Tuberculosis care is quintessentially colonial, even in 2021. While many countries have been emancipated from their colonizers, the heritage of the colonial mindset, culture and even entire economies is deeply embedded within high burden TB countries in the post-colonial era.
A disease of poverty, TB has historically been terribly neglected. Although the number one infectious killer, raising funds for TB continued to be a challenge, as the disease failed to rank high as a priority once TB cases and mortality started to decline in wealthy countries. Colonizers deployed controversial strategies such as relegating infected people to sanatoria. More recently, the DOTS (directly observed therapy, short-course) strategy was touted for its purported cost-effectiveness – as agents of previous colonizers continued to drive the TB disease control agenda in poor economies.
From the pre-colonial to the post-colonial era, we continue to struggle for equitable partnerships with funders and global policy makers to truly make an impact. This results in an ongoing divide between the global north and global south, where the south struggles to find a seat at the table to raise local TB voices for global change.
All aspects of TB work have colonial roots, including research, technical assistance, monitoring programs, policy making, and service delivery. These are all undergirded by choices, made by individuals not infrequently brandishing the agenda of the donors, rather than considering what is best for the recipients. These choices manifest themselves in whom to fund, which groups to support, and which programs to criticize. As we mark World TB Day, the objective of this piece is to reflect on and unravel some key areas through the lens of a TB implementer from a low-income setting.
Disclosures: I am a physician, working in global public health representing the global south. I work in TB, interested mainly in multidrug-resistant forms of TB. I have survived ocular TB and it pains me that we continue to struggle to make progress in TB care.
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Source: Health Policy Watch