i want to participate in this forum because it will give me the opportunity to meet people who will

come together to explore the key issues facing this generation, and determine our role in
implementing the Global Goals. As young people will be the ones living with the decisions made
today, we should help shape them. this forum will offer platforms for collaboration to ensure that
the voice of young people is heard on the international stage. we can discuss together, openly and
frankly, the many realities, challenges and opportunities. to work together and build a future that
embraces and empowers all young people. besides, i want to participate in genuine, informed
discussions on issues critical to health and prosperity, and then share our agreed priorities and
recommendations with policy makers at the highest levels. we can also have a brilliant time
engaging with peers of different cultures from across the world. Youth Forum plays an important
role in strengthening youth advocacy and engagement efforts. It is also a time for the young people
to come together, share knowledge, and benefit from the rich diversity. It is where the next 15 years
of global development, and beyond, will be discussed through a youth lens and in a way that
involves and recognises the capabilities of young people to play an important part.

 You can do the work and deliver exceptional results

 You will fit in beautifully and be a great addition to the team

  You possess a combination of skills and experience that make you stand out from
the crowd Industry experience
 Experience in performing certain tasks or duties
 Technical skills
 Soft skills
 Key accomplishments
 Awards/accolades
 Education/training
 “From the experience, my empathy when dealing with patients is quite different. I
always look at my patients from that angle I was in. Having been to that other side, I
am always very polite and compassionate to them,” a joyful Dr Mungai says.
 “My message to TB patients is that it’s curable.
 He believes he acquired the disease from his regular interaction with TB patients in
the wards and calls on everyone working in hospitals and clinics to be cautious while
at the same time maintaining professionalism to avoid discrimination to the patients.
 He concludes with a message to the public that TB patients need a lot of support from
the family and the society at large in the form of encouragement, prayer, nutrition,
finances to travel and pick their medication. When looking after a patient one is
supposed to have protective gear in terms of a mask and the patient also needs to
understand it is their loved ones taking precaution of not acquiring the disease by
putting on the mask.
i am a doctor (GP) within more than 4 years experience working on rural area in south
sumatera. i have both combination of skills and experience that make me understand the
underlying problems of health care in my country. The inequalities in Indonesia comes from
many reasons, one of them is those people who live in rural locations are poor. Incomes of
those who live in the city still much higher than the rural incomes, this leads to many poorer
health outcomes in many ways. I hold the basic beliefs that rural communities have the right
to access medical and health services locally and that the resident GP is the key provider and
coordinator of those services. by joining IDYF 2019, I believe that i can strengthen the
foundation of my workplace as in rural area; i will embrace the future and be part of shaping
the workforce that delivers best health services. I also have been working with Tuberculosis
issues. These were endorsed by all countries and became the focus of national and
international development efforts. i can share my point of view on how the overall goal to
End the global TB epidemic, and targets for reductions in TB deaths and cases.

idyf.inquiry@gmail.com

The Tuberculosis Accelerated Response and Care (TB ARC II) activity, is a five-year USAID funded
project, supporting the National TB program to reduce the TB burden. The Centre for Health
Solutions – Kenya is the lead implementing partner and together with other partners are supporting
the development of a medical surveillance policy targeting Health Care Workers and full
implementation of infection prevention and control interventions across all counties in Kenya.

Rural GPs will remain the entry point for the health system and will continue to provide the first and
often last port of call for many rurals. i want to provide a sense of certainty for a voice for rural
communities especially from a helathcare provider point of view.

Option 2 -What is the problem related to “international development” you are motivated to
solve? Please write as specific as you can. (10-50words)
How do you think you can solve the problem mentioned above? Identify the stakeholders and
offer the best solution you can think of. (300 words)
we have to provides the workforce to enhance the health and wellbeing of rural communities.

