The Local Health Systems and the Care for People with Tuberculosis: Documenting complexity and acting on local systems from Nicaragua

Macq, Jean [UCL]

Tuberculosis control has often been managed as a simple issue, the belief being that activities to care for people affected by tuberculosis can be uniformly standardized and centred on tuberculosis diagnosis and treatment. It is undeniable that this approach has been successful in re-organizing unstructured national tuberculosis (TB) control programs. Today, many countries¿ programs are better organized and have reached good case detection and cure rates. There are arguments to enlarge the scope of activities to care for people affected by TB beyond the classical standardized strategies for diagnostic and treatment of tuberculosis. Indeed, it has become widely accepted that to increase further coverage of TB diagnosis and treatment, it is necessary to address the economic and psychosocial problems of people affected by tuberculosis, particularly for those having the least access to and worse quality of care. This will be possible only if, in addition to the current approaches, customized care can be developed taking into account the complex nature of care organisation as part of local systems.