Successful Restructuring

Peru’s struggle with tuberculosis has been a long and hopeful road, despite the skepticism this case study describes Suarez faced by the late 1990s. The true focus of this case study should be on the strategic efforts made by Suarez and his team when they began the battle against TB in 1990. Suarez’s approach was successful because it involved an evaluation method. Throughout the many stages of his work as the director of the National Tuberculosis Control Program (NTP), Suarez sought to identify the flaws in the Peruvian healthcare system in order to identify where supports and improvements needed to exist for successful implementation. He and his team identified the following problems: Limited to no funding, lack of available healthcare staff, and inconsistency in clinical practice by physicians and other healthcare workers.

The lack of monies is a consistent problem in the world of global public health, especially for high-burden countries, such as Peru. This problem is often one of that weakens existing programming and structure. Suarez’s approach to this problem was extremely innovative. He asked to utilize funds and personnel from local entities as a way to revive the NTP, thus resolving, to some extent, the first two primary issues identified.

The last aforementioned barrier to NTP success was the most cumbersome of them all, as it encompassed a multitude of other issues. The problems found in clinical practice included inconsistent terminology usage, diagnosing, case monitoring, treatment and evaluation. Suarez’s plea for a meeting from all available practitioners helped identify these critical issues in practice and support a joint effort from the medical community in Peru to “cure tuberculosis” (Harvard Medical School, 2011). Recommendations from Suarez and his team led to the development of uniformed TB control standards. These national standards helped move the NTP from being a vertical to more of a horizontal approach.

In an article written by Suarez et al., a summation of 10 years’ worth of work towards controlling the TB epidemic in Peru highlights a statistically significant and steady decline in TB morbidity and mortality (2001). As per his findings, an estimated 91,000 deaths were averted between 1991 and 2000; a monumental accomplishment for a developing nation with limited resources. He and his team’s attention to detail with regards to diagnostic and treatment methodology, patient monitoring (via databases for case detection and treatment histories), and policy are what catapulted the NTP into a successful 10-year stride in their fight against TB.


Suarez, P.G., Watt, C.J., Alarcon, E, Portocarrero, J., Zavala, D., Canales, R, Luelmo, F., et al.

(2001). The dynamics of tuberculosis in response to 10 years of intensive control

effort in Peru. J Infect Dis. 184(4): 473-478.


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