In the 1990s, progress by DOTS programmes in countries such as Tanzania, China, Vietnam, and Peru showed that well financed NTP units, anchored within a country’s ministry of health, could guide substantial improvements in service delivery and treatment outcomes. But many countries struggled with restricted programmatic support, and poor linkage between tuberculosis programmes and health-sector reforms.49 Such limitations led to calls for development of effective health-system governance to mount coherent responses to the worsening epidemic.