Policy and Advocacy Strategies for Tackling Tuberculosis Issues

Week 11 assign 6050 Policy and Advocacy for Improving Population Health (Walden University) Studocu is not sponsored or endorsed by any college or university Downloaded by aly ssum (Alyssum2001@gmail.com)

Use this document to complete the Module 6 Assessment Global Healthcare Comparison Matrix and Narrative Statement Global Healthcare Issue Tuberculosis (TB) is caused by a bacterium called mycobacterium tuberculosis. This is a severe infectious disease that mainly affects the lungs and other parts of the body like the kidneys, brain, and spine. TB is spread from person to person through tiny droplets released into the air via cough and sneeze. (Tuberculosis- Symptoms and Causes, 2021). Description • In the year 2020, a total of 1.5 million people died from tuberculosis. T.B. is the 13th leading cause of death globally and the second leading infectious killer after COVID-19. • T.B. is present in all the countries and affects all age groups. However, it can be cured and prevented. Multi drug resistance T.B. remains a public health crisis and a health security threat. • Ending the T.B. epidemic by 2030 is among the health targets of the United Nation's sustainable development goals. (World Health Organization, 2021) © 2018 Laureate Education Inc. 2 Downloaded by aly ssum (Alyssum2001@gmail.com)

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Country United States India Describe the policy in each country related to the identified healthcare issue • Maintaining and strengthening the Current T.B. control policies and increasing the efforts to identify and treat latent T.B. infections among the high-risk populations can help eliminate the T.B. epidemic in the United States of America. Following are the strategies to control tuberculosis is in America- • Investigate and report every case of T.B. disease • Identify contacts and provide treatment to future T.B. cases • Genotype T.B. bacteria and test for drug resistance. • T.B. control faces daunting challenges in India. Although India has managed to scale up essential T.B. services in the public health system, the rate of decline is too slow to meet the 2030 sustainable development goals of ending the T.B. epidemic. The health strategies to eliminate T.B. work on four strategic pillars: detect, treat, prevent, and build. It is also known as the DTPB approach. The DTPB Approach of 2017 to 2025 is • Scale up free, high sensitivity diagnostic tests, universal testing for drug resistant T.B., and systemic screening of high-risk populations. • Free T.B. drugs for all T.B. cases, patient- © 2018 Laureate Education Inc. 3 Downloaded by aly ssum (Alyssum2001@gmail.com)

• Ensure provision of medical care, laboratory testing, and other services to achieve complete cure of T.B. patients to halt further transmission. (CDC, 2018) friendly adherence monitoring, and social support to sustain T.B. treatment. • Scale up airborne infection control measures at health care facilities, treatment for latent T.B. infection (LTBI) in contacts of bacteriologically confirmed cases. • Build and strengthen enabling policies, empowered institutions and human resources with enhanced capacities • Initiate and sustain all patients on appropriate anti-T.B. treatment wherever they seek care, with patient-friendly system and social support. (Central T.B. Control Division, Government of India, 2017). What are the © 2018 Laureate Education Inc. 4 Downloaded by aly ssum (Alyssum2001@gmail.com)

strengths of this policy? • The Center for Disease Control prevention provides technical support on epidemiology and surveillance and supports clinical and operational research. • NIH funds for T.B. research and development and supports basic Clinical research and development for new drugs, vaccines, and diagnostics. • The U.S. Agency for international development in 23 countries has successfully been able to decrease the T.B. incidents, and T.B.-related mortality by 29% and 47%, respectively, since 2000. (KFF, 2021) • Better T.B. case reporting, fewer missing cases. since May 2012, reporting of T.B. cases by the private sector have grown 200 times, and also in the public sector, there is a 21% increase in reporting of T.B. cases. (Khaitan, 2020). • High levels of political and administrative commitment with a fresh perspective to fight against T.B. in the country. • Availability of new drugs, diagnostics, approaches, and strategies to end T.B. • In country innovations and pilots with potential for replication and scaleups. • SDGS and end T.B. strategy provide ambitious targets to aim for by the national effort. (Central T.B. Control Division, Government of India, 2017). © 2018 Laureate Education Inc. 5

