Facilitators for and Barriers to the Implementation of National Tuberculosis Management Guidelines

Abstract

The South African government developed the National Tuberculosis Management Guidelines (NTBMGs) to provide guidance to professional healthcare workers on the management of people with TB and also those co-infected with HIV. However, little is known about primary healthcare (PHC) nurses’ perceptions of the implementation of the NTBMGs, despite their critical role in TB management. The purpose of this study was to explore PHC nurses’ perception of the implementation of the NTBMGs in order to identify factors influencing the implementation of the NTBMGs and to make recommendations to improve the implementation of the NTBMGs. The study was conducted in the Eastern Cape, South Africa. The Normalization Process Model (NPM) was used as a theoretical framework to understand the factors influencing the implementation of the NTBMGs. A qualitative, explorative, descriptive and contextual research design was utilised. Data were collected using individual semi-structured interviews on a purposive sample of 10 PHC nurses working in rural clinics. Data were analysed following a descriptive method of Tesch. The study revealed several facilitators for and barriers to the implementation of the NTBMGs based on the NPM. The facilitators included the PHC nurses’ satisfaction with the Directly Observed Treatment, Short Course (DOTS) strategy in rendering health services to TB patients, the PHC nurses’ perception of TB meetings as an appropriate platform for problem-solving, of the NTBMGs to be consistent with TB management, and of job satisfaction in relation to patient improvement. The barriers included poverty, inadequate training, shortage of staff, and a lack of material resources, a proper infection control policy, and space. There is a need for the provision of adequate human, material and infrastructural resources in order to eliminate the barriers to the implementation of the NTBMGs.