I believe that:

*Sustainable rural communities need sustainable rural health services

*Every person living in rural and remote has a right to have access to a general practitioner (GP)

*GPs are the cornerstone of rural health services in

*It is crucial that the GP workforce is capable, competent and confident

*Excellent primary health service needs a workforce of doctors, nurses, midwives and allied health
professionals working together
what we have to do are:

* Acts with transparency and integrity

* Makes decisions in a timely and fair way

* Forms partnerships to enrich and improve rural health services such as local goverment

*Responds to the individual needs of its constituents as well as corporate and community needs

*Fosters innovation in rural health services

Our job is to make sure we have the right people in the right places able to deliver health services to
the people who live there. Health services and hospitals aren’t just about getting a service when you
need it. For people who live and work in rural it is about having a confidence that your community is
strong and stable. Access to healthcare is fundamental when rural people measure their worth and
the wellbeing of the area. Since our inception we have built a knowledge base which gives us an
intimate understanding of not only the workforce but the communities they live in and visit. This is
invaluable when we are matching workforce to service models for particular communities. it is
important role sharing of our knowledge and a capability to translate policy into programs,
programs into services and services into actions that meet local needs while pursuing the equity that
rural towns and rural people deserve. We partner with other rural service providers, training
organisations, Local Community Controlled Health Services, insurance and State jurisdictions often
providing the conduit that facilitates solutions. We have a capacity to interpret the needs of local
communities while ensuring that they remain strong and independent.

1. Dalam tidak lebih dari 300 kata, beri tahu kami tentang waktu ketika
Anda menggunakan keterampilan kepemimpinan Anda untuk mencapai hasil yang
sukses, idealnya terkait dengan pembuatan kebijakan.
Pengaruh dan kepemimpinan, membentuk dan mempromosikan perilaku positif,
keterlibatan dan keterampilan mempengaruhi, termasuk bagaimana Anda
menginspirasi orang lain untuk terlibat dan mencapai hasil, hasil atau
perubahan yang memiliki skala dan dampak.

What are policies in healthcare?

Healthcare Policies. Health policy refers to decisions, plans, and actions which were
undertaken to achieve specific health care goals within a society. ... They may cover topics
of financing and delivery of healthcare, access to care, quality of care, and health equity.

What is the major purpose of health policy?

Health policy refers to decisions, plans, and actions that are undertaken to achieve specific
health care goals within a society. An explicit health policy can achieve several things: it
defines a vision for the future which in turn helps to establish targets and points of reference
for the short and medium term.

What are the five stages of the policy making process?

Howlett and Ramesh's model identifies five stages: agenda setting, policy formulation,
adoption (or decision making), implementation and evaluation. Let us briefly examine each
of these stages.Oct 11, 2013
2. Tidak lebih dari 300 kata, beri tahu kami tentang perubahan global yang
ingin Anda saksikan dan bagaimana Anda akan menggunakan pembuatan kebijakan
untuk mencapai hal ini. Jelaskan dampak yang akan ditimbulkan secara global
dan pada negara tempat tinggal mereka, gunakan jawaban ini untuk
menunjukkan pemahaman tentang bagaimana peluang kebijakan terjadi, jelaskan
bagaimana mereka akan terlibat dalam membuat perubahan kebijakan terjadi
dan bagaimana ini akan berdampak, baik negara tempat mereka tinggal dan
internasional.

The Role of Public Health in Ensuring Healthy Communities

 Date: Jan 01 1995

 Policy Number: 9521(PP)


Key Words: Community Health Programs

I. Statement of Problem and Purpose of Position Paper

Discussions of health care reform in the United States largely overlook the importance of
public health principles and the roles of public health agencies in maintaining and improving
the public's health. This statement is intended to identify these principles and roles and to
clarify their relationship to personal health services and other health activities provided by the
private sector.

II. Introduction
Society must create and maintain the conditions under which members of the community can
be healthy. The responsibility for maintaining and improving the public's health lies with all
sectors of society.