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What are the weaknesses of this policy? • Wide state-to-state variation in T.B. control makes it difficult to implement best practices for high-risk populations or screening approaches. • Fragmentation in federal and state responsibilities often does not provide sufficient funding to achieve T.B. elimination goals. • Federal gaps in screening. Millions of individuals who arrive in the country on a temporary visa for work or study do not • T.B. epidemiology in India is diverse, and many communities have been poorly served by one-size policy prescription. • T.B. program structure is too narrow for the growing demands for eliminating T.B. • Amplification of drug resistance bacteria. • Insufficient budgets allocation for the treatment and prevention of T.B. by the health and welfare department. © 2018 Laureate Education Inc. 6

require T.B. screening. Thus, states must fill in the screening gaps, and only a handful of states have adopted additional post arrival screening measures for foreign-born immigrants. (Singer et al., 2017) Explain how the social determinants of health may impact the specified global health issue. (Be specific and provide examples) • Provision of better-quality health care to all the people living in the United States of America is much better when compared to other developing or underdeveloped countries. Here we have numerous resources and technical support to combat regular cases of tuberculosis and multi drug-resistant cases. However, some health disparities can impact the efforts of eliminating tuberculosis. • The first one is racial and ethnic disparities. • India, a developing nation, has high levels of illiteracy, poverty, pollution, increased population, and lack of medical facilities. These all factors significantly impact the efforts of eliminating T.B. • Social habits such as lack of cough etiquette, discriminant spitting, sneezing without covering the face, delay in reaching health facilities for help contribute to an increasing number of cases. © 2018 Laureate Education Inc. 7

For example, people from Hispanic, African American, and Asian backgrounds have higher cases of T.B. as compared to the white population. (Health Disparities in T.B., 2020) • Certain medical conditions such as diabetes, cancer, HIV that suppresses the immunity system puts a person at high susceptibility for getting infected. • Homeless people or people living in congested areas are most susceptible to getting infected. • Overcrowded public transport, lack of treatment compliance, and lack of treatment availability due to poverty are other reasons that impact the efforts to eliminate tuberculosis. • Other factors are pure negligence by the health care facilities. For example, no cough screening is done, lack of mask provision for health care workers, an infectious patient getting admitted to general wards, no concept of isolation, overcrowding in the world, and no restricted entries. How has each country’ government • The Patient Protection and Affordable Care Act continuously control tuberculosis in the United States of America by enrolling • Patients receive free testing, diagnosis, and treatment for tuberculosis in India. Once diagnosed, all the government facilities provide © 2018 Laureate Education Inc. 8

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addressed cost, quality, and access to the selected global health issue? millions of uninsured Americans into the health care system. • This act intends to increase access to affordable health insurance, improve health care provision, curb healthcare costs, and improve health care quality and outcomes. (Balaban et al., 2015) • U.S. government is trying to create an environment that will focus on improving attitudes and behaviors of health care providers, community leaders, the community itself in reducing stigma related to T.B. All the individuals who reside in this country and suffer from tuberculosis should have no fear of stigma and get easy access to the appropriate treatment. (USAID.gov, 2019) free treatment, and even for private sectors, it is mandatory to provide free of cost treatment to all positive patients. To address quality and safety issues, there is a standard for testing, diagnosis, and treatment that is uniform throughout the country (Dias et al., 2018). © 2018 Laureate Education Inc. 9

