Montenegro

Tuberculosis Control Programme

Programme activities are being implemented in three areas:

1. Improving TB surveillance system and integrating it into the national general system of surveillance will allow thorough data collection. Reporting that data to concerned parties will help in the development of annual action plans and budgets
2. Strengthening TB diagnosis and treatment - building human and system capacity for all players involved in the national TB control programme and the national health system. This effort will result in an improved base of knowledge for professionals involved in the battle against TB, be they doctors, nurses, lab technicians, social workers or policy decision makers. In terms of detection, strengthening the National Reference Laboratory is one of the main objectives.
3. Community Advocacy and Mobilization - will increase public awareness of TB. It will help those afflicted with the disease by reducing discrimination against them. This will also make it more likely that citizens will submit to screenings and treatments more willingly.

The programme started in July 2007 and will run for five years, if the first two year phase is evaluated positively.

The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) is providing the programme’s budget, which is 1.3 million EUR.

Because Montenegro did not gain its independence until 2006, there was no specific hard data about TB for the country. The first Montenegro-specific report on TB was released in 2007 and showed that there is a low prevalence of the disease in the country.

Since the programme’s inception screening of the most vulnerable members of society has increased and 75 % of newly detected TB cases have been successfully treated. In November 2008, 5000 individuals classified as vulnerable were screened. Results of that effort have not yet been announced.

The programme has been responsible for improving inpatient facilities in Montenegro. There are currently 20 hospital rooms dedicated to TB patients in the country, all of which are contained in one facility. Those rooms provide excellent physical comfort for patients, which is very important because there is no realistic method of forcing patients to stay in a care facility if they are not comfortable. A policy of providing incentives for patients to check into and stay in treatment facilities has also been adopted. Properly detected and treated, patients can usually be cured in several months but treatment can take six or more months on occasion.

One thing that has hampered the effort slightly is the fact that there is not yet a full time microbiologist employed at the detection laboratory. However, a search is presently underway and it is anticipated that that problem will be rectified soon.

The key partner of the programme is the Government of Montenegro, specifically the Ministry of Health, Labour and Social Welfare and the Special Hospital for Lung Diseases (SHLD) in Breozvik. There are no NGOs in Montenegro that are working exclusively on the control of TB. However, one local NGO working on HIV/AIDS has agreed to work with UNDP on the effort.

A WHO operated laboratory in Zagreb, Croatia works in conjunction with and oversees the laboratory in Montenegro, which has been upgraded under the programme. If treatment does not cure a patient, or if the patient does not administer medicines as directed, the patient can contract multi resistant TB. In such cases, patients are treated with second line drugs and the laboratory in Croatia is doing drug sensitivity testing for second line drugs.

TB patients and their families have been the primary beneficiaries of the programme. Approximately 2000 individuals (families of TB patients, youth and peer trainers) have attended lectures and workshops about TB issues. Prisoners in Montenegrin penal facilities have also benefited from detection and treatment efforts. Unfortunately, police have not always been willing or able to transport prisoners to and from detection facilities, so a mobile x-ray machine has been purchased to rectify the problem. The programme is also currently working with the psychiatric hospital in Kotor to provide detection and treatment for its patients.

The programme has initiated an effort to build the capacity of all stakeholders. Training has been given to 240 health care professionals, including doctors, nurses and laboratory personnel. Doctors are now sharing information about TB problems in the country and region. An informed community of professionals engaged in the fight against TB – including health care professionals, social workers and decision makers - has been created. That community is now working cooperatively and communicating efficiently in an integrated manner because of the programme, instead of duplicating efforts or possibly even working at cross purposes in a haphazard manner, as they were before the introduction of the programme.

The programme is nationally owned. However, because the disease does not respect geographic borders and because those who are afflicted with it travel between countries, TB must be attacked on a regional basis. Montenegro is cooperating very closely with those who are fighting TB in Serbia, Bosnia and Herzegovina and Macedonia. Experts from Serbia visit Montenegrin facilities at least once a month.

Because the programme has been largely successful, the main goal now is to make sure that it is sustainable after it is concluded. Should funding for the programme be cut now because of the global financial crisis, the effort would not be sustainable. It is, however, doubtful that funding will be cut because the government has a primary responsibility to provide health care for its citizens and that responsibility is a budgetary priority. UNDP Montenegro has enjoyed an excellent relationship with the government is extremely confident that that will not change.

Results achieved over the last 18 months:

1. Fully reconstructed and equipped 20 hospital rooms for TB and MDR TB patients within the Special Hospital for Lung Diseases. Isolated 3 rooms for treatment of MDR TB patients
2. Equipped the National Reference Laboratory with necessary lab equipment and supplies and provided protection equipment for medical doctors, nurses and lab staff
3. Provided support to SHLD and regional facilities by providing IT equipment for laboratory and patient registration
4. Developed new software for patient registration on national level which is going to be used for synchronization of data between regional facilities and SHLD
5. Developed software for the laboratory which is integrated into the reporting system
6. Provided capacity development for more than 240 health professionals (general practitioners, specialists, nurses, social workers, microbiologist, epidemiologists)
7. Established DOT (directly observed treatment) with 2 field teams that are covering 50 % of population (for the mobile team provided two vehicles)
8. Improved diagnostic in SHLD through procurement of X-ray and digitalization of a mobile x-ray in order to improve screening activities in the field
9. Established first contact with Supra National Reference Laboratory and continued activities in order to assess quality of work in NRL. Developed protocol for proficiency testing between SNRL and NRL
10. Provided education for TB patients and their families about TB and HIV/AIDS
11. Increased capacity of one local NGO to extend their activities from HIV/AIDS to TB also
12. In order to reduce stigma and discrimination of TB patients, more than 2,000 youth, peer-educators and TB patients' family members were educated about TB
13. Printed various educational materials for TB patients and their families and specific TB materials for health professionals