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Improving the health of the population in Romania by increasing TB control

Project financed by the Norwegian Grants 2009 - 2014, within the RO 19 - Public Health Initiative.

Foto V.Olsavszky_OMS Romania

Interview with dr. Victor Olsavszky, Head of the WHO Country Office in Romania

In August 2015, under the project called Improving the Health Status of the Romanian Population in Romania, by Increasing Tuberculosis Control, a contract was signed whereby the World Health Organisation will ensure the technical assistance for the National Tuberculosis Prevention, Surveillance and Control Programme (NTPSCP). A large part of the assistance actions complete and consolidate the project activities.
In order to find out more about the priorities of the WHO mission and about the concrete working methods, we talked to dr. Victor Olsavszky, the Head of the World Health Organisation Country Office in Romania.

Dr. Olsavszky, what aspects of tuberculosis control in Romania should represent the top priorities of the National Tuberculosis Prevention, Surveillance and Control Programme at the moment?

Everything is a priority. Above all, however, we believe that we must place the correct and timely treatment of tuberculosis, particullary of multidrug-and extensively drug-resistant tuberculosis. We say this because it is obvious that, in order to make progress, we have to contain the reservoir. And this reservoir is the infected patient. We know that we have good surveillance, the program in place is very well organised, but the data from the surveillance and from the programme assessment show that there are shortcomings regarding the treatment. This means that the patient is not diagnosed on time. This is what the new project does. It brings the necessary diagnostic instruments, namely those that enable us to make a quick diagnostic instead of waiting for two or three months, as it has been the case so far, before we are able to realise whether the tuberculosis is sensitive or resistant to treatment. Ant then, when this is implemented, one can very quickly shift to a better and more efficient treatment, which means that, at least for the multidrug-resistant tuberculosis cases, the cure percentage can be increased (at this time it is somewhere below 25 %), and this can reduce the flood. It is true that as far as the sensitive tuberculosis is concerned, things are much better. Practically, in this case, the cure rate is already high, but it must nevertheless be increased, because this is where the multidrug-resistant tuberculosis cases originate from (because of treatment interruptions).
So, in short, we could say that the correct, complete and timely treatment is the priority.

What does the WHO assistance to the NTPSCP consist of for the following period?

There are five main lines. Technical assistance has been constant so far as well, even before these projects and financial assistance from donors existed. The most important part goes to the DOT (directly observed treatment). If DOT means that the treatment takes place under the direct supervision of the doctor, of the nurse and so on, we apply the same principle to the Ministry of Health. Meaning that we directly observe what the ministry does in relation to the NTPSCP. In other words, before, we would come every six months and directly observe what was happening. And this will continue.
In particular, under these projects, we will provide assistance for the development of Guidelines for the management of tuberculosis cases in children. In this area, we have already contributed with a donation of paediatric formula drugs, which were not available on the Romanian market. It is natural that they were not available here because, since the market is small, no producer was interested in bringing them. This being the case, we came with this donation, with this support. Then, there will be the Clinical Guidelines for the cases of tuberculosis and HIV – meaning that we will provide technical support for the development of these guidelines. The third important aspect – because we consider that the involvement of the primary care is essential – is that we will conduct an analysis of the financing and compensation of activities at the level of the family doctor. Family doctors should be involved in the project. The fourth important thing is related to the streamlining of the use of resources and is related to the centralised procurement of drugs. Of course, we have centralised procurement now as well, but we consider that this procedure can be improved, and this is related to the fifth important component, what we call governance, or let’s call it the management of the entire programme. Because NTPSCP is based on an entire network that is organised and functions both in hospitals, and in TB dispensaries – sure, the aim is to also involve the family doctor – a series of dysfunctions have been noted with regard to hierarchies and management and, in addition, with regard to the financing mechanisms, at least those from the Ministry of Health budget. This is about not having resources, or that the Ministry of Health does not make these resources available, but in the sense that their use is not optimal, because of bureaucratic procedures which make things move very slowly. This will contribute to all the other aspects that I mentioned above and will solve the number one priority – the rapid and efficient treatment.

How will you actually work, so that the national decision-makers implement the recommendations and information in the reports and guidelines of the technical assistance missions?

First of all, we will do what we have also been doing so far: every six months we come and see what has happened. But most importantly, we will also come with the experience of other countries. Because, sure, Romania is at the top when it comes to cases of multidrug-resistant tuberculosis, but the Baltic Countries come very close to our country. There, MDR-TB is a public health priority and we can show what has been done there in this regard. Secondly, in terms of how the project is conceived with financing from donors, it takes into account what we call direct involvement of the beneficiary, the direct involvement of the decision-maker.
In other words, nothing can be done outside the decision-making chain or outside the system in which the programme must operate.