The efforts to treat tuberculosis (TB) – a deadly and contagious disease – is facing disruptions due to the termination of USAID funds that helped run the National Tuberculosis Control Programme (NTP) activities.
To tackle the shortage of funds, the government has bumped its contribution to the programme from 50 to 70 per cent, NTP sources say.
However, a number of health officials and patients have expressed concerns over the possibility of TB re-emerging as an endemic disease in Bangladesh.
Back in 2016, the World Health Organization (WHO) set out to eliminate tuberculosis by 2035. Bangladesh is also moving towards the same target. Massive fund cuts introduced by US President Donald Trump have thrown a wrench in this plan.
Trump took a swipe at USAID as soon as he came to power, and the agency’s support for the TB control programme in Bangladesh stopped due to his decision. This has caused support programmes and camp operations to shut down across the country, negatively impacting the lives of TB patients.
TB treatment in Bangladesh
The National Institute of Chest Diseases and Hospital – located in the city’s Shyamoli area – is a 250-bed TB Hospital. There are also two Icddr,b Tuberculosis Detection Centers in Kamalapur and Mohakhali areas.
TB treatment is also available in hospitals throughout different districts and upazila health complexes, as well as private hospitals and clinics. In 2021, the country’s first one-stop tuberculosis (TB) service centre was launched in Shyamoli, the capital, with the support of USAID.
Tuberculosis treatment in government hospitals is usually provided free of charge, and patients do not have to pay for medicines and tests. There are also TB detection camps located across the country.
According to the National Tuberculosis Control Programme (NTP) data, the success rate in tuberculosis treatment is about 95 per cent. In 2015, the country reported 66,000 deaths due to tuberculosis, which later decreased to around 44,000 in 2023.
The mortality rate has decreased by 33 per cent. NTP officials are confident that if current TB control initiatives continue, Bangladesh will be able to eliminate TB by 2035.
Foreign fund shrinks, treatment options too
Cumilla resident Runa [not her real name] has been getting TB treatment at the National Institute of Diseases of the Chest and Hospital (NIDCH) for the last five months. The local medical facilities are no longer offering TB tests.
So, she must visit Dhaka every month for treatment.
Detailing her predicament, Runa told TIMES of Bangladesh, “I am still receiving TB medicine for free of charge. But coming to Dhaka regularly for tests is getting expensive. The transportation and food costs are adding up.
“People from an NGO used to check up on me frequently. They have stopped visiting me. Sometimes I feel like surrendering to the disease and accepting my fate.”
Another TB patient Rafique [not his real name] said, “I live in Old Dhaka. The area used to have multiple TB detection camps. These camps provide free TB tests and medicines. But many of these camps have shut down.
“I now have no option but to go to private hospitals and pay them for TB tests.”
‘Govt allocations must increase’
Health experts warn that the sudden fund cuts by USAID have made it very difficult to complete the “last mile” of the tuberculosis control programme. They have recommended taking some quick steps in addition to increasing the budget to deal with the ongoing situation.
An NTP official, on condition of anonymity, told TIMES, “Government allocations must be increased to achieve 100 per cent success in the tuberculosis control programne. If necessary, a ‘special budget’ should be formed with support from the World Bank.
“The government should continue Q-screening and contact tracing with its own funding. Field-level manpower should be made permanent health workers. And a minimum operational budget must be ensured.”
The official further said, “As some key USAID-funded components have been shut down, tuberculosis detection may decrease by up to 10 per cent. If the foreign fund-based work stops, even if we have the set-up, not enough patients will be able to get the treatment they need.”
‘No immediate concerns, but budget an issue’
Commenting on the matter, Shyamoli 250-bed TB Hospital Deputy Director Dr Ayesha Akhter said, “Our hospital has a one-stop service. One doctor working there has been removed due to the USAID funding cut. But we still have enough doctors.
“There is still a balance between the number of patients and the number of beds. But if the budget deficit increases, the pressure on us will increase as well.”
Meanwhile, Directorate General of Health Services (DGHS) Director General Dr Abu Jafor said, “The five-year plans are being changed into a two-year Development Project Proposal (DPP). The proposals, including manpower and other support requirements, have been submitted to the health ministry.
“We can share more details publicly if our requirement is passed. Later, a 90-to-100-day programme will be taken up to support tuberculosis control initiatives, and those that are feasible will be implemented.”
Restructuring the initiatives
National Tuberculosis Control Programme Program Manager Dr Md Jahangir Kabir said, “A number of organisations are working alongside the government to bring down tuberculosis cases. The goal is to reduce the number of deaths from TB by 95 per cent by 2035.
“The USAID did not directly give money to Bangladesh. It worked as a partner through various NGOs, including one-time assistance in developing training modules for doctors. Since the components they used to finance have been discontinued, we are restructuring the initiatives through government allocation, other donor organisations and our own funds.”
Dr Jahangir then added, “The government is increasing domestic funds due to the decrease in foreign funds. We used to procure effective drugs using foreign funds, but the government is now making the purchase.
“We have plans to continue training, guidelines, and module updates through domestic funds.”
Assuring that other donors, including the World Health Organization (WHO), are still funding TB control initiatives in Bangladesh, Dr Jahangir said, “Many such initiatives are continuing on a limited scale.
“But we will be able to return to 100 per cent operational capacity as soon as the Development Project Proposal (DPP) is approved.”