Intended for healthcare professionals


Reforms to the health sector must retain vertical programmes like those for tuberculosis

BMJ 2000; 320 doi: (Published 24 June 2000) Cite this as: BMJ 2000;320:1726
  1. John Crofton, emeritus professor of respiratory diseases, University of Edinburgh (
  1. 13 Spylaw Bank Road, Edinburgh EH13 0JW

    EDITOR—Health sector reform has become the policy urged on poor countries in the developing world. Basically it entails transferring responsibility for health services and health budgets to local communities. I am sympathetic to this approach. But its uncritical application by governments has a dangerous obverse.

    Vertical programmes—for instance, central coordination and monitoring of the World Health Organization's DOTS (directly observed treatment short course) programme for control of tuberculosis—may be discouraged. The programme may be suddenly abolished. The economy of scale …

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