Tuberculosis (TB)

Community and patient involvement in TB care and prevention


Community involvement in Mexico
WHO/L. Velebit

Community participation in primary health care is not a new idea. In the last decade, WHO has coordinated projects to evaluate community contributions to effective TB control in six sub-Saharan countries which resulted in improved case detection rates and treatment success rates through decreased default and transfer out rates. In other regions, different approaches were used successfully as well.

In March 2006, WHO officially launched the new Stop TB Strategy which builds on the positive experience of the global expansion of the DOTS strategy over the last decade. It addresses the challenges that have emerged whilst implementing the DOTS strategy in varying epidemiological contexts and as a result of different societal and health system changes across the world.

The Stop TB Strategy includes important new components, the fifth calling for the empowerment of people and communities affected by TB. Despite numerous experiences gained at country level under very different circumstances, component five has been interpreted in different ways. This has indicated that urgent clarification is required if this component is to be adapted and included in strategic plans being prepared by countries for the next decade. WHO has therefore embarked on a study to better define the meaning, background and most important operational aspects of "Empowering people with TB, and communities" in order to provide recommendations and specific guidance to national health authorities committed to the implementation of the strategy.

This has included:

  • a global review of experiences on community-based approaches to combatting TB, focusing on several countries (in different WHO regions) which have already incorporated such approaches in their TB control policy
  • the creation of an ad hoc Task Force on Community Involvement in TB Care and Control, to discuss the findings, with the participation of representatives of the communities involved, national health authorities and international experts
  • a literature review focused on models of community involvement and motivation of community members involved

The discussions, evidence and experiences gathered have been documented as Guiding principles for community involvement in TB care and Prevention: Towards partnerships for health [pdf 800kb].