Tuberculosis

Information on health expenditure suggests that most poor countries have a large and growing private medical sector. Surveys indicate that the private sector is an important source of care, even for poor people and even where public services are widely available. Experts believe that private practitioners manage a large proportion of the unreported majority of tuberculosis cases. [adapted from author]

In this study, we aimed to determine the cost and cost-effectiveness of involving health extension workers in tuberculosis treatment in Southern Ethiopia. This paper presents an ancillary cost-effectiveness analysis of data from a randomized control trial. [adapted from introduction]

Documentation of test results for latent tuberculosis infection is important for health care workers and students before they begin work. A negative result provides a baseline for comparison with future tests. A positive result affords a potential opportunity for treatment of latent infection when appropriate. This study sought to evaluate the yield of the referral process for positive baseline tuberculin tests, among persons beginning health care work or studies. [from abstract]

This handbook provides background information on the current workforce situation in the health sector and summarizes the issues and challenges; introduces the HRH Action Framework and the Stop TB (tuberculosis) Strategy; applies the Framework to human resource development (HRD) for comprehensive TB control; describes how to prepare a strategic plan for HRD in support of comprehensive TB control; and gives a step-by-step guide on how to develop HRD plans based on the structures and processes described. [adapted from introduction]

This article describes a systematic process to develop and implement two strategic action plans focussing on competence development based on specific job descriptions. The approach was a change from only focussing on training, to a broader, long term approach to human resource development for comprehensive TB control. [adapted from abstract]

This article reports on the obstacles to care and the outcome of treatment for patients presenting with tuberculosis to four hospitals in the rural South African region of Sekhukhuneland. [adapted from article]

This study involves the development and evaluation of training materials for provider-initiated HIV counseling and testing, HIV prevention and integrated primary HIV care and support for use by health care workers involved in the care of patients with TB at the primary health care clinic level in the Democratic Republic of Congo. [adapted from abstract]

The purpose of this survey was to identify nurses' perceived challenges in implementing a community-based TB program in the Omaheke region of Namibia. The HIV pandemic has increased the number of TB patients and increased nurses' workloads, aggravating the burden of TB as a resurgent disease in this region. In order to implement a successful community-based TB program, the patient-related, access-related and knowledge-related challenges, perceived by the nurses, need to be addressed effectively. [from abstract]

The current global tuberculosis (TB) epidemic has pressured health care managers, particularly in developing countries, to seek for alternative, innovative ways of delivering effective treatment to the large number of TB patients diagnosed annually. One strategy employed is direct observation of treatment for all patients. In high-burden settings innovation with this strategy has resulted into the use of lay community members to supervise TB patients during the duration of anti-TB treatment.

This article compares the quality, quantity and distribution of tuberculosis physicians, laboratory staff, community health workers and nurses in Nigeria and Kyrgyzstan, and highlights implications for (re)training tuberculosis workers in developing countries. [from abstract]

Early detection of smear positive tuberculosis (TB) cases by smear microscopy requires a high level of suspicion of TB among primary care physicians. The objective of this study is to measure TB suspicion and knowledge among private and public sector general practitioners using clinical vignette-based survey and structured questionnaire. [from abstract]

In Asia the majority of tuberculosis (TB) patients get their diagnosis and treatment from private medical practitioners - yet private doctors are notoriously bad at providing adequate TB services. At the same time, public services find it difficult to provide services that are easily accessible to patients. Surprisingly, one approach - public-private partnerships - may address both of these problems. [author’s description]

This paper analyzes the use of financial and material incentives for patients and healthcare providers to improve tuberculosis detection and successful completion of treatment.

The objective of this study was to assess whether adding a training intervention for clinic staff to the usual DOTS strategy (the internationally recommended control strategy for tuberculosis (TB)) would affect the outcomes of TB treatement in primary care clinics with treatemet success rates below 70%. [from abstract]

The goal of this policy is to help management and staff minimize the risk of TB transmission in health care facilities and other facilities where the risk of transmission of TB may be high due to high prevalence of both diagnosed and undiagnosed TB such as prisons.