Society's efforts have been carried out through a combination of the personal health care
(sometimes called "medical care") and public health systems. Through the activities of both
private and governmental health care providers, organizations, and institutions, the personal
health care system provides primarily curative services, such as treating illnesses and injuries,
to individuals with relatively little attention to prevention. The financing of these services
comes from the out-of-pocket payments of patients, private health insurance, and
government.

However, to enhance and maintain the public's health, preventive programs and activities are
needed. The public health system focuses on prevention through population-based health
promotion-those public services and interventions which protect entire populations from
illness, disease, and injury-and protection. The primary providers of these public health
services are government public health agencies. Public health agencies in communities
throughout the United States are responsible for protecting, assessing, and assuring
individual, community, and environmental health. These agencies build partnerships and
often provide or coordinate direct services to ensure that there is access to adequate health
services in a community. Public health agencies have particularly played this role in efforts to
reduce the toll from illness, injury, and environmental and other risks. They have also directly
taken on the challenges of addressing the health care service needs of the most vulnerable and
at-risk. Public health agencies meet obligations to their communities in many different ways:
by fostering a wide range of policy-guided community initiatives to promote health and
improve health conditions; through the collection, monitoring, and dissemination of
information about health status and disease occurrence; through the direct provision of
service in the community and in the home; and through community education. Another role
public health agencies play is to regulate sources of risk and promote health and safety
practices such as by licensing restaurants and health facilities, and regulating water and air
quality.1

Public health tasks are carried out primarily by governmental health and environmental
protection agencies at local, state, and national levels. Some non-governmental organizations
and private individuals perform public health activities in cooperation with or at the request
of government agencies. Frequently, the government agency provides either financial or
technical assistance. Because government functions as a representative of the people and
needs to be responsive to them, the ultimate responsibility for public health activities must lie
with government agencies.

Non-governmental organizations carry out many useful activities. However, only government
agencies derive their authority from the entire community, locality, and nation and are
therefore accountable to the entire public. Public health agencies, even while being cost
conscious, are in principle not constrained by profit motives nor by agendas other than that of
the public's health.

Since 1900, American life expectancy at birth has increased from 45 to 75 years. Much of
this 30-year increase is the result of actions by the public health system and improvements in
living conditions such as better sanitation, the provision of clean drinking water and safe
food, and the elimination of occupational and worksite hazards.2 The major health problems
we face today-workplace and environmental hazards, tobacco-induced illnesses, drug abuse,
HIV (human immunodeficiency virus), poor nutrition, low birthweight infants, sedentary
lifestyles, injuries, especially from violence-call for policy-guided population-based public
health interventions. Coronary heart disease, stroke, diabetes, and certain cancers are the
result of environmental, occupational, or social conditions that have been responsive to public
health interventions. Morbidity associated with some of these chronic diseases can be
controlled or eliminated by public health activities.3

Public health interventions focus on the health needs of the entire population or population
groups. Personal health care providers have little incentive to consider population-based
services, although they may provide individual clinical preventive care. Even with increased
attention to the provision of clinical preventive services by managed care organizations and
others, the clinical preventive services provided will often be those with short-range,
immediate payoffs. Moreover, populations most at risk for increased morbidity and mortality
may be least likely to receive these clinical preventive services because of financial and non-
financial barriers. Public health addresses these issues through outreach, health education,
transportation and translation services, and culturally sensitive provision of services. These
are provided by the public health system.

Personal health care can help heal injuries, alleviate disorders, and treat many diseases, but it
is public health programs that prevent the onset and spread of disease and diminish the
likelihood of injury. Yet, the vast bulk of health spending in the United States is in the
personal health care system; public health programs are funded by a very small and
decreasing portion of health expenditures, with the result that society is not provided with all
the public health services necessary to maintain the public's health.3 If the public's health is to
be assured, the content of all activities must be altered to focus more on disease and injury
reduction and on health protection and promotion-that is, on how the public health system
supports the public's health.

