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

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    Author
    Martins, N; Kelly, PM; Grace, JA; Zwi, AB
    Date
    2006-10-01
    Source Title
    PLoS Medicine
    Publisher
    PUBLIC LIBRARY SCIENCE
    University of Melbourne Author/s
    Lopez, Alan
    Affiliation
    Melbourne School of Population and Global Health
    Metadata
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    Document Type
    Journal Article
    Citations
    Martins, N., Kelly, P. M., Grace, J. A. & Zwi, A. B. (2006). Reconstructing tuberculosis services after major conflict: Experiences and lessons learned in East Timor. PLOS MEDICINE, 3 (10), pp.1765-1775. https://doi.org/10.1371/journal.pmed.0030383.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/255038
    DOI
    10.1371/journal.pmed.0030383
    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.

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