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Free Content Impact of national consultants on successful expansion of effective tuberculosis control in India

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SETTING: India, during a period of rapid expansion of DOTS services. DOTS expansion has been slow in many countries.

OBJECTIVE: To document use of consultants to expand DOTS effectively.

DESIGN: Staff were contracted to monitor DOTS expansion and implementation. To estimate the impact of these staff, we compared areas with and without consultants, and individual areas before and after consultants were assigned. Consultants were preferentially assigned to the more difficult areas; the temporary absence of consultants reflected non-availability of candidates.

RESULTS: Areas with consultants met pre-defined criteria and began DOTS service delivery faster (median 9 vs. 18 months of preparation) than areas without consultants. Rates of sputum conversion (87% vs. 83%, P < 0.001) and treatment success (83% vs. 78%, P < 0.001) were significantly higher in areas with consultants present.

CONCLUSION: Assignment of consultants resulted in much more rapid implementation of the DOTS strategy, and better quality performance. Continued effective performance in these areas will rely on many factors, but the need for consultants appears to be decreasing, suggesting that they have provided sustainable improvements. The effectiveness of local consultants may have important implications for efforts to scale up public health interventions for tuberculosis, malaria, AIDS and other diseases in developing countries.

Keywords: DOTS; WHO; supervision; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Regional Office for Southeast Asia, World Health Organization, New Delhi, New Delhi, India; NYC Department of Health and Mental Hygiene, New York, New York, USA; and National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 2: Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India; and FIDELIS, International Union Against Tuberculosis and Lung Disease (IUATLD), Paris, France

Publication date: September 1, 2003

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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