title: Strong general health care systems: a prerequisite to reach global tuberculosis control targets.
abstract: We argue that tuberculosis control cannot reach its proposed global targets without investment in an adequate network of accessible, effective and comprehensive health services. Lessons from the past are reviewed. They underscore that passive case-detection and adequate case management is the central technical strategy for tuberculosis control. There is no compelling evidence to support active case-detection in the general population. We elaborate on why a strong health care system is a prerequisite in the framework of case-detection and treatment. The necessity to improve quality and accessibility of general health services for ensuring early detection and subsequent cure is demonstrated. It is argued why the need for strong public health care system becomes even more eminent in the light of the tuberculosis/HIV dual epidemics and of the rapid growth of unregulated private-for-profit services. We finally examine the financial gaps for tuberculosis control and discuss the need for allocating more resources to the strengthening of general health care systems.
authors.affiliation: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. ymahendradhata@itg.be
authors.forename: Yodi
authors.initials: Y
authors.lastname: Mahendradhata
authors.forename: Marie-Laurence
authors.initials: ML
authors.lastname: Lambert
authors.forename: Armand
authors.initials: A
authors.lastname: Van Deun
authors.forename: Francine
authors.initials: F
authors.lastname: Matthys
authors.forename: Marleen
authors.initials: M
authors.lastname: Boelaert
authors.forename: Patrick
authors.initials: P
authors.lastname: van der Stuyft
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D003140:Communicable Disease Control / Q000458:organization & administration; D003695:Delivery of Health Care / Q000458:organization & administration*; D017598:Efficiency, Organizational; D014943:Global Health; D006801:Humans; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000995:Antitubercular Agents