Bangladesh
Tuberculosis (TB) is a major public health problem in Bangladesh. In 2008, the World
Health Organization (WHO) ranked Bangladesh sixth among the world’s 22 high-burden
TB countries. In 2007, there were an estimated 353,103 new cases, 1,587,797
of which were sputum smear-positive (SS+) TB cases; more than 70,900 were TBrelated
deaths. The TB mortality rate (45 deaths per 100,000 population) in Bangladesh
is 45 percent higher than the Southeast Asian region average (31 deaths per 100,000
population). Bangladesh’s National TB Control Program (NTCP) began implementing
DOTS (the internationally recommended strategy for TB control) in 1993. DOTS
coverage reached 100 percent in 2006 and remained at that level in 2007.
While the treatment success rate is fairly high at 92 percent, around one-third of the
cases go undetected, resulting in a larger number of undiagnosed and untreated cases
that spread the disease further. Full implementation of DOTS by all public health
facilities, private sector providers, and nongovernmental organizations (NGOs) is not
yet realized. Given that private practitioners and NGOs provide a major portion of
health services, implementation of DOTS by NGOs and within the private health care
system is paramount. Although Bangladesh is a low-HIV/AIDS-prevalence country, the
NTCP is introducing more collaborative TB-HIV/AIDS-related activities as well as
managing multidrug-resistant (MDR) TB. The Green Light Committee (GLC) has
approved the treatment of 700 MDR-TB patients over five years; patient enrollment
will begin soon, with plans for the enrollment of up to 1,500 patients.
USAID Approach and Key Activities
USAID is helping to fight TB in Bangladesh by supporting the goals outlined in the
NTCP’s five-year strategy for 2006–2010, which include expanding and enhancing
DOTS, strengthening health systems, empowering people with TB, and reducing the
risk of TB in populations most at risk of acquiring HIV/AIDS. USAID will focus on
improving the quality of DOTS, as this is critical to sustaining current achievements,
increasing case detection rates, and preventing the further development of drugresistant
TB. USAID will continue to strengthen and improve the quality of DOTS
services provided by USAID-supported NGOs. USAID funding for TB programming in
Bangladesh totaled $3.7 million in fiscal year 2008.. USAID assistance includes the
following activities:
- Increasing availability of drugs for the treatment of TB by building capacity for
supply chain management and procurement practices
- Developing and maintaining coordination among relevant authorities and
NGOs by ensuring information sharing among partners
- Intensifying urban DOTS expansion and enhancement (urban case detection
rate lower than rural areas) with increased numbers of community volunteers
- Supporting the expansion of TB lab services by strengthening the regional lab
network and improving MDR-TB detection
- Providing quality assurance services to decrease the error rate in diagnosing
TB
- Ensuring appropriate care for TB patients by strengthening referral networks
and referral health centers
- Establishing better outreach to populations at risk for acquiring HIV/AIDS
through referral links between clinics providing TB and HIV/AIDS services
- Supporting and conducting behavior change and communication activities, such as health education sessions, advocacy
meetings, distribution of educational materials, and observation of national and international TB days
- Developing new tools and approaches to increase case detection rate through support for operational research on
laboratory activities and field work
USAID Program Achievements
Since the initiation of support, USAID has developed excellent collaboration and coordination with the NTCP and has generated a
large amount of support for NGOs. Recently, USAID facilitated the expansion of a Memorandum of Understanding among the
NTCP and its partner NGOs, thereby sustaining the strong collaboration among the government and NGOs. USAID program
achievements in 2008 include the following:
- Provided quality control of laboratory services
- Trained 965 medical personnel in standard clinical training for TB-related services
- Provided DOTS at 56 clinics, detecting 5,000 new SS+ cases
- Established one external quality assurance center for 12 microscopy centers in Dhaka
- Conducted a situation analysis of DOTS service delivery and identified gaps and needs of the program
- Developed a curriculum and implemented quality, supervision, and monitoring activities at selected sites
- Supported the NTCP in the development of a DOTS-Plus pilot project to manage 700 patients with MDR-TB, which
was approved by the GLC
- Assisted the NTCP in operationalizing the public-private mix (PPM) DOTS strategy, provided support to develop
the PPM strategy of the Global Fund to Fight AIDS, Tuberculosis and Malaria, and supported the updating of the
PPM-DOTS technical guidelines
- Drafted three TB laboratory training modules, focusing on technical aspects and requirements for appropriate
diagnostic facilities, and internal and external quality assessments
Case Detection and Treatment Success Rates Under DOTS
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Note: DOTS treatment success rate for 2007 will be reported in the WHO Report 2010.
Source: Global Tuberculosis Control WHO Report 2009 |
Partnerships
Forming partnerships has been one of the most important elements in combating TB in Bangladesh. In addition to USAID,
international collaborators that have invested in efforts to improve the TB situation in Bangladesh include WHO, the Asian
Development Bank, the Bangladesh Rural Advancement Committee, the Damien Foundation, the Global TB Drug Facility, and the
Canadian International Development Agency. To fill the gaps in program interventions and resources, Bangladesh has received
three rounds of grants from the Global Fund to implement a number of TB activities. In Round 3 in 2004, the country received
$42.5 million; $43.3 million in Round 5 in 2006; and $5.7 million in Round 8 in 2009. Ten of the USAID-supported NGOs
received Global Fund support, extendable through 2011, based on satisfactory performance. With this support, NGOs will
strengthen DOTS implementation in urban areas, involve the private sector more closely, conduct advocacy and mobilization
campaigns, and develop TB-HIV/AIDS collaborative activities.
May 2009
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