Integrating TB Services With Maternal Health and HIV/AIDS Services: Moving From Data to Action

Ashton Wingate — July 15, 2011 – 4:38 pm

Elizabeth Do, RESULTS Educational Fund Global Health Intern, recently attended a talk on “Maternal Health Challenges in Kenya: What Research Evidence Shows” at the Woodrow Wilson International Center for Scholars in Washington, DC. She left with more questions than answers. Questions that should embolden us to propose important changes in the intergration of health services not only in Kenya, but in the many areas where TB is prevalent.

“Though improvements have been made in the recent past, [we] have not yet met the international standards.” — Geoffrey Mumia Osaaji, Professor at the University of Nairobi (Kenya) and moderator

This week I attended a talk on “Maternal Health Challenges in Kenya: What Research Evidence Shows” at the Woodrow Wilson International Center for Scholars in Washington, DC. Despite huge increases in public expenditures, Kenya’s maternal mortality ratio has worsened over the last two decades, rising from 380 to 530 maternal deaths per 100,000 live births.

While the panel discussed various potential causes for this increase (lack of access to family planning, education) — they all agreed on one suggestion to fight maternal death: integration of health services and health supply chains. Maternal health services shouldn’t be delivered separately; instead, when visiting clinics during pregnancy women should receive a wider range of health services. One example used was HIV/AIDS, which accounts for approximately 14 percent of maternal deaths in Kenya. The panel concluded that in order to confront this, all pregnant women accessing prenatal care must also have access to HIV/AIDS services.

But what about Tuberculosis (TB)? I wondered. Why did none of the panelists mention integrating TB services with maternal health and HIV/AIDS services? At the end of the presentation, I asked the panelists about this but did not receive a very clear answer. This shows that we need to continue raising the issue of TB in pregnancy. We need to ensure that all governments — not just Kenya — incorporate TB services into maternal and child health programs.

Of course, this requires both investments in healthcare by the government and great political will. Not only will the Kenyan government need to increase its health care funding to 15 percent of the budget (right now it is 8 percent), but it will also need to enact legislation that is both effective and efficient. What this means is that some sort of monitoring and evaluation system will have to be set up and used to see what is going well and what isn’t. Since these changes are mostly top-down in its approach, our role here would most likely be one rooted in advocacy and research, or as one contributor from Nairobi put it, one requiring “political will” and “good use of data.”

We have a job to do as well. As anyone who went to the RESULTS International Conference knows, RESULTS/RESULTS Educational Fund already has the “political will” to bring about important change. As this event presented today, we also need to be programmatic in moving from evidence/data to action. We need to ask ourselves, what are our priorities and why? How will our proposed changes affect the lives of others and to what scale? What will be the cost per outcome achieved? We have to be ready to answer these questions when we propose change. Let’s go out there and find the answers.