Tuberculosis care and control.

Tuberculosis care, a clinical function consisting of diagnosis and treatment of persons with the disease, is the core of tuberculosis control, which is a public health function comprising preventive interventions, monitoring and surveill lance, as well as incorporating diagnosis and treatment. Thus, for tuberculosis control to be successful in protecting the health of the public, tuberculosis care must be effective in preserving the health of individuals. There are three broad mechanisms through which tuberculosis care is delivl ered: public sector tuberculosis control programmes, private sector practitioners having formal links to public sector programmes (the public–private mix), and private providers having no conl nection with formal activities. In most countries, programmes in both the public sector and the public–private mix are guided by international and national recommendations based on the DOTS tuberculosis control strategy — a systematic approach to diagnol sis, standardized treatment regimens, regular review of outcomes, assessment of effectiveness and modification of approaches when problems are identil fied.1,2 As a consequence of this sysl tematic approach, there is reasonable assurance that tuberculosis services are of acceptable quality in public sector and mixed public–private programmes. In contrast, though there are many publ lished guidelines and recommendations for tuberculosis care, there are no formal mechanisms directed towards ensuring that private sector services for tubercul losis meet acceptable standards. There is limited information about the adequacy of tuberculosis care del livered by practitioners outside formal programmes, but evidence suggests that the poor quality of care delivered by nonlprogramme providers hampers global tuberculosis control efforts.3 For example, it is likely that underldiagnosis and underreporting by the private sector