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Will the circle be unbroken? - includes related article on population assistance to developing countries - child survival programs and fertility decline.
UN Chronicle. 1998 Winter; 35(4): p..The demographic transition which has been under way in the developing countries since the middle of the twentieth century has shown much difference, both in its course and in the factors behind it, from the transition which started two centuries ago in countries that are now developed. In the developed countries, the gradual improvement in living conditions accompanying industrialization and urbanization, coupled with broadening education and sanitation and a growing understanding of the principle of hygiene and nutrition, resulted in progressive gains in child survival and declines in mortality at all ages. These same forces of development were progressively changing attitudes towards reproduction, reducing the demand for children and lowering marital fertility. In the developing countries, there have been unprecedented declines in mortality over a few decades since midcentury. Only sub-Saharan Africa as a whole Ires not yet entered into this phase of demographic transition to a significant extent. A distinguishing feature of this transition has been that declines in mortality and fertility were not accompanying major gains in economic development. (excerpt)
Traditional medicine development for medical and dental primary health care delivery system in Africa.
African Journal of Traditional, Complementary and Alternative Medicines. 2005; 2(1):46-61.Traditional African Medicine (TAM) is our socio-economic and socio-cultural heritage, servicing over 80% of the populations in Africa. Although, it has come a long way from the times of our ancestors, not much significant progress on its development and utilization had taken place due to colonial suppression on one hand, foreign religions in particular, absolute lack of patriotism and political will of our Governments, and then on the other hand, the carefree attitudes of most African medical scientists of all categories. It is incontrovertible that TAM exhibits far more merits than demerits and its values can be exploited provided the Africans themselves can approach it with an open mind and scientific mentality. The degree of sensitization and mobilization by the World Health Organization (WHO) has encouraged some African countries to commence serious development on TAM. The African Regional Director of the WHO has outlined a few guidelines on the responsibilities of all African nations for the realistic development of TAM, in order to sustain our health agenda and perpetuate our culture. The gradual extinction of the forests and the inevitable disappearance of the aged Traditional Medical Practitioner should pose an impending deadline for us to learn, acquire and document our medical cultural endowment for the benefit of all Africans and indeed the entire mankind. (author's)
'Combine incentives for research with access to medication for the poor' -- Kofi Annan meets with pharmaceutical companies; AIDS treatment in developing countries.
UN Chronicle. 2001 Mar-May; 38(1): p..Secretary-General Kofi Annan met with six of the world's leading pharmaceutical companies on 5 April in Amsterdam, the Netherlands to agree on what further steps need to be taken to improve access of developing countries to better health care, and HIV (human immunodeficiency virus) and HIV-related medicines, as part of further action to combat acquired immune deficiency syndrome (AIDS), including prevention, education and research. The Secretary-General met with the Chief Executive Officers and senior executives of Abbott Laboratories, Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Hoffman-La Roche and Pfizer. He was joined at the meeting by Gro Harlem Brundtland, Director-General of the World Health Organization, and Peter Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS).The pharmaceutical companies have made significant progress individually in providing an expanded number of drugs to combat AIDS, including antiretrovirals and treatments for opportunistic infections. Prices have come down substantially as a result of the companies' individual actions. Mr. Annan urged them to continue and accelerate these initiatives. Special emphasis was placed on the least developed countries, particularly those in Africa, as well as the need for continued country-by-country negotiations in other developing countries. All recognized that qualified non-governmental organizations and appropriate private companies offering health care to employees and local communities should also be considered for increased accessibility to HIV/AIDS medicines. (excerpt)
Geneva, Switzerland, WHO, Division of Diarrhoeal and Acute Respiratory Disease Control, 1994 Nov. 3 p. (Update No. 18)If diarrhoea in children is to be managed correctly, there is need to look beyond public sector health facilities. Good management has to be promoted in the home, and there is also a need to improve the practices of all providers of care, particularly in the private sector. Retail drug businesses are particularly important providers of care because: in most countries, pharmacies and over-the-counter drug stores are widely distributed geographically; they are the most frequently visited of all health-related facilities; for purposes of training, drug retail outlets are relatively easy to reach; products sold and advice given to customers for treating diarrhoea are generally inappropriate and, in some cases, dangerous. (excerpt)
