The "vertical-horizontal" debates: time for the pendulum to rest (in peace)?

Abstract

Historia magistra vitae said Cicero: history is the teacher of life. It is an inevitable law of nature that unless there is a solid foundation of the past no secure edifice of the future can be raised. Those who do not look at the past cannot devise means for the future; and unless the future is built on the past it will be raised merely on stubble. The article on tuberculosis (TB) programmes in developing countries published in The Bulletin of the International Union against Tuberculosis and Lung Disease four decades ago illustrates how past efforts to control TB could and should inform future interventions. Dr Halfdan Mahler WHO Director-General from 1973 to 1988 spent a decade in India beginning in the early 1960s and was instrumental in designing what became a blueprint for a national tuberculosis programme in a developing country. As WHOs Director-General he later promoted the concept of primary health care (PHC) eliciting extensive global support and initiating the health-for-all movement. Like the swing of a pendulum both PHC and global TB control efforts subsequently suffered a decline. The pendulum has however begun to swing in the opposite direction. TB programmes have been reinforced and the PHC concept is being revived by WHOs new Director-General Dr Margaret Chan. The challenges facing national TB programmes today include TB/HIV coinfection multidrug-resistant TB (MDR-TB) health sector reforms effective community engagement and a need for new tools for diagnosis treatment and prevention. These problems seem more complex yet the fundamental approaches discussed in Mahlers article are still central to TB control and to addressing these current challenges. In addition to raising some pertinent questions this commentary draws four key messages from the article that deserve the attention of all concerned: policymakers programme managers scientists and activists. (excerpt)