Mrs Dev Kumari Guragain and Dr Roshan Pokharel, Secretaries, Ministry of Health and Population, Nepal; Dr Sangita Kaushal Mishra, Additional Secretary, Ministry of Health and Population, Nepal; Dr Dipendra Raman Singh, Director General, Department of Health Services, Nepal; Other senior officials of the Ministry of Health and Population; Ms Blessina Kumar, Global Coalition of TB Advocates, and all civil society members and advocates; colleagues, partners and friends,
Good morning and welcome. It is a privilege to host you, and a pleasure to be back in Kathmandu.
My sincere gratitude to the Ministry of Health and Population, Government of Nepal, for helping to convene this event and for continuing to accelerate efforts to end TB.
This is reflected:
First, in Nepal’s active collaboration in co-hosting our High-Level Meeting towards Ending TB, which was held in 2021, and resulted in the Region-wide adoption of a new Strategic Plan towards Ending TB;
And second, in the 2021 launch of the country’s National Strategic Plan to End TB, which was accompanied by the TB-Free Declaration Initiative, which aims to reorient TB services to the primary health care level, within communities.
Your commitment is truly commendable and is precisely what is needed to get us back on track to achieve our targets and goals.
Because you needn’t be reminded: The last few years have been immensely difficult. Difficult for TB patients. Difficult for TB programmes. And difficult for TB-affected communities.
In 2021, across our Region, almost 5 million new TB cases emerged – nearly 350 000 more than pre-COVID-19 estimates.
More than 780 000 people in the Region are estimated to have died from TB and TB-HIV co-infection, which is about 20% higher than the 2019 figure.
An estimated 30–80% of TB-affected families faced catastrophic health spending.
Today, the Region accounts for more than 38% of the global incidence of rifampicin resistant and multi-drug resistant TB cases.
It contains six of the world’s 30 highest TB-burden countries – Bangladesh, DPR Korea, India, Indonesia, Myanmar and Thailand.
And while the Region’s treatment success rate for drug-sensitive TB is acceptable, at more than 85%, the treatment success rate for rifampicin resistant and multi-drug resistant TB is low, at 58%.
We have challenges, yes – but we also have strengths, especially in empowering communities for meaningful engagement.
Consider India’s path-breaking Pradhan Mantri TB Mukht Bharat Abhiyaan. Launched in 2020, amid the COVID-19 response, the Abhiyaan calls for a ‘Jan Andolan’ – or people’s movement – to end TB, including through community-led efforts to strengthen nutritional support.
Or consider Nepal’s P-A-Y initiative. Launched in 2022, by the National Youth Movement Against TB, the P-A-Y continues to strengthen public communication, advocacy and youth mobilization to address TB, with a focus on ending stigma and discrimination.
Or take ongoing efforts in Indonesia to support and empower POP-TB, a community of TB survivors. Since 2016, POP-TB has helped design, implement, monitor and evaluate interventions to improve people-centred TB services.
Across the Region, these and other change-making movements continue to enjoy high-level support, while at the same time being very much owned and operated at the grassroots, by TB-affected communities.
Need it be said: To recover lost ground, to build health system resilience, and to achieve the 2030 End TB targets, civil society and community leaders must continue to be engaged and empowered.
This is especially the case for increasing Region-wide uptake of TB preventive treatment, which is central to the Region’s Strategic Plan towards Ending TB 2021–2025, as well as to the global UN High-Level Meeting targets, which as you know, will be reviewed later this year.
It is critical for updating and implementing TB policies that are gender-sensitive, rights-based and equity-oriented, in line with Strategic Action 6 of the Region’s Strategy for Primary Health Care.
And it is particularly important for TB programme planning and monitoring, which will be the focus of your deliberations.
This is because TB-affected communities have a unique vantage point from which they can assess TB services, providing valuable insights that bring lived experience to the fore.
It is because they can not only identify gaps in service delivery, but also find innovative, people-centred solutions, drawing on first-hand knowledge of what works, what doesn’t, and what could really turn the tide.
And it is because they can provide critical inputs to inform research and development priorities, while at the same time mobilizing whole-of-community awareness and action, catalysing a cascade of change.
Today, I have four messages to help all countries of the Region strengthen community capacity for meaningful engagement, building on what is already one of our greatest assets.
First, in all countries, let us map-out clearly – and comprehensively – context-specific activities to build community capacity. Activities that enable communities to plan, support and deliver care, to conduct active case-finding and outreach, and to advise on which interventions and tools are best suited to reach at-risk, marginalised and vulnerable populations.
Second, let us delineate how best we can improve community-led programme monitoring. For this, we must obtain in-depth, systematic user feedback on the quality of TB services, and also on best practices that users would like to see replicated.
Third, let us create custom-built platforms that bring people together, and which facilitate free and frank communication between communities, programme managers and stakeholders. For this, both formal and informal partnerships are required, with clear governance structures and regular meetings.
Fourth, let us develop concrete modalities to support community advocacy. This is especially needed to accelerate adoption of new tools, technologies and drug regimens, as well as for TB vaccines, which could be a game-changer in both Regional and global efforts to end TB by 2030.
My final message is to ensure that in each of these areas, your conclusions are fully integrated into national strategic plans to end TB.
This will not only help formalise and implement your recommendations but also facilitate Global Fund proposals, which I understand several countries will file.
I once again thank the Ministry of Health and Population, Government of Nepal, and wish you productive deliberations, for a South-East Asia Region with active and engaged communities, for accelerated TB outcomes.
Thank you.