Would program performance indicators and a nationally coordinated response accelerate the elimination of tuberculosis in Canada?

Abstract

Twenty years ago, a National Consensus Conference on Tuberculosis (TB) recommended that the provinces and territories of Canada jointly declare a commitment to TB elimination with national coordination and assured funding, executed by a committee of federal and provincial/territorial representatives. Canada has committed to the global TB elimination targets set forth by the World Health Organization but lacks a coordinated response. In particular, with the exception of one published and implemented by Indigenous Services Canada, there has been no national monitoring and performance framework. Herein, we provide a commentary on the importance, to TB elimination in Canada, of developing such a framework. We invite a debate about whether more can and should be done to monitor and report for action at every jurisdictional level. Of utmost importance will be the need to achieve consensus from stakeholders about what is measured, among whom, how often, who collects and processes data, and how to respond to the successes and failures those data indicate. Insofar, as performance targets are well defined and implemented, national progress towards tuberculosis elimination should accelerate.

Tuberculosis and COVID-19 in Canada

“…Implement a dashboard for rapid dissemination of TB information such as was developed for COVID-19, recognizing that there are no technological barriers to its development. Develop robust community-driven data, such as on latent TB infection – a treatable asymptomatic state with some parallels to asymptomatic COVID-19 infection – to inform TB program performance [7] .…”

“…Develop robust community-driven data, such as on latent TB infection – a treatable asymptomatic state with some parallels to asymptomatic COVID-19 infection – to inform TB program performance [7] .…”

“…The discovery of anti-tuberculosis drugs in the 1940s-50 s dramatically reduced mortality and came close to eliminating the disease in all but a few marginalized groups – Indigenous peoples, the inner city poor and homeless, and now the foreign-born whose latent infection is largely imported. In these marginalized groups, it is the complacent, almost indifferent application of certain of the aforementioned public health principles (see Table) [ 6 , 7 ], together with Indigenous and other group-specific social inequities that have sustained the infection [8] .…”

Tuberculosis among northern Manitoba First Nations, 2008–2012: program performance on- and off-reserve

“…It does not apply to TB activities for Indigenous individuals living off-reserve, nor for the general Canadian population, and it does not recommend public reporting of performance. Finally, a recent (2018) Chief Public Health Officer spotlight report on TB elimination in Canada, The Time is Now, did not mention any role for performance measurement in TB elimination, despite current guidance on TB program performance measurement as a valuable tool in the fight against TB (Heffernan and Long 2018;Tam 2018).…”

Strengthening tuberculosis surveillance in Canada

“…Researchers, clinicians and public health personnel in Canada continue to call for a set of national-level TB indicators for high-risk populations. 10 In November 2018, experts gathered to propose an initial list of indicators of program performance for consideration (National Collaborating Centre for Infectious Diseases: unpublished data, 2018). Further consultation will be needed to reach agreements with all jurisdictions in the federation to determine a core set of indicators and recommendations for consistent data reporting at the national level to monitor progress towards eliminating TB.…”