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    Peer Reviewed

    National tuberculosis programme review: experience over the period 1990-95.

    Pio A; Luelmo F; Kumaresan J; Spinaci S


    Over the period 1990-95, the World Health Organization (WHO) conducted 12 reviews of national tuberculosis programs, with emphasis on passive case finding; directly observed treatment, short-course (DOTS); drug supply; and treatment outcome monitoring. Criteria for program selection were: large population (Bangladesh, Brazil, Chile, Ethiopia, India, Indonesia, Mexico, and Thailand); good potential for developing a model regional program (Nepal, Zimbabwe); or advanced stage of implementation of a model program (Guinea, Peru). The 2-3-week review process included interviews with authorities, document reviews, field visits, and discussions of findings. The estimated combined incidence of smear-positive pulmonary tuberculosis was 82/100,000 population--about 43% of the global incidence. These reviews suggested the following observations: 1) program review is a useful tool to secure government commitment, reorient tuberculosis control policies, and replan activities on a more solid basis; 2) the involvement of academic and public health institutions, cooperating agencies, and nongovernmental organizations secures broad support for new policies; 3) program success is linked to a centralized direction that supports a decentralized implementation through the primary health care system; 4) monitoring and evaluation of case management function well if based on the correct classification of cases and quarterly reports on cohorts of patients; 5) a comprehensive program review should include teaching about tuberculosis in medical, nursing, and laboratory workers' schools; 6) good quality diagnosis and treatment are essential requirements for expanding a program beyond pilot testing; and 7) tuberculosis control targets cannot be achieved if private and social security patients are excluded from program coverage.
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