An expanded DOTS framework for effective tuberculosis control
Several challenges impede sustainable implementation and expansion of TB control activities. Many of these stem from a weak political will failing to elicit the required health system and societal response to control TB. In view of these challenges and experiences the WHO Stop TB department published "An expanded framework for effective tuberculosis control" in 2002. It emphasizes that:
- Public health services need to enhance their capacity to sustain and expand DOTS implementation without compromising the quality of case detection and treatment.
- Community involvement in TB care and a patient-centred approach need emphasis and promotion to improve both access to and utilization of health services.
- Collaboration and synergy among the public, private, and voluntary sectors are essential to ensure accessible and quality-assured TB diagnosis and treatment.
- The increasing impact of HIV on the incidence of TB especially in Sub-Saharan Africa calls for new partnerships and approaches.
- A surge in drug-resistant forms of TB in the former Soviet Union and several other parts of the world requires effective implementation of the DOTS strategy to prevent occurrence of new multidrug-resistant (MDR-TB) cases as well as measures to cure existing MDR-TB cases.
- Sustaining DOTS programmes will also entail their integration into primary health care and adaptation to ongoing reforms within health sectors worldwide.
The expanded strategy lays equal emphasis on the technical, managerial, social and political dimensions of DOTS. It acknowledges access to TB care as a human right and recognizes TB control as a social good with large benefits to society. It underscores the contribution TB control makes to poverty alleviation by reducing the great socio-economic burden that the disease inflicts on the poor. The expanded framework reinforces the five essential elements of the DOTS strategy and addresses HIV-related and drug-resistant forms of TB.