Tackling the Tuberculosis Crisis in Zambia

Submitted by benitan on Thu, 08/01/2019 - 11:25
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Tuberculosis (TB) still remains a major public health problem in Zambia and one of the top ten causes of mortality. Recently, Zambia is facing an emerging problem of Multi-drug Resistant TB (DR-TB) and although treatment success rates have improved, treatment is still low and is attributed to the lack of adequate support structures.

TB detection rate currently stands at 62 per cent. A baseline study on national TB health systems in Zambia has raised important concerns regarding the nature of TB services in Zambia. While Zambia has made important milestones in the control and management of TB, the study has identified a number of important gaps that need to be closed for the country to be able to completely eliminate TB by 2035. 

To be able to respond to these and other challenges, the World Bank, the African Union Development Agency (AUDA-NEPAD) and the East, Central and Southern Africa Health Community (ECSA-HC), are supporting the implementation of the Southern Africa TB and Health Systems Support (SATBHSS) Project and Zambia is one of the countries of focus. The project is designed to respond to key constraints in the control of TB and other occupational lung diseases by supporting the implementation of international best practices and scaling up promising interventions in affected countries. 

Within the development of this project, a results framework was developed, including indicators to monitor progress throughout the project. This study was intended to create such indicators to be used to monitor and evaluate project performance during and at the end of the project period. The study also collected some of the key indicators in the M&E framework of the National TB strategic plan that was launched by the Government. It outlines lessons learned that can be applied for future in-country capacity building to address TB interventions in Zambia and regionally. 

Key findings:

  • Although TB and HIV share common epidemiological patterns and presents opportunities for joint programming, the implementation of measures to reduce the burden of TB among people living with HIV/AIDS (PLHIV) face some barriers including delays in diagnosis and low yield of results. 
  • In the mining sector where the risk of TB is known to be high, current legislation requires that any mine worker diagnosed with either TB or silicosis should not work in a scheduled area of the mine. This, however, has become a barrier to mine workers seeking care within the mine health institutions for fear of losing employment. This law also forces some workers to conceal their TB statuses which exacerbate the risk of transmission to other mine workers.

The baseline study has identified high impact areas for strengthening in-country capacity for (1) TB Surveillance, Diagnosis and Support, (2) Quality of Service Delivery, and (3) Occupational TB Services. 

The following are some of the key policy recommendations of the study:

TB Surveillance, Diagnosis and Support

  1. Strengthen community outreach activities to improve active case finding and contact tracing.
  2. Strengthen the Monitoring and Evaluation (M&E) framework especially at the lower level for better management of TB data.
  3. Develop Standard Operating Procedures (SOPs) and algorithms for systematic screening and TB assessment of contacts in order to improve the management of contact tracing.
  4. Strengthen the system of administering Isoniazid preventive therapy (IPT) to People living with HIV (PLHIV) who have latent TB infection.
  5. Strengthen the provision of nutritional and psychosocial counselling support to Drug-Resistant TB (DR-TB) patients to accelerate treatment.
  6. Strengthen data management in collaboration with stakeholders working outside the National Tuberculosis and Leprosy Programme (NTLP) to accelerate TB detection.
  7. Accelerate the renovation of TB laboratories in health facilities to improve TB detection.

Quality of Service Delivery

  1. Strengthen behaviour change communication activities to spread information about TB to vulnerable groups.
  2. Shorten TB tests turnaround time, especially in rural areas, as a way of encouraging TB patients to go for TB tests.
  3. Improve TB drug supplies to avoid stock-outs.
  4. Strengthen capacities of health facilities to effectively deliver the required support to TB patients.
  5. Improve TB patient privacy by ensuring that every health facility has a dedicated TB corner.
  6. Ensure that services are administered by personnel trained in TB treatment.

Occupational TB Services

  1. Strengthen TB screening for miners and close gaps in the data concerning the total number of miners in the country.
  2. Improve TB services in non-mining sectors of the economy; currently, occupational health and safety institute (OHSI) services are more accessible to mining companies and less to other industries that may face similar risks of contracting TB.
  3. Address specific legal requirements that may act as barriers to seeking care among TB patients in the mining sector.
  4. Strengthen provision of TB services for ex-miners; most miners relocate to hard-to-reach places, making it difficult for the OHSI to continue screening former miners.
  5. Increase frequency and quality of mine inspections for TB.