Voluntary Medical TB Testing (VMTBT) Can Make People Connect to What Can End TB By 2030 in the Greater Masaka Region-An Interview with Sebbula Francis, L.C3 Chairperson Kabonera Sub-county, Masaka District By Tom Muyunga -Mukasa and Samuel Waliggo of MOD Public Health Foundation, Uganda
Voluntary Medical TB Testing (VMTBT) Can Make People Connect to What Can End TB By 2030 in Greater Masaka Region-And Interview with Sebbula Francis By Tom Muyunga-Mukasa
Interviewer:
I am so happy to have met with you. I hope you can spare time so that we talk strategy about the end to TB, HIV, and Malaria by 2030. Where in the Greater Masaka do you come from?
Sebbula Francis:
I come from Kabonera which is now part of the Kimaanya-Kabonera Division of Masaka City. I am the recently outgoing Kabonera LC (III) Chairperson, I served for one term from 2014-2016.
Interviewer:
This is quite recent and thank you for serving the community. I am sure this did not just happen but there must be a history of the desire to serve people. Serving in the Government whether at Central, Regional or Local has its nuances. Tell me a little about your nuanced leadership experience.
Sebbula Francis:
Interesting. Indeed, there are nuanced experiences for instance one hears a different kind of English and each sentence has a policy, planning or programming effect. One must be ready to grasp this language as fast as possible. For instance, a day at the headquarters cannot end without one hearing such terms thrown around like school facilitation grants, administration, finance, statutory bodies, production and marketing, health, education, roads and engineering, water, natural resources, community-based services, planning, internal audit, locally raised revenues, discretionary government transfers, conditional government transfers, other government transfers, local development grant, donor funding, and local development grant. Then come the acronyms. I recall many such as PAF, SFG, PHC, LG, and the like. Most interesting is the energy, motivation, and confidence that many people bring with them in the service community. I cherish those memories and I am so grateful for the time I served at that level of Government.
Interviewer:
I am so happy you shared all this with us. What are those acronyms in full?
Sebbula Francis:
PAF in full is Poverty Action Fund; SFG in full is School Facilitation Grant; PHC, LG, and the like.
Interviewer:
Are these just Political words to be employed in Political Speak? How are these linked to the good health and wellness of a person in say, Kabonera where you were a leader?
Sebbula Francis:
That is an interesting question, thank you for asking. LG means Local Government. PHC is Primary Health Care. The Poverty Action Fund (PAF) is a 1997 Government Policy that together with the School Facilities Grant (SFG) assists the neediest communities to complete unfinished classrooms or acquire new ones to ensure that Uganda meets the 1:55 classroom ratio. This meant that there would be structures, furniture, Latrines, and opportunities to involve or work with communities and Central Government directly serving through actions including supervisory roles. So, for a person in Kabonera the schools exist at walkable distances. This means that both girls and boys access education in their own familiar communities. It means parents are not burdened by transport fees or can use the equivalent of food crops to pay for school fees. It also means school retention for both girls and boys translating into critical education qualifications that leverage opportunities for employment or further education. It is my hope that more schools will be provided in my home area.
Interviewer:
I was intrigued when you mentioned PHC and I am glad there is a deliberate policy strategy to locate PHC in local governments nearer to grassroots-based communities. How do you define PHC?
Sebbula Francis:
Primary health care includes such systems and structures that support a person's health needs including enforcement, health promotion, disease prevention, treatment, rehabilitation, and palliative care. It means that health care is delivered in a way that is centered on people's needs and respects their preferences. This empowers communities to participate in demand for quality health services and demand them as a health-seeking practice.
Interviewer:
Together, you and I, let us help our readers connect one health, global and public health to lived experiences and contexts such as engaging in practices to end TB, HIV, and Malaria by 2030.
Sebbula Francis:
My experience is that we shall have to use a multi-sectoral approach if we are to end TB, HIV, and Malaria by 2023. Our performance must be evidence-based, people-centered, and contextual-driven. For instance, the climate-change issues we are experiencing mean that we need to engage in climate-smart activities such as re-forestation; soil regeneration; and diversifying food production. Such indicators as the number of health seekers who are reporting at the health facilities should be compounded with efforts such as garbage removal in our cities, municipalities, or town councils. We must reason and act around the fact that the non-removal of garbage, letting bushes grow nearer to the homes, and weather changes are also supporting the proliferation of mosquitoes. This means more mosquito bites and therefore more people suffering from malaria. One disease can become a problem for the immunity of persons and this in turn allows opportunistic infections to affect this person. Communities must be empowered to take up community-level roles and engage in them to contribute to the promotion of optimal primary health care outcomes. When communities are involved, they connect with what matters and it will mean we have more people involved in efforts to end TB, Malaria, and HIV by 2030.
Interviewer:
You pointed out many strategies but as we wind down I am interested in the relationship between TB, HIV, and Malaria. Malaria is a global problem with about 250 million cases reported, 94% of which are in Africa. According to the Ministry of Health, Uganda has about 150,000 cases of malaria every week. Malaria incidence was 320 cases for every 1,000 people according to the 2022 survey. Uganda is ranked third following the DRC and Nigeria. Malaria affects the way people fare with HIV and TB. How you can be part of those mobilising communities to be linked, retained in care, and become involved in health promoters and eradicators of TB popularising Voluntary Medical TB Testing (VMTBT)?
Sebbula Francis:
Preventing diseases, prolonging life, and promoting health is easier when people make it a practice and culture. In the case of TB Prevention and Eradication, there are some important principles to have in mind: the communities must be organised in such a way as to foster finding those eligible for tests to address under-diagnosis, link those with TB-positive diagnosis to care to address inadequate TB treatment and establish a Voluntary Medical TB Testing and Therapy (VMTBTAT) mechanism to address uneven TB testing, prevention, care, and eradication. We have a chance to create a virtuous cycle of ambition, demand, resources, and performance that can bring us closer to ending TB. This has attendant benefits in that it will contribute to closing research gaps; advancing novel treatment strategies and simpler, more accurate diagnostic tests; and seeking to expedite policy translation to ensure innovations reach communities that will benefit from them. This has bio-medical-social-economic returns and a reversal of inequalities and inequities. People living with HIV will be provided TB Preventive care and this will reduce and address vulnerability to TB disease. People will be taught about the seven symptoms (cough, fever, night sweats, weight loss, anorexia, headache and chills) and where to report for care.
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