University of Toronto

Ending Tuberculosis Through a Comprehensive Health and Social Solution

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To learn more about – or provide significant funding to – this project, please contact Lever for Change.

Project Summary

Although medications to treat TB exist, it continues to be one of the world’s top 10 causes of death, as it is inextricably linked to poverty. Poorly ventilated and overcrowded quarters facilitate its transmission, and those living in poverty have limited access to healthcare and suffer higher rates of malnutrition and disease. People with TB also experience stigma and discrimination, which increases their vulnerability to TB.The Visayas in the Philippines are one of the poorest regions in the country, with the highest TB rates. We plan to end TB in the Visayas regions by providing the medical knowledge to diagnose and treat TB, and the economic tools to elevate 2 million over the national poverty line. Outside of our model sites, findings will be adapted for other regions in the Philippines and beyond. Our multi-pronged approach will uniquely empower communities to combat TB and change lives.

Problem Statement

TB is the leading killer amongst infectious diseases in the world, and the main cause of death in the Philippines. The Philippines has the highest prevalence in the world and more than a third of people living with TB are neither diagnosed, treated nor reported. The extreme poverty that exists in parts of this country exacerbates attempts to curb the transmission of the TB bacteria: crowded environments, malnutrition and poor sanitation increase the spread and susceptibility of individuals to TB.Although TB can be treated effectively with medication, drug-resistant strains are rising, and TB often reactivates in people with diabetes and HIV. Unlike smallpox or polio, TB does not now, nor in the foreseeable future, have an effective vaccine to stop transmission. The most influential way to eradicate TB involves pairing its diagnosis and treatment with the resolution of extreme poverty. Traditionally, TB reduction programs fail to address poverty reduction. But experiences in developed countries in the 1960s and recent progress in limited areas of LMICs, such as Shandong China, have shown that dramatic reduction of TB prevalence only happened in areas which implemented both strong TB control measures and effective poverty reduction strategies. The biggest leverage point in the Philippines exists in the Visayas region, which experiences the highest rates of poverty and the highest prevalence of TB. Globally, TB is most prevalent amongst LMICs. By improving the health and social conditions of the poor, we would eliminate the environment that facilitates the transmission of TB.

Solution Overview

Our team combines multi-sectoral and community connections with the medical expertise needed to end TB in a population of four million over the next five years. We will systematically screen for TB, support patients to complete WHO-standard treatment, and strengthen the local health system through training and by providing technologies to diagnose and treat TB. We will simultaneously facilitate community-led workshops to lift two million over the poverty line. We will target the Visayas where ICM has significant community contacts in the poorest communities, running our health and social solutions simultaneously. Health solution: We will equip 250 public Rural Healthcare Units (RHUs) with mobile detection units outfitted with x-ray machines and rapid testing tools (GeneXpert), coordinated through six branch offices of ICM in the Visayas. We will implement a “train-the-trainer” model for healthcare and community workers and have secured commitments from the Philippines government for long-term maintenance and pathways for scale-up of these mobile clinics. Public-private partnerships form a key part of this work. 80,000 are estimated to be directly saved from TB mortalities, at a cost of $1,250 per person. Social solution: We will change the region’s Poverty Probability Index (PPI) from 20 to 70 within five years. Using ICM’s TRANSFORM program, local volunteers conduct weekly training classes for poor families in each community. During these classes, families are taught hygiene, sanitation, disease prevention, nutrition and climate-resilient agriculture, and invited to participate in micro-savings groups. TRANSFORM also trains mothers to teach children foundational education skills, encouraging greater school attendance.

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