This presentation was given as part of the Christian Health Association’s Conference: CHAs at a Crossroad Towards Achieving Health Millennium Development Goals. It provides an excellent overview of the challenges of Malaria and HIV/AIDS ; discusses the human resource needs in light of these challenges; and how to build and maintain capacity. [from author’s description]

The risk of transmission of Mycobacterium tuberculosis from patients to health-care workers is a neglected problem in many low- and middle-income countries. Most health-care facilities in these countries lack resources to prevent nosocomial transmission of tuberculosis. [author’s description]

The objective of this article was to compare the cost-effectiveness of the tuberculosis programm run by the Bangladesh Rural Advancement Committee, which uses community health workers (CHWs), with that of the government program which does not use CHWs. [adapted from author]

Private health care plays a central role in health-care provision in many developing countries hat have a high burden of TB. It is therefore encouraging that public-private partnerships (PPM) are being set up in various countries around the world to explore possible interaction between the national TB programs and other partners in the fight against TB. The objective of this review was to use the published literature to asses the range of providers included in PPMs for their ability to provide case-detection services for the vulnerable. [abstract]

The Quality Assurance Project undertook a national assessment of private sector tuberculosis (TB) services in Cambodia to improve understanding of private sector practices and the sector’s willingness to participate in efforts to improve TB services. Over 500 respondents, including doctors, pharmacists, drug sellers, and TB patients, participated. In addition, mystery shoppers visited private pharmacists and drug sellers so that the surveyed groups’ reports could be compared to actual experiences. The survey uncovered many aspects of private sector TB services that are undermining the Cambodian Government’s efforts to increase detection and cure rates. Recommendations focus on bringing the private sector into the National TB Program so that all patients seeking TB care will receive quality services. [publisher’s description]

A group of individuals with expertise in areas such as TB control, human resources (HR) development and health systems (Annex 1) participated in a Consultation on HR Development for TB Control convened jointly by WHO and the Rockefeller Foundation and held at WHO headquarters in Geneva on 27 and 28 August 2003. This report summarizes the results of the consultation and the recommendations presented to the Second ad hoc Committee on the TB Epidemic. Although addressed to the Partnership, the recommendations of this report are concerned with broader HR issues and cover areas relevant to the global health care workforce crisis; they are therefore pertinent to other programmes and services.

The checklist described in this document has been developed as a tool to assist those involved in a systematic review of the human resource development component of the NTP. This component is often referred to as “training.” In this document, the term training is used in a broader context than the more traditional interpretation of the term, where training refers to organization and implementation of training courses. Training in this document is often replaced by the term “HR development” to stress the need for a broader and more long-term approach within NTPs. [from introduction]

The objective of this document is to implement and evaluate a public–private partnership to deliver the internationally recommended strategy DOTS for the control of tuberculosis (TB) in Lalitpur municipality, Nepal, where it is estimated that 50% of patients with TB are managed in the private sector. [author’s description]

Recent studies have shown evidence of a direct and positive causal link between the number of health workers and health outcomes. Several studies have identified an adequate health workforce as one of the key ingredients to achieving improved health outcomes. This article explores how the Global Fund addresses the challenges of a health workforce bottleneck to the successful implementation of priority disease programmes. [abstract]

In Mozambique, [Health Alliance International] HAI has been working closely with the MOH for more than fifteen years to support the development and implementation of MOH programs in reproductive health, the response to HIV/AIDS, and malaria control… HAI works with the MOH to implement the nationally designed model of HIV care, and has supported the implementation of voluntary counseling and testing centers, prevention of mother-to-child transmission of HIV (PMTCT) PROGRAMS, and HIV treatment centers integrated into this public sector model of care. [publisher’s description]

Abstract
This Guide is meant to assist members of Country Coordinating Mechanisms and other individuals and organizations involved in preparing proposals, or providing input into these proposals, for Round 6 of the Blobal Fund to Fight AIDS, Tuberculosis, and Malaria. The next-to-last section, which provides some models of successful human resources for health initiatives, may also be useful to individuals and organizations involved in work on human resource and health system strengthening.

Zambian nurses have been greatly affected by the rise in the morbidity and mortality of nurses with TB. This article explains the impact of TB on the Zambian nursing workforce. Review of Zambian government programmes designed to address this health crisis and targeted interventions to reduce TB among nurses are offered. [abstract]

This document describes USAID’s strategy for combating Tuberculosis. The strategy focuses on four main areas: a) expand and strengthen DOTS, b) increase and strengthen human resource capacity, c) develop and disseminate new tools and strategies, and d) adapt DOTS to address special challenges.