Qualitative Assessment of Challenges in Tuberculosis Control in West Gojjam Zone, Northwest Ethiopia: Health Workers’ and Tuberculosis Control Program Coordinators’ Perspectives

Abstract

Background. Weak health systems pose many barriers to effective tuberculosis (TB) control. This study aimed at exploring health worker's and TB control program coordinator's perspectives on health systems challenges facing TB control in West Gojjam Zone, Amhara Region, Ethiopia. Methods. This was a qualitative descriptive study. Eight in-depth interviews with TB control program coordinators and two focus group discussions among 16 health workers were conducted. Purposive sampling was used to recruit study participants. Thematic analysis was used to identify and analyse main themes. Results. We found that intermittent interruptions of laboratory reagents and anti-TB drugs supplies, absence of trained and motivated health workers, poor TB data documentation, lack of adherence to TB treatment guideline, and lack of access to TB diagnostic tools at peripheral health institutions were challenges facing the TB control program performance in the study zone. Conclusions. Ensuring uninterrupted supply of anti-TB drugs and laboratory reagents to all health institutions is essential. Continuous refresher training of health workers on standard TB care and data handling and developing and implementing a sound retention strategy to attract and motivate health professionals to work in rural areas are necessary interventions to improve the TB control program performance in the study zone.

Barriers for tuberculosis case finding in Southwest Ethiopia: A qualitative study

“…Our findings suggest that there were inadequate resources which were necessary for TB case finding. The findings are consistent with previous studies in Ethiopia which reported that there were inadequate resources, such as trained health-care providers and laboratory reagents for the TB control programs [12,39,40]. Inadequate or the absence of necessary resources might significantly hinder the provision of TB diagnostic services as expected, and cause TB case notification to become low in the study area.…”

“…Other qualitative studies also revealed similar barriers to TB control programs, such as a shortage of human resources, inadequate access to TB services, and transportation problems, were reported along the Thai-Myanmar border [58]; a shortage of resources, poor accessibility and a capacity for TB diagnosis, as well as a weak community involvement, were reported in Northern Malawi [59]. Moreover, a shortage of resources, and a lack of access to TB diagnostic services at peripheral health facilities, were reported in Northwest Ethiopia [40].…”

Patients’ and health system’s delays in the diagnosis and treatment of new pulmonary tuberculosis patients in West Gojjam Zone, Northwest Ethiopia: a cross-sectional study

“…Despite the integration of TB screening activities in the general health care and increased access in TB diagnostic and treatment services however, it is surprising that the median health system’s delay observed in the current study is still similar with findings of former studies conducted in Amhara Region of Ethiopia [6, 12]. In a recent qualitative study [22], a number of challenges that may have implications for increased health system’s delay were reported from the study area. Among others, frequent interruptions of laboratory reagents and anti-TB drugs supplies, lack of diagnostic tools for smear-negative TB and lack of laboratory personnel in some health centers were identified as challenges of the TB control program [22].…”

“…In a recent qualitative study [22], a number of challenges that may have implications for increased health system’s delay were reported from the study area. Among others, frequent interruptions of laboratory reagents and anti-TB drugs supplies, lack of diagnostic tools for smear-negative TB and lack of laboratory personnel in some health centers were identified as challenges of the TB control program [22]. Interventions directed at solving these challenges are essential to reduce the long health system’s delay observed in the study area.…”

“…Smear microscopy has very low sensitivity [27] and many patients can get false negative results. The long health system’s delay may also be related to less experienced health providers particularly working at peripheral health centers [22]. Thus TB patients may require to make repeated visits before they are diagnosed and started on treatment.…”