Key enablers | Key constraints |
---|---|
Leadership and governance | |
Stewardship from state-level NTP | Weak bureaucratic accountability from local health system. |
Programme management support | Low government attention to TB control program |
Regular performance review and coordination | |
Health financing | |
External funding for TB control from donors | Budgeted funds are not released to TB control program at the state level. |
Absence of TB in local governments’ budget. | |
TB supervisors’ motorbikes are not replaced for several years. | |
Human resources | |
Supportive supervision of facility TB focal persons. | Unwillingness of health workers to work in TB control programme |
Frequent re-deployment of skilled TB service providers | |
High number of untrained TB service providers. | |
Health workers are owed several months of salaries | |
Health technology | |
Use of dedicated logistics agency for drug distribution. | Logistics agency dumped drugs meant for entire local government in one location. |
Drug kits does not meet needs of extrapulmonary TB patients and those weighing more than 70 kg. | |
Shortage of human immunodeficiency virus (HIV) test kits. | |
Health information system | |
Availability of recording and reporting tools | Change in tools are not matched with training of service providers. |
Adaptation of tools to strategies in TB control. | |
Introduction of electronic recording and reporting system | |
Service delivery | |
Availability of functional microscopic centre | Stigma by health workers |
Introduction of GeneXpert | Concern for contracting TB |
Engagement of community volunteers and patent medicine vendors | Lack of incentives to attract health workers |
Reduction in duration of treatment from 8 to 6 months | Many TB treatment centres lack of TB laboratory |
Poorly functioning GeneXpert. | |
Weak patient tracking system | |
Withdrawal of incentive for community volunteers and patent medicine vendors. | |
Limited number of TB/HIV collaborative sites. |