Tuberculosis and health sector reform: experience of integrating tuberculosis services into the district health system.

SETTING Hlabisa health district, South Africa. OBJECTIVE To describe the integration of a 'vertical' tuberculosis control programme into an emerging 'horizontal' district health system, within the context of health sector reform. DESIGN Descriptive account of the process of integration of the programme into the health system. RESULTS A highly 'vertical' system of delivering tuberculosis treatment (with poor programme outcomes) was converted into a 'horizontal' team, integrated within the district health system, that used available resources such as village clinics and community health workers, with improved programme outcomes. CONCLUSIONS In some settings at least, integration of tuberculosis 'programmes' into the district health system as tuberculosis 'teams' is feasible, and may produce highly cost-effective outcomes.