How has the identified health policy impacted the health of the global population? (Be specific and provide examples) • The United States tuberculosis activities reach more than 50 countries, including at least 20 to 30 high burden countries where most new cases occur, focus on preventing, detecting, and treating tuberculosis, including drug-resistant tuberculosis and research and development. (KFF,2021). • U.S. government’s efforts of achieving 2022 goals of treating 40 million people with T.B. and providing preventative therapy to 30 million people is working well. • The fight for T.B. in India is quite challenging, but the new development in their policies has helped reduce the global burden to some extent. Though the effect is minimal but continuous efforts will undoubtedly prove to be beneficial. • The country's continuous work and participation in research and development to combat T.B. have contributed to the global effort. • Nutritional support to T.B. patients and families, financial incentives to patients and providers, health systems trending and linking patients with existing social and financial support system of the government has © 2018 Laureate Education Inc. 10

tremendously helped in tracking, diagnosing, and treating positive cases with successful efforts of preventing new cases. (Singh & Kumar, 2019) Describe the potential impact of the identified health policy on the role of nurse in each country. • Nurses work with people who are at a high risk of acquiring TB. For example, immunocompromised patients, homeless, immigrants, or refugees increase the risk of nurses contracting the infection. Nurses play an essential role in screening, early detection, and patient education, apart from all the risks. • All the health care facilities have strict and specific policies to prevent infection in healthcare workers. A few examples of such health policies are • Nurses in India work under tremendous pressure when it comes to tuberculosis patients. Lack of isolation and limited access to PPE put nurses at high risk for contracting the disease. • But nurses play an essential role in the directly observed therapy (DOT therapy) for all T.B. patients. This is an initiative taken by the government of India to increase treatment compliance for patients. In DOT, a trained healthcare worker or designated individual provides the prescribed drugs and watches the © 2018 Laureate Education Inc. 11

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 early screening and testing for patients with symptoms of tuberculosis.  strict airborne isolation with negative pressure room.  N 95 masks for health care providers. Mandatory fit test for N95 masks for all health care workers, especially doctors and nurses who work in close proximity with T.B. patients.  Annual T.B. testing for health care workers. patient swallow every dose. Generally, the designated health care worker is a registered nurse in India. • The nurses make sure that patients diagnosed with T.B. finish their prescribed therapy and hence help prevent the risk of developing multidrug-resistant T.B.. Explain how global health issues impact local healthcare organizations and policies in both • Due to globalization and international travels, the population of the United States can be affected by global health issues such as tuberculosis. • Improving global health can improve health in the United States and support national and global • The provision of free testing, diagnosis, and treatment has doubled the financial burden on state and central government. Lack of availability of PPE and high threshold for isolation in healthcare facilities puts a lot of pressure on healthcare © 2018 Laureate Education Inc. 12

countries. (Be specific and provide examples) security interests by fostering political stability, diplomacy, and economic growth worldwide (Office of Disease Prevention and Health Promotion, 2019). employees to provide effective and quality treatment for communicable diseases like tuberculosis. General Notes/Comments © 2018 Laureate Education Inc. 13

Plan for Social Change. All the countries across the world must come together and work in collaboration to eradicate tuberculosis permanently. Since I was born and raised in India, I can see the difference in the healthcare system in both countries. India is a developing nation and has the second largest population in the world. Due to lack of financial resources, inadequate health care facilities, poverty, lack of education, and massive population, it is challenging for this country to fight against tuberculosis effectively. However, they have come up with an updated plan to combat this epidemic. I have suffered from this infection too when I was in high school. It greatly affected my performance and grades for the whole year. When I compare the two countries, India, and the United States of America, I see a big difference in the approach and the whole political and healthcare system. Timely and fast diagnosis, strict airborne isolation in negative pressure room, availability of N95 masks for the health care staff, and post discharge Support to help patients finish their TB medication regimen are some of the great things that are diligently followed across the United States of America. These factors put America in a better position to combat tuberculosis than a lot of other countries. Unfortunately, globalization and international travels open the door for immigrants and various communicable diseases that can be spread from one country to another. Hence there should be strict laws for TB testing and immunization for all immigrants. I live in Stockton, and it is an underserved area in California, so I see a lot of immigrant patients and patients from low socio-economic backgrounds. TB cases are found more in patients with different ethnicities, low socio-economic backgrounds, or immigrants. Hence it is imperative to target the population consisting of minority groups to overcome the TB epidemic. © 2018 Laureate Education Inc. 14

