Abstract
This paper, based on World Health Organization and Sri Lankan sources, examines the attempts to control tuberculosis in Sri Lanka from independence in 1948. It focuses particularly on the attempt in 1966 to implement a World Health Organization model of community-orientated tuberculosis control that sought to establish a horizontally structured programme through the integration of control into the general health services. The objective was to create a cost- effective method of control that relied on a simple bacteriological test for case finding and for treatment at the nearest health facility that would take case detection and treatment to the rural periphery where specialist services were lacking. In the late 1940s and early 1950s, Sri Lanka had already established a specialist control programme composed of chest clinics, mass X-ray, inpatient and domiciliary treatment, and social assistance for sufferers. This programme had both reduced mortality and enhanced awareness of the disease. This paper exposes the obstacles presented in trying to impose the World Health Organization’s internationally devised model onto the existing structure of tuberculosis control already operating in Sri Lanka. One significant hindrance to the WHO approach was lack of resources but, equally important, was the existing medical culture that militated against its acceptance.
Highlights
The Eighth Report of the World Health Organization’s (WHO) Expert Committee on Tuberculosis in 1964 recommended that ‘a national tuberculosis programme must be on a country-wide and permanent basis’ and that ‘tuberculosis services [should] be integratedDownloaded from https://www.cambridge.org/core
The advent of effective chemotherapies from the 1950s that appeared to promise a new environment for disease control suggested, according to this Expert Committee, that the ‘unsatisfactory position in tuberculosis was to a large extent due to the inadequate application of existing knowledge’
By the end of 1969, it was proposed to extend the programme to the Western Province in 1970, Sabaragamuwa and Eastern Provinces in 1971, Northern, Southern and Uva Provinces in 1972 and the whole island by 1973.63 Testament to this perceived success was a WHO seminar held in Colombo on 22–28 February 1970 which was attended by participants from Burma, Nepal and Thailand as well as fifty-one Sri Lankan participants and observers
Summary
The Eighth Report of the World Health Organization’s (WHO) Expert Committee on Tuberculosis in 1964 recommended that ‘a national tuberculosis programme must be on a country-wide and permanent basis’ and that ‘tuberculosis services [should] be integrated. There were six – soon to be nine – chest clinics, over 3500 tuberculosis beds for inpatients, supplemented by ambulatory or domiciliary care, financial assistance for sufferers and protection available for families and friends through the BCG vaccination.[32] Sir Bennett Hance (Medical Adviser to the British Department of Commonwealth Relations) in his 1956 report for the Sri Lankan government on the health services concluded that: ‘Progress despite the limited staff has been spectacular’; evidenced by the halving of death rates from 528 per million of population in 1949 to 210 in 1954, which he attributed to ‘increased effective treatment’.33. These sources expose the deviations, negotiations and resistances that emerged at the national, local and individual level in the implementation of this internationally conceived policy
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