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Social Protection and Participation in the fight against TB: Governments policies in theory whilepeople are losing their lives!

 Jair Brandão de Moura Filho*

“Reach the 3 million”who are not in treatment is the Global Campaign of the World Health Organization and Stop TB Partnership, on 24 March 2014. The current global efforts to diagnose, treat and cure are not enough. One third out of the nine million people with TB are "lost or missing" from the health systems each year worldwide, many living in the poorest communities in the world, including in our country.

In Brazil, despite all improvements, we are no better than other countries when it comes to support and social participation of people affected by TB and Civil Society Organizations. Importantly, we have an excellent regulatory health framework, the Unified Health System, which by the Law 8.142/80 ensures the participation of civil society in the development of public health policies. But the practice is different from theory and in reality,the full participation of society and people affected by TB is not always ensured instates and municipalities of the country. We understand that to face a social disease like TB, society and affected communities’ perspective play a key role when elaborating public policies,therefore accessing technical and financial support from governments to develop community action to fight TB is essential. The lack of community participation elaborating State and MunicipalTB Plans is a national reality. It is difficult to point out a plan that was built in partnership with thesociety. An example of this neglect is the state of Pernambuco, which ranks third in Brazil in TB incidence and second in TB mortality. Among the country’s capitals, Recife ranks fourth in TB incidence and first in TB mortality, which is a huge concern.

Both Pernambucoand Recife are examples of the lack of CSOs integration in policy development. Local governments do not support or finance Community actions on TB, they do not empower people affected by TB and they haveno strategies for including affected people in social programs and actions. This is also the reality in five other municipalities in the state with the highest TB incidence and mortality rates as the case of JaboatãoGuararapes; Cabo de Santo Agostinho, Olinda, and PaulistaCamaragibe. In addition,in these municipalities local TB programmes are inexistent. If this is a reality in some of the most populated cities in the state, imagine the other 179 municipalities! We request immediate actionsfrom local governments.

This fact only reinforces that governments are addressing to the TB problem,partially, in theory. In practice, CSOs are working in the TB fight, even with all the difficulties faced, especially by Community Based Organizations.

At last, despite the breakthroughs in the country, many challenges still need to be addressedin order to eliminate TB as a public health problem. Improving and studyingepidemiological indicators is not enough, but it is important to also consider the social determinants of TB.

The TB affected people often live in poor communities without the minimal basic sanitation structure and very little or no access to public health and social services, which are key to successfully complete treatment and achieve cure. The medicinesare very important and accessing TB drugs is a strategy to lower treatment default and increase cure rate. Taking medications with an empty stomach is a challenge, and often people affected by TB do not have anything to eat. Items other than medicine, such as food andtransportation are essential for treatment conclusion.

We know that food and transportation support is the Social Servicesresponsibility, but regardless of which area is responsible, governments should have the response. They are largely responsible for the lives lost due to TB. There is still a gap in intersectorial dialogue between public policies in states and municipalities. Social participation should take partin the development of socialpublicpolicies. These policies should be respected and encouraged, and not exist only in theory.

The partnership with social movements, the participation of TB affectedpeople and the articulation with other sectors, particularly with social services, justice and institutions promoting human rights, racial equality, combating abuse of legal and illegaldrugs, in addition to articulationswith the Legislative, to enable projects that benefit people affected by TB and their families, with social support and social inclusion programs, and facilitate access to health services are essential elements. These are fundamental steps for more concrete results in the medium and long term.

TB cure is only achievedconsidering medicine access? Considering integral care for the patient is also part of the prevention, treatment, care, support and healing? Think about it!

In this World TB Day we call upon support for all,ensuring and recognizing social protection in actions against TB in Pernambuco, in Brazil and worldwide. "Let's stop TB, not people's lives".