Drug Safety. 2005; 28(4):277-286.Artemisinin combination therapies (ACTs) have been recommended for the treatment of malaria in countries where there is widespread resistance to commonly used antimalarial drugs. Several sub-Saharan African countries are, therefore, in the process of introducing ACTs in their malaria drug policies. However, there is limited information about the safety of ACTs outside South East Asia, where their use has been well documented. As with all other new medicinal compounds, the monitoring of a drug's safety or ’pharmacovigilance’ is important, especially in areas where co-morbid conditions, such as HIV/AIDS, malnutrition and tuberculosis, are common. Because in most malaria endemic countries, particularly Africa, there are no pharmacovigilance programmes in place, it has been suggested that the introduction of ACTs offers an opportunity for these countries to put drug safety monitoring systems in place. Backed by the WHO Roll Back Malaria department and other international cooperating partners, five African countries, which are in the process of introducing ACTs (Burundi, Democratic Republic of the Congo, Mozambique, Zambia and Zanzibar), have drawn up action plans to introduce pharmacovigilance in their health sector. It is planned that once the safety monitoring of antimalarials has been established, these activities can then be extended to cover medicinal compounds used in other public health programmes, such as HIV/ALDS, tuberculosis and the immunisation programmes. This article looks at the rationale for pharmacovigilance, the process of setting up monitoring centres and the challenges of implementing the project in the region. (author's)
Access to HIV / AIDS drugs and diagnostics of acceptable quality. Procurement Quality and Sourcing project. Manufacturers and suppliers whose HIV-related medicines have been found acceptable, in principle, for procurement by UN agencies. 18th ed.
Geneva, Switzerland, WHO, 2004 Aug 9. 19 p.A "Procurement, Quality and Sourcing Project: Access to HIV/AIDS drugs and diagnostics of acceptable quality" was actively started by WHO in collaboration with other United Nations Organizations (UNAIDS, UNICEF, and UNFPA) in March 2001. The World Bank supports this initiative. The background to the project is described in the project description. The procedure for assessing the acceptability in principle of HIV/AIDS drugs comprises various components including 1) The evaluation of product data and information provided by manufacturers and suppliers, and 2) Inspection of manufacturing sites. Due to the particular properties of several substances used in some pharmaceutical finished dosage forms in the treatment of HIV/AIDS (e.g. chiral activity, isomerism, sensitivity to relative humidity etc.), and the current status where there are no Pharmacopoeia monographs and standards available for several substances and finished products, WHO appointed experts have performed a comprehensive and rigorous evaluation of the products included in the list, with a view to establishing their compliance with international standards. (excerpt)
Working in partnership to boost reproductive health commodity security. [Trabajar en sociedad para mejorar la seguridad de los productos de salud reproductiva]
Population 2005. 2004 Sep-Oct; 6(3):10-11.As USAID, through its sub-contracted American NGO John Snow Incorporated (JSI), continues to phase out support to developing countries for reproductive health commodities— contraceptives and essential drugs—the UN Population Fund and interested donor bodies are concerned with how best to marshal and direct commodity assistance for the future. The current focus is on nine countries in the Latin American region: Bolivia, the Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Nicaragua, Paraguay and Peru. To ensure a smooth transition and to help these countries to eventually achieve reproductive health commodity security, or RHCS, USAID and JSI are working closely with partners, including UNFPA, the International Planned Parenthood Federation (IPPF), the Pan American Health Organization (PAHO) and the World Bank. (excerpt)
Population 2005. 2003 Dec; 5(4):9.A survey conducted by the United Nations Population Fund (UNFPA), in collaboration with the International Center for Migration and Health, has tracked startling statistics regarding the health system in Iraq. According to UNFPA, the number of women who die from pregnancy and childbirth in Iraq has close to tripled since 1990. Among the causes of the reported 310 deaths per 100,000 live births in 2002 are bleeding, ectopic pregnancies and prolonged labor. In addition, stress and exposure to chemical contaminants are also partly to blame for the rise in miscarriages among Iraqi women. Access to medical facilities is becoming more difficult for women due to breakdowns in security and weakened communication and transport systems. This has caused nearly 65 per cent of Iraqi women to give birth at home, the majority without skilled help. (excerpt)
Efficacy and safety of artemether-lumefantrine (Coartem) tablets (six-dose regimen) in African infants and children with acute, uncomplicated falciparum malaria.
