Implementing tuberculosis control in Papua New Guinea: a clash of culture and science?

Tuberculosis (TB) remains a major health problem in Papua New Guinea (PNG) and the Directly Observed Treatment Short course (DOTS) strategy has been adopted as a framework for controlling the disease. We review here the local and cultural factors in PNG that act as barriers to implementing each component of the DOTS program. Political Will is needed to tackle the underlying conditions that lead to squatter settlements, e.g. poverty and unemployment, and to build infrastructure for access to rural populations. Better case detection may be obtained by addressing the cultural beliefs that delay presentation to health facilities, as well as providing ongoing training for laboratory technicians, introducing better sputum microscopy techniques and regular service of radiology equipment. Direct observation of therapy may need to be done using the traditional clan structure, e.g. clan chiefs and extended family system in rural areas. Effective drug supply is provided by the World Health Organisation (WHO) Global Drug Facility (GDF). Monitoring and Evaluation will require innovative approaches; perhaps through financial incentives on completion of the program or texting through the mobile text messaging for reminders. There are unique cultural and local issues that need to be addressed when implementing DOTS strategy in PNG.