Dr Sushil Koirala is a medical doctor turned development professional who wears many hats. He currently serves as Country Representative to Nepal for Damien Foundation, which provides technical assistance to the health sector, particularly to curb tuberculosis (TB) and leprosy diseases. Since June 2021, he has been leading the Association of International NGOs (AIN) as its chair.
On the occasion of World TB Day, Nepal Live Today sat down with Dr Koirala to talk about TB and its prevalence in Nepal. Excerpts:
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 theme is highly relevant to Nepal. With novel drugs, new technology, and new treatment regimens, we have better diagnostic tools and treatment outcomes. However, this also comes at some cost. There is a need to invest more in the prevention of TB. Having said that, the good thing is that the government has increased contribution and investment in TB over the years along with Global Fund and other TB partners.
What is the status of Nepal’s efforts in ending TB?
Nepal’s Strategic Plan aims to end TB. But it is much easier said than done. However, there is a political will and commitment for the same. There is a long way to go and we have to speed up things if we are to meet the global and national targets. Nepal is doing pretty well. However, a lot needs to be done in diagnosis and improvement in quality care of patients among others.
What is its prevalence rate in Nepal compared to other countries in the region and the world?
Compared to India and China, we are in a better position for Drug Sensitive TB. However, for drug-resistant TB, Nepal is lagging behind. The government needs to work on it.
What are the major activities of Damien Foundation in TB control?
Damien Foundation works on treatment and cure of patients. The Foundation has also supported the construction of two TB Referral Centers in Gandaki Province and Sudur Paschim Province. We are supporting and collaborating with all three tiers of the government. Likewise, we also support the governments to run the centers effectively.
Similarly, we have also supported construction and renovation of DOTS Centers, OPDs and DR TB wards in various government hospitals in our working area.
Initially, the Foundation started to work on capacity building, training, and provided some additional drugs and medical equipment to the governments. Now we are also providing services in collaboration with the government of Nepal to increase accessibility of Multidrug-resistant tuberculosis (MDR-TB) treatment in nearby health facilities and even at homes.
For needy patients, we bear the cost for diagnosis, admission, among others.
What, in your opinion, is the major challenge to decrease the incidents of TB, access to health care, behavior change and awareness?
In Nepal, both diagnosis and treatment are free but there still are gaps. Patients still have to bear huge costs. Sometimes, the disease is diagnosed late, and by that time patients might have spent a huge amount of money for treatment. In Nepal, the behavior of patients is a challenge. They don’t tend to seek treatment early on leading to late diagnosis.
Covid-19 pandemic has further worsened the situation, and posed new challenges in the fight against TB control.
So, early diagnosis and treatment is one of the key issues that we need to improve. Likewise, people also don’t go for treatment even after diagnosis. These issues need to be addressed.
I believe awareness is the key. The government of Nepal has introduced health insurance for MDR-TB patients. It also provides nutritional support including free treatment. However, the access to diagnosis and treatment of MDR TB is still limited. This should be expanded.
Having said that, the Covid-19 pandemic has further worsened the situation, and posed new challenges in the fight against TB control. As the government imposed restrictions to curb the spread of Covid-19, TB patients visited hospitals much less for treatment.
To fight against TB, the three tiers of the government should allocate adequate budget and human resources. There should be coordination and collaboration among federal, provincial and local governments. While Global Fund is providing resources, additional resources from other donors and partners would further help in the battle to fight against TB.
What are the future plans of your organization in preventing TB incidents in Nepal?
Our focus is on two diseases–TB and leprosy. Within TB, we have further focus on DR TB (Drug Resistant Tuberculosis) in Nepal. We are committed to providing technical assistance and support in the spirit of partnership and collaboration in line with government strategy and priorities. We are more concerned about increasing accessibility and availability of DR TB treatment at local level, patient care and support, strengthening of TB referral centers and capacity building of health care providers by providing training, orientation and resources. We still have a long way to go to end TB in Nepal. All the stakeholders need to work together for this cause.
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