Transactions of the Royal Society of Tropical Medicine and Hygiene. 2005; 99:459-467.Approximately one million children die from malaria each year. A recently approved artemisinin-based tablet, Coartem (co-artemether), comprising artemether 120 mg plus lumefantrine 20 mg, given in four doses, provides effective antimalarial treatment for children in many sub-Saharan countries. However, this regimen is considered insufficient for non-immune infants and in areas where multidrug-resistant Plasmodium falciparum predominates. This open-label study assessed the efficacy and safety of co-artemether administered to 310 African children weighing 5—25 kg, with acute, uncomplicated falciparum malaria. Six doses of coartemether were given over 3 days, with follow-up at 7, 14 and 28 days. Treatment rapidly cleared parasitemia and fever. The overall 28-day cure rate was 86.5%, and 93.9% when corrected by PCR for reinfection. Cure rates at 7 and 14 days exceeded 97.0% (uncorrected) and, on day 28, were similar in infants (5 -<10 kg) previously exposed to malaria infection (partially immune: 88.6% uncorrected; 93.3% corrected), and in those who were non-immune (82.5% uncorrected; 95.0% corrected). Adverse events were mostly mild. There was no electrocardiographic evidence of cardiotoxicity. The co-artemether six-dose regimen, treating acute uncomplicated falciparum malaria in African children, achieved rapid parasite clearance and a high cure rate. Treatment was generally safe and well tolerated. (author's)
Lancet Infectious Diseases. 2005 May; 5:263.The fight to control tuberculosis has made major headway in recent years but more needs to be done to close the implementation gap in case detection and expand treatment in high burden countries, says the WHO’s Global Tuberculosis Control Report 2005. The main residual problem in the implementation strategy for tuberculosis control is “to improve case detection, now about 45% worldwide, which is quite a long way still from the 70% target for 2005”, says Christopher Dye, WHO coordinator for tuberculosis monitoring and evaluation. By contrast, treatment has a high success rate—on average, 82% in 2002, a fraction below the 85% target for 2005. “By implementing the DOTS strategy, we can force down the burden of tuberculosis in line with what is required for the millennium [development] goals [MDG]”, said Dye. The MDG target is to reverse the trend of tuberculosis and to halve the tuberculosis prevalence and death rates by 2015. (excerpt)
Geneva, Switzerland, WHO, 2004 Jun.  p. (WHO/EDM/PAR/2004.4; Development Experience Clearinghouse DocID / Order No. PN-ADB-693)Antiretroviral therapy, prevention and treatment of opportunistic infections and cancers, as well as palliative care are important elements of HIV/AIDS care and support. HIV/AIDS care hence requires a wide range of essential medicines. If available, these effective and often relatively inexpensive medicines can prevent, treat, or help manage HIV/AIDS and most of the common HIV-related diseases. Less than 8% of people who require antiretroviral (ARV) treatment can access these medicines in developing countries. The high price of many of the HIV-related medicines and diagnostics offered by common suppliers – especially antiretroviral and anti-cancer medicines – is one of the main barriers to their availability in developing countries. There are several other important barriers, including a lack of the basic components required for care, treatment, and support of people living with HIV/AIDS (PLWA) such as: trained staff in health facilities, constant availability of laboratory equipment and supplies, sufficient funding, efficient pharmaceutical services, strong political will and government commitment. Wider availability of information on prices and reliable sources of medicines can help those responsible for procurement make better decisions. Since 2000, prices of important first-line ARVs have fallen considerably. This trend is attributable to a cumulation of factors including advocacy, corporate responsiveness, competition from generic manufacturers, sustained public pressure, and the growing political attention paid to the AIDS epidemic. In addition, originator companies began announcing discount offers for the benefit of the poorest countries or those where HIV/AIDS prevalence is highest. (excerpt)
Nature. 2005 Jan 13; 433(7022):91.For Mrs Luat, the H5N1 avian flu virus could bring economic ruin. Three years ago, she and her husband borrowed US$12,500 to establish a small chicken farm in Hay Tay province, near the Vietnamese capital Hanoi. They raise 6,000 chickens at a time in their single shed, selling the entire stock every couple of months to a Thai company that distributes the meat within Vietnam. But last year, their shed lay empty for six months after H5N1 flu hit neighbouring farms. Mrs Luat estimates the couple's losses at $1,500. If it happens again, they may be unable to service their debts. While smallholders such as the Luats face the most immediate threat, the continuing presence of the H5N1 virus in Vietnam and neighbouring countries could spell a global disaster, in both economic and humanitarian terms. H5N1 is deadly to both chickens and people, but thankfully isn't easily transmitted from person to person. But if it exchanges genes with a mammalian flu virus, H5N1 could become a mass killer that would rapidly sweep the globe. If that happens, tens of millions of people could perish. (excerpt)
