Nepal has taken several commendable measures to address the burden of TB: Dr Rajesh Sambhajirao Pandav, WHO Representative to Nepal

"Despite the high disease burden, Nepal has been committed to combating the disease. Through a multitude of efforts and actions, there has been a three percent annual decline in TB incidence rate."

NL Today

  • Read Time 5 min.

Dr Rajesh Sambhajirao Pandav is the World Health Organization (WHO) Representative to Nepal from September 2020. Prior to Nepal, he served as the WHO Representative to Timor-Leste from April 2015 until September 2020. In an interview with Nepal Live Today, he speaks on a range of issues such as TB diagnosis, prevention, treatment, care among others.

Why is World TB Day relevant for the world and Nepal?

On 24 March 1882 German physician, Dr Robert Koch, announced to the world that he had discovered the bacteria that causes Tuberculosis (TB). It was this discovery that paved the way for diagnosing and curing TB. However, decades later TB remains one of the deadliest infectious killers. Each day, over 4100 people lose their lives to TB and close to 28,000 get sick with this disease. World TB Day is an opportunity to raise public awareness about the devastating health, social and economic consequences of TB, and to call on all concerned to step up efforts to end the global TB epidemic.

This year World TB Day’s theme is ‘Invest to End TB. Save Lives’. How do you connect this theme in Nepal’s context?

This year’s theme highlights the urgent need to invest resources to ramp up the fight against TB and achieve the commitments to end TB made by national and global leaders.  This is especially critical given the impact of the Covid-19 pandemic on the “END TB” progress, and to ensure equitable access to prevention and care in line with WHO’s drive towards achieving Universal Health Coverage. More investments towards TB diagnosis, prevention, treatment, and care will save millions more lives.

In the context of Nepal, investment is required for successfully implementing the National Strategic Plan For Ending TB. This means allocation of sufficient resources to improve the quality of diagnosis, prevention, treatment and care services for TB. Investment to expand high quality TB services for children and adolescents in a sustainable manner is another area which requires attention. Empowering health workers  to deliver high-quality TB services and empowering communities to combat TB related stigma and discrimination all require investment.

What is the status of Nepal’s efforts in eradicating TB? What is its prevalence rate compared to other countries in the region and the world?

Each year around 69,000 new TB cases are developed in Nepal as per the National TB Prevalence Survey (2018-2019). Nepal was also recognized as one of the high burden countries for Drug-resistant TB (DR-TB) in 2021. Despite the high disease burden, Nepal has been committed to combating the disease. Through a multitude of efforts and actions, there has been a three percent annual decline in TB incidence rate. Similarly, the treatment success rate is also high with nearly 90 percent of new TB cases being successfully treated each year. From 2015 to 2021 the country has recorded a 12 percent decline in the number of new cases. WHO remains committed to supporting the Government of Nepal in its aim to end TB.  The situation is not much different in other countries in the South East Asia region which holds the highest proportion (43 percent) of the global TB burden. Most countries around Nepal (India, China, Bangladesh, Pakistan)  are all high burden TB countries.

WHO estimates that every day over 4100 people die of TB and nearly 30 000 people fall ill even though it is preventable and treatable. Where lies the gap?

Timely and early identification of TB is key to reducing disease transmission and ensuring patients begin treatment. However, due to limited access to quality screening and diagnostic tools and services, there are many cases that go undiagnosed which contribute to spread of the disease and mortality from the disease. Improving case finding and diagnosis through increased investment and strengthening the health system to support integration of TB services is key to addressing the problem. 

How is WHO Nepal supporting the Nepal government and Nepal’s health system in decreasing the incidents of TB?

As a technical agency, WHO supports the national TB program by providing technical advice, support and guidance aimed at building the national capacity to effectively address the burden of TB. WHO supported Nepal to develop the National Strategic Plan for 2021-2026. In addition, WHO contributed to the development of clinical and programmatic guidelines and for launch of the TB Free Nepal Initiative. WHO staff have been involved in national-level TB programme review and facilitated the generation of high-quality research data through national surveys.

“We must remember that ending TB requires concerted actions by all sectors. Everyone has a role to play in ending TB.” 

WHO continues to provide support for enhancing the capacity of health professionals in diagnosing and treating TB.  WHO also provided evidence-based recommendations to practice and scale up integrated TB services to ensure patient-centered care and high-quality services.

WHO has also been continuously advocating for high prioritization and investment into the TB program. Last year it facilitated the Ministry of Health and Population in co-hosting High-Level Meeting for renewed TB response in the WHO South-East Asia Region.

What, in your opinion, are the major challenges of Nepal to reducing the incidents of TB?

Limited financial and human resources to fully implement key interventions and activities remain a major challenge. While Nepal has been successful in developing strategic plans and launching ambitious initiatives such as the TB free declaration initiative, allocation of adequate resources is still a challenge. This is a problem globally. Which is why we need more investment into the TB program so that more people regardless of their geographical location have access to high quality primary screening, diagnostic and treatment services.

What are some remarkable measures taken by Nepal to prevent TB incidents?

In recent years Nepal has taken several commendable measures to address the burden of TB. Firstly, its adoption of strategies which marks a shift from “control of TB” to “ending TB” is remarkable. Secondly, the country has proactively introduced and scaled up activities like ‘TB free Nepal Declaration initiative’ reiterating high-level political commitment. By investing in generating high-quality research evidence through conducting nationwide prevalence survey, the country now has a more accurate understanding of the disease burden and has been able to prioritize interventions accordingly. Similar investments are being made for the Drug-Resistance (DR) survey which will give better estimates for the country as Nepal is currently labeled as one of the high burden DR TB countries. Nepal is also one of the few countries in the region to make early policy changes in introducing rapid molecular testing (like genexpert) and treatment using short therapeutic courses for Drug Resistant TB.  The efforts to continue TB services during the Covid-19 pandemic is another of Nepal’s achievements.

Any further messages to share on the Day?

On World TB Day WHO would like to bring attention to the urgent need for increasing investments into TB. In the South East Region alone around 700,000 people have succumbed to the disease. More investment will mean more lives saved. Access to care remains a major challenge and our efforts must be concentrated on removing these barriers that prohibit some of the most marginalized and vulnerable population from receiving due care. Together, we must strive for attaining the highest standards of rights-based, stigma-free, quality-assured, people-centric TB preventive, diagnostic, treatment, rehabilitative and palliative care. We must also remember that ending TB requires concerted actions by all sectors. Everyone has a role to play in ending TB – individuals, communities, businesses, governments, societies.