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As a nurse leader, I would advocate for the rights of the poor, minorities, and immigrants to access health care regarding TB testing, diagnosis, and treatment. This is the way to address social determinants of health and overcome their impact on the global health issue. People with TB symptoms such as persistent cough, night sweats, or persistent low-grade fever can face social and economic barriers that may delay timely and appropriate diagnosis. The barriers could be difficulty in transport to the health care facility, inadequate patient information, fear of stigma for TB diagnosis, or lack of social support to seek help during illness. As a nurse or nurse leader, I would advocate and promote efforts to inform people about TB and the factors that increase their risk of contracting this infection and aim to change their behavior and approach. The incorporation of a global perspective into the local practice would contribute towards social change. As our society is rapidly changing from time to time, examples of such changes are LBGTQ rights and women's rights. To bring in the new changes in a society, one must look beyond the borders of a particular country and have a perspective about the global situation. As a nurse leader, I would support the global © 2018 Laureate Education Inc. 15

References Balaban, V., Marks, S. M., Etkind, S. C., Katz, D. J., Higashi, J., Flood, J., Cronin, A., Ho, C. S., Khan, A., & Chorba, T. (2015). Tuberculosis Elimination Efforts in the United States in the Era of Insurance Expansion and the Affordable Care Act. Public health reports (Washington, D.C. : 1974) , 130 (4), 349–354. https://doi.org/10.1177/003335491513000413 CDC. (2018, May 16). Protecting Americans from Tuberculosis | Fact Sheets | Budget | NCHHSTP | Centers for Disease Control and Prevention. https://www.cdc.gov/nchhstp/budget/infographics/protecting-tb.html Central TB control Division, Government of India. (2017). NATIONAL STRATEGIC PLAN FOR TUBERCULOSIS ELIMINATION 2017–2025 . Ministry of Health and Family Welfare. https://tbcindia.gov.in/WriteReadData/NSP%20Draft %2020.02.2017%201.pdf Health Disparities in TB . (2020, October 23). Centers for Disease Control and Prevention. https:// www.cdc.gov/tb/topic/populations/healthdisparities/default.htm © 2018 Laureate Education Inc. 16

KFF (2021, August 9) The U.S. Government and Global Tuberculosis Efforts . https://www.kff.org/global-health-policy/fact- sheet/the- u-s-government-and-global-tuberculosis-efforts/ Khaitan, S. (2020, July 9). India's fight against tuberculosis in six charts . Indiaspend. Retrieved from https://www.indiaspend.com/indias-fight-against-tuberculosis-in-six-charts/ . Office of disease Prevention and Health Promotion. (2019). Global Health. retrieved on October 27, 2019 from https:// www.healthypeople.gov/2020/topics-objectives/topic/global-health Singer, P. M., Noppert, G. A., & Jenkins, C. H. (2017). Gaps in Federal and State Screening of Tuberculosis in the United States. American journal of public health , 107 (11), 1750–1752. https://doi.org/10.2105/AJPH.2017.304076 Singh, S., & Kumar, S. (2019). Tuberculosis in India: Road to Elimination. International journal of preventive medicine , 10 , 114. https://doi.org/10.4103/ijpvm.IJPVM_492_17 © 2018 Laureate Education Inc. 17

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Tuberculosis - Symptoms and causes . (2021, April 3). Mayo Clinic. https://www.mayoclinic.org/diseases- conditions/tuberculosis/symptoms-causes/syc-20351250#:%7E:text=Tuberculosis%20(TB)%20is%20a%20potentially,air %20via%20coughs%20and%20sneezes . USAID.GOV. (2019). United States government tuberculosis strategy. Retrieved from https://www.usaid.gov/sites/default/files/documents/1864/Pillar1.pdf World Health Organization. (2021, October 14) Tuberculosis (TB) . https:// www.who.int/news-room/fact- sheets/detail/tuberculosis © 2018 Laureate Education Inc. 18

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