In accordance with Article 66 of the Rules of Procedure of the Parliament of Montenegro, the Committee on Human Rights and Freedoms and the Committee on Health, Labour and Social Welfare organised today at the Parliament of Montenegro the Conference on the occasion of marking the International Human Rights Day.

The topic of the Conference was "It is my aspiration that health finally will be seen not as a blessing to be wished for, but as a human right to be fought for - Kofi Annan", in light of the signed Barcelona Declaration on Tuberculosis (TB).

The Conference was organised for the purpose of promoting the Barcelona Declaration, fight against TB, raising awareness about this disease, patient support and their families, as well as the support to all actors dealing with prevention, diagnosis, and treatment of TB.

The following spoke at the Conference: Dr Halil Duković, Chairperson of the Committee on Human Rights and Freedoms and signatory of the Barcelona Declaration, Dr Gordana Reljić, Director of the Public Health Institution Special Hospital for Lung Diseases "Dr Jovan Bulajić" in Brezovik, Ms Mina Brajović, Head of the Office of the World Health Organization in Montenegro, Dr Olivera Bojović, National Coordinator for Tuberculosis, and Dr Dubravka Lopičić-Mirković, Head of the Centre for Lung Diseases and Tuberculosis of the Primary Health Care Centre in Podgorica.

In addition to MPs, members of the Committee on Human Rights and Freedoms and the Committee on Health, Labour and Social Welfare, signatories to the Barcelona Declaration, and representatives of the competent institutions who spoke within the main panel, the participants in the conference included the following: Mr Amer Halilović, Advisor to the President of Montenegro, Dr Nebojša Kavarić, Director of the Primary Health Care Centre in Podgorica, Dr Božidarka Rakočević, Director of the Centre for Disease Control and Prevention at the Public Health Institute of Montenegro, Ms Ida Ferdinandi, representative of the UNICEF Office to Montenegro, Ms Milica Kovačević, representative of the Red Cross of Montenegro, and Mr Vladan Golubović, Executive Director of the NGO "CAZAS".

During the opening part of the Conference, Chairperson of the Committee on Human Rights and Freedoms, Dr Halil Duković, pointed out that TB has killed more people than any other infectious disease in human history, that nowadays about 1.5-2 million people per year dies from it worldwide, and that progress in combating this dangerous disease is very slow. He reminded that the parliamentarians of the Parliament of Montenegro: Mr Zoran Jelić, Ms Marta Šćepanović, Ms Branka Tanasijević, Ms Ljerka Dragičević, Mr Almer Kalač, Ms Azra Jasavić, and himself personally signed the Barcelona Declaration, thus supporting the global initiative where politicians from different countries and from different political parties were united in a more effective fight against TB. He said that the Declaration was launched as the initiative of a member of the European Parliament Mr Nick Herbert and the Health Minister of the South African Republic, and more than 580 MPs from 95 countries worldwide have signed it so far. The goal is to connect experts from all signatory countries - from doctors who set the diagnosis and prescribe therapy in treatment to drug manufacturers in combating this disease.

Understanding the significance of joint action against this vicious disease and wanting to include Montenegro among the countries which jointly fight against this very serious disease, by signing the Declaration the parliamentarians agreed that, in cooperation with official organisations, including the World Health Organization, UNITAID, the Global Fund, the Stop TB Partnership, UNION, and UNAIDS, as well as with the NGOs worldwide, overcoming political and geographical divides, they would look for a way, through building commitment in our country and beyond, to exert pressure for a more efficient response to the TB epidemic in order to achieve the goal of the Declaration - to finally find a solution against this infectious disease.

Chairperson of the Committee reminded that the Government of Montenegro adopted the National Tuberculosis Control Program in Montenegro (2013-2017), which represents the five-year plan for implementation of the global Strategy for Control of Tuberculosis, in order to ensure a better and a more comprehensive TB scrutiny, improvement of diagnosis and treatment, greater involvement of community and providing it with more information. One of the ways to raise awareness on TB is to join the initiative which is not directly related to politics, but is strictly professional and may only bring wellbeing to generations to come.

