The implementation of the National Tuberculosis Control Programme (NTCP) at a regional/district hospital and three of its feeder clinics: A Case Study

The purpose of this study was to identify and understand the health system constraints to providing effective care to patients with tuberculosis (TB) in a combined regional/district hospital and three of its feeder clinics in an area with a high incidence of TB and high prevalence of HIV. The study was funded by the National Department of Health.

AIM
The aim of the study was fourfold:
1. To determine the gap between the care recommended by the national TB guidelines for patients with TB and the care received by patients at a combined regional/district hospital and clinic level.
2. To explore reasons for this gap and to identify factors which facilitate and/or constrain the ability of the hospital and clinics to provide the care outlined in the national guidelines.
3. To identify factors which will need to be overcome for the national TB guidelines to be effectively implemented.
4. To determine the potential for leakages of patients from the system at various points and to quantify these leakages where possible.

STUDY DESIGN
A multi-faceted retrospective descriptive case study design was used to provide information about the management of patients with TB at a regional/district hospital and three of its feeder clinics.

STUDY OBJECTIVES AND METHODS
To achieve the objectives of the study, the following methods were used:

• Participant observation and key informant interviews were used to review the implementation of the NTCP at a regional/district hospital and to identify the potential for leakages of patients from the system.
• A retrospective record review of TB and laboratory registers was conducted to examine the process of laboratory diagnosis of pulmonary TB (PTB) and extra-pulmonary TB (ETB) to identify the potential for leakages of patients from the system and quantify these where possible.
• Self-administered, structured questionnaires were completed by clinicians (n = 65) to assess doctors knowledge of the NTCP and consider how this might lead to leakages of patients from the system.