The local health systems and the care for people with tuberculosis

Tuberculosis control has often been managed as a
simple issue, the belief being that activities to
care for people affected by tuberculosis can be
uniformly standardized and centred on tuberculosis
diagnosis and treatment. It is undeniable that
this approach has been successful in re-organizing
unstructured national tuberculosis (TB) control
programs. Today, many countries programs are better
organized and have reached good case detection and
cure rates. There are arguments to enlarge the scope
of activities to care for people affected by TB
beyond the classical standardized strategies for
diagnostic and treatment of tuberculosis. Indeed, it
has become widely accepted that to increase further
coverage of TB diagnosis and treatment, it is
necessary to address the economic and psychosocial
problems of people affected by tuberculosis,
particularly for those having the least access to
and worse quality of care. This will be possible
only if, in addition to the current approaches,
customized care can be developed taking into account
the complex nature of care organisation as part of
local systems.