Disease Prevention and Control / Communicable Diseases / Tuberculosis
Teaching Tuberculosis in Schools of Health: Report of an Expert Consultation
(Cartagena, Colombia, 6–8 October 2004)
Full Text (42 pp, PDF, 1455 Kb)
Alfonso Tenorio Gnecco prepared this publication, with contributions from Ernesto Jaramillo, José Figueroa Muñoz, Mirtha del Granado and Pilar Ramón Pardo. The publication of this book was possible thanks to support from the Office of Sustainable Regional Development,
Tuberculosis is a serious public-health problem in the Region of the Americas and constitutes a priority for the Regional Tuberculosis Program as pertains to the implementation and expansion of the DOTS strategy in the countries of the American continent, it being the most effective global tool for controlling this disease. The progress made since 1996, when DOTS implementation began in the Region, are remarkable; by 2003, 78% of the population of the Region of the Americas was covered by the DOTS strategy. However, the process of expanding the strategy faces some major challenges.
Recent studies clearly revealed that one of the major limitations in DOTS expansion concerns the lack of human resources (HR), both in numbers and in terms of adequate skills and abilities. Recognizing the importance of HR development for tuberculosis control, the World Health Organization has held global meetings and has published documents analyzing the situation, proposing strategies that make it possible to guarantee clear HR policies in the countries—thus facilitating the expansion of the DOTS strategy.
HR development in the area of health encompasses much more than regular training activities for health workers: it includes long-term government policies regulating labor issues, such as job stability, employee turnover, remuneration, and HR distribution, among others. Training and continuing-education activities tailored to the needs of the countries, with their specific health systems and epidemiological situations, are only two of the important aspects of the process of human-resource development.
Factors associated with health-system reform, economic crises, and political instability in many of the developing countries, as well as the emergence of such epidemics as HIV/AIDS, have affected human-resource performance both in the area of health and in the area of the policies that regulate it. Tuberculosis control programs, as well as other agencies in charge of controlling those pathologies that are highly prevalent in the Region, have not appeared to be immune to these situations; and in some cases, they have been negatively affected.
Research carried out with a view to examining the involvement of universities and technical schools training health workers in tuberculosis control reveals that current efforts are insufficient. Teaching on the etiopathogenic and clinical concepts of the disease tends to be limited, is often not integrated into the curriculum, and frequently is outdated. In addition, teaching in the operational aspects of disease control does not occur frequently and, in many cases, is inconsistent both with the national disease-control programs and the DOTS strategy. However, bulk of activities related to disease control—including the identification of patients with respiratory symptoms, diagnosis, and strictly supervised treatment—are developed at all levels of health care within the system by health officials trained in institutions involved in training health workers. Many of them are doctors, nurses, specialists, health-promoters or health-care providers.
The possibilities that HR training institutions have for facilitating DOTS implementation and expansion as well as future strategies for tuberculosis control are very valuable indeed. Academic activities, service delivery, and research by schools of health among undergraduate, masters, doctoral, postdoctoral and specializing students—along with continuing education activities for graduates—constitute one of the major strengths in the struggle against tuberculosis in the countries of the Region.
The Pan American Health Organization, aware of the important role that health schools can play in tuberculosis control, held an initial meeting in Bogotá, Colombia, in 1999 with teaching representatives from 12 countries of the Americas. This first step enabled experts to clearly diagnose the situation and make recommendations on how to improve teaching on tuberculosis in the universities of the Region. Given its immediate interest in promoting the effective involvement of health schools in tuberculosis control, PAHO convened a second meeting in Cartagena, Colombia, from 6–8 October 2004, the results of which are presented in this document.