Health and human security - Environmental and Human Security in the Arctic - page 170

Transferring from the Global South: DOTS in
the FSU
In this section, we pay special attention to the introduction of the WHO's
tuberculosis treatment programme, Directly Observed Treatment with Short-
course chemotherapy (DOTS), as a particularly compelling illustration of both
resistance to and receptiveness of Western medical ideals in the post-Soviet
area and of the general attitudes outlined in the previous section. The Task
Force has not been a major player in introducing DOTS to Russia and the
Baltic states, but the tuberculosis projects under the Task Force are generally
oriented towards the promotion of DOTS. However, many of its tuberculosis
control projects articulate with pre-existing joint programmes run by Baltic
and Russian regional authorities and various international organizations.
The DOTS strategy has been promoted by the WHO since the early
1990s. The current form of the DOTS strategy was formalized in 1994,
although it was based on several decades of experience. DOTS is considered
one of the most effective interventions in global public health ever from
both a health and economic viewpoint . 12 Its average cure rate is nearly 80
per cent, ranging from 70 to 95 per cent, and DOTS is currently the primary
strategy for stopping tuberculosis (WHO 2006). Its low cost per patient
and effectiveness without hospitalization means that it is a feasible approach
even for poor countries. Without DOTS, the annual tuberculosis rates were
expected to rise by 41 per cent from 1998 to 2020 (from 7.8 million to
10.6 million cases per year); achievement of WHO targets would prevent
23 per cent or 48 million cases in the period from 1998 to 2020 (Dye et al.
1998:1886). Furthermore, DOTS provides the best-known defence against
the development of multi-drug resistant strains of Mycobacterium tuberculosis
(Kochi 1997:228). In other words, DOTS is a strategy in the fight against
tuberculosis that has produced well-documented positive effects. According
to Western experts, without improvements in case detection and cure, the
incidence of tuberculosis in Russia is expected to rise by about 10 per cent
per year, i.e. a doubling every seven years. The introduction and expansion
of DOTS is expected to halt the rise and, by 2015, a 10 per cent annual
decline in incidence is predicted if DOTS is widely implemented (Coker
2001:435). However, the reception of DOTS in the FSU has not been alto-
gether positive.
The reception of DOTS in the FSU
A noticeable feature of the introduction of DOTS in the post-Soviet area is that
the Baltic states and the Russian rim regions in the Northwest have embraced
the WHO strategy wholeheartedly. In contrast, tuberculosis experts who are
centrally located in the Russian 'capitals ' 13 o f Moscow and St Petersburg have
displayed opposition, voicing reasons that are in line with those of Mikhail