Thailand - Stop TB Partnership

Executive Summary
Tuberculosis incidence in Thailand, which fell by 50 percent from 1985 to 1991, rose again
in the 1990s with the emergence of the HIV/AIDS epidemic. Today Thailand has an incidence
rate of 142 cases per 100,000 people, and is 18th on the World Health Organization’s
list of high-burden countries.
Thailand, through the National Tuberculosis Programme (NTP), has committed
itself to implementing the internationally recommended DOTS strategy, which emphasizes
directly observed treatment, and achieving the international TB control targets of 70 percent
detection rate and 85 percent treatment success rate. The government reports considerable
progress in meeting these goals: 100 percent DOTS coverage by 2002; and, more recently,
a 71 percent detection rate and 73 percent treatment success rate.
Some Thai experts, however, question the reliability of these statistics. DOTS coverage,
detection, and treatment vary widely from place to place in Thailand. The 73 percent
treatment success rate masks rates as low as 25 percent among some vulnerable groups such
as migrant workers and injection drug users. In addition, since detection and treatment rely
only on one form of diagnosis (active, sputum smear-positive cases), the overall treatment
success rate for those with active TB may be considerably lower.
Budget reductions resulting from health care reforms have had a dramatic impact
on the NTP’s capacity to fight TB, particularly with regard to monitoring and evaluation,
staffing, training, and public awareness-raising efforts. The integration of TB and HIV/AIDS
departments at the central level appears to have resulted in TB being overshadowed by the
more powerful AIDS program, rather than becoming its equal partner.
Civil society actors, such as recovered TB patients and community health activists,
do not play an active role in TB policy development. The NTP’s media outreach efforts have
been minimal, and few nongovernmental organizations (NGOs) have initiated TB advocacy
and treatment education efforts.
In the absence of easily accessible, accurate information about TB and TB/HIV,
public awareness of the basic facts about TB—and the serious threat TB poses to public
health—is low. TB is widely viewed as a curable but rare disease. Stigmatization of people
living with TB and TB/HIV, and of women in particular, is an issue of concern.
Increased NTP funding and support for advocacy, communication, and social
mobilization activities could play a crucial role in addressing many of these concerns. Key
activities could include the following:
• Establish and staff a specialized department within the NTP to oversee the development
and implementation, in partnership with community representatives, of a
plan to increase public awareness about TB and TB/HIV.
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TB POLICY IN THAILAND