This report is the consensus-based, agreed position of the participants in a workshop for experts in sputum smear microscopy organised in August 2005 by the International Union Against Tuberculosis and Lung Disease (The Union), and as such reflects their views, but not necessarily those of their respective organisations. The group reviewed current practices in sputum smear microscopy for tuberculosis (TB) and suggests considering certain changes in standard guidelines for the sputum collection strategy and the definition of sputum smear-positive TB. The Ziehl-Neelsen staining guidelines need to incorporate a wider error margin for widespread application under field conditions. Quality assurance is of utmost importance, and needs more commitment from National Tuberculosis Programmes and other health authorities. In particular, allocation of sufficient resources for rechecking and integration of laboratory supervision must be ensured. Countries must make better investments in the purchase of high quality microscopes and laboratory supplies. To address the human resource crisis, personnel without specific laboratory schooling can, in principle, be trained to respond to immediate needs for TB diagnostic microscopy services. Periodic reporting on acid-fast smear examinations is highly desirable for regular monitoring and a more balanced provision of supplies.