Tuberculosis control in Alberta - A federal, provincial and regional public health partnership

Tuberculosis control is a public health issue and therefore a government responsibility. Less clear is the optimal distribution of responsibility among levels of government: federal versus provincial/territorial versus regional/municipal. Historically, in Canada, each province and territory has organized and funded its own tuberculosis control program. Decentralization of services, from province to region/municipality, and a reduced prevalence of the disease threaten to destabilize tuberculosis control programs: public health budgets are cut, interest wanes, research stops, expertise grows thin and the disease reemerges.(1) In Alberta, the only formal direction provided to the relationship between the province and its regions with respect to tuberculosis control is found in the Public Health Act,(2) with its Communicable Disease Regulations,(3) and the Regional Health Authorities Act.(4) Certain sections of this legislation suggest that Regional Medical Officers of Health (MOHs) and their staff are responsible for tuberculosis control. Other sections of the same legislation suggest that both the province and the regions are responsible for tuberculosis control. Ambiguities surrounding the role of the province and the regions vis vis tuberculosis are inexpedient as they serve neither tuberculosis control nor the need for Regional Health Authorities to delineate their charge within a regionalized health care system. In regionalized Alberta, the major objectives of tuberculosis control are achieved and the best interests of the public's health and purse are served through a partnership of responsibility, key elements of which are transparency, mutual respect, and working through consensus. In this commentary, the rationale and design of the Tuberculosis Control Program of Alberta is outlined.