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HST provides free electronic access to over 500 health systems research related reports, publications and papers. Close to 300 of these are publications that have been commissioned and funded by the Trust. Topics include among others district systems development, drug supply management, human resource development, informatics, legislation, finance, environmental health, mental health, lessons learnt, nutrition and sexually transmitted diseases / HIV/AIDS. The main publication of the HST is the annual South African Health Review. From 2005 all HST publications will be available in low resolution only. To explore the range of publications HST offers use the Advanced search to search using a variety of criteria.

Editorial

When I think of tuberculosis, a picture that comes into my mind is of adults, often elderly men, struggling to take in air, lying in a hospital bed, perhaps sitting outside in the sun, helpless, undignified, their health and social, family and community respect and support lost.

Our response as health workers has been to relegate TB patients to separate clinics, to label them difficult, and to dole out pills in very large numbers, with little explanation of the disease or the treatment. We seldom have the inclination nor make the time to ask, listen or to empathise. We then wonder why patients fail to complete their treatment, and we embark on research programmes to find out what went wrong! Then the WHO comes up with the solution - DOTS, which could be interpreted as getting other people, the community, to do the work for us!

Of course I exaggerate and thank goodness there are countless health workers for whom none of this applies. But we dare not forget the words of an eminent international TB professional who at the end of the national South African TB review in June 1996 said he had never in all his experience of TB seen anything as devastating as the epidemic and its poor management at all levels as he saw here in South Africa. Enough to make one lie awake at night and worry indeed. There are aspects of truth in the statements above that have made tuberculosis such a problem.

This issue of Update has articles that should make us all think. There are statistics on the epidemic, with cold frightening facts about the projected impact of HIV infection. The burden on health services is already almost unmanageable in many provinces, and the cost of the disease with MDR is beyond what the country can afford.

But there are important positive messages and guidelines. Experiences of STD patients and those infected with HIV show us that we must work to destigmatise diseases such as STD, HIV and TB, that we must inform and educate our patients, and that health workers themselves need support in order to give their best. Experience in rural clinics was that nurses lacked training opportunities, encouragement, acceptable working conditions and basic resources.

What works for TB patients? The Hlabisa success story, repeated elsewhere, is DOTS by shopkeepers - not simply delegation outside the service, but a proven, cost effective, acceptable way of helping patients get their treatment. The Tintswalo experience suggests that decentralisation is what patients prefer with accessible services, and that it works, but that good management of staff, drug supplies, laboratory systems and vehicles is crucial. We are reminded of the need to understand cultural beliefs, and to work with them rather than against them. Compliance by all health workers with the proven national standardised diagnostic and treatment guidelines is very important.

The White Paper on Decentralisation of health care delivery published this month is timeous as we consider tuberculosis. When we have established well managed health districts throughout the country, and when we stop to care and to listen to our patients, then we will have patient-friendly tuberculosis services. Then we will achieve 85% cure.