Evaluation of the National Tuberculosis Program (NTP) and Tuberculosis Surveillance System, Jordan 2021 (Preprint)

Abstract

BACKGROUND The National Tuberculosis Program (NTP) and Tuberculosis (TB) Surveillance System in Jordan have never been evaluated systematically and comprehensively. OBJECTIVE Therefore, this study aimed to determine the gaps in the NTP and the surveillance system in Jordan in 2021 and assess the usefulness and the functionality of TB surveillance. METHODS A concurrent embedded mixed quantitative/qualitative methods study has been conducted to assess the NTP and TB Surveillance System in Jordan. A semi-structured questionnaire was developed based on the Updated CDC Guideline for Evaluating Public Health Surveillance System to collect necessary information from service providers and other stakeholders. RESULTS The NTP and TB Surveillance System face several gaps and challenges in the infrastructure, human resources, equipment, training, NTP functions, surveillance system performance, operational framework, coordination, case findings, and data collection and notification. Regarding the Chest Disease and Migrants Health Directorate (NTP central level) location and accessibility, the building is old and dilapidated, located in the capital's heart, and in a crowded area .Furthermore, infection control at the main Chest Diseases and Migrants Health Directorate is a major concern. It was found that not all TB surveillance System objectives were met in the past. The performed analysis of collected data is neither thorough nor checked for outliers or data quality. The data that the system provides are not well utilized or analyzed thoroughly; accordingly, there were no actions taken as a result of the analysis and interpretation of the data from the TB Surveillance System. There is a delay in TB cases notification received from the parties involved in the TB Surveillance System. The data providers' participation rate in the system is moderate. Moreover, the ethical considerations is a concern; the TB patients do not sign a consent form before giving the data, and in many cases, the patient does not know that they should give their consent prior to obtaining the data from them. CONCLUSIONS Our study showed different gaps in the NTP and TB surveillance system across several areas. The structure of NTP and the clinical expertise of human resources does not support TB elimination. An electronic data collection and notification system is fundamental to facilitate TB case detection, reporting, and follow-up. Infection control measures and practices need to be appropriately applied in all health facilities, and ethical considerations have to be improved to ensure confidentiality and patients' data security. Elimination of tuberculosis in Jordan requires multiple interventions and preparations. The Jordan government should consider TB as a national threat even the country faces low epidemic scenarios. Decision-makers should push the TB epidemic on the national health agenda. The country should spend time and effort to allocate national and international resources for TB control programs. There is a need to identify the high-risk and vulnerable groups and the best means to reach them not only for surveillance purposes but also for service provision.