Posted on 18 October 2016
CGHH Research Fellow Dr Margaret Jones has recently published 'Policy Innovation and Policy Pathways: Tuberculosis Control in Sri Lanka, 1948–1990' in the latest issue of Medical History (60: 4, 2016).
Tuberculosis is one of the world’s major killers. This article examines the attempts to control tuberculosis in Sri Lanka in the decades after independence in 1948. It focuses particularly on the implementation in 1966 of a World Health Organization model of community oriented tuberculosis control that sought to establish a horizontally structured programme through the integration of TB services into the general health services. The objective was to create a cost effective method of control that relied on a simple bacteriological test for case detection; and for treatment to be available at the nearest health facility. The intention was to take TB services to the rural areas where specialist TB services were lacking. In the late 1940s and early 1950s Sri Lanka had already established a specialist control programme composed of chest clinics, mass X-ray, inpatient and domiciliary treatment, and the provision of social assistance for sufferers and their families. This programme had succeeded in reducing mortality and enhancing awareness of the disease and with its extensive network of primary health care agencies Sri Lanka thus seemed to have the ideal environment to successfully implement the WHO TB control model. Using WHO archives and Sri Lankan sources a detailed exploration of the implementation of this programme, however, highlights the problems in trying to impose the WHO internationally devised model onto the existing structure of TB control already operating in Sri Lanka. One significant hindrance to the WHO approach was lack of resources once the WHO had pulled out but equally as important in the Sri Lankan context was the existing medical and patient culture that militated against its general acceptance.
You can access this Open Access article via Medical History's website.