“We have to make sure we have universal access to diagnosis and treatment for TB patients”

Interview with Mr. Razvan Vulcanescu, Undersecretary of State with the Ministry of Health

The Ministry of Health is the operator of the “Public Health Initiative” programme, under which the Norwegian Grants 2009 – 2014 provide funding for the project “The Improvement of the Health of the Romanian Population through Enhanced Tuberculosis Control.”

The projects’ major activities include the implementation of a nation-wide functional network of TB laboratories and facilities equipped with high-end rapid diagnosis technology, plus training for the specialised staff in operating this equipment, in order to increase the capacity for tuberculosis control in Romania. In order to find out more about the long-term benefits of the creation of this laboratory network  provided with modern equipment and about the training of pulmonology specialists, we talked to Mr. Razvan Vulcanescu, Undersecretary of State with the Ministry of Health.

The project “The Improvement of the Health of the Romanian Population through Enhanced Tuberculosis Control” has provided training for over 500 pulmonology specialists so far. As a result, they have become important resources for the public TB control system. What does the Ministry of Health intend to do in order to further strengthen the TB control network?

I have always been of the opinion that human resources and the correct empowerment and training of the human resources are absolutely vital when embarking on a journey, if you want to reach a certain level of performance, if you want to make a difference compared to what was previously done. Human resources are an asset for this project, but they will continue to bring results after this project is completed as well. The entire pulmonology network needs people who are very well trained with respect to the latest discoveries in the field, in order to be able to ensure the quality of the standard of care. To achieve this, the Ministry of Health and the National TB Control Programme seek to ensure further training for the staff (and here I refer not only to physicians, but to nurses and laboratory staff as well) and to extend the training to the primary healthcare network for TB control (family doctors, their nurses, community nurses, healthcare mediators, etc.). Practitioners who are very well trained can move from knowing and applying the methods, to becoming trainers in their turn. There are countries where tuberculosis has perhaps a lower incidence than in Romania but which, in the context of globalisation, of migration – especially in Europe at present – are now faced with an increased incidence of tuberculosis cases, in particular among certain social categories. They rely on those who have the latest information on how to control TB, and therefore there is a chance for our colleagues trained under this project to become experts at European level and be able to disseminate the information that they learn both during the training, and by treating patients. This is an opportunity, because the World Health Organisations closely monitors the evolution and control of tuberculosis in Romania. The WHO Report for 2015, which has been published recently, makes specific reference to what the development of tuberculosis control has meant for our country lately, and it praises the palpable results generated by he projects run by the “Prof. Dr. Marius Nasta” Institute of Pulmonology, including this one.

A network of very well endowed laboratories with state-of the-art equipment has been put in place. How will the sustainability of the activities performed in these laboratories be ensured once the project is completed? 

The project was developed in line with the National Tuberculosis Control Programme, which, in its turn, is in line with the National Health Strategy 2014-2020. Clear, distinct and targeted stages have been defined, we followed a Gantt chart that set out a number of stages and the financing for each of them. At this moment, with the Norwegian funds, we have managed to put in place a sort of start-up for tuberculosis control. Under this project, the “Marius Nasta” Institute was provided with substantial amounts of money that it has used according to the stage planning. Then, in our opinion, in addition to human resources, there are other important aspects. People must be helped by being provided with this with equipment, with these laboratories. A correct, rapid and high-quality diagnosis is key to ensuing proper treatment and to stopping TB from spreading to the general population. For the following stages, the Ministry of Health is focused on ensuring the continuity of this intervention. This is why, in 2016, we will organise the national centralised procurement procedure for diagnosis consumables, in order to ensure sustainability and the control of tuberculosis in Romania.

This project also comprises activities aimed at increasing treatment adherence by means of social vouchers for patients who comply with the treatment. Do you believe it will be possible for this intervention to be implemented nation-wide?

What we want to raise awareness about is what the WHO itself wants to raise awareness about in each and every country. It is what is called health in all policies, and it is a centralised and cross-institutional approach to health problems that may have socioeconomic implications. This is why we need the involvement of all institutions, organisations and partners who can play a part in the control of tuberculosis in Romania. Results have already begun to show due to these projects financed by the Norwegian funds. We can see that the treatment success rate for sensitive TB is of over 85%, but the same rate for multidrug-resistant tuberculosis unfortunately continues to remain at approximately 32%, according to our latest data, which means that these interventions that I was referring to before should directly target the categories that are most vulnerable and most exposed to the risk of treatment default. It is important, before ensuring treatment adherence, to make sure that we have universal access to diagnosis and treatment for the patients. Of course, we will take all necessary steps in order to be able to reduce the number of TB cases in Romania and to increase patient adherence to the treatment. We can definitely say that the partnership* for this project between the authorities, patient care institutions and NGOs with a vast experience in the field has functioned very well and is an example to be followed: when everybody sits at the table and knows what it is that must be done, it can lead to the achievement of common goals. When the project is completed, we will be able to effectively assess where we have started from and where we are.

* The project is implemented by the “Prof. Dr. Marius Nasta” Institute of Pulmonology, the Romanian Angel Appeal Foundation, the Centre for Healthcare Policies and Services and LHL’s International Tuberculosis Foundation (Norway)