I am sometimes asked how we were able to help Mexico’s Ministry of Health achieve the success that resulted from our partnership over the past eight years (from 2004-2012). I often say that one of the key elements of that change was being able to put a human face to the disease.
When a clinician thinks about a person affected by TB, precisely as a person first, instead of ‘a case to be reported’ or ‘a problem to be tackled,’ good things can happen. Through the SOLUCION TB program, carried out by PCI first in two municipalities and eventually in 35 priority municipalities across the country, we worked with the National Tuberculosis Program (NTP) and the TB programs from thirteen different states to transform the health service approach from disease-centered to person-centered.
We started by identifying the strengths, assets and needs of first line health workers (physicians, nurses, social workers) who are asked to split their time among twenty-plus priority health interventions. What did they know? What was their perception of TB? Of people with TB? What are the resources they have and the ones they need to do their job the best way possible? What are their technical capacities and their technical areas of improvement? How effectively are (or aren’t) program managers able to provide support, supervision and supplies needed by first line workers?
By first understanding the context, attitudes, knowledge and capacities, we were able to identify the best mechanisms to achieve change and improvement. Technical updates, trainings, ensuring testing and treatment supplies, strengthening lab capacity for detection, and improving collaboration were all areas that were addressed, at different levels, by this collaborative partnership. Indicators of success were identified, and human resources were deployed depending on the level of need.
Now, the process of shifting attitudes required a carefully planned strategy; one that was organic enough to build upon existing strengths while providing health workers not only with the needed information, skills and tools, but a clearer appreciation of the issues that people affected by TB face, and how they affect their outcomes. Improved quality of care, being listened to and respected, receiving treatment services adapting to their schedules, and being understood as a person, with hopes, fears, dreams, strengths and weaknesses, was key to improving the person with TB-health system partnership. While some had families who cared, supportive co-workers, people who were willing to provide support, others were rejected by their loved ones, abandoned by family members, or being kicked out of their jobs, out of their homes was a reality for many.
How much can and should the health system do to address these factors? The answer was simple –as much as possible. And amazing things happened when attitudes changed, when misinformation was directly addressed to combat stigma and discrimination.
Over the last few years, Mexico became a pioneer in Advocacy, Communication and Social Mobilization for TB in Latin America. More people with TB were diagnosed and enrolled in treatment, and improved coordination between TB, Diabetes and HIV/AIDS program led to better integrated services. Mexico has been acknowledged by the Pan American Health Organization for their work in TB-Diabetes, and highlighted as a success story in ACSM for TB y the STOP TB partnership.
According to MOH data, stronger awareness and detection services, resulted in an increase in the number of new TB cases by 8.6% nationwide and 18.3% in the 13 priority states where PCI collaborated, between 2007 and 2011. During this same period, detection of HIV/AIDS and Diabetes improved in people with TB by 154% and 73% respectively (HIV/AIDS and Diabetes). All of these represent potentially, new cases that might not have been diagnosed early enough prior to the health system improvements supported by this successful partnership.
There is much more work to be done, but the Ministry of Health in Mexico remains committed to sustaining programmatic results and expanding the SOLUCION TB project’s approach throughout Mexico. As Dr. Martin Castellanos, head of the NTP said “PCI represented a breakthrough for TB prevention and control in Mexico; a person-centered approach to service delivery, improved awareness of the disease, and improve comorbidity services for HIV/AIDS-TB and Diabetes-TB are direct results of this partnership”. PCI is very proud of the contributions we were able to make to the history of TB control in México.
A person with TB (left) discussing his treatment evolution with a nurse in Monterrey, Mexico.