Health systems that serve: What's the bottom line?

SETTING: Health services in low- and middle-income countries. BACKGROUND: The Global Plan to Stop TB, 2006-2015. OBJECTIVE: Using a framework for evaluation of public health systems, to evaluate evidence that tuberculosis (TB) services contribute to strengthening the health systems. DESIGN: Critical evaluation of published material. RESULTS: The Global Plan to Stop TB 2006-2015 identifies strengthening the health systems as one of its components. Published material illustrates substantial improvement of quality of TB services over the past decade. However, even where these services have achieved a high level of quality, there is little evidence to indicate that other health services in the same locations show similar quality. CONCLUSION: Policies, strategies and actions to strengthen health systems through TB services will require specific plans and priorities to achieve their objectives; this will not occur as a natural effect of improving TB services.