To document the historical evolution of WHO policies assessed in this paper, a thorough review of WHO documents was done. The search focused particularly on policy publications, such as those of the WHO Expert Committees on Tuberculosis, and other published documents available in the official list of WHO documents. We did a Medline search addressing tuberculosis policy to ensure that relevant papers were identified and analysed. We searched for articles under keywords “Tuberculosis”, “Control”,
ReviewEvolution of WHO policies for tuberculosis control, 1948–2001
Section snippets
The vertical programme (1948–63)
After the Second World War, the discovery of effective chemotherapeutic agents against communicable diseases of public health importance (eg, tuberculosis, leprosy, syphilis, yaws) and insecticides against vectors transmitting infectious diseases (malaria, yellow fever, plague) prompted the building of vertical control programmes, also known as categorical or specialised programmes. Each of these programmes established its own structure staffed with specialised personnel from a central level
Integration of service delivery (1964–76)
The first wave of integration was mainly promoted by tuberculosis experts with a long scientific and programmatic experience in less-developed countries. Madras Chemotherapy Centre indicated the efficacy of home treatment and suggested that tuberculosis hospital beds were no longer necessary to cure the disease. The team also highlighted the efficacy of intermittent regimens, which facilitated the full supervision of isoniazid intake as the companion drug of streptomycin injection, given twice
Integration of managerial functions (1977–88)
The second wave of integration was driven by general public-health experts and primary health care promoters. They set aside managers' reluctance to give up their traditional functions in training, supervision, logistics, and communication. Tuberculosis specialists were confined to providing technical guidance to general health managers. The rationale behind these changes was that, because all programmes operated through the same type of managerial and support activities, integration would make
Return to a specialised managerial approach (1989–98)
The result of the philosophical changes in the guiding concepts of the management of health services and programmes had a staggering effect on tuberculosis control during the 1980s. In 1989, the WHO Headquarters staff devoted to tuberculosis had shrunk to two professionals managing a tiny budget for operations. In most WHO Regional Offices, tuberculosis activities were one of the many responsibilities of a general epidemiologist, and no permanent consultants were posted at country level. The
The resurgence of the integrated approaches (1999–2000)
While the cooperation agencies (mostly governmental agencies) and the ministries of health were planning the expansion of the control programmes after the London Declaration, by the end of 1998 WHO was reorganised. This led to the closure of the Global TB Programme at WHO headquarters. The guiding concept for this decision was to integrate the managerial functions of WHO's separate control programmes. The staff working on tuberculosis were incorporated into various new teams organised to
Post-modern tuberculosis control
The post-modern era began with the creation of a partnership aimed at promoting tuberculosis control as an element for health-system development, a basic human right, and an integral part of poverty alleviation strategies. Thus, the StopTB partnership is working in such a way that governments of endemic countries receive, where needed, the adequate support to fulfil their commitments to tuberculosis control. National organisations and institutions, both public and private, have been enlisted
Conclusions
The history of the managerial policies for tuberculosis control shows that the vertical approaches of the early days did not succeed in less-developed countries. It also shows that the integration waves of the 1970s and 1980s have produced mixed results. However, the experience of the past decade, when tuberculosis control again became a special priority at WHO and elsewhere, suggests that without a wider alliance encompassing public and private sectors, public health academic institutions, and
Search strategy and selection criteria
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2021, Journal of Clinical Tuberculosis and Other Mycobacterial DiseasesCitation Excerpt :However, it was soon noted that success with integrated programs was at best patchy [39]. While successes with integration were observed in immunization, logistics, and laboratory services [25], Pio and Raviglione noted that these were overshadowed by “… failures in key areas of tuberculosis control in many less-developed countries” [25]. In 1978 the WHO Tuberculosis Unit was transformed into a Tuberculosis and Respiratory Diseases Unit with additional tasks but without a commensurate increase in staff and funding.
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