Message of the Regional Director, Dr Luis G. Sambo, on the occasion of World TB Day, 24 March 2005

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Theme: Front-line health workers: Heroes in the fight against tuberculosis

World TB Day, commemorated on March 24 each year, is an opportunity to raise awareness about the serious public health threat presented by tuberculosis in our region. This year, the World Health Organization and the Global Stop TB Partnership have chosen to focus the world's attention on the central role played by front-line care providers in the fight against tuberculosis.

Tuberculosis remains an important cause of adult and childhood morbidity and mortality in our region. Every year, many new infectious cases of TB occur. Although the region contributes only 10% of the world's population, it accounts for at least 25% of global notified TB cases every year. Between 2002 and 2003, the region experienced a 7.8% increase in total reported TB cases and a 12.8% increase in new reported smear-positive pulmonary TB cases, the most infectious form.

Because the effective management of TB from diagnosis to cure involves contact with a health care provider, these increases are exerting a heavy workload on health care providers, including the many often unrecognized but very important front-line TB workers. It is therefore befitting that these unsung heroes in our fight against tuberculosis worldwide receive the recognition they deserve during this year's World TB Day commemoration.

When we talk about front-line TB workers, we should think about all persons who work directly or indirectly to provide services for tuberculosis control. We should think about those with technical skills to diagnose and treat TB as well as all the others providing support and linkages, including paid and unpaid workers, specialists and the general cadres, the urban and rural, those in public and private practice. It includes laboratory workers, community workers and volunteers who toil long hours to bring life-saving and pain-relieving medicines to those in need. It includes the guardians who link the health system with TB patients on treatment, as well as members of village health committees with the responsibility of referring potential TB patients. The list goes on. It is all of these and more whom we must recognize and salute during this year's commemoration of World TB Day.

I am gratified and happy to recognize that through the untiring efforts of these front-line workers, an ever-increasing number of people in the region are now able to access TB services based on the internationally recommended TB DOTS strategy. This has helped to slowly but definitely help us edge towards the World Health Assembly (WHA) 2005 targets for TB control. Clearly, we need to do more at an even faster pace. However, we cannot make much progress to improve current performance unless we are assured of a minimum number of competent front-line TB workers, the real heroes in the fight against TB.

To achieve this, governments need to recognize and provide training and logistics for all front-line health workers. Improved TB programme performance in all countries of the region is a prerequisite for attaining the WHA and Millennium Development Goal targets for TB control. These achievements are only possible with the dedication and selflessness of front-line health care providers everywhere.

In recognizing front-line TB workers, I wish to reiterate what has been said about human resources for health. The development of human resources for health in the African Region has witnessed many innovations in order to deal with changing economic and social situations. This has affected health worker training, retention, motivation, skills and career development, utilization and distribution.

The Regional strategy for the development of human resources for health recognizes that the health system is a combination of knowledge, skills, clients, services, infrastructure and managers, of which human resources is a vital part. It is important that all health systems invest in human capital which impacts on other health system investments, performance and output. This aptly applies to the situation of front-line TB workers. While increased financial resources have recently become available to several countries for scaling up TB control activities, the lack of human resources to facilitate the delivery of those services has become even more pronounced.

I think the message is clear. We need to cherish front-line health care providers and continue to invest in human resource development for health in order to attain the goals and objectives envisaged in the regional and global commitments for human development and TB control. Countries should understand the socioeconomic and demographic implications of the tuberculosis epidemic, and their understanding should be reflected in policies and plans for the development of human resources for health. Countries should review and rethink the effectiveness of existing human resource interventions; they should develop new profiles for different health cadres in order to enhance their impact on needy populations in the fight against TB and other priority diseases. Motivation and incentives for health workers should be constantly reviewed to improve human resources within the health work-force network.

Governments in our region owe it to their people to retain the few health workers and keep them happy and functional, and also to take the necessary steps to build an even more robust body of heath care delivery workers capable of delivering quality health services. Many countries have already made efforts to develop innovative and different profiles of health workers to meet special needs of their populations while also being cost-effective. Significant skills have been imparted to these new cadres who operate mainly in remote areas and among populations who would otherwise be denied access to skilled services. These are encouraging developments in the context of the current human resource crisis being faced by many health delivery systems. I should also like to challenge those in the private and corporate sectors to partner with governments in fighting TB and other diseases as part of their social obligation. Human resource development is undoubtedly a crucial part of this partnership for health for all. Effective technical tools and strategies exist; it is now our duty to ensure and provide for the people who work for our health.