This interview first appeared in the March 2019 edition of the “Don’t Fly Away” magazine, Odessa Way Home Charity Fund, Ukraine 

Photo of Daniel Kashnitsky

Only approaches based on care, respect and motivation for health can induce a person to begin, and most importantly, complete TB treatment!

Let us introduce our guest, Daniel Kashnitsky, Capacity Building Manager from TB Europe Coalition. Daniel came to Odessa for a three-day visit to do research into our experience in active finding of missing people with tuberculosis. Daniel found time to answer a few questions for our journal.

Daniel, tell us about TB Europe Coalition and its main activities.

TB Europe Coalition (TBEC) was created as a network of civil society organizations working in the WHO European Region in 2009. In 2018, the TBEC secretariat was founded in Kiev, Ukraine to be closer to the region of Eastern Europe and Central Asia (EECA), where some of TBEC’s main projects and the most affected countries of the WHO European Region are located. TBEC has two main objectives – to develop the capacity of activists in advocacy, including supporting more local activities as well as civil society campaigns at national and international level, not to mention developing organizations’ capacity in direct service provision.

TBEC has three thematic areas: budget advocacy – here we particularly mean the transition of TB services to national funding (this is currently a very hot topic in Ukraine). The second topic is human rights. Here we are talking about access to TB services that are focused on people’s needs. And the third theme is support of access to new and effective methods of diagnosis and treatment of TB.

How does TBEC support civil society organizations?

In short, the main focus of support are: the active participation of civil society in the national tuberculosis programs, assistance in the development of parliamentary platforms to fight TB, and the development of communities of activists who have survived tuberculosis. In terms of the international agenda, we help civil society to push their governments to meet national obligations in achieving the goals of the UN political declaration adopted in September 2018 to reduce TB mortality and morbidity.

Tell us more about the work of the TB programs in the countries of the EECA region. Where do they have good results and where do they not work at all?

I would first like to clarify what we consider to be a success in the context of our activities: first of all, participation of civil society in programs of adherence to treatment and in active search for missing people with TB. There was some success achieved by countries such as Ukraine, Kyrgyzstan, Moldova, mainly with the support from the Global Fund and some other international donors. However, if we want to see sustainable success, these programs must become part of the state funding system. Given that the countries of the region are actively undergoing reforms of TB services, which implies expansion of ambulatory care, the role of psychosocial support is increasing in order to ensure successful completion of treatment. Non-governmental organizations in many countries of the world successfully provide these services. Therefore, state social contracting is so important to be able to transparently select NGOs that will provide social services.

In the EECA region, similar programs already started in Kazakhstan two years ago. In Ukraine, state social contracting programs should start in 2019 for HIV and TB. When launching the state social contracting, the role of civil society is crucial for several reasons: participation in planning and monitoring of services, implementing the project and, finally, putting some pressure on the government in case it does not allocate sufficient funding, which is quite likely, as you might guess.

In general, I think with some pain about the withdrawal of the Global Fund from our region. On the one hand, it is high time, and we knew exactly when international assistance would end, but on the other hand, I recall the experience of every single country where the transition has already led to a sharp reduction in prevention and support programs, primarily among vulnerable groups and it makes me feel a little sick.

In the logic of the transition to national funding, we, representatives of communities and civil society, are put on the same bar with government officials. But we often have a great gap in values, and although dialogue is growing, it is still very fragile.

What do we have to do with the fact that the GDP per capita in our region has reached the middle-income level if we are still deprived of access to vital services and the right to respect and safety?

We find it difficult to relate to the economic indicators for our everyday life, but donors rely on it when planning their funding priorities. In an era of rapidly growing economic inequality, when 42% of world wealth is concentrated in the hands of one percent of the population, why don’t we think that donor funding for vulnerable groups should be more sustainable? Sustainability could involve a long-term commitment of the powerful to those who are less fortunate.

I think that for our region it is necessary to actively advocate for national funding, but not to forget about the replenishment of international funds, primarily the Global Fund.

Daniel, what are the main problems and difficulties that have to be overcome in treatment of TB in EECA countries?

The main difficulties in overcoming the epidemic are identifying all people with tuberculosis, ensuring that everyone starts treatment and remains adherent during the treatment course. These difficulties are associated not so much with the shortage of drugs and qualified doctors, but rather with the lack of social assistance that NGOs normally provide. If we want to achieve the indicators of the End TB Strategy, it is necessary to achieve a 10% annual decrease in TB incidence rate by 2025. In 2015, when the strategy was adopted, the reduction in TB incidence rate was only 2% per year. We understand that without a significant increase in funding and awareness of the important and unique role of civil society in eliminating TB, this goal will simply not be fulfilled. That is why, speaking about any aspect of drug procurement, treatment, infection control, diagnostics and social support, we are constantly returning to the need in a strong civil society which is able to provide effective services to the most vulnerable people and, thus, support national TB program.

Please, share some of your impressions of what you have seen in Odessa.

I am impressed with the high standards of the work “Way Home” does to find missing people with tuberculosis among vulnerable groups. The high level of coordination with the tuberculosis service, respect for the program’s clients and an unconditional focus not to give up on the most “resistant” clients is impressive. Only approaches based on care, respect and motivation for health can support the person to begin treatment, and most importantly, to complete treatment. In Odessa, both in the charity sector and the Odessa regional center of socially significant diseases understand this well. On the one hand, a huge number of homeless people are living in the streets of the city, but the extensive network of charity services is amazing.

I am glad to see that city police do not chase the homeless people. It is very important that the treatment of tuberculosis in Odessa is available for both domestic and international migrants. It is a great achievement that you do not have to have a passport or a local registration to start and continue TB treatment. There are still many problems, as I said, such as, anxiety about sustainability, but the most important condition is met: a person is treated like a person. This is the only way to make the person appreciate his or her health and the health of those around them. And this is the key condition for elimination of TB.

Interview conducted by Artem Zverkov



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