Tuberculosis is one of the oldest diseases and is widely prevalent on a global scale. While most governments have tried their best to keep this disease under check, most have been unsuccessful given the ability of the bacteria to adapt to newer drugs. This paper will critically examine the past lessons initiated in order to control the disease as well as the medical impact of the disease in the UAE. The paper will also conclude with a few recommendations in order to control TB in the future.
The World Health Organization (2009) states that one of the key methods for controlling TB was the Stop TB Plan that was launched in 2001. (p. 8) The overall plan consisted of developing and providing new diagnostics, vaccines and drugs that would successfully control TB, including a methodology called Direct Observation Therapy (DOT). This method was extensively used by the WHO to detect and cure cases of TB, especially across the developing world. In special cases such as MDR-TB (Multi-Drug Resistance TB), the Stop TB program has failed due to its inability to sustain an increase in global scale. Thus, one can see that failure occurred at two different levels: 1. At the local and national government levels, possibly due to apathy and, 2. In some cases, an inability to expand the program and scale it to national levels, particularly in case of special strains of TB exacerbated the problem.
However, all these methods collectively failed to show expected results. This meant that while TB was controlled in a few countries, the results were not uniform, which prevented the WHO from implementing the second phase of the Stop TB plan, namely the eradication of TB from the planet. For instance, the nations of the African region severely lagged behind their Eastern European and Mediterranean counterparts in both detection and cure of the TB epidemic. (WHO, 2009)
Reasons for the failure
This paper will briefly explore three fundamental reasons for the failure to control the TB epidemic on a global scale. It becomes imperative that administrators of anti-TB programs correct these deficiencies in order for the program to be successful.
Inability to secure core functions: The biggest current problem that this method of control faces is the lack of sustainable funding at the governmental level. (Leinhardt, 2012) Most countries simply do not dedicate adequate funds to this project as a result of which the collective effort fails.
Health System Support: The deficiencies in the health systems of certain countries in which the control methods operate are largely to blame for the collective failure of certain countries to meet TB control targets. (Leinhardt 2012) Some of the African nations lack even basic health facilities and, as such, natives of these countries are cut off from health care. This factor is a major reason for the failure to control TB on a global scale.
Lower investment in research: The only answer to the ever resistant strains of TB is adequate investments in research of better drugs and development of new tools for the diagnosis, treatment and prevention of TB. (Leinhardt, 2012). However, this is easier said than done because a number of countries ignore this important aspect either because of budgetary constraints, excessive corruption within the health system or because of sheer apathy toward TB patients. The result of this is that patients suffering from TB are often not even given basic guidance due to which they later get infected with the MDR strains that often cause death.
TB in the UAE
The medical health system in the UAE is regulated and individuals have mandatory health insurance coverage. The Ministry of Health is involved in all aspects of the health care system ranging from the establishment of new hospitals to the collection of data on health related issues within the country. (WHO, 2012)
Tuberculosis remains present in the country at negligible rates, 2 cases per 100, 000 population. The tuberculosis prevention program is not integrated within primary health care services and functions as a separate parallel program. Due to this structure the program is efficient. One can understand that the efficacy of this separate TB prevention program has played a key role in the control of TB in the UAE, although a substantial part of the population is immigrant in nature. In fact, Mohammed Areeshi and others (2014) tends to support the view put forth by the Ministry of Health. A detailed research conducted by Areeshi and his team revealed that the UAE had the lowest number of TB patients (amongst the GCC countries) at only 3.9% compared to Saudi Arabia at almost 45%. (Areeshi, 2014) However, of these, UAE had a higher number of patients suffering from the dreaded MDR type. The bacterial type that was largely observed in the UAE had a complete resistance to Pyrazinamide and Ethambutol. Also, the patients in the UAE showed an extremely high resistance to all first line drugs of TB. (Areeshi 2014) The findings pointed out that this prevalence in the UAE was due to poor laboratory support causing poor prognosis, low to nil levels of investments in the fight against TB as well as a lower allocation of funds to fight TB since health authorities typically perceived TB as a low incidence disease in the UAE. (Areeshi 2014)
Recommendation and Conclusion
The case of the UAE in handling TB provides a unique case study to other developing nations. One must consider that the UAE and other GCC countries are recipients to large scale immigration (largely short term) from other countries in Africa and Asia where TB may be prevalent. Despite this drawback, one sees that the only reason for the low incidence of TB in the UAE is the excellent primary health care system as well as the access to the system that the country provides to its citizens. The country also provides subsidized drugs to its citizens so that everyone can afford the treatments for TB. One can view this as a success in the fight against TB. However, on the flip side, the UAE also contains the largest number of MDR cases within the TB epidemic. This indicates the lackadaisical approach that the health ministry takes with respect to the availability of better secondary healthcare facilities, better laboratories and dedicated facilities to the treatment of MDR-TB.
The recommendation would be to improve these secondary health care facilities so that patients can avail timely medical care so that the MDR-TB bacterial strains do not spread further. The GCC countries, in general, and UAE, in particular, must implement stringent screening procedures for immigrants and must commence screening and treatment for their citizens at all government health centres.
In conclusion, one clearly sees that the reasons for failure discussed earlier in this paper play a very critical role in the control of TB. The UAE, like other countries, needs to allocate more resources to better TB control in accordance with the WHO guidelines so that a worsening TB scene does not render it in the same position as its other GCC counterparts.
Areeshi, M.Y, Bisht S.C, Mandal, R.K. (2014). Prevalence of drug resistance in clinical isolates of tuberculosis from GCC: a literature review. Journal of Infections in Developing Countries, 8(2). pp. 1137 – 1147. [Online] [Accessed 11th July 2015] Available at: <http://www.jidc.org/index.php/journal/article/viewFile/25212078/1148>
Leinhardt, C, 2012. Global Tuberculosis Control: lessons learnt and future prospects. Microbiology Journal, (10), pp. 407 – 416. [Online] [Accessed 11th July 2015] Available at: <www.nature.com/reviews/micro.>
World Health Organization [WHO]. 2009, The Global Plan to Stop TB 2006-2015: Progress Report 2006-2008, Stop TB Partnership. [Online] [ Accessed 11th July 2015] Available at: <www.who.com>
World Health Organization[WHO]. 2012, Country Cooperation Strategy for WHO and the United Arab Emirates 2012–2017, Regional Office for the Eastern Mediterranean - UAE. [Online] [ Accessed 11th July 2015] Available at: <www.who.com>