Tuberculosis and health sector reform: experience of integrating tuberculosis services into the district health system in rural South Africa

Setting: Hlabisa health district, South Africa. Objective: To describe the integration of a 'vertical' tuberculosis control programme into an emerging 'horizontal' district health system, within the context of health sector reform. Design: Descriptive account of the process of integration of the programme into the health system. Results: A highly 'vertical' system of delivering tuberculosis treatment (with poor programme outcomes) was converted into a 'horizontal' team, integrated within the district health system, that used available resources such as village clinics and community health workers, with improved programme outcomes. Conclusions: In some settings at least, integration of tuberculosis 'programmes' into the district health system as tuberculosis 'teams' is feasible, and may produce highly cost-effective outcomes.