The activities within the public health and personal health care systems must be integrated
and coordinated. A better job of integration and coordination needs to occur within each of
these systems as well as between them. 4

III. Functions of Public Health Agencies

The public health system forges community partnerships and community action, providing
leadership for the integration and coordination of the personal health care and public health
systems. Health departments and agencies can be objective, are publicly accountable, and
have legal responsibility for those in their geographical jurisdictions. Improving and
maintaining the public's health also requires a concern for social, economic, and
environmental hazards that few individuals can avoid without strong governmental protective
action. Prevention of the health consequences of workplace hazards, polluted air and water,
and contamination of the food supply requires government action and intervention, as only
government has the legal authority to require action. In order to understand the risks and
health status of populations, data and surveillance systems must be maintained and improved.
The monitoring of health hazards, including newly emerging diseases, and the creation of
standards of protection are important functions of public health agencies. Public health
laboratories, other facilities, and the tools for carrying out health hazard appraisals are crucial
for maintaining the critical surveillance systems. Public health research allows scientific
advancement in protecting the public's health. Many local health agencies have experience in
working with their communities to develop public policies, plan improvements, implement
new interventions, and translate research into community-appropriate programs.

Within the public health system, governmental health agencies have a legal and constitutional
responsibility for protecting the health of the public.1 These agencies should be encouraged to
extend their present authorities to include a role in the coordination of public and personal
health care systems. The participation of these agencies in such activities should result in the
health care system placing greater emphasis on disease prevention and health promotion.

Historically, most health agencies have not been able to act consistently upon such a broad
interpretation of their role, nor have they been funded to do so.1 Public health functions are
usually divided among several government agencies, e.g., those dealing with environmental
hazards, those dealing with mental health, those assuring the provision of personal health care
for low income persons, and those providing other public health services. This results in
fragmentation of services.

To meet their goals, health agencies must first assess the state of health of their communities,
identify variations in health status, and analyze the factors responsible for poor health.
Interventions then must be designed to address these factors. To do so requires a three-
pronged approach: developing appropriate social and public policies; developing community-
based prevention activities; and assuring the delivery of comprehensive and high-quality
personal preventive services. The social and public policies will need to ensure adequate food
and shelter, clean air and water, and protection from workplace hazards. Community-based
health promotion programs must be planned with the participation of the community to
address its priority areas. Personal preventive services should be part of comprehensive care
and meet the standards developed by the U.S. Preventive Services Task Force.

Rapid changes in the organization and delivery of personal health services, specifically the
growth of for-profit medical care and managed care organizations, affect access for
vulnerable populations, the health outcomes of the general public, and the activities and
abilities of local public health agencies to operate. Public health agencies have a critical new
role to play in overseeing these changes in the organization and delivery of services, assuring
capacity to care for all populations, monitoring, evaluating, and improving quality, and
understanding the relationship between changes in health services delivery and the public's
health. Finally, the effectiveness of these solutions must be reviewed and modified in the
light of what was learned.

Government health agencies will need to develop comprehensive plans working

collaboratively with the community, social agencies, and the personal health care system,
including both the public and private sector.

Public Health Agency Roles:

Public health functions and agencies exist on the federal, state and local levels. The division
of responsibilities and authority varies considerably by state. Nevertheless, at each level of
government, the public health agency is responsible for the following essential health
services:

 collecting and analyzing health status and utilization information;

 developing policies and policy recommendations to maintain and protect the public's
health by building upon the data and its analysis and responding to community
values;
 informing the public and policy makers of its analysis and recommendations;
 working to develop consensus on needed action; and
 making sure that necessary public health and personal health services are provided to
all.

The agency must have sufficient capacity and financial support to carry out these functions.
The Federal Government's Role is to:

 provide leadership, technical assistance, and funds for the nation;

 create national standards as needed and a national framework for their
implementation;
 assure national data, monitoring, and surveillance systems; and
 engage in research and epidemiological studies.

National funding can provide resources necessary for improving the public's health as well as
assurance of equity across all the states, so that a person's health doesn't suffer because of his
or her place of residence. Past federal funding has concentrated on categorical programs
intended to deal with specific problems. Some of these programs have been very important
and successful.

