Community contribution to tuberculosis care in countries with high tuberculosis prevalence: past, present and future.

Effective tuberculosis control requires the collaboration of many partners. There is increasing interest in harnessing the contribution of communities to effective ambulatory tuberculosis control, as part of national tuberculosis programme activities. Understanding the lessons learned from the 1980s about community participation in Primary Health Care is important in understanding how communities may contribute specifically to tuberculosis care. Most of the published experience of community contribution to tuberculosis care is quite recent, small scale, and reports non-standardised results of effectiveness of tuberculosis treatment. There has been little attention to the issues of cost-effectiveness and acceptability. A multi-national collaborative project is underway in sub-Saharan Africa, coordinated by the World Health Organization, and aims at evaluating in a standardised way the effectiveness, cost-effectiveness and acceptability of community contribution to tuberculosis care. This should pave the way towards the development of international policy guidelines, to promote community contribution to tuberculosis care in ways which are effective, cost-effective and acceptable.