The Millennium Development Goals (MDGs) represent a global partnership to reduce extreme poverty by setting out a series of time-bound targets, with a deadline of 2015. In 2000, world leaders made a historic commitment: at the United Nations Headquarters in New York to eradicate extreme poverty and improve the health and welfare of the world’s poorest people within 15 years. The commitment, adopted at the Millennium Summit in September 2000, was described in the United Nations Millennium Declaration. It was expressed in eight time-bound goals, known as the Millennium Development Goals (MDGs).
To assess where Guyana is in terms of the targets outlined, Stabroek News continues a series looking at goal 6: malaria and tuberculosis.
By Iana Seales
Tuberculosis (TB) has been called a “tough fight” by Health Minister, Dr Leslie Ramsammy and of the health-related goals he said this one will not only pose more serious challenges, but that it could end up being the single one where the sector fails to reach the targets set by 2015.
Guyana is currently doing well in the TB fight, Ramsammy said, but not well enough. The recorded numbers have remained considerably high in the country and despite the efforts of the ministry, progress has been slow.
Ramsammy said the disease has been around for so long “yet we know so little about it” and according to him, the sector has not done a good job educating the populace about TB. “I keep telling my officers this… NGOs are not attracted by TB because unfortunately in this country NGOs follow the money and there is money in HIV,” he stated.
Outside of its inability to pull stakeholders, Ramsammy said TB has also not attracted much funding at the international level. The Global Fund contributes to the fight against TB, but Ramsammy noted that a considerable amount of the funding goes to HIV. In addition, he said Guyana’s small population makes it even more difficult for the country to attract any significant amount of funding for TB, noting that at international forums the numbers here pale in comparison to the figures recorded in other countries with large populations.
“…If you look at countries where the population exceeds one million and they are dealing with a serious TB problem then that is considered major. There are countries out there talking about hundreds of thousands who have died while Guyana would be citing a few dozen cases, which is a big problem here,” the minister said.
Ramsammy believes Guyana is paying the price for some of the poor decisions taken in another period of its history. However, he said many countries can relate to this, particularly where TB is concerned. He continued saying that the decision to close down the local TB programme in the 1980s was not unique to Guyana, but that it was a “huge mistake”. He said building the capacity for TB now has become difficult, but the sector is pushing to reverse the numbers.
With the continued challenges in the sector, Ramsammy said they are considering involuntary quarantine. In the past, patients here were quarantined at Best Hospital and treated in isolation. Ramsammy said the practice today could be frowned upon, but he also believes that might be the solution to the problems facing the sector. According to him, the sector now views as critical, the need to build a specialized TB ward where patients will be treated separately. “It is something we have already decided on,” he added.
Ramsammy said the problems within the sector are coming from the patients. He said TB patients are hanging out any and everywhere. “We will be forced over the next few years to consider involuntary quarantine and we will have to address it seriously,” he said, adding that many patients are leaving them with no choice. He said that one patient had to be quarantined involuntarily recently because of his actions.
In time, he said, the health sector will not permit people who have been diagnosed with TB and are on treatment to leave the jurisdiction because “it concerns the health of others”. He said that the best science will not reverse the numbers because it calls for patients and their families to comply with the advisories. People have been treating TB with some nonchalance, Ramsammy stated, adding that the time has come for the public recognise how serious the problem is.
TB prevalence in the country is currently around 80 per 100,000. Ramsammy said the sector also faces challenges with multiple drug resistance, but that it is not a “major issue”. He said the sector is working on bringing the numbers down and reducing the prevalence to around 20 per 100,000, but pointed out that “we need to do more”.
The United Nations 2010 progress report on TB noted that if current trends are sustained, the world as a whole will achieve the MDG target of halting and reversing the incidence of tuberculosis, but it noted that sustained funding is required to win the fight. Tuberculosis remains second only to HIV in the number of people it kills, the UN noted.
Malaria
Ramsammy said malaria reductions are never going to be “a straight line down”, explaining that statistically the curve will fluctuate. He declared that based on the MDGs figure in 1990, the country has reached the targets and achieved the goals set for 2015. However, he said Guyana is now focused on elimination.
He said Guyana has achieved the MDGs goal of reducing by half the number of malaria cases by 2015 using the 1990 baseline, adding that the country has far exceeded the target. The numbers in 1990 were recorded around 94,000 officially, but Ramsammy said there was likely underreporting so the figure could have been around 130,000 cases.
But over the next five years the sector will address the question of how to get below the 10,000 number of recorded cases each year. The health sector has set an 8,000 target for 2012, Ramsammy said, noting that the figure this year is likely to be above the 10,000 mark. “…This means that for the last three years we have been struggling with this”, the minister said of the efforts to bring the mark down below 10,000 cases.
He said that around the 6,000 mark a country is entering elimination stage, but pointed out there are challenges towards reaching that figure. Ramsammy cited the difficulty of keeping up with the economic activities in the malarious region; the miners and foresters who go into areas that the health sector is not able to keep up with. He said malaria workers are not dedicated to following these groups, but that the sector is now looking at the possibility of expanding the mobile malaria health worker group which was intended to work at outbreaks.
The second challenge facing the sector is the behaviour of the miners and foresters, Ramsammy said who hardly pay attention to sanitation and using bed nets. “They are not complying with the advisories,” he said adding that this is a major challenge. According to him, the sector cannot be standing over their shoulders and watching them all the time.
People’s non-compliance with the medicine is another challenge the sector is grappling with. The minister said many people tend to self-diagnose and that they also take their own medication. Ramsammy stressed that this is a serious problem because malaria medication is different depending on the type of malaria. He said too that many are also not sticking to the treatment regimen.
Another issue is the problem of the private sector procuring malaria medicine that is not part of the health sector’s regimen. He said some of the drugs are not available to the private sector, noting that the medicines in the public sector are free and available to everyone.
Additionally, he said too the impregnated mosquito nets have worked but that they are not being utilized effectively. Further, he said that in some communities it is advised that people sleep under bed nets but many are not complying.
The country is not going to reach the elimination stage if many of the challenges the sector is facing are not addressed, Ramsammy emphasized. He said too that the sector needs to encourage personal use of insect repellents. “We are looking at the possibility of increasing the usage of repellents in the interior areas,” he added.
Malaria prevalence rate in the country is about 2,000 cases per 100,000 and according to Ramsammy “more needs to be done”.
