Successful implementation of active surveillance of Tuberculosis (TB) in South Africa's under-resourced areas hinges on a multifaceted approach that focuses on close cooperation between healthcare authorities and affected communities as well as strengthening teams of community health workers (CHWs).
This is one of the main findings of a recent study at Stellenbosch University (SU).
“Approximately 150,000 TB cases are missed annually in South Africa. Identifying them requires the implementation of active surveillance for TB, which is a policy of the National Department of Health," says Dr Febisola Ajudua, a Family Physician in Ibhayi near Port Elizabeth. She is also affiliated with the Division of Family Medicine and Primary Care at the Faculty of Medicine and Health Sciences at SU and the Department of Family Medicine and Rural Health at Walter Sisulu University.
She and Prof Bob Mash from SU interviewed provincial and district managers of the Eastern Cape's TB programme to gain a better understanding of the challenges associated with the implementation of active surveillance for TB in the Province. The Eastern Cape has the highest incidence of TB in the country.
The findings of their study were published in the open-access journal PLOS ONE recently.
“We spoke to managers of the Province's TB programme because we believe their views on active surveillance and the priority it should be afforded in ending the TB epidemic will help us understand the contextual enablers and challenges unique to this area," says Ajudua.
“We found that managers supported the idea of active surveillance for TB in communities, but said it was limited by budgetary constraints, the inequitable distribution of resources between rural and urban areas, and the inefficient coordination of existing resources that were divided between government and non-government organisations."
According to Ajudua, the managers identified a disconnect between the numbers of people screened positive for symptoms in high-risk communities and the numbers of patients investigated for TB at healthcare facilities.
“They had doubts about achieving their goals for TB screening and thought the main problem was that stakeholders didn't coordinate their activities well. They strongly believed that facility-based screening was a key component in achieving the goals of the National TB Programme.
“Managers also alluded to the need for more engagement with community leaders and CHWs, for retaining outreach team leaders in rural districts, and addressing the underlying social determinants of health through intersectoral collaboration to reduce TB transmission.
“They also highlighted the important role CHWs play in tracing and screening patients in communities despite challenges such as poor coordination and duplication of services, a lack of transport, supportive supervision, as well as security issues."
Ajudua says the managers did point out that there was adequate coverage by Ward Based Primary Health Care Outreach Teams in some districts and that a uniform training curriculum and mentoring opportunities for all CHWs have been developed through the provincial department of health which have contributed to successes of the community-based services so far. In addition to innovations to improve screening, there were also strategies to improve the capability of CHWs, she adds.
According to Ajudua, active surveillance for TB should be supported by adequate community engagement and collaboration to improve the security of CHWs through increased acceptance and understanding of their roles by the community.
“Health reform relies heavily on a community-oriented primary care approach which can help to promote health, prevent and screen diseases, enable early diagnosis of infectious diseases and make it possible for CHWs to address social as well as health problems in communities with fewer resources."
She says although the study focused on the Eastern Cape, some findings could be applied to similar settings in other parts of the country.
FOR MEDIA ENQUIRIES ONLY
Dr Febisola Ajudua
Division of Family Medicine and Primary Care,
Faculty of Medicine and Health Sciences
Stellenbosch University
Email: febijudus@gmail.com
ISSUED BY
Martin Viljoen
Manager: Media
Corporate Communication & Marketing
Stellenbosch University
Email: viljoenm@sun.ac.za