Creating adequate environment for those afflicted by TB is our top priority and demands continuous fight against the stigma and discrimination in all segments of society with special emphasis on employees in health, education, and social protection systems.

The Chairperson emphasised that we must not forget that the universal human rights must not be called into question, and that the obligation of all of us is to protect them.

With that intention, the National Tuberculosis Control Programme defined the list of entities and institutions in charge of control of this disease in Montenegro, developed at the primary, secondary, and tertiary level of health care.

Taking into account the fact that all people should be able to live without the tyranny of disease, the Chairperson of the Committee concluded that it was necessary to provide all the required assistance to patients dealing with this disease, as well as to the health care professionals who make efforts to stop the TB epidemic.

He pointed out that the Committee on Human Rights and Freedoms, by organising this Conference in cooperation with the Committee on Health, Labour and Social Welfare, and with participation of persons who directly and daily undertake activities in combating TB, wanted to give its modest contribution to improving the situation in this field.

MP Ms Marta Šćepanović, moderator of the Conference, thanked Dr Jovan Kojičić, who connected members of the Parliament of Montenegro with the member of the European Parliament Mr Nick Herbert with a view to signing the Barcelona Declaration. She reminded that the signatories of the Declaration, considering that every man, woman and child should be able to live their lives free from the tyranny of the disease, declared the following:

- that tuberculosis (TB) has killed a greater number of people than any other infectious disease in human history and continues to be responsible for 1.5 million deaths a year, often affecting the most vulnerable, and that it should be a global political priority.

- that the current rate of progress in combatting TB is too slow, such that the disease will remain a threat to the social and economic wellbeing of millions of citizens around the world for centuries to come, and that accelerating progress against the disease should be recognised by all governments to be in the interests of all. 

- that drug-resistant TB clearly demonstrates a failure to address the disease properly, thus it should be the focus for urgent action.

- that TB imposes on patients a triple burden, combining the devastating health impact of the disease itself, the harsh burden of treatment, and the isolation of social exclusion driven by stigma and fear, and that these problems should be addressed holistically by national health programmes.

They committed to using all means at their disposal to demand sustained action from their governments, to secure the necessary international and domestic resources to combat TB, and to press for the prioritisation of the disease on political agendas.

MP Ms Šćepanović pointed out that, in that sense, the Decision was adopted on establishing a new global parliamentary caucus to press for a more effective response to the TB epidemic, working with official organisations including the World Health Organization, UNITAID, the Global Fund, the Stop TB Partnership, the Union and UNAIDS, and with NGOs worldwide, in order to stop the TB epidemic.

She also said that today’s Conference was very significant both from the aspect of exchanging opinions and for defining further steps that need to be undertaken jointly for the wellbeing of the entire humankind.

Representatives of competent health institutions informed the participants of the Conference on the activities undertaken regarding the control of TB in Montenegro, as well as on experiences they were facing every day.

Dr Gordana Reljić, Director of Public Health Institution Special Hospital for Lung Diseases "Dr Jovan Bulajić" in Brezovik, who also spoke in capacity of the representative of the Ministry of Health, voiced pleasure for participating in the Conference where the TB control programme in Montenegro was being analysed. She pointed out that TB had been a decade-long problem on the global level, recognised also by the Ministry of Health of the Government of Montenegro, which was undertaking numerous activities to resolve it. Ministry of Health is implementing the National Tuberculosis Control Program for the period 2013-2017. She pointed out the importance of providing fast and quality diagnosis of TB patients and the importance of monitoring the treatment of patients which would lead to an average decline in TB patients by 5 percent per year. According to the statistical data kept at the Special Hospital for Lung Diseases, there were 110 newly diagnosed patients with TB in 2013, and now there are only 67 newly diagnosed cases of registered TB, so they are very pleased with the achieved results. When it comes to therapy treatment, she pointed out that TB requires specific therapy, so-called first-line, second-line, and third-line tuberculostatic drugs. The hospital in Brezovik estimates the annual drug requirements, and "Montefarm" provides their procurement. All the information on TB are collected in the national register at the Special Hospital for Lung Diseases in Brezovik.