However, categorical programs are competitive and not available to all communities.
Reliance on such single-focus programs for financing has sometimes left public health
agencies with insufficient resources to deal with health threats not included in those
categorical programs, and little funding for broad health promotion and prevention efforts.
Broader funding, such as a general operations budget, is necessary at all levels to provide the
public health system with ongoing capacity to monitor, anticipate, and respond to health
problems.

Public health services should be considered part of the social safety net which is the
responsibility of government to provide for all people. Stable funding is also necessary. One
way of ensuring stable funding is by requiring organizations and institutions paying for
personal health services to support public health in proportion to the amount they spend on
personal health care.

State governments have carried a major responsibility for governmental health activities. The
scope of these activities, and the organizational entity within the state government
responsible for them, varies from state to state. Variation among the more than 3,000 local
public health agencies is even greater.1 They range from large autonomous comprehensive
agencies in some major metropolitan areas to small agencies primarily in rural areas. Several
political jurisdictions may be served by a jointly sponsored multi-county or city-county
agency. The relationship of these agencies to their state agencies is complementary, and
varies widely. The local health agency's scope of programs is generally more limited than the
state's and the extent of its autonomy varies, although local health agencies remain the point
of service for most public health programs and functions.

IV. Action by the Public Health Community

APHA and the public health community should encourage and assist in:

1. Defining the role of the government with respect to health and strengthening the role
of federal, state, and local health agencies.

A stronger government health system which ensures the provision of essential public health
services and works actively with the personal health system to promote and protect health
will result in improved health and cost efficiency across the nation.

The federal government must:

 provide standards and guidelines;

 conduct research and disseminate its findings;
 ensure equity across states; and
 develop priorities for the nation.

Federal, state, and local public health agencies must:

define standards for public health that improve the overall health of the population and
provide strategies for achieving greater health system efficiency and effectiveness;

 promote the most efficient methods of public health action based on the political and
health traditions of each particular state or locality;
 have a specific role in monitoring health effects and advising policy makers on the
effectiveness of programs in meeting health objectives;
  develop innovative and effective public health programs supported by research-driven
questions that are directly applicable to meeting public health needs and by evaluation
studies which provide support for program planning and quality improvement;
 be funded at the several levels necessary for performance of their responsibilities; and
 provide leadership for the creation of comprehensive health records and mechanisms
which assure shared utilization of data by private and public sector providers and by
community-based groups so as to facilitate: disease surveillance and assessment of
progress toward meeting prevention goals, evaluation of utilization patterns, quality of
personal health services practices and health outcomes, and the identification of gaps
in health care access.

1. Establishing a leadership role for the public health community in decisions that shape
the personal health care system and models of health care delivery.
2. New ways of making policy and of organizing the purchase and delivery of personal
health care are needed, and public health officials should have a major role in
developing them to ensure health promotion and prevention. This requires a central
role in the allocation of capital resources and in ensuring the adequacy of the primary
care infrastructure and the distribution of adequate primary care personnel to currently
underserved areas.
3. State and regional health planning should draw together the public and private sectors
in a collaborative model that is publicly accountable. State and local health agencies
should articulate the division of labor between agencies. State and local health
agencies should collaborate with purchasers and providers of personal health care and
with community-based organizations representing ethnic and other minorities,
women, and vulnerable groups to assure that health plans and health delivery are
culturally sensitive and are appropriate to meet population needs. Working with the
private sector, public health agencies must define standards to ensure high quality
services are provided to all populations, and encourage a phased redistribution of
resources from illness to preventive care with targets and timelines.

