In this week's Lancet we publish a Seminar on tuberculosis, a disease that remains a major cause of death worldwide. Although tuberculosis is curable and preventable, long treatment durations, multidrug-resistant strains, a deadly association with HIV, and an inextricable link with poverty all mean that the disease presents an enormous challenge for countries to tackle. Although there has been commendable progress in case detection and aversion of deaths by treatment, in recent years the rates of decline in tuberculosis incidence have not been falling fast enough to meet global targets.
The central operation of global tuberculosis control is led by WHO's STOP TB department. It is aided by the STOP TB partnership, which is also housed at WHO, and consists of a coalition of different partners whose common aim is to rid the world of this disease. The partnership's core function is one of coordination, communication, and generation of the necessary advocacy around tuberculosis. Essentially, it is tasked to complement the role of WHO. At a time when global health governance is in transition, away from WHO as a monopoly and towards a more pluralistic leadership, many organisations are being plunged into a phase of change. As WHO prepares for reform, it is also adjusting to a new financially constrained environment. WHO's STOP TB department, like others, has to downsize and refocus its activities. With increasing demand for guidance, technical support, and capacity-building in countries, the STOP TB department and partnership will have to do more with less in the future.
As tuberculosis enters a new era, with promising new diagnostic approaches and drugs, WHO's role will be crucial. But there is also an opportunity to broaden the global response and engage with other partners more effectively in much the same way as the HIV/AIDS community has done successfully. A Lancet Series last year argued strongly that it was time to move away from the over medicalisation of tuberculosis and recognise its intersection with other sectors and populations—eg, women and children. If the next phase of the epidemic is to be truly different, so too must be the organisational response. A status quo in tuberculosis control is unacceptable.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61000-3/fulltext?rss=yes
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