Thailand - Stop TB Partnership

Following the initiation of the program, the cure rate in Kilombero jumped from 48 to 78
percent. 58 One district representative commented that the program was able to maintain a
high quality of treatment services at a fraction of the cost to patients because travel costs
had been eliminated. 59 One patient from the Temeke district of Dar es Salaam described the
program as a “savior,” especially for communities far from health facilities or where roads
are impassable during rainy seasons. 60 In Temeke, too, the program both maintained quality
of services and improved cost effectiveness by 37 percent. 61 However, both pilot projects
have now been terminated due to lack of funding. Community health workers continue to
implement some community-based TB services on an ad hoc basis, 62 but without financial
support for transportation or training from district health management teams these efforts
have remained limited in scope.
In Thailand, village health volunteers and family members assist health workers
in the provision of health services, including the distribution of TB drugs and the administration
of DOT. However, there are some indications that the government has not devoted
sufficient attention and resources to providing training and support for these volunteers. In
addition to administering DOT, village health volunteers provide a wide range of primary
health services, including TB education, in return for free medical care. Family volunteers
do not receive even this level of compensation. Some village health volunteers report that
they find their jobs are unappealing, 63 and others report that the responsibility of providing
community and patient education is too great to be left to volunteers. 64 Many Thai health
administrators agree that volunteer workers “need to be supported and salaried. We can’t
make them work for free all the time.” 65
Community-based DOTS programs provide a promising model for extending the
capacity of government TB programs and engaging affected communities and individuals
in becoming actively engaged in TB control efforts. However, Public Health Watch research
suggests that NTP participation and leadership, particularly in providing infrastructural and
technical support and training, may be important if the “scaling-up” and long-term sustainability
of such programs is to be considered.
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TB POLICY IN THAILAND