Geneva, Switzerland, WHO, 2005.  p. (Integrating STI / RTI Care for Reproductive Health; USAID Development Experience Clearinghouse DocID / Order No: PN-ADC-591)This Guide is intended to be a reference manual, and a resource to educate and to remind health care workers of the need to consider STIs/RTIs when providing other reproductive health services. It recommends prevention and care practices for patients who have or may be at risk of acquiring a reproductive tract infection. As such, it could be used for preservice or in-service health provider education and training, as a source of up-to-date, evidence-based recommendations, and as a selfeducation tool for health care providers on the prevention, treatment, and diagnosis of RTIs. Programme managers can use it as a starting-point for improving policies, programmes and training on the prevention and management of STI/RTI, adapting the information and recommendations as needed to local conditions. The information is grouped according to “reasons for visit”. Providers are encouraged to consider the possibility of STI/RTI, educate and counsel clients about prevention, and offer necessary treatment. Providers can use the Guide as a whole, or focus on the sections that are relevant to their daily practice. (excerpt)
Geneva, Switzerland, WHO, 2003 Jun.  p.This report sets out to provide market information that can be used to help procurement agencies make informed decisions on the source of medicines and serve as the basis for negotiating affordable prices. The aim is to help increase access to medicines for people living with HIV/ AIDS in developing countries. The data provided by the manufacturers serves to highlight the multiplicity of suppliers and the variation in price of some essential HIV/AIDS-related medicines on the international market. Without this information, there is a risk that low-income countries may be paying more than needed to obtain essential medicines. Price variations are highlighted through the tables and graphs included. Provision of price information addresses only one barrier to access to medicines in countries with limited resources and, it is appreciated that many other factors will affect the availability of medicines. Some of the other issues that must be considered in relation to the purchase of medicines for HIV/AIDS and related conditions are health infrastructure, human resources, and supply and distribution systems. (excerpt)
Geneva, Switzerland, WHO, 2004 Jan. 118 p. (Integrated Management of Adolescent and Adult Illness [IMAI] No. 1; WHO/CDS/IMAI/2004.1)The IMAI guidelines are aimed at first-level facility health workers and lay providers in low-resource settings. These health workers and lay providers may be working in a health centre or as part of a clinical team at the district clinic. The clinical guidelines have been simplified and systematized so that they can be used by nurses, clinical aids, and other multi-purpose health workers, working in good communication with a supervising MD/MO at the district clinic. Acute Care presents a syndromic approach to the most common adult illnesses including most opportunistic infections. Instructions are provided so the health worker knows which patients can be managed at the first-level facility and which require referral to the district hospital or further assessment by a more senior clinician. Preparing first-level facility health workers to treat the common, less severe opportunistic infections will allow them to stabilize many clinical stage 3 and 4 patients prior to ARV therapy without referral to the district. (excerpt)
Geneva, Switzerland, WHO, . 47 p.The Caregiver Booklet is designed to help patients, family members, and community caregivers in the home-based care of serious long term illness. Home care is best for many people with long term illnesses, including those who are close to the end of life. All patients being cared for at home should be first assessed and treated by a health worker, who will help caregivers provide high quality home care and ensure that medicines are taken correctly. This booklet explains how to: 1. Deal with specific symptoms. 2. Provide care for terminal and bedridden patients at home. 3. Decide when to seek help from a health facility. The booklet should be given to the patient or caregiver and its contents explained by a nurse or community worker. The first section of the booklet covers ways to prevent problems from occuring and should be followed in all patients. The second section explains how to treat specific symptoms that may occur. (excerpt)
Palliative care: symptom management and end-of-life care. Interim guidelines for first-level facility health workers.
