Skip to content

Health Surveillance and Disease Management / Communicable Diseases / Tuberculosis

Ist Meeting on the Practical Approach to Lung Health (PAL) Strategy

(San José, Costa Rica, 4–6 December 2006)


Full Text (in Spanish, 60 pp, PDF, 483 Kb; chapter heading translated below for user orientation)
1. Preface     2. Background
3. Workshop Objectives & Methodology

3.1—2 Objectives
3.3. Expected Results
3.4. Methodology
3.5 Opening Session
4. Expert Presentations
4.1 PAL's Place in the Stop TB Strategy and the 2006–2015 Regional Plan
4.2 PAL Concept and Its Implementation at Global Level
4.3. Steps to Adapt and Develop PAL in a Country
4.4. Function of PAL Working Group
4.5. Key Principles and Factors for Conducting the PAL Feasibility Study
5. Expert Presentations on Country Experiences Applying PAL
5.1 Practical Experience Applying PAL in Kyrgyzstan
5.2 Perspectives on PAL Development in El Salvador
5.3 PAL Development and Implementation in Bolivia: Conditions Favoring Its Adoption and Implementation
5.4 Experience Developing PAL in Chile
6. International Standards for TB Care
7. Report of Working Group: Formulating or Updating National Plans to Develop or Implement PAL

7.1 PAL Implementation Project in Argentina
7.2 Perspectives on PAL Development in Brazil
7.3 Additional Steps in PAL Implementation in Chile
7.4 Perspectives on PAL Development Process in Cuba
7.5 PAL Implementation Steps in El Salvador
7.6 Perspectives on PAL Development in Nicaragua: Vision of Damian Foundation
7.7 Perspectives on PAL Development in Uruguay
8. Conclusions
9. Recommendations
10. Annex: List of Participants

WHO Links
- About PAL
- Stop TB Strategy
- Stop TB Department
- WHO TB Page


Definition: The Practical Approach to Lung Health (PAL; in Spanish, Atención integrada de tuberculosis y enfermedades respiratorias, or AITER/PAL) is a syndromic approach to the management of patients who attend primary health care services for respiratory symptoms. The PAL strategy targets multi-purpose health workers, nurses, doctors, and managers in primary health care settings with successful TB control programs in low and middle-income countries.

Preface |  Background |  Objectives |  Expected Results |  Methodology

Preface: The PAL strategy is part of the Stop TB strategy and serves as the component to strengthen health systems. PAL objectives are to strengthen

  1. the quality of care to patients with respiratory symptoms who visit primary care services and
  2. the efficient organization of providing care for respiratory diseases within district health systems

The emphasis of the PAL strategy as it relates to primary care revolves around three respiratory illnesses: tuberculosis (TB), acute respiratory infections (ARIs), and chronic respiratory diseases (CRDs), with emphasis on asthma and chronic obstructive pulmonary disease.

This workshop was organized by PAHO/WHO with support from the primary health care system of the host country, with the goal of providing support to selected countries in the adaptation of the methodology, the elaboration of plans, and the implementation and/or strengthening of the PAL strategy within their health systems.

Background: The PAL initiative was started by WHO in early 1998. Field experience helped develop the guides and implementation methodology and PAL adoption in the countries. At present 20 countries throughout the world are carrying out PAL activities. The data obtained from these experiences indicate that PAL can

  1. significantly increase TB case detection;
  2. improve the integration of respiratory care into primary care;
  3. decrease the prescribing of medicines, particularly antibiotics and coadjuvant drugs, as well as prescription costs per patient; and
  4. improve care for persons with chronic respiratory illnesses.

Concerning PAL development in the Americas,

  1. Peru is in the development phase,
  2. Bolivia is in the phase of formulating its implementation plans, and
  3. Chile and El Salvador are in the implementation phase.

It is expected that more countries in the Region will introduce PAL activities into their healthcare services over the coming years.

General Objective: Train the participating countries in how to adapt the methodology, elaborate plans, and implement and/or strengthen the PAL strategy within their health systems.

Specific Objectives

  • Explain the concept of the PAL initiative and establish the necessary requirements for its implementation in the countries.
  • Discuss the existing conditions for adapting and introducing the PAL strategy in Argentina, Brazil, Costa Rica, Cuba, and Uruguay.
  • Discuss the key steps necessary for PAL development: designating the National PAL Working Group, developing guidelines and training materials, conducting a PAL feasibility study, and holding a national evaluation and implementation meeting.
  • Establish a timeline for PAL adaptation and implementation in Argentina, Brazil, Costa Rica, Cuba, and Uruguay.
  • Establish, examine, and discuss a plan spanning several years to develop and implement PAL in Bolivia, Chile, El Salvador, and Peru.

Expected Results

  • The countries adopting PAL as a strategy for strengthening their health systems and including it in their National Strategic Plans for TB Control for 2006–2015.
  • The countries adopting PAL as a strategy to improve quality of TB control, with emphasis on detecting TB cases.
  • The countries having elaborated their plans to adapt and implement/expand PAL, in accordance with their resources and situation.

Methodology: The methodology of the workshop over the three days of work combined expert presentations, working groups, and discussions.

  • On the first day the group analyzed the PAL concept, its important for primary care as part of the National TB Control Program, and the methodology for its implementation, using real-life examples from countries both inside and outside the Region. In addition, the countries presented their experiences with and perspectives on PAL.
  • On the second day the group discussed the International Standards for Tuberculosis Care (ISTC) and how PAL might be used to meet them. There were working group activities where the countries worked on elaborating their national plans for PAL with help from facilitators and experts.
  • On the third day each country presented its plan, with discussion on each one, and the group formulated their conclusions.

Regional Office for the Americas of the World Health Organization
525 Twenty-third Street, N.W., Washington, D.C. 20037, United States of America
Tel.: +1 (202) 974-3000 Fax: +1 (202) 974-3663

© Pan American Health Organization. All rights reserved.