Thailand - Stop TB Partnership

the general budget for primary health care and subject to reallocation. 29 According to one
regional TB official, “We need someone to show the flag. . . . If we have political commitment
at the highest levels, then district-level officials and provincial-level examiners will
be more cooperative; but if TB isn’t on the ‘priority list’ of health inspectors, district and
provincial officials will not make a commitment to TB work.” 30
The NTP should develop innovative ways of encouraging a greater level of accountability
for performance on TB control efforts among health officials. For example, one
national TB official suggested that publicizing regional and district case detection and treatment
success rates on the NTP website might be “one way to stir things up.” 31 Providing
feedback to health officials at these levels would increase their awareness of how the statistics
they compile contribute to TB control efforts and enhance their sense of engagement
in a common, national cause. Another regional TB official suggested developing a “traffic
signal” system, which would award districts red, yellow, and green lights based on performance
as a way of creating competition among them to achieve better results. 32
There are few nontraditional actors involved in the development of TB control
policy. This contributes to a sense that TB control is best left to the specialists, limits the
level of “political buy-in” from other government ministries, and reduces the likelihood
that public pressure will play a role in prompting more effective government action. As one
activist puts it: “Designing plans for TB control should involve all stakeholders, but this is
something I haven’t seen yet. . . . If we compare TB policy to a tree, and the managers are
on top, we might have to find stakeholders to shake the tree—to shake the whole tree, but
not too hard; otherwise it will fall down.” 33
The NTP should expand its efforts to involve a broader range of stakeholders,
including recovered patients and community health activists, in TB policy development
and implementation. This could help generate a greater shared sense of commitment to
TB control efforts, and greater public pressure for more effective TB and TB/HIV services.
Public mobilization
Public awareness of the threat posed by TB is generally low. TB is widely viewed as a curable
but rare disease, while HIV/AIDS is seen as a fatal disease deserving more attention. 34
NTP media outreach efforts have been minimal, particularly when compared to the scope of
national campaigns around HIV/AIDS. In the absence of easily accessible, accurate information
about TB and TB/HIV, local organizations lack the resources and knowledge to educate
their communities, 35 and stigmatization of people living with TB and TB/HIV continues to
be an issue of concern.
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TB POLICY IN THAILAND