India’s national tb programme: The struggle for innovation and control

This chapter presents a case illustrating how innovation in national health programmes is undermined when agenda setting and branded global health programmes are adopted but not adapted during policy transfer for biopolitical reasons. Briefly described is a multi-centred community-based research project mounted to develop a culturally sensitive, bottom-up TB education programme and patient screener designed to identity patients at high risk for treatment default. Instead of receiving encouragement, the efforts of a group of highly trained clinician researchers having years of experience treating TB patients were dismissed by members of India’s National TB programme responsible for implementing the WHO DOTS programme. Paradoxically, such research was being called for by other WHO related programmes and the necessity for such research was recognized by other members the national TB programme. In short, an opportunity was lost for implementing DOTS in a more ‘patient-centred’ and ‘people-centred’ manner.