PHM Bolivia: WHO (EB-2014): Global strategy and goals for prevention, care and control of tuberculosis after 2015

18 Mar 2014

On the occasion of the recent 134th Meeting of the Executive Board (EB) of  WHO (World Health Organization) in Geneva (Switzerland), some weeks ago, organizations such as People's Health Movement  (PHM / MSP), Medicus Mundi International (MMI), among others, issued a statement in relation to item 6.1. "Strategy and objectives for tuberculosis prevention, care and control all over the world after 2015",  they  welcomed the strategy and universal objectives from 2015 commenting some key points about raised global strategy and goals prevention, care and control of tuberculosis after 2015, which is now discussed in this article.

The strategy clearly recognizes the role of the social determinants of health  (SDH) to face the epidemic of tuberculosis in the policy framework  which should have a Human Rights perspective, ethics and fairness. However, it requires stronger controls for monitoring in order to address effectively the real causes and roots for propagation and current status of the disease, including aspects such as marginalization, exclusion and detention in refugee camps, among others.

To take actions on the Social Determinants a powerful focus on Human Rights and efficient National Health Systems (NHS) structured according to the principles of Comprehensive Primary Health Care (PHC) is essential,

Therefore, these organizations encourage the World Health Organization (WHO) to work with the Human Rights Council of the United Nations (UN) to strengthen support to public hearings and possible litigation, using the authority of  law to defend the Right to Health and Health Care of patients, in this case Tuberculosis patients, to pursue  their right to health, a timely diagnosis and effective treatment of high quality and to benefit them with actions related to the SDH, principal reason of the disease. Tuberculosis control and health care should be  well protected by philosophy, strategy and content of comprehensive PHC, so professionals, workers and decision-making authorities, fulfill their role, not only as providers of health care but as patient advocates and defenders of Patients' Rights.

Concerning the targeting strategy, is necessary to give a higher emphasis to have serious and reliable information, strengthening the National Health Information Systems (NHIS), to make available better data on the provision of services helping to define effective actions to prevent the disease efficiently and effectively and not only on the number of cases under treatment. Likewise, regular and timely access to treatment is vital to improve cure rates reflecting reality.

An important set of actions are still missing in the strategy  for prevention and control of tuberculosis and it is  necessary to overcome barriers of access to diagnostic procedures and drugs associated with restrictions coming from extreme  measures to protect intellectual property followed by prohibitively high prices to access to necessary control technologies for disease.

Such actions should promote and encourage the full use of  flexibilities in international trade agreements ( TRIPs ) and to stop completely  the proposals and provisions raised by the  TRIPs -plus,  unfortunately  progressing through bilateral trade agreements, damaging the Right to Health .
The WHO and the mentioned institutions, appeal to close ties for the implementation of this strategy including  parallel actions on  the Executive Board (EB ) agenda such as the need to increase public investment in health and going to eliminate  health innovation associated with prices.


Tuberculosis ( TB) is one of the deadliest diseases in the world: third of the world population is infected with TB. It is estimated  in 2012 , 8.6 million people became ill with tuberculosis and 1.3 million died from it . More than 95 % of TB deaths occur in low and middle income countries, such as Bolivia. This disease is one of the three leading causes of death in women between 15 and 44 years.
In 2012, it was estimated 530,000 children became ill with tuberculosis and 74,000 seronegative children died from tuberculosis. TB is the leading cause of death for people infected with HIV, it causes a quarter of deaths in this group. The tuberculosis death rate decreased by 45 % between 1990 and 2012. However only in the United States of America 9,945 TB cases were reported (with a rate of 3.2 cases per 100,000 people) in 2012. Even in these circumstances the number of reported TB cases and case rate was reduced  with a decrease of 5.4 % and 6.1 %, respectively, compared to 2011.

Twenty years ago the WHO described TB spread as a global public health emergency before the explosion of cases not just in poor countries but also in rich countries, mainly caused by the sindemia plus AIDS.
It is worrying  that  increasing emergence of strains of resistant tuberculosis to first-line drugs (MDR-TB) and extremely resistant to second-line drugs (XMDR-TB) has been detected  almost in all countries. It is globally estimated 630,000 people are sick with MDR-TB. Nearly 4% of recently sick with TB are already resistant to multiple drugs from the beginning. That means that MDR-TB is transmitted directly from one person to another (1). The number of people identified with MDR-TB increased to 94,000 worldwide in 2012 (over 40%), which shows concern about the situation and the need to act.



According to official data, itis estimated that in Bolivia an average of 8,000 cases per year with an incidence (new cases ) of 72.2 cases per 100,000 population emerges, for this reason  it could  be inferred the prevalence is twice (144/100.000 inhabitants). Santa Cruz, La Paz and Cochabamba departments produce 77.2% of cases, that is about 90,000 respiratory symptom reported in the country, with a rate of 1.5 cases of men per woman, this drama affects more  the male population. However, 4.9% of patients abandon treatment before completion due to inaccessibility of health services, particularly in depressed and remote areas  where the poorest people live in precarious conditions, so they are most exposed and susceptible to get the disease being silent victims of discrimination in  exercise of  Health’s Right and  lack of guidance on the disastrous  consequences of this disease.
If the National Health System ( NHS) is not reformed to make it more efficient focusing on Human Rights, Justice and Equality and if sufficient resources for community education, supervision and support are not provided, adherence to treatment could be difficult and consequently the infection could spread more than today. The vast majority of patients could be cured if medicines are available timely and successfully taken. This requires an efficient  NHS  and more resources into the program, independent researches to increase production, translation and transmission of valuable knowledge.
Poverty and its consequences, including tuberculosis, are multifactorial in nature and require a multidimensional approach. It expands beyond monetary income, education, health, political participation and advancement of their own culture and social organization. For this reason Dr. Paul Farmer holds " the poorest places in the world are usually the places where one can clearly see the worst of medicine and not because doctors in these countries have different ideas about what is modern medicine, but it is the system and its limitations to be blamed . "


1 -. WHO - Director-General's message on World TB day - Geneva March 18.2013.
2 - David Legge: [email protected] - PHM - PHM / MMI Statement to the Executive Board of WHO in the strategy and objectives for tuberculosis prevention, care and control after 2015 Global - Chiara Di Girolamo - Mon, January 20, 2014.
Global Call to Action Against Poverty (GACP Bolivia)
Member of People Health Movement  (Bolivia PHM)
Red IDESAL (Bolivia)
Telefax: (591 2) 2228596 - 725 15932
E-mail: [email protected]
La Paz - Bolivia


News and Analysis: 
PHM Circles: