| dc.description.abstract | In 1993, WHO (World Health Organization) declared Tuberculosis a “Global Emergency”. Shortly after this declaration, WHO started recommending a new strategy for the treatment and control of Tuberculosis under the brand name of “DOTS” (Directly Observed Treatment Short-course). The strategy was described as proven and cost-effective, and it was recommended as a global strategy.
DOTS has not been used in Turkey. The main objective of this thesis has been to explore what the necessary conditions are for a successful implementation and usage of DOTS, and how the strategy may be used in Turkey. It has also been to question whether DOTS may be a global strategy.
A combination of literature on diffusion of innovation and transfer of technology has been used to develop a theoretical framework. The process of implementing the technology has been seen as a process of both social and technical change. The conditions that have been studied are the actors’ technological capabilities, or the resources needed to generate and manage a process of technical change, and the structure, norms, and interaction/communication in the system involved.
Qualitative data have been collected from semi-structured interviews with staff-members of WHO, with health care workers and health officials in Turkey, and from publications by WHO and the Turkish Ministry of Health. Quantitative data have been collected from statistical publications.
Two social systems have been studied in this case study; the General Directorate of Primary Care, which WHO recommends that DOTS should be implemented within, and the system that is currently involved with treatment of TB (Department of TB Control, and the General Directorate of Curative Services). They have seemed to be quite different. Even though the picture has nuance, the former has seemed to be relatively weak in terms of technological capabilities, whereas the latter is stronger. The latter has also seemed to have a strong history, whereas the former has received inadequate support and trust. Moreover, the health care system has been shown to have a relatively complex and complicated structure, and the two social systems are currently weakly integrated.
It has been concluded that the conditions of the Turkish health system are such that considerable changes in terms of functions and responsibilities are required for an implementation of DOTS according to WHO, i.e., within the country’s primary health care system. It has also been concluded that some aspects related both to this system and the current system of TB treatment may cause obstacles towards these changes. It has also been concluded that the technological capabilities available within the system of primary care are not adequate to manage the process of technical change. For a more closely adaptation of DOTS to the Turkish system, where the current system for TB treatment is acknowledged and included, the technological capabilities may be stronger. However, there are still conditions related to the social systems that may challenge both the social changes and the technical changes involved, and thus put additional requirements on the technological capabilities available.
Based on the case study on Turkey it has been concluded that for DOTS to be global, neither the technology nor the social systems will be identical in all countries.
It has also been concluded that policy formulations should focus on how both the social systems, and DOTS, may be changed or innovated so that they may be incorporated or linked with each other to achieve good results. Moreover, it has been argued that a policy formulation should focus on strengthening the necessary conditions required to perform both the adaptation of the technology to the countries’ context, and the necessary social changes. | nor |