Article ID: CBB402892466

Between Donor Interest, Global Models and Local Conditions: Treatment and Decision-Making in the Somalia-Finland Tuberculosis Control Project, 1981–3 (2020)


Despite numerous global health initiatives after World War II, tuberculosis still poses a major threat in sub-Saharan Africa. This article examines one attempt to tackle this problem: the Somalia-Finland Tuberculosis Control Project. Conducted in the 1980s as a bilateral development aid project between the two countries, it became the most extensive – and expensive – tuberculosis initiative in Somalia in that decade. An interesting feature of the project is that, despite a lack of previous experience in tuberculosis work in developing countries, the Finnish partner decided not to follow the WHO global guidelines designed to standardise tuberculosis activities across the developing world. Instead, Finns established their own treatment programme based on X-ray and short-course chemotherapy – otherwise rarely used in clinical practice in Africa. Through a close reading and comparison of the correspondence, project plans, memos and minutes, the article analyses the formation of this strategy. Focusing on ground-level decision-making, it argues that the decisions were based not only on a belief in the superior clinical effectiveness of these methods, but also on the fact that they better suited Finnish ambitions and project logic. Thus, the article supports the notion that donor perspectives on resources and project objectives determined what was seen as feasible treatment in a developing country. By shedding light on the debate between the supporters of short-course chemotherapy and the WHO standard treatment strategy, it also contributes to the early history of DOTS (directly observed treatment, short course).

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Authors & Contributors
Aronowitz, Robert
Petryna, Adriana
Coker, Richard
Bertolli Filho, Claudio
Amrith, Sunil S.
Welshman, John
Medical History
História, Ciências, Saúde---Manguinhos
Social History of Medicine
Comparative Studies in Society and History
Journal of the History of Biology
Wellcome Open Research
Rio de Janeiro, Editora Fiocruz
Palgrave Macmillan
Oxford University Press
Routledge/Taylor & Francis Group
Yale University
University of Pennsylvania
Public health
International cooperation
Disease and diseases
Therapeutic practice; therapy; treatment
Great Britain
Timor Island
20th century, late
21st century
20th century, early
19th century
20th century
World Health Organization (WHO)
United Nations
Atomic Bomb Casualty Commission

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