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WHO World Health Organization |
Nearly two million people die from tuberculosis every year according to the statistics of the World Health Organization (WHO). Almost one-third of the planet’s population is carrying of TB infection. Number of TB cases has doubled in the Russian Federation since 1990. The incidence TB rate among children has also doubled in the past ten years.
The TB situation is even more complex in the correctional facilities. In some territories of the Russian Federation the case rate among prisoners is almost 30–40 times higher than in the civilian sector. Annually, 25 % of all new TB cases are notified within the penitentiary system. In 2001, the case notification rate in correctional facilities was 2,783 per 100,000 convicts and 1,509 per 100,000 persons in detention centers.
First TB projects, according to the WHO TB control recommendations started, in Russia in 1994–1995 in Tomsk and Ivanovo Oblasts. Presently, over 30 international organizations support such projects implemented in 26 territories of Russia.
A High Level Working Group (HLWG) on TB in the Russian Federation was established in August 1999 to coordinate international organization’s efforts in fighting TB, to integrate advanced world experience into traditional Russian TB service and to attract additional investments for TB control. The HLWG consists of the representatives of the Russian Ministry of Health, the Russian Ministry of Justice, the Central TB Research Institute of the Russian Academy of Medical Sciences, the Research Institute of Phthisiopulmonology, the WHO and the Council of Europe.
In framework of improving TB control in the Russian Federation an Interagency Coordination Committee Meeting was held on 24 September, 2002.
Opening the meeting Dr J.W Lee, Director of STOP TB, WHO Headquarters Geneva, emphasized necessity to strengthen coordination of international organizations’ activities in the Russian Federation that is why Interagency Coordination Committee (ICC) is to be established.
The
meeting was chaired by Prof Anatoly Vialkov, First Deputy Minister of Health
of the Russian Federation. He stressed in his opening speech that "taking into
account increase of TB incidence and mortality rates alongside with the shortage
of resources there was a great need for a relevant administrative decision to
be made. One of the decisions is cooperation with the international organizations.
TB control organization and application of the most advanced techniques targeted
at increase in treatment outcome efficiency. We should understand international
specialists’ theory and be open. HLWG establishment was of great significance
and now it is time to make some conclusions to see what was good and what is
to be improved".
In the course of discussion Russian health care authorities, outstanding Russian and international TB experts stressed that the HLWG was an effective way of cooperation but still a new mechanism is needed to ensure coordination of international organizations’ activities.
A press conference was held in the course of the meeting. Professor A. Vialkov, First Deputy Minister of Health; General Kononetz, Deputy Director of GUIN; Dr J.W. Lee, Director of "Stop TB", WHO/HQ; Dr K. Castro, Director of National Center for HIV, STD and TB Prevention, CDC; Dr R. Zaleskis, WHO/EURO responded to the numerous journalists’ questions.
This meeting resulted in a draft resolution which gave description of ICC, its aims and objectives as well as organization of its activities, composition and functioning.
On 25–27 September, 2002 a Scientific and Practical Conference "New framework for TB control organization. Lessons learnt and exchange of experience gained from the pilot projects implementation" was held in order to:
– consolidate lessons learnt from all internationally supported TB pilot projects in the Russian Federation;
– agree on the elements of TB pilot projects to be replicated to other territories of the Russian Federation;
– discuss the experience of the pilot projects to be taken into account in the revision of the national TB Control Strategy in the Russian Federation.
Russian TB doctors and their international partners came together to share the results of joint TB projects implementation in the Russian Federation. This conference attracted TB specialists from all over the Russian Federation including those not participating in the international projects. That proves the specialists’ great interest to the work within joint TB control project. All regions and international organizations working in the Russian Federation on TB control reported about the results of their work. Role of international donors, technical agencies and partners was discussed. Cost-effective approach towards TB control activities were presented and discussed.
Vast experience gained applying WHO recommendations in different regions of Russia was considered by the participants as a success that worth being widely replicated. The Conference resulted in an adapted Resolution where it is stressed that in spite of positive trends in TB epidemic situation in Russia the bases for the successful TB programmes implementation should be ensured, i.e. political commitment to TB control, uninterrupted TB drugs supply and integration of TB control programmes into general health care and penitentiary medical service. It is recommended that all launching TB control projects should be considered with the Ministry of Health, the Ministry of Justice, HLWG, supervising research institutes and the WHO Collaborating center. International organizations’ TB-related activities should be considered with HLWG. Strengthening of supervising system and improvement of educational system are emphasized in the Resolution as well.
