Despite the availability of TB guidelines/ standards in high burden TB countries, provider adherence remains a challenge. In most cases, provider adherence to guidelines is not a problem of individual performance, but a problem located in the health system itself – at the political, health services, community, and patient levels.
Between 2011-2012, TB CARE II conducted multi-country studies in Bangladesh, Zambia, and Kenya to gather information on: (1) Knowledge and skills of providers to provide standard TB services; (2) Providers’ compliance with national and service delivery standards; (3) Existence of systems for maintaining TB service delivery capacity; and (4) TB patients’ perceptions of quality of care received at facilities.
Some general findings included:
- While all health facility managers had access to adult TB guidelines, fewer had access to specific guidelines, such as for MDR-TB and TB-HIV.
- Some new guidelines had been developed by the NTP but not yet disseminated, illustrating a system delays in getting guidelines from the NTP to facility levels.
- While most facilities had functioning TB register systems in place, issues were found such as data from monitoring TB activities not being always used for decision-making, scheduling a follow-up, recording of symptoms and contact tracing mechanism was much less often done.
- TB drug shortages were reported by many health facility managers.
- There appeared to be a training-knowledge gap: most providers had been trained but many did not have adequate knowledge about TB, including those at highest risk of TB; treatment of TB in pregnancy; and TB testing in HIV+ patients.
- While all countries had a functional TB supervisory system in place, supervision was not always done as often as stipulated by guidelines and adequate follow-up was not always being provided.
- There were gaps in the information health providers communicated to TB patients or those with TB symptoms – especially having to do with information about side-effects of TB treatment; the need to have family members and close contacts screened for TB; not linking all patients to DOTS support; and for the countries with high HIV prevalence offering HIV counseling and testing to patients with unknown HIV status and referring HIV positive patients for ART.