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Op-Ed: Tackling Communicable Diseases in the 21st Century

WASHINGTON, March 24, 2011—Controlling communicable diseases in today’s globalized world is an essential priority for all countries, which have seen how tuberculosis, SARS, or influenza can now spread across continents with daunting speed. From a sudden powerful outbreak of a new strain of influenza to the intermittent resurgence of old enemies such as tuberculosis or polio, communicable diseases in the 21st century have one thing in common—they move just as quickly as people do. To tackle them successfully, public health authorities now require access to information on diseases and their patterns of movement that is accurate, reliable, and in real time.

East Africa, with its rapidly integrating economic community, is no exception. The good news is that the region is proactively preparing for the public health challenges that may stem from increased labor mobility and greater contact between countries and with the world at large. Four nations—Kenya, Rwanda, Tanzania, and Uganda—have begun a major effort to coordinate surveillance of communicable diseases. They are establishing a regional network of public laboratories that will improve access to high-quality diagnostic services among vulnerable populations living in the cross-border areas of all four countries. The network will share information on diseases quickly and will investigate disease outbreaks cooperatively.

This is noteworthy progress to report on World Tuberculosis Day, because efficient laboratories are essential weapons against tuberculosis, and also against a wide range of other diseases. Laboratories that produce accurate and rapid diagnostic results are not only key to detecting tuberculosis—the most common opportunistic infection in people living with HIV—but also contribute greatly to increasing the chances of survival among patients suffering from cholera, meningitis, and Rift Valley fever.  Enhanced rural access to such services means less need to travel long distances to seek care, and lower risk of transmitting diseases.

Historically, laboratories have been one of the weakest links in Sub-Saharan Africa’s health systems, seriously hindering each country’s ability to confirm and respond in a coordinated way to outbreaks of disease. The US$63.7 million East Africa Laboratory Networking Project (financed by the World Bank; coordinated by the East, Central, Southern Africa Health Community, ECSA-HC, in collaboration with the East African Community; and prepared with support from United States Centers for Disease Control, the World Health Organization, the United States Agency for International Development, and the International Union against Tuberculosis and Lung Disease) is addressing common challenges facing the four countries:  inadequate laboratory infrastructure and supply of trained staff, as well as outdated manual information systems that do little for efficient decision-making.

Today, each of the four countries is taking the lead on a different aspect of the laboratory network, with potential savings for all. Kenya, for instance, is leading on integrated disease surveillance and response, and on operational research. In February this year, participants from EAC member states took stock of research gaps in Nairobi, and developed a joint research agenda, including on the effectiveness of new tuberculosis diagnostic tests, and mapping of malaria drug resistance.  Further, a Kenyan team together with a representative of ECSA-HC visited Rwanda to study the provision of quality health care for patients with multi-drug resistant tuberculosis. Finally, countries are working together with partners to develop e-learning modules, for priority areas such as outbreak investigations and disease surveillance.

In an effort to boost the network’s connectivity, Rwanda is serving as the center of excellence for internet and communications technologies as well as for performance-based financing (an area where it has achieved strong results by paying frontline health facilities based on predetermined results). Uganda is taking the lead on laboratory networking and accreditation, while Tanzania is planning for the launch of joint training activities at its state-of-the-art new Quality Assurance and Training Center.

Elsewhere in Africa, other efforts are underway to tackle tuberculosis-HIV co-infections. For instance, in Swaziland, which has the world’s highest HIV prevalence rate, a new US$41 million project supported by the World Bank and the European Union is expected to improve access to quality health services in the country, with a special focus on primary health care, maternal health, and tuberculosis/HIV integrated care. It will also increase social safety net access for orphans and vulnerable children through a pilot cash transfer mechanism.

Efforts such as these will contribute to the achievement of the Millennium Development Goals that several nations agreed to pursue at the turn of the century. With just four years to go for these goals to come due, the need of the hour is more innovation and cooperation so that the sixth goal—which includes the specific target of halting and reversing the spread of HIV/AIDS and a number of infectious diseases by 2015—comes within reach in Africa. Reaping economies of scale and adopting cost-effective approaches are more important than ever as both donors and developing countries struggle, with shrinking revenues, to do more with less.

These examples of coordinated investments in health that are led by African countries will support the continent to become more competitive and resilient than before in the aftermath of the global economic crisis and help ensure that workers stay healthy and productive as all countries in the region push towards higher and more sustainable economic growth.

Jean Claude Nsengiyumwa, Josephine Kibaru-Mbae and Ritva Reinikka

 Mr. Nsengiyumwa is Deputy Secretary General, Productive and Social Sectors, East African Community; Dr. Kibaru-Mbae is Director General, East, Central and Southern Africa Health Community; and Ms. Reinikka is Director, Human Development (Africa Region) at the World Bank.


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