Along with the preparation of the above events the WHO TB Control Programme made a comprehensive survey of the range of activities performed by international organizations and NGOs involved in TB control in Russia. The received information on the number of international partners, donors and scope of their work was analyzed and presented at the above conferences.
Orel Region that is one of the territories where WHO recommendations have been applied successfully for three years was visited by a joint acquaintance mission with participation of Academician Perelman, Chief TB Specialist of the Ministry of Health, and representatives of USAID and CDC within the Orel demonstration project. The agreement on a long-term use of TB second line drugs has been achieved with the Ministry of Health of the Russian Federation. This is a great step forward and display of growing commitment to TB control activities.
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The Sub-regional Consultative meeting of NIS on the Framework Convention on Tobacco Control was held in Moscow, 6–7 September 2002. The meeting was initiated and organized by the Ministry of Health of the Russian Federation in cooperation with the WHO European Regional Office.
Delegations from 12 NIS countries attended the meeting: Azerbaijan, Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Republic of Moldova, Russian Federation, Tajikistan, Turkmenistan, Ukraine and Uzbekistan. WHO representatives took part in the meeting and provided necessary administrative and technical support.
The meeting was opened by Dr Gennady Onishenko, the First Deputy Minister of Health. He highlighted the importance of the coordination process for NIS countries and the European Region as a whole. The Russian Federation stated their strong position with regard to tobacco control as a public health problem. WHO stressed the important role of coordination. The delegates reviewed in an extremely collaborative atmosphere the text for a Framework Convention.
Dr Haik Nikogosian
Regional Adviser on Tobacco Control WHO Regional Office
for Europe/ Copenhagen
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A 4-week course on Malaria Control and its Planning was organized
in the Moscow Region starting from 9 September.
Twenty-six participants, representing 12 countries (Armenia, Azerbaijan, Belarus,
Bulgaria, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russian Federation, Tajikistan,
Ukraine, and Uzbekistan) attended. The course, organized jointly by the World
Health Organization, the Russian Academy of Advanced Medical Studies (RAAMS)
and the Martsinovsky Institute of Medical Parasitology and Tropical Medicine,
provided participants with knowledge and skills in malaria epidemiology, malaria
control and planning, management and the evaluation of malaria control activities.
The course was designed for health personnel currently involved in malaria-related
activities or those who will be responsible for malaria control in the future,
particularly managers and personnel of disease control programmes and provincial/
district medical officers. The major subject areas dealt with included basic
epidemiology, medical statistics, parasitology, the diagnosis of malaria, disease
prevention and control of epidemics, planning and management of malaria control,
and implementation and evaluation of control programmes.
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Reproductive health covers a wide range of issues, including family planning, infertility, sexual behaviour, pregnancy and childbirth, sexually transmitted diseases and HIV infection.
Over the past decade or so, research in reproductive health has become increasingly complex and also increasingly international in the way in which it is carried out and funded. It is essential, therefore, to ensure that the highest possible ethical standards are applied to such research and that these standards are established and maintained within and among the centres taking part in this research. It is with this in mind, that – over the past five years – the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction has organized a series of Workshops on Ethical Issues in Research in Reproductive Health.
The most recent of these Workshops, for the WHO European Region, was held in Moscow on 22–26 September 2002. Local coordination and support was provided by staff of the Research Centre of Obstetrics, Gynaecology and Perinatology of the Academy of Medical Sciences of Russia in Moscow and by the office of the Special Representative in Russia of the WHO Director-General.
The
Workshop brought together 33 participants from 11 countries (Armenia, Azerbaijan,
Georgia, Germany, Hungary, Kazakhstan, Russian Federation, Slovenia, Sweden,
Uzbekistan and the UK) as well as experts from Hungary, Lithuania, Russia, Sweden,
and USA .
The Workshop alternated plenary sessions and working groups. The four working groups were constituted in advance to provide a mixture of nationalities, professional backgrounds and gender and remained together throughout the Workshop to foster the development of positive group dynamics and to facilitate discussion.
Topics addressed included the need for ethical review, informed decision-making, risks and benefits, inducement, confidentiality, ethical considerations in social science and epidemiological research, research involving adolescents, questions concerning partner agreement, and the constitution and good conduct of ethical review committees. As additional background and reference materials, the participants were provided with copies of internationally accepted guidelines relating to reproductive health research.
As the previous four Workshops, this fifth one was considered by both participants and faculty to have been a highly successful exercise. All participants were very positive about the beneficial impact of the Workshop on themselves, personally, and on future activities in this area in their countries and the region. They were encouraged to organize similar national workshops on return to their institutions.
P.D. Griffin
Scientist, Reproductive Health Research WHO/Headquarters/Geneva