Discussion of the case study this week on TB in Peru seems to speak to a number of issues including the complexity of addressing health needs, difficulties in addressing data collection, uncertainty of results and forward thinking decisions that must be made to either continue the plan or refocus national health initiatives. The issue of uncertainty in medical science and how do we, as public health professionals, deal with adversity in the face of uncertain conditions or data seems to pose an interesting and probably common dilemma in public health. In the case of Peru, it was clearly noted that socio-economic conditions were playing a significant role in the prevalence of TB, but policy that was aimed at small feasible solutions seemed to be at least moderately effective.
In the article “The Science of Muddling Through,” author CE Lindblom addresses this complexity of making policy decisions in an environment that is fraught with uncertainty. This uncertainty, according to Lindblom, arises with the increasing use of science to make political decisions, ‘science for policy’ so to speak. In the case of Peru, data collection on TB prevalence and drug response was already going to be an ardent task because of the poor towns with a lack of a central health reporting system, but using statistics generated from incongruent data to make policy decision on a specific topic can be pack with uncertainty. For instance, the physicians who did not follow protocol or accurately report incidences can become marginalized and towns with a high need for treatment can be overlooked. The reality is, experts are most uncertain about the topics they understand the least and are most certain about decisions in their area of expertise. Decisions that are made by people such as Suarez or the WHO reflect that certainty, leaving skeptics or non-experts to question the judgment calls made.
Should Peru continue to the NTP program for TB? I’m not entirely sure, but I do think that the decision maker, specifically Suarez, would be wise to stop and consider the professionals hesitancy, especially when it is their own field of expertise.
The problem is, there are few other viable options and often the best decision is to build upon previously established policy, as Peru did with their Retratamiento estandardizado and Esquama uno, dos and tres.