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Background In the European Union and European Economic Area only 38% of multidrug-resistant tuberculosis patients notified in 2011 completed treatment successfully at 24 months’ evaluation. Socio-economic factors and patient factors such as demographic characteristics, behaviour and attitudes are associated with treatment outcomes. Characteristics of healthcare systems also affect health outcomes. This study was conducted to identify and better understand the contribution of health system components to successful treatment of multidrug-resistant tuberculosis. Methods We selected four European Union countries to provide for a broad range of geographical locations and levels of treatment success rates of the multidrug-resistant tuberculosis cohort in 2009. We conducted semi-structured interviews following a conceptual framework with representatives from policy and planning authorities, healthcare providers and civil society organisations. Responses were organised according to the six building blocks of the World Health Organization health systems framework. Results In the four included countries, Austria, Bulgaria, Spain, and the United Kingdom, the following healthcare system factors were perceived as key to achieving good treatment results for patients with multidrug-resistant tuberculosis: timely diagnosis of drug-resistant tuberculosis; financial systems that ensure access to a full course of treatment and support for multidrug-resistant tuberculosis patients; patient-centred approaches with strong intersectoral collaboration that address patients’ emotional and social needs; motivated and dedicated healthcare workers with sufficient mandate and means to support patients; and cross-border management of multidrug-resistant tuberculosis to secure continuum of care between countries. Conclusion We suggest that the following actions may improve the success of treatment for multidrug-resistant tuberculosis patients: deployment of rapid molecular diagnostic tests; development of context-specific treatment guidance and criteria for hospital admission and discharge in the European context; strengthening patient-centred approaches; development of collaborative mechanisms to ensure cross-border care, and development of long-term sustainable financing strategies. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4216-9) contains supplementary material, which is available to authorized users.

Namibia is among the five countries worstly affected by tuberculosis (TB) with a notification rate of 465/100,000 in 2011. This paper describes how the National Tuberculosis Leprosy Program (NTLP) developed from a poorly performing TB control program in 2002 into a well performing program in 2011. The program achieved 85% treatment success for new sputum-positive patients, high coverage and performance on TB/Human Immunodeficiency Virus (HIV) collaborative program activities, and institution of Programmatic Management of Drug-Resistant Tuberculosis (PMDT) where this was absent before. Provision of significant short- and long-term technical assistance provided by KNCV Tuberculosis Foundation (KNCV) in the period 2002-2011 was catalytic in leveraging a total of U$ 80million of external funding in a stepwise approach balanced with absorption capacity, in combination with national policy review and support for its implementation on the basis of two consecutive costed national strategic plans. The technical assistance by KNCV, in partnership with other international technical agencies for specialized areas, proved to work very well in this context where Namibian human resources and funding for TB control were initially limited and the Ministry of Health and Social Services (MoHSS) welcomed extensive technical assistance.

Sector-wide approaches (SWAps) are currently implemented in several, predominantly highly donor-dependent low-income countries, particularly in Sub-Saharan Africa. SWAp intends to enhance health sector performance, especially efficiency, effectiveness, coherence and sustainability. SWAps have been criticized for not being able to produce tangible results and the credibility of a SWAp would increase substantially if such results in terms of health services outputs could be demonstrated. We argue that the monitoring of tuberculosis within the SWAp reviews held to assess sector performance deserves a higher profile. Tuberculosis constitutes in the first place and one of the major public health problems in most of the countries, where SWAps have been introduced, but provided that the programme is integral part of the sector policy and financial management, the indicators used for monitoring TB control programmes can also be used as excellent proxies for monitoring overall health sector performance.