Through service providers\u2019 eyes: health systems factors affecting implementation of tuberculosis control in Enugu State, South-Eastern Nigeria

Daniel Chukwuemeka Ogbuabor

doi:10.1186/s12879-020-4944-9

Abstract

BackgroundWell-functioning health systems are essential to achieving global and national tuberculosis (TB) control targets. This study examined health system factors affecting implementation of TB control programme from the perspectives of service providers.MethodsThe study was conducted in Enugu State, South-eastern Nigeria using qualitative, cross-sectional design involving 23 TB service providers (13 district TB supervisors and 10 facility TB focal persons). Data were collected through in-depth, semi-structured interviews using a health system dynamic framework and analysed thematically.ResultsStewardship from National TB Control Programme (NTP) improved governance of TB control, but stewardship from local government was weak. Government spending on TB control was inadequate, whereas donors fund TB control. Poor human resources management practices hindered TB service delivery. TB service providers have poor capacity for data management because changes in recording and reporting tools were not matched with training of service providers. Drugs and other supplies to TB treatment centres were interrupted despite the use of a logistics agency. Poor integration of TB into general health services, weak laboratory capacity, withdrawal of subsidies to community volunteers and patent medicine vendors, poorly funded patient tracking systems, and ineffectual TB/HIV collaboration resulted in weak organisation of TB service delivery.ConclusionHealth systems strengthening for TB control service must focus on effective oversight from NTP and local health system; predictable domestic resource mobilisation through budgets and social health insurance; training and incentives to attract and retain TB service providers; effective supply and TB drug management; and improvements in organization of service delivery.

Highlights

Introduction of GeneXpertConcern for contracting TBEngagement of community volunteers and patent medicine vendorsLack of incentives to attract health workersReduction in duration of treatment from 8 to 6 monthsMany TB treatment centres lack of TB laboratory Poorly functioning GeneXpert.Weak patient tracking systemWithdrawal of incentive for community volunteers and patent medicine vendors.Limited number of TB/human immunodeficiency virus (HIV) collaborative sites.strategies: “we changed from eight months to six months treatment
Low- and middle-income countries (LMICs) still struggle with health system strengthening for TB control
Leadership and governance Stewardship from the State and Local Governments emerged as key theme

Summary

Introduction

Introduction of GeneXpertConcern for contracting TBEngagement of community volunteers and patent medicine vendorsLack of incentives to attract health workersReduction in duration of treatment from 8 to 6 monthsMany TB treatment centres lack of TB laboratory Poorly functioning GeneXpert.Weak patient tracking systemWithdrawal of incentive for community volunteers and patent medicine vendors.Limited number of TB/HIV collaborative sites.strategies: “we changed from eight months to six months treatment. Lack of incentives to attract health workers. Many TB treatment centres lack of TB laboratory Poorly functioning GeneXpert. Withdrawal of incentive for community volunteers and patent medicine vendors. Poor recording and reporting resulted from work overload and lack of incentives. This study examined health system factors affecting implementation of TB control programme from the perspectives of service providers. Well-functioning health systems are essential to achieving global and national tuberculosis (TB) control targets [1]. Comprehensive changes to policies and regulation, organisational structures, processes and relationships and effective use of resources are needed to achieve and sustain goals of TB control programme [3, 4]. Low- and middle-income countries (LMICs) still struggle with health system strengthening for TB control

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Results

Discussion

Conclusion