Op-ed - The growing need for public health care, due to health emergencies and humanitarian crises, has created the need to rethink the healthcare system.

Strengthening multi-sector partnerships is a prerequisite for improving the healthcare system. To realize its full potential, multi-sector commitment must involve all key players within the health sector and beyond, including governments, civil society organizations, and the private sector. In this article, I will highlight the impact of a strong multisectoral collaboration in addressing the TB burden in Uganda.

Uganda remains among the 30 high-burden TB/HIV countries in the world with an annual TB incidence of 200 cases per 100,000 population and a TB/HIV co-infection rate of 40%. Approximately 30 Ugandans die daily from TB disease. Tuberculosis is influenced by a wide range of determinants that include health, economic, social, and environmental determinants. To end TB by 2030, there is a need to accelerate actions, investments, political leadership, innovation, and multisectoral engagement and accountability.

In 2020, under the leadership of the Office of the Prime Minister, Uganda adopted the WHO Multi-sectoral Accountability Framework for Tuberculosis (MAF-TB). The framework is aligned with the End TB strategy and the United Nations 2030 sustainable development goals, the National Development Plan III, and the Health Sector Development Plan II. It recognizes that TB mortality and morbidity are impacted by multiple factors far beyond the health sector including living conditions, food security, education, and income levels.

Implemented as part of the National Tuberculosis and Leprosy program, MAF-TB has delivered remarkable results, with an observed increase in the number of people diagnosed with TB each year from 65,897 in 2019 to 94,000 in 2022, and a reduction in tuberculosis-related mortality of more than 50% by 2022.

Some of the innovations that came through the multi-stakeholder partnership toward ending TB in Uganda include the launch of a ground-breaking initiative for TB awareness, screening, and control (CAST-TB Campaign). CAST-TB is conducted twice a year, approximately 2.8 million households have been screened, and 40,000 cases of tuberculosis have been diagnosed during the first two campaigns held in 2022.

With leadership from the Ministry of Health through the TB program, CAST-TB is implemented in schools with support from the Ministry of Education, in prisons with support from the Ministry of Defense, and bus Parks with support from the Ministry of Transport. The implementation of the CAST-TB campaign involves the use of mobile TB clinics offering all available services, along with other activities such as door-to-door awareness-raising, referral, and provision of TB preventive therapy to eligible people.

At the political level, a policy to integrate TB and HIV into the world of work has been introduced to reduce stigma in the workplace and promote social protection for those affected. In addition, all ministries' HIV focal persons have been trained to better advocate for the mainstreaming, planning, budgeting, and implementation of HIV and TB services.

In collaboration with the private sector and government, the program has trained 520 health workers in comprehensive TB management and accredited over 36 private health facilities to provide TB services.

Based on the gains in the MAF-TB program and CAST-TB Campaign, the country is working with stakeholders to pilot the integration of other health services in the TB response, including malaria, HIV, nutrition, water and sanitation, maternal and child health, and immunization.

I recommend that all other healthcare sectors learn from the TB multi-sectoral accountability framework initiative to improve the healthcare system. You can always count on WHO in this regard.

I acknowledge the Government and all the MAF-TB stakeholders for making this initiative a success for the benefit of Ugandans. 

Article By Dr Yonas Tegegn Woldemariam, the WHO Representative to Uganda