Geneva, Switzerland, WHO, 2003 Dec. 50 p. (Integrated Management of Adolescent and Adult Illness [IMAI] No. 4; WHO/CDS/IMAI/2004.4)Palliative care includes symptom management during both acute and chronic illness and end-of-life (terminal) care. This module provides guidelines to prepare health workers to provide palliative care treatment and advice in clinic and to back up community caregivers and family members who need to provide home-based palliative care. For each symptom, the guidelines for the health worker include both a summary of non-pharmaceutical recommendations for home care and the clinical management and medications which the health worker might also provide, based on a limited essential drug list on the last page of this module. Alternative or additional drugs can be added during country adaptation. (excerpt)
Nature. 2005 Jan 13; 433(7022):91.For Mrs Luat, the H5N1 avian flu virus could bring economic ruin. Three years ago, she and her husband borrowed US$12,500 to establish a small chicken farm in Hay Tay province, near the Vietnamese capital Hanoi. They raise 6,000 chickens at a time in their single shed, selling the entire stock every couple of months to a Thai company that distributes the meat within Vietnam. But last year, their shed lay empty for six months after H5N1 flu hit neighbouring farms. Mrs Luat estimates the couple's losses at $1,500. If it happens again, they maybe unable to service their debts. While smallholders such as the Luats face the most immediate threat, the continuing presence of the H5N1 virus in Vietnam and neighbouring countries could spell a global disaster, in both economic and humanitarian terms. H5N1 is deadly to both chickens and people, but thankfully isn't easily transmitted from person to person. But if it exchanges genes with a mammalian flu virus, H5N1 could become a mass killer that would rapidly sweep the globe. If that happens, tens of millions of people could perish. Since H5N1 starting spreading through Asian poultry flocks in 2003, the World Health Organization (WHO) has been sounding the pandemic alarm. Two main actions are required. First, surveillance for human and animal flu viruses in affected countries needs to be stepped up, to provide an early warning of the emergence of a possible pandemic strain. Second, nations around the world must develop plans to protect their populations should this occur. This will require stringent quarantine procedures, plus the rapid deployment of vaccines and antiviral drugs. (excerpt)
Science. 2005 Jan 7; 307:33.It seemed like a classic case of bait and switch. In 2004, the World Health Organization (WHO) and the Global Fund for AIDS, Tuberculosis, and Malaria threw their weight behind a radical change in the fight against malaria in Africa. Old, ineffective drugs were to be abandoned in favor of new formulations based on a compound called artemisinin that could finally reduce the staggering death toll. More than 20 African countries have signed on. But the catch is there aren’t nearly enough of the new drugs to go around. Just before Christmas, WHO—which buys the tablets from Novartis for use in African countries—announced that it would deliver only half of the 60 million doses anticipated in 2005, leaving many countries in the cold. “It’s a very cruel irony,” concedes Allan Schapira of WHO’s Roll Back Malaria effort. (excerpt)
International Journal of Tuberculosis and Lung Disease. 2004 Jan; 8(1):130-138.The Global TB Drug Facility (GDF) is a new initiative to increase access to high quality tuberculosis drugs. The GDF, a project of the Global Partnership to Stop TB, is managed by its secretariat, in the World Health Organization (WHO), Geneva. It aims to provide tuberculosis drugs to treat up to 11.6 million patients over the next 5 years and to assist countries to reach the WHO global TB control targets by 2005. The GDF was launched on 24 March 2001. Six rounds of applications have been completed, with 46 countries and non- governmental organizations (NGOs) approved for support. The GDF is not a traditional procurement mechanism. It has adopted an innovative approach to the supply of drugs, by linking demand for drugs to supply and monitoring, using partners to provide services, using product packaging to simply drug management and linking grants to TB programme performance. This paper describes the GDF operational procedures and experience gained so far. Key achievements to date are also outlined, including the creation of a flexible supply system to meet differing to meet differing programme needs, rapid establishment of procedures, reduction in TB drug prices--a catalyst for DOTS expansion in countries, standardisation of products, and collaboration with partners. The GDF is flexible enough to meet the needs of countries with a TB burden. The GDF experience could be used as an example for global procurement of drugs and commodities for other diseases, such as HIV/AIDS and malaria. In the future it is likely that the GDF will expand to include second-line drugs and diagnostic materials for TB and could assist other partnerships to develop similar mechanisms and facilities to meet country needs. (author's)
