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Reconstructing tuberculosis services after major conflict: Experiences and lessons learned in East Timor

Martins, Nelson, Kelly, Paul M., Grace, Jocelyn A. and Zwi, Anthony B. (2006). Reconstructing tuberculosis services after major conflict: Experiences and lessons learned in East Timor. PLoS Medicine,3(10 - Article No. e383).

Document type: Journal Article
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Title Reconstructing tuberculosis services after major conflict: Experiences and lessons learned in East Timor
Author Martins, Nelson
Kelly, Paul M.
Grace, Jocelyn A.
Zwi, Anthony B.
Journal Name PLoS Medicine
Publication Date 2006
Volume Number 3
Issue Number 10 - Article No. e383
ISSN 1549-1277   (check CDU catalogue open catalogue search in new window)
Total Pages 11
Place of Publication United States of America
Publisher Public Library of Science
HERDC Category C1 - Journal Article (DEST)
Abstract Background: Tuberculosis (TB) is a major public health problem in developing countries. Following the disruption to health services in East Timor due to violent political conflict in 1999, the National Tuberculosis Control Program was established, with a local non-government organisation as the lead agency. Within a few months, the TB program was operational in all districts.

Methods and Findings: Using the East Timor TB program as a case study, we have examined the enabling factors for the implementation of this type of communicable disease control program in a post-conflict setting. Stakeholder analysis was undertaken, and semi-structured interviews were conducted in 2003 with 24 key local and international stakeholders. Coordination, cooperation, and collaboration were identified as major contributors to the success of the TB program. The existing local structure and experience of the local non-government organisation, the commitment among local personnel and international advisors to establishing an effective program, and the willingness of international advisers and local counterparts to be flexible in their approach were also important factors. This success was achieved despite major impediments, including mass population displacement, lack of infrastructure, and the competing interests of organisations working in the health sector.

Conclusions: Five years after the conflict, the TB program continues to operate in all districts with high notification rates, although the lack of a feeling of ownership by government health workers remains a challenge. Lessons learned in East Timor may be applicable to other post-conflict settings where TB is highly prevalent, and may have relevance to other disease control programs.
Keywords complex emergencies
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