I was impressed with Ian Harper's knowledge on Nepal's health care and delivery system (Letters, #250). But his concerns about the success of the DOTS program are baseless and not supported by any recent reports. As the original article by Naresh Newar states, in the 10 years of conflict, except for rare incidences, neither side has targeted health workers ('TB or not TB', #248). While other services have been hit, health posts, health centres and health workers have been spared. Health services are still as accessible as they were 10 years ago, probably with a more qualified workforce because of the surge in training of the health professionals and CMAs. Admittedly, health services have been unable to expand and health workers have become more reluctant to travel to provide health care but I don't think the level of services available in-house has deteriorated. In a country with a high incidence of TB and half the general population carrying the bacteria in some form, any effort made by the private sector to combat the disease and save lives should be commended, not disputed. I would be more worried and would prefer to research casualties due to non and under-diagnosis of the condition than the distribution of patients between NTP and the private sector. I don't mean opening the floodgate and letting all pharmacies sell TB drugs but base my comments on a recent trip to a few health posts in Argakhanchi, newspaper reports and analyses, and informal discussions with health workers.

Santosh Khanal,
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