Catalysing, Supporting, and Amplifying LMIC Expertise in Global Health
Center LMIC expertise in global health initiatives - including through dialogue, curation of expertise, and convening forums.
TB Community Service Delivery during COVID-19: Lessons from Cambodia, Kenya, India, and Indonesia
- Best Practices Documentation
Due to the COVID-19 pandemic, 1.4 million fewer people received care for TB globally in 2020 compared to 2019. There has been no documented evidence of community-led interventions to fill in the gaps for TB high-burden countries as COVID-19-related barriers disrupted care. As a result, Matahari was engaged by the Global Coalition of TB Advocates (GCTA) to document, analyse, and write-up experiences of TB community health workers (CHWs), most of whom are *unpaid*, in terms of their promotive and clinical roles in ensuring TB communities are linked to diagnostics, treatment, and care. Matahari travelled to Kenya, engaging TB communities and documenting their experiences in depth, GCTA conducted interviews in India and Indonesia, and project partner KHANA interviewed communities in Cambodia.
- CHWs providing TB services innovated by delivering drugs to homes, conducting online counselling, and jointly conducting COVID and TB awareness activities. Ministries of Health innovated by allowing longer take-home doses of TB medications and facilitating medicines pick-up if individuals were locked down in different states.
- CHWs TB duties include home delivery of medications, referral to testing, psychosocial support, counselling, supply of food, advocacy with local authorities, and other duties. Some worked at night to avoid individuals being marked by neighbours as potentially having COVID – and work was mostly done by foot. In all countries, community health workers worked unpaid or for minimal stipends. The majority of CHWs interviewed were women. In several cases, community health workers told of needing to spend their own money to provide food to TB communities so they could remain on TB medications. (Cambodia, India, Indonesia, Kenya)
- Due to the door-to-door nature of work by CHWs, they were particularly vulnerable to police harassment, violence, arrests, and extortion during COVID lockdowns and curfews. This included arrests due to non-masking, despite some CHWs stating that they could not afford masks. CHWs also reported having insufficient supplies of PPE in the initial stages of the pandemic. (India, Kenya)
Convening and Facilitating Global and Regional Consultations on Stigma and Discrimination in TB
- Policy & Advocacy Strategic Engagement & Convening
In late 2021, working with the Global Coalition of TB Advocates, Matahari convened regional and national consultations with TB communities and experts in Africa, Eastern Europe and Central Asia, Latin America and the Caribbean and Asia-Pacific regions, and one national consultation in India, to discuss and map remaining challenges with human rights, stigma, and discrimination faced by TB communities. These rich discussions found, inter alia, that TB guidelines in Perú were last updated in 2013 and thus were outdated, and that they failed to account for TB services that were suited to indigenous populations and migrants. The discussions also showed that TB services for prisoners were found waiting in Haiti, with one expert saying:
“Here in Port-au-Prince where we work, the prisons are overcrowded, that is to say, a prison that was meant for a thousand people has four thousand prisoners. And a lot of people with tuberculosis in prisons come from the slums and have secondary illnesses or comorbidities, so what’s needed isn’tjust the TB drugs, but nutrition and access to drugs for their comorbidities. (Rolandy Edouard, Health through Walls, Haiti)”
Mapping Research and Policy Priorities on Racism in Global Health
- Policy & Advocacy Strategic Engagement & Convening
With the support of the Open Society Foundations, Matahari and the AIDS and Rights Alliance of Southern Africa (ARASA) convened a meeting with twenty Black and Brown global health experts (including communities living with diseases) to identify and discuss key priorities on racism in global health. The two hour discussion manifested in the below report, which identified a number of salient themes – notably that:
- Repeatedly, participants pointed to the absence of white voices in dismantling racism in global health. “White people cannot expect those who are oppressed to change a system of oppression, which was made by and sustained by them. These are important issues for white people to address.”
- Participants recounted experiences with several common phrases and behaviours that uphold white supremacy. One phrase is “We don’t see colour.” In particular, participants see this trait appear more strongly among European and UK colleagues, regions which participants considered further behind in their discourse on white supremacy and racism than the USA.
- Diverse hiring was recognized as important. But at least as important is attention to governance and the composition of boards of directors at international organizations and donors. In a participants’ own words: “This is significant because those are the bodies that are in power and make decisions about hiring at the top. [About] who is then responsible for the human and financial resources that are at the disposal.”
- Participants remained wary of the current ability of Black and Brown people to utilize human resources for gaining equity. “You may not get a fair hearing or fair process when you speak up, as some human resource people are blind to some of these issues. [This] really makes it difficult for people to speak up.”
The project continues to seek funding to work on identified research areas.