With the incurrence of multidrug-resistant tuberculosis (MDR-TB), i.e. patients immune to the existing manner of treatment, they are facing a problem, because there is great threat of contamination for the environment. From 2010 to 2015 there were 14 patients with MDR-TB, out of which one patient is alive with progressed extensively drug resistant tuberculosis (XDR-TB), one was cured, one patient abandoned treatment, while three were completely cured and nine died. Each patient being treated in the Special Hospital in Brezovik is also tested for HIV.

National Tuberculosis Control Program also encompasses the special programme for enclosed spaces and high-risk groups, such as prisons, refugee camps and Roma settlements. The National Programme insists on primary health care protection and points out the importance of education of doctors and patients. She pointed out that the Ministry of Health undertakes quality, intensive, and continuous activities in this field, in order to successfully cure a large number of patients. She reminded once again that TB is a disease from which nine million people worldwide fall ill every year, and two million people die.

Director of Special Hospital for Lung Diseases "Dr Jovan Bulajić" in Brezovik, the only institution in Montenegro engaged in provision of complete diagnosis and therapy for all diseases from the field of pulmonology, said that the Hospital has six facilities, and each of them is a hospital facility with its own pathology, polyclinical and administrative wards, while all of them operate as a high quality unit. In the past five years, a complete reconstruction of the Hospital was performed, from the architectural parts to procuring the latest modern equipment, and by the end of the year she announced the opening of the first pulmonology clinic in Montenegro. The TB patients are accommodated in the third pavilion and isolated from other patients, which is very important for treatment of other patients with otherwise bad immune systems. The UNDP programme was implemented from 2007 to 2012, which also included the Hospital in Brezovik, and within the project significant positive results were achieved. The third pavilion was refurbished then, and the microbiology laboratory used for final diagnosis was partially renovated.

During the following year, they plan to implement modern micro-molecular diagnostic methods, fast TB diagnosis methods, taking into account the fact that by using these methods diagnosis can be determined in 2-3 hours, and using current methods it takes up to two months. She pointed out that our national laboratory was given a certificate by the supranational laboratory in Zagreb, with which they have excellent cooperation, stating that the Zagreb laboratory has been implementing micro-molecular diagnostic methods since 2012.

Hospital in Brezovik has a national register of TB patients and they have developed a good network of anti-tuberculosis medical units of all primary health care centres in Montenegro. In 2013, of all recumbent patients a percent of TB recumbent patients was 4.9 percent while in 2015 it was 2.6 percent.

The Director of Special Hospital for Lung Diseases "Dr Jovan Bulajić" in Brezovik urged MPs and other present to support them in the period to come, primarily in financial terms.

Ms Mina Brajović, Head of the WHO Country Office in Montenegro, welcomed Parliament’s efforts aimed at providing support to this important initiative, and expressed hope that greater contribution would be given to achieving a higher level of support to TB control in Montenegro as well as to the respect of human rights in Montenegro. Health is the greatest asset of an individual and society as a whole, as well as the measure of development, whereby the health itself is a result of the development. If isolated from social, economic, political development, health cannot contribute to human development.

She gave a short overview of global epidemiological situation, with a particular emphasis on the situation in Europe, and presented the Global Plan to End TB, offered by the World Health Organization.

According to data of the World Health Organization, a great progress has been achieved in the previous 25 years with regard to the control of the
global TB epidemic. Since 1990, the global community has reduced the number of deaths
from TB by 45 percent, while TB prevalence has been reduced by 41 percent. Annual TB incidence is declining at the rate of 1.5 percent. According to data of the World Health Organization, around 61 million of persons in the world has been cured from tuberculosis, in the period 1995-2013. However, globally, tuberculosis is still a serious threat to public health, confirmed by data that one-third of the world's population has latent TB and one in ten latent infections eventually progresses to active disease during the lifetime, while the risk is higher for persons with poor immune system. Statistics shows that one person dies of TB every three minutes. Tuberculosis is a leading cause of death among persons living with HIV virus and is responsible for approximately one quarter of all HIV-related deaths. Unfortunately, children are not spared of tuberculosis, thus there are more than 500,000 cases of TB among children each year. The proportion of TB cases among all TB cases of the Euro region countries is 4 percent, but if we look into data on drug-resistant TB and MDR-TB, we may conclude that Europe is in the first place, given that one-fourth of all cases originates from Euro region. Average TB incidence in Europe is 39 cases per 100,000 people, which is significantly higher than incidence in Montenegro.

