortality can be prevented.

Kirigwajjo Moses Nsaire is Programs Officer -Uganda national Health Consumers Organisation (UNHCO), Implementing SPEED Partnership project with Makerere University School of Public Health. 

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