Transcript of WHO podcast - 18 April 2008

Experts assess progress in tackling XDR-TB; steps to further reduce maternal and child deaths

Vernica Riemer: You’re listening to the WHO podcast. My name is Veronica Riemer and this is episode 32.

In this episode,

• Experts gather in Geneva to assess progress on tackling XDR-TB; and
• Countdown 2015 meets to discuss the need for accelerated action in reducing maternal and child deaths.

Story 1

Vernica Riemer: 18 months ago, WHO first warned of the emergence of extensively drug-resistant tuberculosis - or XDR-TB. It's a form of TB that is virtually untreatable with the drugs now available. The WHO warning was based on findings from South Africa where all except one patient out of a group of 53 had died within 3 weeks. A special task force of experts put forward eight recommendations in 2006 to address the XDR-TB emergency.

Last week, WHO invited international experts again to Geneva for a second special task force meeting - this time to assess the progress made in tackling XDR-TB. The experts identified further steps that will strengthen those eight initial recommendations. WHO Stop TB Director Dr Mario Raviglione elaborates:

Dr Mario Raviglione: There was a very clear call for guidance on certain aspects where we still need to elaborate what the standards are. Take infection control, for instance, in congregated settings. Take the care and involvement of all care providers, involvement of communities in delivery of care to people affected by MDR- and XDR-TB. There was a call to define better the ethical and the legal issues that surround XDR-TB that have been quite prominent in the past one-and-a-half years. There has been a call to strengthen laboratories further so that now we can utilize the new tools that have become available. There is a call on setting up centres of excellence that would allow the training, the rapid systematic training of people on a variety of aspects linked with XDR- and MDR-TB.

Vernica Riemer: Dr Salmaan Keshavjee, chair of the Green Light Committee, which helps countries in buying TB drugs at reduced prices, says more funding is needed to put these recommendations into action.

Dr Salmaan Keshavjee: The key thing will be to get national governments on board as quickly as possible. Some have come on board and as we saw in these sessions some countries have done quite a bit. But there are some major countries that haven't. That's one. The other thing would be to do fundraising. WHO has clearly outlined what the needs are. I think that we need western donors, people with a lot of resources to rise to the occasion and help countries implement. We can't move forward without the right funding.

Story 2

Vernica Riemer: This week, Cape Town in South Africa is the venue of the Countdown to 2015 conference. Health experts came together to discuss what steps can be taken to reduce maternal and child deaths.

On this occasion, a new report was released. According to this report, 68 developing countries account for 97% of maternal and child deaths worldwide. And few of these countries are making sufficient progress to provide critical health care to women, infants and children.

Many countries have increased the coverage of vaccinations, vitamin A supplements and insecticide-treated mosquito nets. But more needs to be done to provide 24-hour care for women and children. The areas that need immediate action are: skilled care at birth, clinical care for sick children, and nutrition and family planning.

Daisy Mafubelu is the WHO Assistant Director-General for Family and Community Health. We reached her in Cape Town and asked her: Are the United Nations Millennium Development Goals 4 and 5 on reducing maternal and child mortality achievable targets?

Daisy Mafubelu I think it is a realistic prospect. Because although we talk about Africa as a whole not being on track to meet MDG 4 and 5, there are a number of countries within the region that have made considerable progress. So yes, I think it is possible, that it can be done. I can give you a few examples. If I start with MDG 4 and we look at a country like Tanzania - which you know is not a rich country - this country has reduced under-five mortality by 40% since the year 2000. Egypt has cut under-five mortality by two thirds since 1990. And countries like Madagascar, Malawi and Mozambique, they have made recent progress in the right direction. If you then go to maternal health, MDG 5, and you look at a country like South Africa and you take skilled attendants. We have said that at least by 2015 the target should be 80% of all births should be attended by skilled health personnel. South Africa is standing right now at 92%; Botswana is standing at 98%. So yes, it is something that is achievable.

Vernica Riemer: We asked Daisy what more can be done.

Daisy Mafubelu: One is to put in place policies to ensure that women have care that they need before they get pregnant, when they are pregnant, during child birth and after delivery. Secondly, most of these countries have increased investment. Going to the example of Tanzania and you look at the government per capita expenditure by Tanzania: it has moved from US$ 4.7 per capita to US$ 11.7. So that is a massive increase in spending. The strengthening of health systems particularly human resources: train and retain the health workers, this will ensure that we can achieve the MDGs. So if countries, all the 68 countries that we are focusing on today, can put in place these measures, I am sure that in 2015 it will be a totally different picture.

Vernica Riemer: That's all for this episode of the WHO podcast. Thanks for listening. If you have any comments on our podcast or have any suggestions for future health topics do drop us a line. Our email address is Podcast@who.int

For the World Health Organization, this is Veronica Riemer in Geneva.