Pursue high-quality DOTS expansion and enhancement
Element 1: Political commitment with increased and sustained financing
Clear and sustained political commitment by national governments is crucial if basic DOTS1 and the Stop TB Strategy are to be effectively implemented. Political commitment is needed to foster national and international partnerships, which should be linked to long-term strategic action plans prepared by national TB control programmes (NTPs). Strategic action plans should address technical and financial requirements and promote accountability for results at all levels of the health system; they should include TB-related and other relevant indicators, and - where appropriate - political commitment should be backed up by national legislation.2 Local partnerships with many potential contributors will help improve TB care in terms of access, equity and quality.
Adequate funding is essential. Current resources are inadequate, and further effort is required to mobilize additional resources from domestic as well as international sources, with a progressive increase in domestic funding. The global financing and partnership resources now available for poverty reduction, health systems improvement and disease control offer new opportunities for TB control programmes. Even with adequate financing, critical deficiencies in human resources in the health sector will impede progress in many low- and middle-income countries, especially in Africa. Political commitment is required to support the overall structural and financial changes needed to improve the availability, distribution and motivation of competent health workers. Special efforts, including good strategic planning, will be needed to ensure the availability of adequate and competent human resources for health care in general and TB care in particular.3 4