ICN Project to Increase Nursing's Capacity to Assist in Global TB Control

The World Health Organization (WHO) has identified a growing 'workforce crisis' as a serious obstacle to achieving global tuberculosis (TB) control. The International Council of Nurses (ICN) has joined forces with other health care professionals and Eli Lilly and Company to tap the enormous potential of the nursing workforce for the diagnosis, care, treatment and surveillance of TB and Multi-Drug Resistant Tuberculosis (MDR-TB).

MDR-TB is a type of TB that often develops in patients who do not complete the proper treatment for TB. MDR-TB is especially threatening because without proper treatment, super-resistant strains can emerge, resulting in longer and more expensive treatment. The widespread and continuing increase in HIV infection in the countries with a high burden of TB has contributed to the serious situation.

Roughly 3 million nurses work or are registered in the 22 countries with the highest burden of TB. In most of these countries nurses are the primary health care provider, and often the only source of care. Lilly provided funding to support ICN in developing, jointly with other partners, guidelines for nurses in treating TB and MDR-TB. In addition, ICN developed a training of trainers program for nurses in high burden countries reporting staffing shortages so that they will be mobilized, motivated and equipped for TB and MDR-TB prevention and care.

'Today there is a growing recognition of the crucial role nurses play in the prevention, detection and treatment of TB and MDR-TB', said Tesfamicael Ghebrehiwet, ICN Consultant for Nursing and Health Policy. 'Nurses are the most important resource for the often struggling health systems of developing countries. We are working to enhance the quality and quantity of human resources for TB control and care.'

Lilly has initiated a $70 million multi-faceted program to combat the growing pandemic of MDR-TB and meet the WHO goal of treating 20,000 patients annually by the year 2010. 'Lilly knows that nurses play an important role in delivering health care services and we want to engage nurses in the effort to fight the spread of MDR-TB', said Dr Patrizia Carlevaro, Head of the International Aid Unit at Lilly. 'Nurses are the first, and often the only, health care professional to see a person with TB. ICN and nurses on the ground can play a key role in delivering therapy, improving compliance and therefore helping to reduce and control drug resistance.'

ICN's other partners are: Union, the WHO Nursing and Midwifery Services and Stop TB Department. Recently the International Hospital Federation and the World Medical Association joined the partnership.

ICN developed the publication, TB Guidelines for Nurses in the Care and Control of Tuberculosis and Multi-Drug Resistant Tuberculosis as a practical tool for the generalist nurse. The Guidelines address issues such as diagnosis, improving adherence to antituberculosis treatment, prevention of drug resistance and follow-up care. They include evidence-based interventions and standards for TB control and care.

The Guidelines were launched at the 35th Union Conference of Lung Health in Paris in late 2004. The Guidelines are being disseminated through ICN's 129 member national nurses associations, national TB programmes and schools of nursing.

With funding provided by the Swedish Association of Health Professionals, a Russian language version of the Guidelines also has been made available. In the autumn of 2004 an ICN delegation visited the Russian city of Tomsk to discuss the development of training material, a 'training of the trainers' programme and seminars for nurses there. Since 1990 reported cases of TB have doubled in Russia.

Using the Guidelines as the central resource, ICN developed a training programme for nurse leaders and managers serving countries with a high burden of TB. The programme will equip those trained nurses to train others working in their facilities and regions.

Stigma, including stigma among health care workers, is a major barrier to fighting TB. ICN conducted a global survey of nursing schools and nurses to explore the extent of TB-related stigma. This information was used in developing an information and action toolkit to help eliminate TB stigma in health care facilities.