Weak health systems are hindering global efforts for tuberculosis care and control,
but little evidence is available on effective interventions to address system bottlenecks.
This report examines published evidence, programme reviews, and case studies to identify
innovations in system design and tuberculosis control to resolve these bottlenecks.
We outline system bottlenecks in relation to governance, financing, supply chain management,
human resources, health-information systems, and service delivery; and adverse effects
from rapid introduction of suboptimum system designs. This report also documents innovative
solutions for disease control and system design. Solutions pursued in individual countries
are specific to the nature of the tuberculosis epidemic, the underlying national health
system, and the contributors engaged: no one size fits all. Findings from countries,
including Bangladesh, Cambodia, India, Tanzania, Thailand, and Vietnam, suggest that
advances in disease control and system strengthening are complementary. Tuberculosis
care and control are essential elements of health systems, and simultaneous efforts
to innovate systems and disease response are mutually reinforcing. Highly varied and
context-specific responses to tuberculosis show that solutions need to be documented
and compared to develop evidence-based policies and practice.
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