Existing models need to be utilized and new models need to be developed that go beyond the
provision of personal health care to enhance the health status of populations. These models
require particular emphasis on culturally sensitive personal health delivery systems. One such
model is Community-Oriented Primary Care (COPC), which designs and evaluates
community health interventions as an integral part of the provision of primary medical care.
Many community migrant health centers and other models of integrated practice have
developed COPC practices in which personal health services and public health interventions
are combined in one organizational model. Such programs have great potential to develop
more effective health promotion, social support, and personal health care approaches to all
populations.5-9

Even when there are no financial barriers to care, private providers may not meet the needs of
all residents or provide the special services and expertise required by high risk populations
that are now offered by many public health programs and agencies. Local public health
agencies and other community-based organizations may therefore need to continue to serve
the needs of these persons, in addition to the agencies' broader role in the health care system
as a whole. Particular attention must be paid to assure personal health care for indigent
persons not eligible for Medicaid.
V. Methods of Implementation
APHA should play an active role in:

1. Educating public health workers, public and private sector policy makers and leaders,
health service payers and providers, and the general public about essential public
health functions to be performed by federal, state, and local governments and the
private sectors, and their implementation and effectiveness around the nation.
2. Encouraging the training of public health professionals to participate in influencing
public policy.
3. Encouraging academic health centers to emphasize the teaching of concepts, skills,
and attitudes about prevention and coordination to students of the health professions
and research to document the cost effectiveness of prevention.
4. Providing technical assistance and encouragement to public health workers to actively
participate in national and state health reform efforts, articulating the appropriate role
for public health in such efforts.
5. Advocating funding for essential public health services.
6. Advocating a strong infrastructure that will be capable of implementing the roles and
responsibilities described in this position paper.

THE POLICY-MAKING PROCESS

INTRODUCTION:

A policy is a set of rules governing a community to achieve a desired outcome. It directs

actions and decisions towards certain goals to have the best results. A policy is important in
order for individuals to live in harmony within the community.

As nurses, it is our duty to be advocates not only for our patients, but also to the public in
general. We must know and be familiarized that there are existing regulations or policies that
may act as an obstruction or opposing our views. To be successful advocates, we should
understand these factors so that we may be able to apply or use them properly.

BODY:

Being advocates, it is essential to have a clear understanding of how the policies are being
developed. This is done in order for us to participate in the process. A policy undergoes
different processes before it is carried out by the government. Each phase is equally
significant as the next. These key stages include:

Problem identification and agenda setting. This is the first step in making a policy. It
involves recognizing existing problems, carefully examining those problems and its causes,
and doing extensive research and brainstorming of different ideas to find the possible
interventions or solutions. Once it has being identified, a list of prioritized plans will be done.
This generally happens when a group of people require government action to an issue(s), or
when the public do not agree on the processes in addressing certain problems.

Policy formation. There are several potential ways to solve a certain problem so
brainstorming is required in formulating a policy. In this process, policy makers come up
with new methods of solving the identified problems. People from the legislature and
bureaucracy are involved in the process. Among these processes are:
 1. Organize the policy process. In this process, policy makers decide how to manage
the development process that will classify the policy’s structure, its major goals, and
its priority components. In here, planning of people or groups involved in the process
is also recognized.

B. Identify the main problems. This step in policy-making requires skilled people from
different departments to take part in the analysis and give suggestions on what actions
to make in order for the problems to be addressed appropriately. After they have come
up with a proposal, discussion is then made for them to have a unanimous
recommendation to the government.

C. Make a detailed situation analysis. In this process, there is a need to look at the
identified problems more closely and its causes to pinpoint possible interventions,
planning what are the things that need to be done first, selection of most appropriate
strategies to the desired result is made, and sets a baseline for monitoring and
evaluation.

D. Set goals and objectives for a national health policy. After the existing problems
have been identified, setting of attainable as well as realistic goals and objectives are
done and planning of suitable approaches towards addressing the main problems is
made. An example of this may be the need for accessible essential drugs for everyone
in the community. Based on the given example, one possible objective would be to
make the drugs affordable and increase the supply of medicines especially in remote
areas.