The Head of the WHO Country Office in Montenegro spoke of factors that made this global public health problem even more complex. She emphasised that there was a problem of TB bacilli resistant to the existing anti-TB drugs. She said that MDR-TB was recorded in all regions of the world, while XDR-TB existed in more than 200 countries worldwide. One of the factors that further complicates the situation is the fact that TB treatment is time-consuming. According to the World Health Organization, TB treatment success rate is 85 percent when the treatment is administered correctly and completely. When it comes to MDR-TB patients, TB treatment success rate is 50 percent.

TB is complex, not only health, but also a financial problem, because it strikes financially an individual suffering from the disease and his household as well. The cost of TB treatment varies in different countries, and in average it amounts 4-7 percent of gross domestic product. Given the nature of this disease and the fact that it is spread by air, TB is increasingly seen as one of the serious risks for national security.

The vision of the World Health Organization is a world free of tuberculosis, so that no person dies from the consequences of this contagious disease. TB is a disease that disproportionately affects the poor, often causing and contributing to poverty, thus creating even greater inequality between the rich and the poor. She reminded that ministers of health of the World Health Organization countries at the Assembly of the World Health Organization of May 2014 adopted a global 2015-2035 TB Efficient Control Strategy, which overlapped with time frame for the implementation of sustainable developmental goals recognising health as one of the 17 Sustainable Development Goals. The Strategy of the World Health Organization is designed to recognise the three basic pillars on which an effective response to TB epidemic should be based. There is no efficient TB response if the framework for integrated provision of services is not provided, both in treatment and prevention, which includes the services of early diagnosis, testing of TB bacteria on anti-TB drugs as well as creating adequate conditions for successful treatment of TB patients. It is necessary to integrate programmes of TB control with programmes of HIV infection control, provide preventive programmes for persons who are under the risk and vaccinate against TB. Strategic response of the World Health Organization indicates to the need of creating the overall environment which will serve for effective control of TB.

The Head of the WHO Country Office in Montenegro pointed out that a political commitment was very important as well as allocation of relevant financial means for the sector of health, and for the programme of effective fight against TB. In addition, the cooperation with civil sector and establishment of broad partnership are very important, as well as promotion and application of universal health protection which means the accessibility to high-quality and equally accessible health protection. Additionally, the system has to provide financial protection of the diseased. Science and innovations are important for achieving success. Governments of members of the World Health Organization should provide a support for fighting TB, and act in partnership with civil sector.

World Health Organization firmly advocates that the implementation of the global strategy and European action plan for TB epidemic control may be successful only if it ensures full respect of human rights. Effective TB control from the perspective of respecting human rights implies the prevention of the risk that someone fall ill with tuberculosis, providing the access to high-quality services of diagnosis and treatment, as well as access to effective, safe and high-quality medicines. All of this is tightly connected with a set of human rights, such as right to work, education, adequate housing, right to privacy, freedom of movement, prevention of discrimination and any other non-human treatment and behaviour. Often, a person suffering from TB does not consent to be treated, and does not accept appliance of certain public and health measures, such as isolation during the infection phase, and measures of treatment by prescribed therapy. In such circumstances, the aim of public heath - preserving health of all of us as a community and society - is compromised. A whole set of international legal documents guarantees the fundamental individual rights, and on the other hand, there is a collective interest. International laws ensure that individual human rights are limited, calling upon the concept of public health. Siracusa Principles of 1985 adopted by the UN Economic and Social Council precisely defines the principles that must be followed in order to make that limit acceptable in a democratic society. Primarily, a limitation must be based on the law and implemented in the manner prescribed by the law, and also the limitation of individual right on freedom of movement may be achieved if it accomplishes the goal necessary for democratic society. The limitation should be a need of a democratic society and must be less restrictive compared to any other existing limitation, and also it must be based on science and scientific proofs.

