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.