Since the introduction of the DOTS strategy in the early '90s, significant progress has been made in global tuberculosis control. Although significant, this progress has not been enough.
Several challenges impede sustainable implementation and expansion of TB control activities.
The general public health services need to enhance their capacity to sustain and expand DOTS implementation. Community involvement in TB care and a patient-centred approach need emphasis and promotion. Collaboration and synergy among the public, private, and voluntary sectors are essential to improve access to quality TB care. The increasing impact of HIV on the incidence of TB calls for new partnerships and approaches. Sustaining DOTS programmes will also entail their integration into primary health care and adaptation to ongoing reforms within health sectors worldwide.