The Head of the WHO Country Office in Montenegro said that Montenegro, as a country that aspired to be true democracy and a state which continuously and consistently had been working on the implementation of assumed international and legal obligations in the field of human rights, could not allow that any patient with XDR-TB be "behind" and not to be seen, but it had to provide access to efficient medication, as well as efficient services of diagnosis and treating of the disease.

She emphasised that the World Health Organization had supported several expert mission in Montenegro conducted in 2011, 2012, 2014 and in July 2015, and following all those missions, it was pointed out to shortcomings and lack of basic elements for the efficient TB control in Montenegro. Primarily, the Report says that one of the key shortcomings is the lack of isoniazids, one of the most important drugs for the treatment of TB patients. Additionally, it was emphasised that there was no functioning system for the procurement of drugs of the second and third line, necessary for the MDR-TB control. Also, work conditions in the laboratory of Special Hospital for Lung Diseases in Brezovik, the only laboratory for tuberculosis in the whole country, are suboptimal. Work conditions in this laboratory are highly unfavourable as well as in facilities for clinical reception of patients with MDR-TB, what represents a serious problem when it comes to the control of infection. She voiced hope that MPs, who influence on defining of the basic principles in health, which must also be supported financially, will draw attention to creators of the overall policy, and stress that it is imperative to provide Special Hospital in Brezovik with the adequate means for treating TB patients.

Dr Gordana Reljić explained that treatment of the patient with the XDR-TB costs EUR 2.270 per month, and the effect was rather weak, while Dr Nebojša Kavarić, Director of the Primary Health Centre in Podgorica, said that he was very proud of interconnection of the system in treating and controlling of TB.

Dr Olivera Bojović, National Tuberculosis Coordinator, a physician who encounters TB patients on daily basis, presented concrete data and her experience. She stressed that 2015 was a year for assessing results of the previous Stop TB Strategy, launched in the early 1990s, when a global threat from this disease was declared. She assessed that certain progress has been made. Since 2000, TB incidence at the global level has been falling, but slowly, namely 1.5 percent at the annual level, while the prevalence rate is 42 percent lower than in 1990, even though the planned aim was 50 percent. According to the World Health Organization, global mortality rate for 2014 has fallen by 47 percent compared with the referent 1990, whereas the aim was 50 percent.

She stressed, that according to the World Health Organization, there was 9.6 million TB patients in 2014, of which 6 million was registered, and approximately 3 million non-diagnosed, while 1.2 million of TB patients were among HIV-positive people. It is estimated that there are 480,000 new cases of MDR-TB. Since 2000, 37 million people have been cured of TB, but in 2014 around 1.5 million people died from the disease, so it is still a leading cause of death among infected patients despite the fact that the disease is curable.

Global Strategy and Targets for Tuberculosis Prevention, Care and Control was adopted by the Assembly of the World Health Organization in 2014, and aims to end global TB epidemic, which implies reducing TB mortality rate by 95 percent and TB incidence rate by 90 percent compared with 2015. The end of the global TB epidemic is possible only if the number of TB patients and number of deaths caused by TB dramatically decline, as well as the by the elimination of the economic and social burden of this disease. If this does not happen, there will be serious consequences for global public health.

She stressed that the achievement of these goals requires willingness, management and accountability of governments, stronger association of civil society organisations and communities, protection and promotion of human rights and adaptation of strategies and goals at the country level with global cooperation. Better and faster diagnostic procedures are required, the discussion on which happened also during previous years, and safer and easier treatment is necessary, including shorter treatment regimens with new drugs, new vaccines, safer and more effective treatment of latent TB infection (LTBI), in order to reduce the number of new TB cases arising of about 2 billion people worldwide who are infected with this germ.

In the previous period in Montenegro, only the NGO "CAZAS" from among non-governmental organisations participated in TB control project.

In Montenegro, the incidence rate in 2014 was 18 per 100,000 people, which is a significant decrease compared to 2005 when it amounted 27 per 100,000 people. Since 2010, Montenegro has turned from a high-risk country to a country with the low rate of disease from TB. She emphasised that the goal for 2015 was the incidence rate less than 15 per 100,000 people.

