Pharmacists Play a Significant Role in TB Control Schemes in Cambodia

By Bobby Ramakant

The private pharmacists are real partners in TB control. They help tremendously in increasing new TB case detection and treatment in Cambodia.

Senior TB advocate Hara Mihalea from PATH presented the best practice example of Cambodia at the 41st Union World Conference on Lung Health in Berlin, Germany.

Hara reported that just like India where close to 70-80% patients go to private sector on first symptom. In Cambodia, an assessment was conducted by the National TB Control Programme (NTCP)on 2004. The results showed that 75% of TB patients first seek healthcare in the private sector. These findings were very similar with the findings of the 2002 prevalence survey report.

Cambodia ranks in 21st position in the list out of 22 TB high-burden countries in the world. It is estimated that 64% of the total population in Cambodia has latent TB infection.

In Cambodia, pharmacies in the private sectors outnumbered the number of pharmacies in the public sector. More private clinics and private labs are cited.

In the year 2000, advocacy efforts began with the ministry of health and the national TB control program in Cambodia to involve other sectors. In 2004, the assessment mentioned above was conducted that clearly showed that 75% of individuals assumed to have TB first seek healthcare in private sector.

In response to this assessment, a private public mix (PPM) strategy was developed and approved in 2005. From 2006 to 2010, this PPM strategy was scaled up in 11 provinces and 42 operational districts.

Almost 2000 pharmacies from 11 provinces were engaged in TB control as partners. They were regularly referring, reporting and recording suspected TB patients. The sale of anti-TB treatment drugs went down in private pharmacies. Before PPM strategy, the team had confirmed the availability of anti-TB treatment drugs in private pharmacies. But in recent evaluation, it was found that there were no anti-TB drugs in the pharmacies participating in PPM activities. This reduces the risk of anti-TB drug resistance.

"PPM is not easy to implement. It needs persistence, collaboration and networking skills," said Hara.

There was no financial incentive for private pharmacies over the past years to help improve TB program performance. But they were recognized as equal partners in TB control. One pharmacist said that he makes merit by referring TB patients to the proper healthcare facilities.