ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

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SRI LANKA-New Entrants

with the existing health care facilities would grasp. How then has this 'innovation' gained so much ground?
A recent article in Lancet gives the background to the evolution of the strategy. Non-compliance is not a new problem; it has given rise to several innovative research studies. Two early studies which looked at the issue were conducted in Hong Kong and Madras. Proper follow-up of ambulatory patients, ensuring their regular reporting to the clinics and patient education were among the measures tried. But more recently, in an attempt to cope with the problem of noncompliance among the poorer populations in New York, DOT was evolved and tried out successfully. It is this study that the WHO is apparently recommending as the model for all TB control programmes to adopt. The question that many have been raising is whether a programme, no matter how successful in the urban area of New York (or for that matter Hong Kong or Madras) will work, say, in the deserts of Rajasthan or the forests of Gadchiroli? Given the diverse environments and health problems in the country, national disease control programmes must be allowed the flexibility to incorporate the design that suits their needs. But this is possible only if disease programmes are directly linked to evaluation and research components, the ICSSR-ICMR Committee (1980), among others, had recommended that the entire research set-up on diseases be reordered with well established linkages with the field so that the objectives of research evolved from the needs of the disease programme and the results of research studies could be directly communicated to the field. There is no practical difficulty in incorporating such a scheme, only it makes redundant the health care and research 'pundits' who take their cue only from WHO. And unfortunately, despite all the well-intentioned recommendations on a variety of fronts, the WHO too has not furthered the cause of strengthening the linkages between research and control programmes within countries. This blind spot is likely to affect the management of numerous programmes even more now, with the compression of the central and state allocations to public health. With scanty resources, the only solution is to devise and incorporate programme strategies at the local level, and national programmes must make this flexibility possible.

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