There are five basic components of the DOTS program: 1) political commitment to

implement and sustain the program, 2) diagnosis of cases using TB bacteriology

particularly quality-assured sputum microscopy, 3) regular and uninterrupted supply of
anti-TB drugs and other supplies 4) standardized TB chemotherapy with direct
observation of treatment (DOT) by a responsible treatment partner and 5) standardized
recording and reporting system that allows the monitoring and evaluation of the
program, and of the individual.
Political commitment with increased and sustained financing
Strong political commitment by the government is essential in the success of the TB
control program. Political commitment can help create local, national and
international partnerships. Local partnerships could also help improve access,
quality and equity of TB care.
Diagnosis of cases using TB bacteriology particularly quality-assured sputum
microscopy
Detection/ diagnosis of tuberculosis is primarily based on direct sputum smear
microscopy. In order to ensure a quality-assured diagnostic test, it is recommended
that there should be a network of properly equipped laboratories and well-trained
personnel
.
Regular and uninterrupted supply of anti-TB drugs and other supplies
The success of TB control also depends on the availability of good quality anti-TB
drugs. Presence of an accurate recording and reporting system can provide
information needed in planning, procuring, distributing and maintaining the supply if
drugs equally in the health facilities.
Standardized TB chemotherapy with direct observation of treatment (DOT)
The directly observed treatment is recommended by the World Health Organization
as for treatment and control of tuberculosis. This is a short-course regimen which
uses fixed dose drug combinations and can last from six to eight months. Direct

observation of treatment by a treatment partner can ensure regular intake of drugs

and completion of treatment. Supervised treatment can improve the adherence of
the patient to the treatment, thus achieving cure and preventing the development of
drug-resistant tuberculosis.

A treatment partner must be properly trained, and

accessible to the patient. Treatment can be done in the health facility, in the
community, workplace or at home.
Standardized recording and reporting system
Establishing a monitoring and evaluating system facilitate easy review of the TB
program. This includes standardized recording of patient information regarding
treatment, and treatment outcomes. Establishing this system can help effectively
monitor and manage the program.
References:

http://www.who.int/tb/dots/whatisdots/en/
THE STOP TB STRATEGY Building on and enhancing DOTS to meet the TBrelated Millennium Development Goals by WHO

The WHOs framework for action has six building blocks: 1) health service delivery,
2) health workforce, 3) health information system, 4) medicines, vaccines, and
technologies, 5) health financing, and 6) leadership and governance.
Health service delivery
Good health services are those which could provide to those in need health
interventions, such as prevention, treatment or rehabilitation, that are safe, quality and
effective. A health system must be people-centered which provide services that people
want or desire.
Health workforce
A health workforce is considered well-performing when it can provide services efficiently
to achieve best health outcomes. The health workforce includes the health service
providers, health management and support workers. Health workers must be
responsive, fair, competent and productive with the available resources and
circumstances.
Health information system
Health information systems must be well-functioning to facilitate easy review of data.
This can help ensure monitoring, analysis, and dissemination of information about
health determinants, health system performance, and health status.
Medicines, Vaccines, and technologies
Access to essential medicines, vaccines, and technologies must be equitable,qualityassured, safe, and cost-effective. There must be a system for procurement, distribution,
management,as well as regulation of drug, medical products and equipment.
Good health financing
An ideal health system must have a good financing system. Programs for health must
be adequately and fairly financed to ensure that essential services are being provided to
those in need. Aside from this, it must also provide financial risk protection to people.
Seeking health care must not impoverish or lead individuals or families into financial
catastrophe. A health financing system that does not deter people from receiving health
care due to financial constraints can help improve health outcomes.
Leadership and governance

Leadership and governance which is also called stewardship is about the role of the
government in health. This requires strong political support in different health programs.
The government must also provide leadership by guiding the whole health system. This
also includes ensuring coordination between health sectors involved in health care
planning, and implementation, health policy making.
References:

Everybodys business
Stop TB policy paper: contributing to health system strengthening: guiding
principles for national

tuberculosis programmes. WHO (2008)