Connect the "DOTS": a new era in Turkish tuberculosis control

Abstract

This study examines how national health policy is both influenced by global health concerns and institutionalized accordingly, taking DOTS (directly observed treatment strategy-short course) as an area of observation. The research looks at how DOTS, the name given to a global treatment and control strategy for tuberculosis (TB) promoted by World Health Organization (WHO), was negotiated, taken up and translated in practice by the Turkish TB establishment and what its effects are. In fact, it is a delicate negotiation between national and global forces. Basically, it reveals how DOTS, as a part of global governance, transformed the national practice. As it constitutes a poignant example of the “globalization of health”, the history of DOTS presents us with a rich account of how health policy is being shaped by globalization and, in turn, how globalization in its current form is exhibited through such health policies. The study also deals with the historical background of TB control both internationally and from the Turkish experience to trace the evolutionary stages and WHO’s role as a leading global health governing body. Focusing on the reception of DOTS in Turkey, it attempts to reveal the essential conflict within the TB community and demonstrate a few manifestations of it. The conflict itself is meaningful from a sociological standpoint, to the extent that, it can be seen to be indicative of the larger conflict at work, not only in the medical realm, but also in wider economic, political and social spheres. The conflicts are in the nature of preferences of national versus global approaches.