Bacteriological confirmation of the disease was found with 61 percent of cases, which was not at a satisfactory level and was the lowest percentage in the region, while modern standards being that bacteriological confirmation of disease be greater than 80 percent. In Brezovik Hospital rapid molecular techniques have not been applied, but only conventional methods in the laboratory lacking basic conditions, having to wait for lab results for four or more weeks, during which time patients are treated with expensive antibiotics and kept in hospital significantly longer than the proposed standard, which is irrational. She stated that our laboratory was the only one in the region that has failed to modernise diagnostic methods. The price of that new device is between EUR 30 and 35 thousand, and the reduction of antibiotic consumption would save for buying of this device. Cases of TB co-infection with HIV appear sporadically, but there are more and more patients with pulmonary TB among patients on anti-TNF therapy due to lack of more specific and more sensitive immunological tests for uncovering LTBI. Montenegro does not possess immunological tests, but sends its patients to regional centres in Belgrade, Zagreb and Dubrovnik.

In the period 2005-2015, 13 cases had laboratory-confirmed MDR-TB, two cases of which with new patients, and the rest with previously treated. Resistance to second-line drugs is not done in Montenegro, but in Zagreb, and on the friendly relations basis, because this has not been regulated by the agreement between Montenegro and Croatia, which should be defined as soon as possible. The percentage of cured patients in this group of patients is extremely low, about 30 percent, the goal being 70 percent. The cause of failure is mostly difficulty and discontinued supply of drugs for the treatment of these patients, and she pointed out that at the same time provision of all drugs needed for treatment was necessary, i.e. procurement of five drugs to treat one patient. The therapeutic regime was recommended by the ERS/WHO Tuberculosis Consilium, but these drugs we did not have in Montenegro. The price of one of the recommended drugs for one patient for six months of treatment ranges between USD 900 and 3,000, while the price of other two drugs, per box, ranges between USD 100 and 110, and the treatment lasts up to two years. It is necessary to consider whether it is rational for such cases to provide treatment in a European centre, or still work on strengthening our own capacities. Care of these cases is a challenge for even more developed systems which have an experienced and trained staff, which provide high quality drugs at more favourable supply conditions, have developed laboratory facilities and centres for accommodation of these patients by modern standards for infection control, something that Montenegro is missing. In 2013, EUR 13,719 has been allocated for the treatment of 120 sensitive TB cases with first-line drugs, and EUR 53,645 for the treatment of three cases. Most MDR-TB cases in Montenegro were from Podgorica. She pointed out that in accordance with our legislation, these patients cannot be forced to treatment.

The total budget for the control of TB in Montenegro for the period 2013-2017 amounts under EUR 3 million, two million of which for the implementation of a quality strategy that basically implies strengthening diagnostic capacities and treatment with quality drugs under direct supervision with the continuous supply. She believes that Montenegro is the only country in the region that pays for the basic drug for the TB treatment, the production of which is 40 years old.

According to Dr Bojović, achievement and realisation of the vision by which the world will be free of TB and Montenegro free of TB requires a lot more commitment and responsibility of the ones competent than hitherto.

Dr Dubravka Lopičić-Mirković, Head of Centre for Lung Diseases and Tuberculosis of the Primary Health Care Centre in Podgorica informed the participants of the Conference about the activities of the Centre for Lung Diseases and Tuberculosis. She stated that these were regional centres, which provided all preventive, diagnostic and therapeutic services and measures for patients suffering from TB and lung disease. The Centre for Lung Diseases and Tuberculosis in Podgorica, as the regional centre, covers an area of Danilovgrad, Kolašin and Podgorica. In Montenegro there are ten more such centres, set up for areas of 20,000 to 30,000 inhabitants. The team at the Centre consists of a doctor, two medical technicians and an X-ray technician. In Podgorica the Centre employs two doctor specialist pneumophtisiologists, while two other doctors attend specialist practice outside their Institution. In order to prevent spread of TB, they implement the following measures and procedures: detect TB patients, conduct identification of persons who are in contact with those suffering from TB, clinical, radiological and bacteriological examination of persons. Bacteriological examination involves sending samples to the national laboratory in the Special Hospital for Lung Diseases in Brezovik, which they have good cooperation with and receive lab results very quickly. A positive TB lab result means that a patient is infected and is being invited and urgently sent for treatment to the Special Hospital for Lung Diseases in Brezovik. In order to prevent spread of TB they do TB tests, and work on detecting LTBI. Five to ten percent of people with LTBI can develop the disease, and it can happen after a number of years if the immune system is weakened due to aging, serious illness, alcohol, drugs, HIV infection or other diseases. They carry out diagnostic procedures with patients who are suspected to have TB. All the cases with active TB are sent to be treated in the hospital in Nikšić, where the initial phase of treatment is performed. They provide recommendations for DOTS implementation, directly supervise giving of treatment by a health professional. They perform check-in and check-out of patients in Brezovik, perform the registration cases suffering from TB. According to the information they possess, there were 46 cases in 2010 and 38 in 2014, and they have two living patients suffering from MDR-TB.

