TB Infection Control

In India Accredited Social Health Activists - ASHA are the last leg in delivering primary health care. RNTCP is seriously considering including ASHA for delivering TB services in National Rural Health Mission-NRHM

There is no doubt that programme sustainability especially in developing
countries depends on a strong health delivery system. However an entry and
exit strategy is critical to achieving this objective. More resources are
spent on the entry strategies. The exit strategies are after thought and
takes place at the end of the project, leaving governments to sustain the
programmes.

A few practical examples.
• As much as possible strengthen/improve existing system to deliver TB
services as part of integrated service delivery
• Ensure integrated M&E systems
• Avoid labeling support as TB. only related support. E.g TB information
officers, TB computers for collating TB data etc
• Avoid creating TB coordinators at primary levels though a national
programme manager is essential especially at the beginning of programme
implementation.
Ghana is making use of the private sector (example chemical sellers) at the
community level.
--
Dan osei
Deputy Director
PPMED-GHS

Dear Colleagues

I just wanted to add that an important step in the process of integration related to Training health care workers to be competent in managing and control of TB which in many countries has been running as a vertical program.

I have been wondering if there are minimum set of competencies for TB and TBHIV that have been developed to guide intergration of TB clinical care and control into training curricular from preservice to inservice?
To me this woruld be a good step in integration

Moses

Dear Moses

What a wonderful breath of fresh air you are! I have been in IPC for 35 years mainly in the UK and we were very proud of our containment policies because these were wide and all embrassing. If the basics are in place the rest follows. I totally agree that with TB as with HIV, teaching has been in silos and no one is really aware of what someone else is doing- therefore complete IPC policies cannot be implemented. The only way to understand IPC is that it is a PROCESS of Quality CARE- therefore cannot be in a vertical programme. All the IPC training courses (including the two-year Post graduate Diploma in IPC) we run are wide- to ensure understanding of IPC at a fundamental level- thereafter the implementation of PPE, ventilation and other IPC measures just fall into place, such as isolation, segregation etc. all these aspects are covered anyway in hospital design, risk assessement and management, microbiology and decontamination and sterilization. We know that in Africa at least 10% of infection both HIV and TB are nosocomial-- should we not be talking about bronchoscopy, decontamination and other related topics?
However, the sad thing is that ...

Dear Moses

What a wonderful breath of fresh air you are! I have been in IPC for 35 years mainly in the UK and we were very proud of our containment policies because these were wide and all embrassing. If the basics are in place the rest follows. I totally agree that with TB as with HIV, teaching has been in silos and no one is really aware of what someone else is doing- therefore complete IPC policies cannot be implemented. The only way to understand IPC is that it is a PROCESS of Quality CARE- therefore cannot be in a vertical programme. All the IPC training courses (including the two-year Post graduate Diploma in IPC) we run are wide- to ensure understanding of IPC at a fundamental level- thereafter the implementation of PPE, ventilation and other IPC measures just fall into place, such as isolation, segregation etc. all these aspects are covered anyway in hospital design, risk assessement and management, microbiology and decontamination and sterilization. We know that in Africa at least 10% of infection both HIV and TB are nosocomial-- should we not be talking about bronchoscopy, decontamination and other related topics?
However, the sad thing is that this is not universal and often causes more confusion than clarity- the result is that these TB programmes are not sustainable without ownership.
I agree with you totally!!
Shaheen

Prof Shaheen Mehtar
MBBS, FRC Path (UK), FCPath (Micro) (SA), MD (Eng)
Head of Academic Unit for Infection Prevention and Control
Tygerberg Hospital & Stellenbosch Uni
PO Box 19063,
Tygerberg 7505, Cape Town

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