Through service providers’ eyes: health systems factors affecting implementation of tuberculosis control in Enugu State, South-Eastern Nigeria

Abstract

Background: Well-functioning health systems are essential to achieving global and national tuberculosis (TB) control targets. This study examined health system factors affecting implementation of TB control programme from the perspectives of service providers. Methods: The study was conducted in Enugu State, Southeastern Nigeria using qualitative, cross-sectional design involving 23 TB service providers (13 district TB supervisors and 10 facility TB focal persons). Data were collected through in-depth, semi-structured interviews using a health system dynamic framework and analysed thematically. Results: Stewardship from National TB Control Programme (NTP) improved governance of TB control, but stewardship from local government was weak. Government spending on TB control was inadequate, whereas donors fund TB control. Poor human resources management practices hindered TB service delivery. TB service providers have poor capacity for data management because changes in recording and reporting tools were not matched with training of service providers. Drugs and other supplies to TB treatment centres were interrupted despite the use of a logistics agency. Poor integration of TB into general health services, weak laboratory capacity, withdrawal of subsidies to community volunteers and patent medicine vendors, poorly funded patient tracking systems, and ineffectual TB/HIV collaboration resulted in weak organisation of TB service delivery. Conclusion: Health systems strengthening for TB control service must focus on effective oversight from NTP and local health system; predictable domestic resource mobilisation through budgets and social health insurance; training and incentives to attract and retain TB service providers; effective supply and TB drug management; and improvements in organization of service delivery.

Influence of Public Health Services on the Goal of Ending Tuberculosis: Evidence From Panel Data in China

“…Both the prevalence of patient discovery and prevalence of cure of TB are higher than expected (41). Third, quantitative indicators aid the monitoring the quality of PHS, and strengthening supervision is an effective measure to strengthen PHS for TB (42). Early detection of TB patients and control of the infection source are crucial to stop rapid and contagious infection (43).…”

Bibliometric structured review of tuberculosis in Nigeria

“…Some recent studies expanded the literature on tuberculosis with focused on the South-Eastern part of Nigeria and shed more light on health system factors that affected the implementation of the tuberculosis control program with concentration on the service providers and discovered that lack of human resources management is a bottleneck of tuberculosis service delivery. The authors also discovered that prevalence and development of tuberculosis drug resistance in the community were both influenced by factors such as combination therapy, multiple therapies, and non-compliance with treatment [22][23] , evaluation of the prevalence of drug-resistant tuberculosis and focus on trend and determinants of tuberculosis treatment 20 . Further, another study examined the challenges Nurses at a Federal Teaching Hospital in Nigeria faced while caring for tuberculosis patients 19 .…”