Romania: TB advocate travels to Brussels to urge the EU to address drug resistant TB
There is a certain absurdity about an American anthropologist traveling to Brussels to the European Union to report on drug-resistant tuberculosis and brief decision-makers on the severity of TB in Romania. While some consider TB in Romania to be a national issue, TB is never a ‘national matter’. Fighting it requires the cooperation of national governments, international organizations, public and private researchers, as well as the international corporations that produce lifesaving TB medicines and diagnostic equipment. Even in the comparatively wealthy economies of Europe, it is not well controlled.
Romania, an EU member state since 2007 and classified as ‘upper-middle income country’, has one of the worst multi-drug resistant TB (MDR-TB) treatment success rates in the entire world— only 20 percent or those treated are cured (WHO 2011:41). These rates are much worse than most other countries around the world, including the Democratic Republic of Congo or Kyrgyzstan. This is due to a number of factors ranging from a severe lack of national funding and frequent drug stock-outs to stigmatization and a lack of knowledge about the disease and the severity of the situation, even among decision-makers.
During my trip to Brussels I met with a variety of decision makers, including Members of European Parliament like Romanian MEP Cristian Silviu Buşoi, officials from the European Commission, the Permanent Representation of Romania to the EU, representatives from the Global Fund to Fight AIDS, TB and Malaria and civil society. At first, most were shocked to hear that drug-resistant patients are dying because they cannot access standard treatment that is available even in the developing world. However, most were also very open and eager to help.
I have been working on TB in Romania for over six years, and I remain convinced that the majority of decision makers, from civil servant all the way up to the president and prime minister, are not wilfully ignoring the TB problem, but rather, they are not fully informed. I believe that, when fully informed about the social and economic burden of TB in Romania, decision makers will act in the best interest of the country. Our meeting with Stefan Staicu, the Health Attaché for the Romanian Permanent Representation, reinforced this feeling.
As Romania’s wealth increases, it faces a reduction in international funding that donors are looking to allocate to the world’s poorest countries. While country income is a starting point for deciding how to appropriate a limited amount of funds, country income does not determine the number of people who have access to health services.Romania’s national budget currently cannot fund its expenses related to drug resistant TB, but more creative and aggressive requests for EU structural or cohesion funds could help to fill this gap.
Romania will soon be launching a four year plan to combat MDR-TB. This is admirable and may indicate that Romanian authorities are finally recognising the country’s TB problem. Yet while this plan will come with an increase in domestic funding, combined with a small grant from the Global Fund, a substantial funding gap for TB control will remain. Urgent steps need to be taken to strengthen the country’s aging health infrastructure, an issue that will not be addressed by the increased fund for MDR-TB.
Based on my visit to Brussels, real opportunities exist for Romania to access EU funds to strengthen its health system, but only if Romanian decision makers, including the Minister of Health Vasile Cepoi, convey to the Romanian Permanent Representation in Brussels specific projects that EU money could finance. Just as TB is a complicated disease with many facets, so is the process of accessing funds to fight it.
Local activists might argue for more domestic funding to fight TB, but how many can lay out the case for greater requests for EU structural or regional development funds? After my trip to Brussels, I am left feeling that there are un-seized opportunities for civil society, and the Romanian Government and the EU should work together to capitalise on EU funding opportunities. This means making health a priority for Romania at the regional level by working with decision makers to find ways that existing but untapped streams of funding can be used to improve the Romanian health system and aid in the fight against drug-resistant TB.
TB Europe Coalition
