This is my first time in the [log in to unmask] I am working in the National TB control programme of Nepal for last 6 years. Nepal has achieved very encouraging result in this programme after implementation of  DOTS (Directly Observed Treatment, Shortcourse) strategy from  1996. We provide treatment from primary health care facilities of government health care system, NGO and private practitioners as well. Our national cure rate is gradually increasing every year and is around 85%. This 85% is the national target as well. However,  we have high rate of defaulters and have not very effective  defaulter tracing system. We know that the high number of defaulters could be prevented by an effective health education  to the patients at the beginign of treatment because TB needs to 8 months long treatment in our country. We realise that patient education that is being provided  by the health workers is not found effective and adequate enough to make the patients to complete their treatment. The health workers usually complain that they do not have enough time to teach the patients due to limited number of staff  and high nunber of patients in  some of these facilities. But we think this is not only the reason for poor or ineffective patient education. It is found that  most of the health workers are not patience to teach patients who are illiterate villagers.   My question to you who are involved in the TB programmes is that, how can we encourage those health workers to teach their patients an effective way so as to reduce the defaulters to make the programme success.What makes the health workers motivate for  quality health education? Could  you please give me some examples and success stories about this issue so that we could practice those tips in our country?

Rishi Ram Parajuli
National TB Center 
Thimi, Bhaktapur
Nepal