Evaluation of the community based directly observed treatment for tuberculosis-short implimentation in Rukungiri district, Uganda

Abstract

The Community Based Directly Observed Treatment Short course program for tuberculosis has been proved to be one of the most effective of all health interventions, but its performance in Rukungiri district was still poor considering indicators including enrolment rate of 22% during 2002, among others. The study objective was to carry out an evaluation of the program implementation particulary regarding capacity, drugs/supplies management, community participation in case management, monitoring and supervision so as to provide information to improve its performance. METHODS AND MATERIALS: A Cross sectional was conducted during April 2004 in all the 12 health facilities and their catchment areas. Data was collected using checklists, key informant interviews and focus group discussions. Performance was scored using a percentage scale (very good =>90), good=76-90, fair = 50-75, poor= 35- <50 and very poor = <35). RESULTS: Overall performance was 74%, capacity 84%, drugs/supplies management 66%, monitoring/supervision 60% and case management 91%. The following performance indicators (rates) were obtained. Case finding 59%, enrollment 80%, treatment success 72% (completion = 44% + cure = 28%), conversion at 2 (3) months 63%, default 13%, deaths 13% and failure 0%. Capacity was affected by poor integration of activities into primary health care work plans (46%), drugs supplies management by poor estimation/procurement (42%) and monitoring/supervision by poor performance on tuberculosis control indicators (30%). Problems included poor access to health units, drugs/supplies stock outs and mis-conceptions about tuberculosis and patient stigimization. CONCLUSIONS: Case finding efficiency and cure rates remained low mainly due to inadequate laboratory performance and poor patient follow-up. Poor integration of activities into primary health care work plan, inadequate drugs/supplies and low community awareness, affected the program. RECOMMENDATIONS: Health facilities need to improve laboratory diagnosis, drugs/supplies, estimation/procurement, supervision and community sensitization and to monitor performance indicators especially and cure rates.