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Structure and management of tuberculosis control programs in fragile states--Afghanistan, DR Congo, Haiti, Somalia

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Listed:
  • Mauch, Verena
  • Weil, Diana
  • Munim, Aayid
  • Boillot, Francois
  • Coninx, Rudi
  • Huseynova, Sevil
  • Powell, Clydette
  • Seita, Akihiro
  • Wembanyama, Henriette
  • van den Hof, Susan

Abstract

Objectives Health care delivery is particularly problematic in fragile states often connected with increased incidence of communicable diseases, among them tuberculosis. This article draws upon experiences in tuberculosis control in four fragile states from which four lessons learned were derived.Methods A structured inventory to extract common themes specific for TB control in fragile states was conducted among twelve providers of technical assistance who have worked in fragile states. The themes were applied to the TB control programs of Afghanistan, DR Congo, Haiti and Somalia during the years 2000-2006.Results Case notifications and treatment outcomes have increased in all four countries since 2003 (treatment success rates 81-90%). Access to care and case detection however have remained insufficient (case detection rates 39-62%); There are four lessons learned: 1. TB control programs can function in fragile states. 2. National program leadership and stewardship are essential for quality and sustained TB control. 3. Partnerships with non-governmental providers are vital for continuous service delivery; 4. TB control programs in fragile states require consistent donor support.Conclusion Despite challenges in management, coordination, security, logistics and funding, TB control programs can function in fragile states, but face considerable problems in access to diagnosis and treatment and therefore case detection.

Suggested Citation

  • Mauch, Verena & Weil, Diana & Munim, Aayid & Boillot, Francois & Coninx, Rudi & Huseynova, Sevil & Powell, Clydette & Seita, Akihiro & Wembanyama, Henriette & van den Hof, Susan, 2010. "Structure and management of tuberculosis control programs in fragile states--Afghanistan, DR Congo, Haiti, Somalia," Health Policy, Elsevier, vol. 96(2), pages 118-127, July.
    • Handle: RePEc:eee:hepoli:v:96:y:2010:i:2:p:118-127
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    References listed on IDEAS

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    1. Reilley, B. & Frank, T. & Prochnow, T. & Puertas, G. & Van Der Meer, J., 2004. "Provision of health care in rural Afghanistan: Needs and challenges," American Journal of Public Health, American Public Health Association, vol. 94(10), pages 1686-1688.
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    Cited by:

    1. Thomas K. Dasaklis & Costas P. Pappis, 2018. "Critical success factors for implementing cholera vaccination campaigns in humanitarian emergencies: a DEMATEL-based approach," EURO Journal on Decision Processes, Springer;EURO - The Association of European Operational Research Societies, vol. 6(1), pages 1-20, June.
    2. A Sanaie & C Mergenthaler & A Nasrat & M K Seddiq & S D Mahmoodi & R H Stevens & J Creswell, 2016. "An Evaluation of Passive and Active Approaches to Improve Tuberculosis Notifications in Afghanistan," PLOS ONE, Public Library of Science, vol. 11(10), pages 1-12, October.
    3. Laura Martin & Jorge Coronel & Dunia Faulx & Melissa Valdez & Mutsumi Metzler & Chris Crudder & Edith Castillo & Luz Caviedes & Louis Grandjean & Mitzi Rodriguez & Jon S Friedland & Robert H Gilman & , 2014. "A Field Evaluation of the Hardy TB MODS Kit™ for the Rapid Phenotypic Diagnosis of Tuberculosis and Multi-Drug Resistant Tuberculosis," PLOS ONE, Public Library of Science, vol. 9(9), pages 1-8, September.

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