Multi-sectoral approach to DOTS--the only hope.

This article reviews both the global and Kenyan tuberculosis (TB) situations and gives a manager's perspective of the management of a national TB control program with limited resources. It demonstrates how complex it can be to manage a control program with a 500% increase in case load and a 60% decline in real per capita health expenditure during the last 20 y. The picture is complicated even further by a high prevalence of TB among the country's nomadic population inhabiting the arid and semi-arid parts of the country. Acceptable treatment results are achieved through a combination of appropriate strategies. However, the future picture is grim unless more personnel are used to implement the DOTS strategy.