Publications
HST provides free electronic access to over 500 health systems research related reports, publications and papers. Close to 300 of these are publications that have been commissioned and funded by the Trust. Topics include among others district systems development, drug supply management, human resource development, informatics, legislation, finance, environmental health, mental health, lessons learnt, nutrition and sexually transmitted diseases / HIV/AIDS. The main publication of the HST is the annual South African Health Review. From 2005 all HST publications will be available in low resolution only. To explore the range of publications HST offers use the Advanced search to search using a variety of criteria.

Key findings:
A district TB coordinator oversees the provision of TB services in the district. Each PHC facility has a TB coordinator. In some clinics this role and function is rotated from one staff member to another. There is an indication that this happens because nurses are reluctant to get involved with TB management. TB data appears to be lacking in complete reliability and accuracy. Furthermore, some nurses are inadequately informed about the correct use of the TB register. The high proportion of re-treatment patients reflects the general failure of the TB programme to cure patients. This corresponds to the fact that a significant number of patients are not on a DOTS system. A proportion of re-treatment cases did not have sputum culture tests done, despite the fact that these are the patients who are at higher than average risk of having drug resistant bacilli. There appears to be some confusion and misunderstanding about the value and purpose of the different diagnostic procedures for TB.

Varying practices apply to active case&ndashfinding and prophylactic treatment. No clear policy exists with regard to testing and counselling TB patients for HIV.

In search of solutions:
Each clinic nurse who is committed to and interested in TB management needs to be identified and developed to be an efficient local TB coordinator.

Basic day-to-day management of TB patients must become the shared responsibility of all clinic staff. Health facility staff need to receive continued training and encouragement to provide effective health promotion, TB education, use TB registers properly, and to use correct diagnostic procedures. With regard to TB record keeping, a thorough audit of all TB data collection needs to be done so that the system can be rationalised and simplified. The DOTS system needs to be thoroughly assessed in terms of its strengths and weaknesses.

GPs need to come to a shared agreement with public services about a clinical policy for TB diagnosis. Clear guidelines must be established for case-finding and prophylactic treatment. It is important that MDR TB patients are appropriately detected and managed. The district needs to develop an appropriate policy on voluntary testing and counselling for TB patients with HIV.