By the late 1990s, the NTP was an independent program within MINSA under the head of Dr. Suarez. Initially going from a tiny, underfunded, and unknown program within Peru, Dr. Suarez was able to guide the NTP to become an internationally recognized standard for tuberculosis programs. Despite initial gains, the NTP still suffered from various shortcomings including faulty data gathering, inability to unite Peru’s physicians regarding treatment, and the development of drug resistant TB strains. At this point, the atmosphere at the NTP was once again filled with uncertainty as costs increased, cure rates plateaued, treatment failures remained a problem, and staff members continued to disagree with each other regarding policy.
While the NTP was understandably focused on developing proper treatment guidelines, they appear to have missed a crucial step in combating TB: prevention. Upstream factors should have also been dealt with while concurrently continuing their initial plans of treating TB. The lack of upstream efforts mentioned in the case to fight TB seem particularly shocking especially when they seemed to acknowledge the importance of upstream factors. For example, as part of the program, community organizations and social workers faulted poverty and social injustices for TB instead of the patients. More directly, a MINSA physician was even quoted as saying, “The Ministry battles the bacillus, but it’s the socioeconomic conditions of the people that cause TB.”
Battling poverty alone as a solution to fighting TB would be expecting far too much from the NTP. However, the NTP at the least indirectly recognized socioeconomic factors contributing to the rise of TB and the need for community involvement. Ogden et al found in their review of literature regarding treatment failure of TB in India that treatment failures are not the fault of patients. Instead, they argue that they are in fact system failures rather than because of patients’ beliefs and behaviors. For example, they found that in the case of India, difficulties with access to public services played a large role in TB treatment failures in addition to socioeconomic factors. They conclude in their study that governments should not focus on the patient, but rather improving access and addressing the socioeconomic side of TB.
While definitely a complex problem, instead of solely focusing on treatment regimens, the NTP should consider these methods to counter TB outside of the standard and accepted treatment regimens.
Ogden JA, Rangan S, Uplekar M et al. (1999b). Shifting the paradigm in tuberculosis Control: illustrations from India. International Journal of Tuberculosis Lung Disease 3, 855–861.