Geneva, Switzerland, World Health Organization [WHO], 2001.  p. (WHO/CDS/TB/2001.287)This is the fifth annual report on global TB control, based on case notifications and treatment outcome data supplied by national control programmes to WHO. Six consecutive years of data were used to assess worldwide progress in TB control, focusing on 23 high-incidence countries that account for 80% of all new cases (the TB80 group). The main aim was to assess progress towards 2005 targets for case detection (70%) and treatment success (85%), and to begin to evaluate the epidemiological impact of diagnosing and curing larger numbers of patients. Analysis of progress from 1995 to 1999 included a revision of incidence estimates for all countries in these years, together with projections to 2005. During 2000, a standard data collection form was sent to 211 countries via WHO Regional Offices. The form has three sections which request information about: policy and practice in TB control; the number and types of TB cases notified in 1999; and the outcomes of treatment and retreatment (DOTS areas only) for smear-positive or culture-positive (mainly Europe) cases registered in 1998. (excerpt)
The WHO dose pole for the administration of praziquantel is also accurate in non-African populations.
Transactions of the Royal Society of Tropical Medicine and Hygiene. 2005; 99:78-81.In 2001, WHO developed a pole for the administration of praziquantel without the use of weighing scales, with encouraging results in African populations. In the present study, the pole was tested on height/weight data from 9354 individuals from 11 non-African countries. In more than 98% of the individuals (95% CI 97.8—98.4) the pole estimated an acceptable dosage (30—60 mg/kg), a performance statistically similar to that observed in African populations. Reproducing the present pole in the form of a strip of paper and including it in each container of praziquantel would greatly facilitate the administration of the drug in large-scale interventions. (author's)
In: WHO updates medical eligibility criteria for contraceptives, by Ward Rinehart. Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health Project [INFO], 2004 Aug. 5. (INFO Reports No. 1; USAID Grant No. GPH-A-00-02-00003-00)Considering depressive disorders for the first time, the October 2003 MEC meeting concluded that there is no need for restriction on use of hormonal contraceptives for women with depression. A variety of studies have found no increase in symptoms among depressed women using combined or progestin-only oral contraceptives, DMPA injectable, or Norplant implants. A single study reported that taking fluoxetine (Prozac) for depression did not reduce the effectiveness of combined or progestin- only oral contraceptives. Conclusions cannot be reached concerning postpartum depression or bipolar disorder because current evidence is inadequate. (excerpt)
Lancet. 2004 Nov; 4:653.WHO is not doing enough to control rising levels of tuberculosis, according to researchers at Harvard University, MA, USA. Despite almost 10 years of Directly Observed Treatment, Shortcourse (DOTS), WHO’s main strategy for treating active tuberculosis infections and reducing its prevalence, most of the world remains no closer to controlling this disease. The DOTS programme detects tuberculosis by sputum-smear microscopy then administers standard shortcourse chemotherapy under a directly observed therapy approach. WHO’s goal is to identify 70% of patients with positive smears, and to cure 85% of them by the end of 2005. But this tactic, says author Timothy Brewer, is likely to have only a modest effect on population-based tuberculosis control. (excerpt)
Untangling Gordian knots: improving tuberculosis control through the development of “programme theories.”
International Journal of Health Planning and Management. 2004; 19:217-226.We argue that if the lessons from tuberculosis control programmes are to be drawn effectively then a more nuanced understanding is needed that takes account of the complex health system environment within which they sit. We suggest that a conceptual framework that draws upon the World Health Organization’s DOTS strategy can be harnessed to assist the systematic analysis of programmes in a way that links this vertical, disease specific strategy to horizontal health system factors so that comparisons can be made. This multi-disciplinary, multimethod approach to the evaluation builds upon the work of others including Pawson and Tilley and their ‘programmes theories’. This work has informed the application of an evaluation toolkit which has been successfully applied in a number of settings and assisted in the sustainable implementation of a DOTS strategy in Russia. (author's)