Bangladesh struggles to achieve 2035 tuberculosis elimination goal

Tuberculosis (TB) continues to be one of the leading causes of death globally. As an airborne disease, it threatens everyone, but those in high-incidence settings, such as Bangladesh, are at greater risk. Like many nations, Bangladesh is aligned with the World Health Organisation's (WHO) End TB Strategy, which seeks to reduce TB incidence and mortality by 2035 drastically.

Bangladesh currently ranks 7th among high-burden TB countries. 

The End TB targets for 2035 aim to achieve a 90% reduction in TB-related deaths compared to 2015 levels, which would mean cutting down from approximately 80,000 deaths. Additionally, the strategy seeks an 80% reduction in TB incidence, measured as new cases per 100,000 population. Finally, one of the critical goals is to ensure zero catastrophic costs for households affected by TB, alleviating the financial burden on vulnerable families.

While Bangladesh has made notable progress in TB case management, challenges remain in tackling drug-resistant TB (DR-TB), reaching marginalised populations, addressing funding gaps, and overcoming regulatory barriers to private sector involvement. The country's TB response can be assessed through the three pillars of this year's World TB Day theme: "We Can End TB: Commit, Invest, Deliver."

Commitment to TB control hinges on strong governance, political will, technical expertise, and community awareness. In Bangladesh, however, government leadership in TB management remains fragile.

A recent example of the challenges faced by Bangladesh's TB program is the Stop Work Order on USAID funding globally. This decision caused significant disruptions, as the program heavily relies on donor-funded support. Despite this setback, the government has not taken decisive action to sustain progress or mitigate the impact.

Compounding these issues is a shortage of skilled healthcare professionals, which further weakens TB control efforts. This gap is particularly evident in the management of drug-resistant TB (DR-TB), where specialised expertise is critically lacking. Rural and hard-to-reach areas face even greater challenges, as healthcare workers in these regions are often overburdened and underresourced.

The government has yet to implement timely measures to address these systemic issues, opting instead to rely heavily on development partners. This dependence underscores poor governance and a lack of strong commitment to achieving TB elimination.

Investment in TB control in Bangladesh remains overwhelmingly donor-dependent. The Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) serves as the primary donor, covering a substantial portion of program costs, including staff salaries and TB medicines. 

However, despite this support, a significant funding gap persists. As of 2023, the estimated annual funding requirement for TB control is $300 million, yet only 50-60% of this need is currently met. Domestic funding remains inadequate, with the government allocating only a small fraction of its health budget to TB, further highlighting the need for greater financial commitment.

Increased domestic investment and resource mobilisation are essential. Reliance on international donors is not a sustainable long-term strategy. To achieve its TB control targets, Bangladesh must strengthen its financial commitment and prioritise TB within national health funding through strategic purchasing.

Effective TB service delivery hinges on strong commitment and adequate investment. When these two pillars falter, service delivery is compromised, hindering optimal outcomes. Bangladesh's TB program is currently navigating a critical transition period, grappling with severe challenges that threaten to derail progress.

One of the most pressing issues is the ongoing medication crisis. TB treatment demands uninterrupted access to medication and consistent follow-up to ensure successful outcomes. Any disruption in this process can have dire consequences. Furthermore, real-time monitoring of TB cases and treatment outcomes is essential for tracking progress and making data-driven decisions. However, these services remain heavily reliant on donors and implementing partners, rather than being sustainably managed by the government.

Despite being the rightful custodian of the nation's health, the government has yet to take full ownership of the TB program, largely due to its persistent dependence on external support. Recognising these challenges is a crucial first step. If Bangladesh is serious about strengthening its TB response, it must confront these realities head-on and take decisive, actionable steps.

The interim government has been working on reforms for over six months, yet no tangible progress has been achieved, and TB services continue to be neglected. A key concern is the lack of clarity on how the technical aspects of TB programs will be managed in the absence of major donor support. Additionally, the role of NGOs in the donor transition process and their access to government funding remain uncertain. These critical questions must be addressed urgently.

Despite the current stagnation, there is hope that the anticipated reforms will prioritise neglected health issues, including TB, and establish clear, actionable strategies. The people of Bangladesh expect nothing less than a robust and sustainable approach to tackling this public health challenge.

To achieve the End TB target by 2035, Bangladesh must prioritise domestic investment and resource mobilisation, strengthen healthcare systems, and tackle the social determinants of TB. A multi-sectoral approach involving the government, private sector, and communities is essential to bridge existing gaps. Streamlining TB services with the main health programs can enhance efficiency and sustainability to improve health outcomes. 

Monaemul Islam Sizear is a health system researcher and organising secretary, Public Health Foundation Bangladesh. He can be reached at: sizear.monaemul@gmail.co

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.