A growing "workforce crisis" is a serious obstacle to achieving targets for global tuberculosis control set for 2005 by the World Health Organization (WHO). Faster and more effective recruitment and training of TB health workers is needed to ensure vacancies in developing countries are filled quickly, says a draft report written by TB experts.
Poor pay and conditions, unhealthy and often unsafe work environments and HIV-related illness among staff are factors which the report says are restricting progress towards the goal of detecting 70% of cases and curing 85% of the people detected. In addition, failure to retain skilled workers is accentuating the crisis as many leave the health sector or government service due to poor career prospects.
TB professionals at a conference in the Netherlands this week paid tribute to the life and work of Dr Annalena Tonelli, who was shot dead in Somalia on Sunday. Her death is an unfortunate reminder of the often dangerous situation facing TB and other health workers in conflict situations.
Sixty-year-old Dr Tonelli ran a clinic for refugees in Somalia and was instrumental in developing DOTS tuberculosis control programmes in Africa, ensuring that patients stay under her care and complete their course of medication. The strategy prevents patients from abandoning treatment and limits the development of multi drug resistant TB, but it requires long term dedication of both the patient and of adequately trained staff.
WHO Director-General Dr LEE Jong-wook spoke of Dr Tonelli"s dedication and humanitarian vision. "This was an outstanding person, totally committed to caring for people who otherwise would not have received any treatment. Her death reminds us all of the perils facing people who risk their lives in the service of the health of others."
Delegates to the conference, hosted by the Dutch KNVC charity, reviewed the current status of DOTS and its impact on the WHO 2005 TB targets. Latest figures reveal a steady rise towards 85% in cure rates, but case detection remains low at 32%. A rapid expansion of DOTS across the world is now required if the targets are to be reached.
The DOTS Expansion Working Group of the Stop TB Partnership have identified key constraints to the targets.
ôWe are clearly seeing a general ‘workforce crisis’ in the TB community,” said Dr Mario Raviglione, Director of the WHO Stop TB Department. ôOne solution is to remove the administrative barriers causing the delays in appointing new staff, especially when major new funds come in. The challenge we face with TB is too great for this to occur. Other priority health programmes will also face the same problem.”
Of the 22 high burden countries (HBCs) which account for 80% of the world"s TB cases, 17 reported that their efforts to reach the 2005 targets are being hampered by staffing problems.
ôFor a country’s economy to grow, it must have a healthy workforce. At the same time the workforce has to depend on highly motivated and qualified staff in the health sector,” said Dr Leopold Blanc, WHO Co-ordinator for the Stop TB Department.
We need to promote improved working conditions for TB control staff that are attractive and also an incentive for them to stay working in TB. Opening up career opportunities and supporting ongoing training schemes is one way to ensure we retain staff.”
Other action areas considered critical to the success of the 2005 targets include :
Health workers - Commitment in the face of risks
Every day, thousands of volunteers and health workers deliver lifesaving TB drugs to patients under the DOTS strategy. For some, the dangers are very apparent.
Solange Cavalcante works for the City of Rio de Janeiro’s health department. Her job is to implement DOTS to 90,000 residents in the Rocinha district.
Safety is declining and crime has become more dangerous,” says Cavalcante. ôGang fighting and illegal drug trafficking are on the increase. This is a real limitation on the DOTS programme. If there’s a gang war for a week, you can’t go to check that patients are getting their treatment.”
One successful project piloted in the area involved training and recruiting 40 community health workers who live in the Rocinha neighbourhood.
It’s been challenging, but it also been a success. There are six million people here in Rio and the city has a high incidence of TB. If we can implement such a scheme here, we can implement it anywhere.”