Tuberculosis success in Nepal

Nepal has one of the most successful tuberculosis fighting programs in the under-developed world. In 1990, only 45 percent of people were cured of TB, now it up to 90 percent. In addition, Nepal has also seen improvements in other health factors such as malaria, maternal health, and AIDS.

Nepal achieves this health success through a centrally located strategy from its government. Instead of having several NGOs run their own programs within the country, Nepal asks for them to instead donate the money to their own health program.The Doctors in charge of the program also demand constant improvement in health results.

From the Guardian, writer John Donnelly is traveling with the World Health Organization to report on Nepal's progress.

Here, however, the government announced just last month that it would be working with donors in a new way – with three groups, DfID, the World Bank, and the GAVI Alliance – funneling money directly into a pooling arrangement for better maternal and child health. The hope is that the arrangement will reduce duplication and lead to better health outcomes. (And the government could even improve its performance: In the past year around 30 health ministry workers, including senior leaders, have attended workshops put on by the Ministerial Leadership Initiative for Global Health on how to better negotiate with donors).

In TB control, the government has cooperated closely with partners for several decades. But it wasn't until 1996 that things started to work well. That's when Nepal became one of the first countries in Asia to introduce the DOTS strategy, which calls for health workers to observe patients take their TB medicine every day for at least six months. It wasn't easy in a country as poor with so many remote villages, but strong central leadership at the time from the energetic Dr Dirgha Singh Bam and Dr Ian Smith, who later became WHO's first medical officer in Nepal – helped to build a national programme.

In the early 1990s, just 45% of TB patients were cured; today, that figure has doubled to 90%. Twenty years ago, a couple of hundred health facilities oversaw TB treatment; today, more than 4,000 sites, including tiny health posts in the mountains, administer the anti-TB drugs.

That's all positive, but health leaders remain concerned about new problems. There's HIV-TB co-infection; an estimated 40,000 people each year contract TB, which isn't much less than 15 years ago; and those with multiple-drug resistant (MDR) and extensively drug resistant (XDR) types of TB can't go to isolation wards because there are none.

So patients with MDR and XDR-TB walk into centres every day, and then go back into the community. Authorities wouldn't allow that to happen in London, or in many places around the world.