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Health sector reform and tuberculosis control: the case of Zambia
1Royal Netherlands Tuberculosis Association, The Hague. bosmanm@who.ch
Setting:
Zambia, 1995-1997.
Objective:
To describe the process leading to the collapse of Zambia's National Tuberculosis Programme NTP).
Design:
A descriptive analysis of health sector reform in Zambia and its effects on the NTP during the period 1995-1997.
Results:
By the end of 1997 the NTP had stopped functioning. The main reason was that external support had ended, while the National Strategic Health Plan 1995-1999 had no budget for special programmes according to the policy to integrate these into the general health services. As a consequence, technical support for tuberculosis control to districts ended as staff was reduced to one officer responsible for the national coordination of AIDS/HIV, sexually transmitted diseases (STD), tuberculosis and leprosy. The most serious effect of the transition was the interruption of supplies of anti-tuberculosis drugs in 1998.
Conclusions:
The experience in Zambia demonstrates the urgent need for constructive dialogue between 'health reformers' and 'disease controllers'. The aim of this dialogue would be to develop a model that ensures that tuberculosis patients are properly diagnosed and cured in countries that are embarking on a reform of their health services.