Health sector reform and tuberculosis control: the case of Zambia.

SETTING Zambia, 1995-1997. OBJECTIVE To describe the process leading to the collapse of Zambia's National Tuberculosis Programme NTP). DESIGN A descriptive analysis of health sector reform in Zambia and its effects on the NTP during the period 1995-1997. RESULTS By the end of 1997 the NTP had stopped functioning. The main reason was that external support had ended, while the National Strategic Health Plan 1995-1999 had no budget for special programmes according to the policy to integrate these into the general health services. As a consequence, technical support for tuberculosis control to districts ended as staff was reduced to one officer responsible for the national coordination of AIDS/HIV, sexually transmitted diseases (STD), tuberculosis and leprosy. The most serious effect of the transition was the interruption of supplies of anti-tuberculosis drugs in 1998. CONCLUSIONS The experience in Zambia demonstrates the urgent need for constructive dialogue between 'health reformers' and 'disease controllers'. The aim of this dialogue would be to develop a model that ensures that tuberculosis patients are properly diagnosed and cured in countries that are embarking on a reform of their health services.