Turkmenistan
Tuberculosis (TB) control is a priority for the Government of Turkmenistan, as the
health system is vulnerable to the many challenges posed by TB. The DOTS (the
internationally recommended strategy for TB control) case detection rate has not
reached the World Health Organization’s (WHO’s) target of 70 percent, though over
the past three years, the rate increased from 33 percent in 2004 to 84 percent in 2007.
While case detection remains low, treatment success rates are satisfactory. The
treatment success rate reached 86 percent in 2004, above the WHO target of 85
percent, but fell slightly to 84 percent in 2006. The DOTS strategy was introduced in
Turkmenistan in 1999, and DOTS coverage reached 100 percent in 2007.
In 1999, the Ministry of Health and Medical Industry of Turkmenistan (MOHMIT)
established the National Program for Tuberculosis Prevention and Control (NPTPC),
and, in coordination with the Interdepartmental Coordination Committee, the NPTPC
has produced two five-year action plans. In 2008, the NPTC approved the second fiveyear
plan, the National Program of Tuberculosis Prevention Turkmenistan for 2008–
2015, which is based on the Stop TB Strategy. A major challenge to expanding DOTS
is the vertical nature of the TB management system, which is not well integrated into
other health structures, especially with primary health care (PHC). In 2008, only 677
out of 1,671 (41 percent) of PHC facilities had DOTS services, and just 7.4 percent of
TB patients were detected at the PHC level. Because many of the prisons still practice
outdated, non-DOTS case management, a pilot initiative was started in 2008 in one prison.
Turkmenistan has low levels of multidrug-resistant (MDR) TB compared with other
regions, but more data are needed to obtain accurate estimates on the prevalence of
MDR-TB. Turkmenistan is in the initial stages of setting up the infrastructure to
manage MDR-TB, and the capacity for infection control and testing of MDR-TB is
limited. The TB-HIV/AIDS co-infection is low in Turkmenistan, and while routine
testing of TB patients occurs, patients do not often receive their results.
USAID Approach and Key
Activities
Since 2000, USAID’s main partner, Project HOPE, has implemented a multi-component
program to provide assistance to the Government of Turkmenistan to improve the
quality and accessibility of medical services and to improve the awareness of the
population about TB treatment and prevention. USAID funding for TB totaled
$780,000 in fiscal year (FY) 2008. USAID has supported the fight against TB by helping
the NPTPC implement DOTS through national-level interventions (policies, national
guidelines, and capacity building of the NPTPC as well promoting community advocacy
and social mobilization. USAID assistance includes the following activities and
interventions:
- Strengthening political commitment and establishing the proper coordination
between national health authorities and international partners in TB control
- Providing a wide range of training for public health professionals, including
training PHC staff on integrating TB services at the PHC level to increase
patient access to DOTS, and training managers on conducting operational
research
- Advocating for the implementation of appropriate drug management
procedures for second-line drugs
- Supporting rational planning of the TB laboratory network and training of staff
to ensure efficient use of TB resources and qualified staff to conduct
laboratory services
- Promoting the use of appropriate control measures in laboratories providing culture and drug susceptibility testing and in
MDR-TB treatment facilities
- Supporting training, monitoring, and management of first line drugs to ensure patients receive correct drug regimens without
interruptions in supply
- Improving program management by strengthening monitoring and evaluation skills of NPTPC staff through training on data
collection, analysis, and application and introducing the electronic surveillance case management system, installed by the U.S.
CDC
- Collaborating with the Press Center of the MOHMIT to facilitate increasing capacity in developing information, education,
and communication (IEC) materials; change the behavior of medical staff and TB patients; and inform the public about TB
USAID Program Achievements
USAID program achievements include the following:
- Integrated DOTS at all levels of the medical education system
- Financed the expansion of DOTS to cover an additional 18 percent of the population.
- Developed a logistics management information system (LMIS), with future nationwide roll out planned.
- Supported the opening of a TB training center at the Turkmen State Medical Institute by providing educational materials,
equipment and renovating the Training Center.
- Trained 82 TB specialists, 78 PHC doctors, 324 nurses, 113 other staff cadres, and 23 lab technicians in FY 2008, and
provided DOTS materials to 2,500 health workers nationally.
- Developed LMIS guidelines to ensure an adequate TB drug supply nationwide
- Assisted the MOHMIT in drafting its National Strategy on Health Communication and applying for Global Drug Facility
funding for TB medication for children, which was approved
- Developed and disseminated IEC materials for health workers, the general population, and patients
- Facilitated the formation of a high-level working group, which provides a forum for donors and technical agencies to
coordinate their activities with the national government, approve technical documents, and develop recommendations for the
government
- Delivered 40 binocular microscopes, reagents, and other laboratory materials to MOHMIT sites, enabling the country to
further expand 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
USAID is one of the main donors and provides technical assistance in almost all areas of TB control through Project HOPE. Project
HOPE is the lead member of a consortium that includes John Snow, Inc., Johns Hopkins University’s Center for Communication
Programs, and the New Jersey Medical School Global Tuberculosis Institute. Turkmenistan has not received any funding from the
Global Fund to Fight AIDS, Tuberculosis and Malaria, although USAID will provide technical assistance for proposal preparation for the
Round 9 application for funding.
June 2009
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