Tuberculosis and health sector reform: experience of integrating tuberculosis services into the district health system in rural South Africa.
METHODS
Hlabisa health district, South Africa.


OBJECTIVE
To describe the integration of a 'vertical' tuberculosis control programme into an emerging 'horizontal' district health system, within the context of health sector reform.


METHODS
Descriptive account of the process of integration of the programme into the health system.


RESULTS
A highly 'vertical' system of delivering tuberculosis treatment (with poor programme outcomes) was converted into a 'horizontal' team, integrated within the district health system, that used available resources such as village clinics and community health workers, with improved programme outcomes.


CONCLUSIONS
In some settings at least, integration of tuberculosis 'programmes' into the district health system as tuberculosis 'teams' is feasible, and may produce highly cost-effective outcomes.
Wilkinson
D
D
South Australian Centre for Rural and Remote Health, University of South Australia-Whyalla Campus, Whyalla Norrie. david.wilkinson@unisa.edu.au
D019033:Delivery of Health Care, Integrated / Q000458:organization & administration / Q000639:trends*; D018166:Health Care Reform / Q000458:organization & administration / Q000639:trends*; D006801:Humans; D010348:Patient Care Team / Q000458:organization & administration / Q000639:trends; D019035:Rural Health Services / Q000458:organization & administration / Q000639:trends*; D013019:South Africa; D014376:Tuberculosis / Q000175:diagnosis* / Q000628:therapy