Thailand - Stop TB Partnership

Civil society engagement in TB policymaking
Public pressure is still not felt by the National TB Programme; it’s still a
specialist program, and we’re still telling the public what to do—that we
know best. We need to show that the right belongs to the people [and the]
provision of TB services has . . . to be seen as an obligation. Until we do
this, [TB control] is not sustainable, and we won’t reach the targets.
—Afsan Chowdhury, Public Health Watch researcher and director of
advocacy, BRAC, Bangladesh 66
Civil society engagement in the design, implementation, and evaluation of TB policies
at the national and international levels has been minimal. Though the importance of
community involvement in addressing many of the issues raised in Public Health Watch
reports is increasingly acknowledged at the rhetorical level, there are still far too few mechanisms
and opportunities for meaningful participation. NGOs working in the field of health
are still seen primarily as service providers; their role in promoting and demanding greater
governmental accountability for delivering effective TB policies and services is not widely
recognized.
At the national level, TB officials are not accustomed to receiving scrutiny from
civil society actors. In Nigeria and Tanzania, Public Health Watch researchers found that TB
officials were resistant to the idea that “nonexperts” could have a role to play in assessing
quality of services or in helping to design and implement community-based and patientcentered
programs. “The attitudes of some government health workers—maybe they have
to change,” a health activist in Thailand said. “It seems like [TB experts] think they know
everything. They are very knowledgeable, but they don’t trust that NGOs can work on these
issues . . . because we have not been formally trained.” 67 In other countries, there are initial
signs of increasing support for civil society engagement in TB policymaking. For example,
BRAC’s impact on the development and implementation of TB policy in Bangladesh and
beyond is widely acknowledged. And since 2003 the Brazilian NTP has indicated greater
receptivity to community sector involvement in monitoring implementation of its policies;
in 2004, the Ministry of Health announced its support for a new “Brazilian Partnership
Against TB,” a visible sign of renewed support for a multisectoral TB control effort.
At the same time, civil society engagement at the international TB policymaking
level has been minimal, though there are signs that this situation too may be changing with
the increasing involvement of experienced HIV/AIDS activists and former TB patients in the
Stop TB Partnership and other international bodies. To date, WHO officials have insisted
that the primarily statistical and epidemiological nature of its annual Global Tuberculosis
Control report must be preserved. As such, NGOs have not generally been invited to
PUBLIC HEALTH WATCH MONITORING REPORTS 27