<p>TB MDR is a significant public health threat, the author provides a detailed background, with clear objectives. However, the indicators are not clearely defined i regards to what is optimal or not. The authors states a content analysis I assume for the qualitative data but the results do not show the findings from content analysis. The statistical methods are not clearly stated. No recommendations are given considering that the system is donor dependent we should be concerned about the sustainability of the system.</p>