In order to prevent falling ill with TB, continuous education of health professionals at primary health care level is required, for early detection of TB, prevention of relapse and multidrug-resistant forms of TB. In order to improve DOTS program, or directly observed treatment short-course by health professionals, training of health professionals is essential at the primary health care level, but the training of patients as well. She also pointed to the importance of regular taking of treatment, because the success of treatment depends on the patient's ability to adhere to the prescribed drug regimen.

Bearing in mind that 50 percent of patients contact doctors at already advanced stage of the disease, it is necessary to improve the prevention aimed at early detection of TB, because a delay in treatment results in a worse outcome of treatment, which leads in a further decrease in lung function, poor lifestyle, which can lead to death. Diabetes and HIV represent an additional challenge for a TB patient and early diagnosis of this disease is very important. Therefore, spreading knowledge of TB is very important. It is necessary to improve the control for vulnerable population, migrants, ex-convicts, alcoholics, homeless, addicts of psychoactive substances and mentally disabled in terms of the development of specific measures for members of this population. It is necessary to ensure availability of anti-TB drugs at any moment for each patient, because the continuity of treatment is very important. In practice they are faced with the problem of continuity in TB treatment, because there are patients who cannot afford the drug, and sometimes there is no basic anti-TB drugs, isoniazid, stating that one of her patients was not able to find the drug, even though having money. The problem is not that the drug is not to be found in the public health institution, but not in the private one as well. It happens that this drug is not to be found from time to time, so there is a risk of relapse and MDR-TB. It is recommended that TB drugs be prescribed only by pneumophtisiologists, as for the possession of adequate statistics of these patients as well.

Director of the Hospital in Brezovik, Dr Reljić said that treatment of all patients with TB diagnosis is funded by the state of Montenegro. Dr Olivera Bojović added that isoniazid is on the positive list, but it is not matched in a computer system, so patients must pay for the drug even though it is to be found in state pharmacies, while private pharmacies are recommended not to purchase or put in sale anti-TB drugs. She said that the problem was not even Montefarm, because this drug is available, but the problem is in the distribution to peripheral pharmacies that do not make demands upon the drug in timely fashion.

In light of this problem, MP Ms Azra Jasavić assessed that there was a communication problem and considered that national co-ordinator should have the contact with Montefarm and to mediate in the distribution of the drug to peripheral pharmacies. Dr Bojović said that it was essential that the doctor informed of the absence of the drug, after which she as a coordinator would mediate with Montefarm.

During the closing part of the Conference, MP Ms Marta Šćepanović urged other MPs, when considering the Proposal for the Law on Budget for 2016, to consider the possibility for provision of additional funding to address some of these problems, and representatives of relevant state authorities, responsible for the implementation of the National Tuberculosis Control Programme in Montenegro (2013-2017) to make further efforts and apply for funds from international organisations and funds, in order to provide additional sources of revenue necessary for the implementation of a number of program activities.

She expressed expectation that international organisations, in accordance with their programming orientation and realising the importance of this issue, be prepared to help, in accordance with their capabilities. She also expressed hope that the non-governmental sector will be active in this field, and that with the synergistic action of all relevant parties, with the assistance of the international community, further activities would be undertaken in this area, which should contribute to constant improvement of the situation.