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National tuberculosis programme review: experience over the period 1990-95
1National Programme Support, Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland.
Bulletin of the World Health Organization
|January 1, 1997
Summary
Comprehensive program reviews by the WHO Global Tuberculosis Programme (GTB) strengthened national tuberculosis control efforts. These reviews, focusing on directly observed treatment, short-course (DOTS), improved government commitment and policy reorientation for better tuberculosis management.
Area of Science:
- Public Health
- Infectious Disease Control
- Global Health Policy
Background:
- The WHO Global Tuberculosis Programme (GTB) has guided national tuberculosis program revisions since 1990.
- Focus has been on directly observed treatment, short-course (DOTS) and close monitoring of treatment outcomes.
- Comprehensive program reviews were supported by WHO between 1990-1995 for selected countries.
Purpose of the Study:
- To evaluate the effectiveness of comprehensive program reviews in reorienting national tuberculosis control strategies.
- To identify key lessons learned from WHO-supported program reviews.
- To provide recommendations for improving tuberculosis program implementation and evaluation.
Main Methods:
- Conducted 12 comprehensive program reviews in countries with large populations, potential for model programs, or advanced implementation stages.
- Reviews involved multidisciplinary expert teams (15-35 members) and a structured 3-phase process (documentation review, field visits, recommendations).
- Data included tuberculosis incidence, HIV prevalence, and program management aspects.
Main Results:
- Program reviews secured government commitment, reoriented policies, and facilitated replanning.
- Involvement of diverse institutions ensured broad support for new policies.
- Centralized direction with decentralized implementation via primary healthcare was crucial for success.
- Effective monitoring relies on accurate case classification and cohort reporting.
- Quality diagnosis and treatment are essential for program expansion.
- Inclusion of private and social security sectors is vital for achieving control targets.
Conclusions:
- Comprehensive program reviews are valuable tools for tuberculosis program reorientation and policy development.
- The methodology is recommended for countries needing program reform and for periodic evaluations.
- Sustained government commitment and multi-sectoral collaboration are key to effective tuberculosis control.