Community involvement in tuberculosis control: lessons from other health care programmes

Decentralising tuberculosis control measures beyond health facilities by ha rnessing the contribution of the community could increase access to effecti ve tuberculosis care. This review of community-based health care initiative s in developing countries gives examples of the lessons for community contr ibution to tuberculosis control learned from health care programmes. Source s of information were Medline and Popline databases and discussions with co mmunity health experts. Barriers to success in tuberculosis control stem fr om biomedical, social and political factors. Lessons are relevant to the is sues of limited awareness of tuberculosis and the benefits of treatment, st igma, restricted access to drugs, case-finding and motivation to continue t reatment. The experience of other programmes suggests potential for an expansion of b oth formal and informal community involvement in tuberculosis control. Info rmal community involvement includes delivery of messages to encourage tuber culosis suspects to come forward for treatment and established tuberculosis 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 comb ined with a variety of complementary activities: disseminating messages to increase awareness and promote adherence, tracing patients who interrupt tr eatment, recognising adverse effects, and case detection. Programmes should generally take heed of existing political and cultural st ructures in planning community-based tuberculosis control programmes. Polit ical support, the support of health professionals and the community are vit al, and planning must involve or stem from the patients themselves.