title: Knowledge and perceptions of national and provincial tuberculosis control programme managers in Pakistan about the WHO Stop TB strategy: a qualitative study.
abstract: OBJECTIVE
  To understand how national and provincial tuberculosis programme managers in Pakistan perceive and engage with the Stop TB strategy, its strengths, weaknesses and their experience in its implementation. National and provincial tuberculosis programme managers play an important role in effective implementation of the Stop TB strategy.
  
  
  METHODS
  A qualitative interview study was conducted with 10 national and provincial tuberculosis programme managers to understand how they perceive and engage with the Stop TB strategy, its strengths, weaknesses and their experience in its implementation. Managers were selected purposively; 10 managers were interviewed (six national staff and four from provincial level).
  
  
  METHODS
  National and provincial tuberculosis programme managers in Pakistan. Managers were selected purposively; 10 managers were interviewed (six national staff and four from provincial level).
  
  
  METHODS
  National and provincial tuberculosis programmes in Pakistan.
  
  
  METHODS
  1. Knowledge and perceptions of national and provincial tuberculosis programme managers about the Stop TB strategy 2. Progress in implementing the strategy in Pakistan 3. Significant success factors 4. Significant implementation challenges 5. Lessons learnt to scale up successful implementation.
  
  
  RESULTS
  The managers reported that most progress had been made in extending DOTS, health systems strengthening, public -private mixed interventions, MDR-TB care and TB/HIV care. The four factors that contributed significantly to progress were the availability of DOTS services, the public-private partnership approach, comprehensive guidance for TB control and government and donor commitment to TB control.
  
  
  CONCLUSIONS
  This study identified three main challenges as perceived by national and provincial tuberculosis programme managers in terms of implementing the Stop TB strategy: 1. Inadequate political commitment, 2. Issue pertaining to prioritisation of certain components in the TB strategy over others due to external influences and 3. Limitations in the overall health system. To improve the tuberculosis control programme in the country political commitment needs to be enhanced and public -private partnerships increased. This can be done through government prioritisation of TB control at both national and provincial levels; donor-funded components should not receive undue attention; and partnerships with the private health sector, health institutions not yet covered by DOTS services, non-governmental organisations and patient coalitions should be increased.
authors.affiliation: University of Bath, Bath BA2 7AY, UK.
authors.forename: Wasiq Mehmood
authors.initials: WM
authors.lastname: Khan
authors.affiliation: Liverpool School of Tropical Medicine, Merseyside L35QA, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Smith
authors.affiliation: Government of Pakistan Ministry of Health, Islamabad 44400, Pakistan.
authors.forename: Ejaz
authors.initials: E
authors.lastname: Qadeer
authors.affiliation: Imperial College London, London W6 8RP, UK.
authors.forename: Sondus
authors.initials: S
authors.lastname: Hassounah
keywords: Stop TB strategy; health system; managers; perception; tuberculosis