Housewives battle TB in Bangladesh

Mohammed Salim Sheikh carries a treatment chart in one hand and a stainless steel water glass in the other. He crosses the threshold of a house.

Mohammed Salim Sheikh carries a treatment chart in one hand and a stainless steel water glass in the other. He crosses the threshold of a house. The housewife inside, Zahida Khatun Jharna, fetches his medication and fills his water glass. Then she ticks off his chart for the day and sends him home.

The routine plays out in countless villages across this country every morning, and it represents a simple but apparently effective effort to tackle a stubborn and deadly epidemic: tuberculosis, a scourge that kills 1.6 million people worldwide each year.

Plagued by years of sluggish governance, Bangladesh has come up with a novel innovation to curb the disease. Private groups have stepped in to take charge of the national tuberculosis treatment programme.

The largest effort, run by the Bangladesh Rural Advancement Committee, or BRAC, deploys an army of housewives like Jharna, one of nearly 70,000 women across the country.

They conduct daily household surveys in their neighbourhoods, hunt for patients like Sheikh who have been coughing for more than three weeks, coax them to get tested and, administer a long and rigorous treatment.

The enterprise has steadily borne fruit. The detection rate in Bangladesh inched up to more than 70 per cent in 2006, according to the WHO, and the cure rate to 89 per cent. Among the 22 countries that are considered to be burdened by tuberculosis, few have reached those levels, the health organisation says.

8220;They are a doorstep away from whoever supervised the treatment,8221; said Marijke Becx, until recently the tuberculosis adviser for the WHO in Bangladesh. 8220;They don8217;t need to walk for hours or spend money for buses or rickshaws to get their treatment, and this largely contributes to the high cure rate.8221;

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A survey by her office found that 80 per cent of tuberculosis patients in Bangladesh now received treatment from community-based approaches.

The Bangladesh programme8217;s army of housewives acts as the eyes and ears of the public health system. Its reach is an apt metaphor for how the non-profit sector has filled a gap in delivering the most basic public services. For instance, it also runs a university, a bank and a network of schools that educate over a million children nationwide.

To help ensure that patients stay in treatment, the health workers collect a deposit. Jharna holds the equivalent of about 3 cash from Sheikh, a tidy sum here. At the end of six months of treatment, she will have to make sure Sheikh is tested one last time. If his lungs are clean, she will return the deposit.