E. Draft the text of the policy. Once systematic analyses of the main objectives, goals
and methods have been made, a draft of the text is arranged. It must contain the
overall aim of the policy. Mostly, necessary drugs are guaranteed accessible, safe, and
of high quality to the residents. The specific goals should also be discussed. With
regards to healthcare, a draft outline of the plan of the national drug policy must be
arranged. It must establish the broader purpose of the policy. In general, this is to
make sure of the availability, dependability, efficiency, and of high quality of vital
drugs for the individuals in the community.

F. Circulate and revise the draft policy. After the text of the policies have been
drafted, they must be disseminated to all the people concerned, primarily within the
ministry of health, then in other departments, and lastly to significant organizations
and institutions outside of the government in order for them to give their insights or
critics. After an extensive discussion of the draft policies is done, they are then edited
and finalized based on the suggestions or critics of the different organizations.

Adoption. Following a variety of presented plans, one policy is acknowledged by the

decision-makers. The adoption of a policy takes place when the Congress passes legislation.
Policy adoption requires a lot of time in that a series of processes are made in order to come
up with a complex policy.

Policy implementation. In this stage, the policy is translated into action. It entails circulation
of the facts about the adopted policy and implementing it. Checking of financial resources is
important to correspond with the plans and interventions that will be implemented. This step
also requires proper communication and cooperation to be successful in applying the policy.
Policy monitoring and evaluation. This is the last step of policy-making wherein the policy
is being examined and analyzed if it is really addressing the problem being identified and if
the goals and objectives were met. In here, people scrutinize the process and the outcomes of
the policy. This stage is an ongoing process and may be a basis for modification in the
agenda, policy formation, or its implementation.

CONCLUSION:

Policy-making is then a cyclical and continuous process, with many people being involved in
the course of action. The process of creating and adopting laws takes lots of time, and of
course, budget. Everyone is influenced by policies in the health care system everyday thus it
is important to review them daily so that public’s safety and well-being is assured. As nurses
work hand in hand with the clients and their families, primarily they are the ones to assess if
the health care system is effective or not in dealing with the needs of the clients.

MSF

In the Medicine and Health Policy item by Dinesh Sharma about practical challenges in the
implementation of the directly observed treatment, short-course (DOTS) strategy for tuberculosis
control (Apr 3, p 1122),
1

Rowan Gillies, President of Médecins Sans Frontières (MSF) International, criticises the DOTS
strategy as an approach that “is not good enough because of its over-emphasis on patients with
smear-positive pulmonary tuberculosis.” He claims that “many people with active tuberculosis are
excluded”, including smear-negative patients and patients who have previously been treated under
non-DOTS regimens.

WHO is very appreciative of the work of MSF and the many other partners involved in global
tuberculosis control, and takes seriously comments on improving implementation of the DOTS
strategy. At the beginning of its implementation in the early 1990s, there was, as Rowan Gillies
indicates, an emphasis on providing free treatment to patients with sputum smear-positive
pulmonary tuberculosis. This emphasis was justified by the need, in the face of severely constrained
resources, to achieve the greatest public health effect through detection and cure of the most
infectious cases. However, rising availability of resources for tuberculosis control has lessened the
need to prioritise resources for the detection and cure of infectious patients over non-infectious
patients. Therefore, there is now a global emphasis on ensuring that all tuberculosis patients
(irrespective of infectivity) have access to the international standard of care.

WHO policies
2

provide clear guidance on the management of all categories of tuberculosis patients (adults and
children, new and retreatment cases, sputum smear-positive and smear-negative, pulmonary and
extrapulmonary), thus indicating the inclusive nature of implementation of the DOTS strategy for the
benefit of all tuberculosis patients. The Global Partnership to Stop TB provides the opportunity,
through its various working groups, for all stakeholders in tuberculosis control to contribute to
ensuring universal access to effective tuberculosis care under the DOTS strategy and to develop the
new tools for tuberculosis control (drugs, diagnostics and vaccines) that are so badly needed. We
look forward to our continued collaboration with MSF and other partners through the Global Stop
TB Partnership in implementing the global plan to stop tuberculosis.
4