Increasing TB Case Detection Rates in Six African Countries: A Conversation with Dr. Eliud Wandwalo

Dr. Eliud Wandwalo. {Photo credit: MSH.}Photo credit: MSH.

MSH works with international, national, and local partners to strengthen the capacity of health systems, national tuberculosis (TB) programs, and health managers to improve the lives of those affected by TB and prevent the spread of the disease. MSH participates in several global TB initiatives, including USAID’s Tuberculosis CARE I Program (following the TB CAP program); the STOP TB Partnership; and the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Through these initiatives and additional country projects, MSH works in more than a dozen countries, including nine in Africa.

MSH spoke with Dr. Eliud Wandwalo, an MSH Regional TB Advisor for Africa, about meeting TB challenges through a patient-centered approach in Democratic Republic of the Congo (DRC), Ethiopia, Ghana, Nigeria, South Sudan, and Tanzania.

MSH supports TB programs in nine African countries, including six that you advise: DRC, Ethiopia, Ghana, Nigeria, South Sudan, and Tanzania. What is the biggest TB challenge in these regions?

One of the biggest TB challenges in Africa is low case detection. According to the 2011 WHO Global TB Report, the African region has the lowest TB case detection rate in the world—only 60% of people with TB are accurately diagnosed. The WHO target for TB case detection is 70% and above. We attribute this low case detection to poor access to TB diagnostics, poor skills among health workers, and low public knowledge about TB.

What is MSH’s approach to the challenge of low TB case detection?

MSH works with National TB Programs to strengthen health systems for better TB detection. Since 2009, MSH has been introducing Standard Operating Procedures (SOPs) at the health facility level in Ghana, Nigeria, Ethiopia, and Tanzania. These guidelines, which include screening all patients for TB regardless of their reasons for visiting the health facilities, are proving very effective: We are seeing significant increases in case detection in the program areas of all of these countries, including a 30% increase in two years in Ethiopia and a 50% increase in one year in Tanzania.

The SOPs focus on improving the organization and flow of patients within health facilities; implementing a multidisciplinary team approach to TB and integrating TB with other services, such as HIV and maternal & child health; improving the skills and knowledge of staff through on-the-job training, mentoring, and provision of job aids and diagnosis algorithms; improving monitoring, supervision, data use, and evaluation of TB activities; and taking a patient-centered approach to TB care and improving the quality of TB service delivery.

What does it mean to take a patient-centered approach to TB? What are some examples of patient-centered interventions for TB?

Traditionally, TB services have been provided through a “vertical” approach that focuses on the disease without taking the patient’s convenience into consideration. A patient-centered approach is a more horizontal, or diagonal, approach that aims to create a patient-friendly environment.

Some of MSH’s patient- and health worker-centered interventions include:

  • Integrating TB services into HIV, maternal and child health, and other services
  • Training health workers on communication skills and counseling patients
  • Assigning multidisciplinary TB teams in health centers instead of only TB nurses
  • Allowing patients to choose to take their medications at the health facility or at home and pick who will supervise his/her treatment
  • Providing standard operating procedures to health workers in health facilities and patient-friendly health communication materials to patients in their communities

We make TB services more holistic and comprehensive, and take patient convenience into account. Focusing on the needs of patients also means improving the capacity of health workers to deliver high-quality services.