Authors: Harries, A.D.¹; Jensen, P.M.²; Zachariah, R.³; Rusen, I.D.⁴; Enarson, D.A.⁴

Source: The International Journal of Tuberculosis and Lung Disease, Volume 13, Number 10, October 2009 , pp. 1194-1199(6)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

Weak and dysfunctional health systems in low-income countries, particularly in sub-Saharan Africa, are recognised as major obstacles to attaining the health-related Millennium Development Goals by 2015. Some progress is being made towards achieving the targets of Millennium Development Goal 6 for tuberculosis (TB), HIV/AIDS and malaria, with the achievements largely resulting from clearly defined strategies and intervention delivery systems combined with large amounts of external funding. This article is divided into four main sections. The first highlights the crucial elements that are needed in low-income countries in sub-Saharan Africa to deliver good quality health care through general health systems. The second discusses the main characteristics of infectious disease and TB control programmes. The third illustrates how TB control and other infectious disease programmes can help to strengthen these components, particularly in human resources; infrastructure; procurement and distribution; monitoring, evaluation and supervision; leadership and stewardship. The fourth and final section looks at progress made to date at the international level in terms of policy and guidelines, with some specific suggestions about this might be moved forward at the national level. For TB and other infectious disease programmes to drive broad improvements in health care systems and patient care, the lessons that have been learnt must be consciously applied to the broader health system, and sufficient financial input and the engagement of all players are essential.

Keywords: health systems; sub-Saharan Africa; TB control programmes; HIV/AIDS; primary health care

Document Type: Regular paper

Affiliations: 1: International Union Against Tuberculosis and Lung Disease, Paris, France; and London School of Hygiene & Tropical Medicine, London, UK 2: RESULTS Educational Fund, Washington, DC, USA 3: Médecins sans Frontières, Medical Department, Operational Research Unit, Brussels Operational Centre, Brussels, Belgium 4: International Union Against Tuberculosis and Lung Disease, Paris, France

Publication date: 2009-10-01

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• 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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