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.