||Hadley M & Mather D
||Community involvement in tuberculosis control : lessons
from other health care programmes
||INTL J TB & LUNG DIS 2000, 4, 401-408
Decentralising TB control measures beyond health
facilities by harnessing the contribution of the community could
increase access to effective TB care. This review of community-based
health care initiatives in developing countries gives examples of
the lessons for community contribution to TB control learned from
health care programmes. Sources of information were Medline and
Popline databases and discussions with community health experts.
Barriers to success in TB control stem from biomedical, social and
political factors. Lessons are relevant to the issues of limited
awareness of TB and the benefits of treatment, stigma, restricted
access to drugs, case finding and motivation to continue treatment.
The experience of other programmes suggests potential
for an expansion of both formal and informal community involvement
in TB control. Informal community involvement includes delivery
of messages to encourage TB suspects to come forward for treatment
and established TB patients to continue treatment. A wide range
of community members provide psychological and logistic support
to patients to complete their treatment. Lessons from formal community
involvement indicate that programmes should focus on ensuring that
treatment is accessible. This activity could be combined with a
variety of complementary activities: disseminating messages to increase
awareness and promote adherence, tracing patients who interrupt
treatment, recognising adverse effects, and case detection.
Programmes should generally take heed of existing
political and cultural structures in planning community-based TB
control programmes. Political support, the support of health professionals
and the community are vital, and planning must involve or stem from
the patients themselves.
|KEY WORDS: COMMUNITY PARTICIPATION; DEVELOPING COUNTRIES;