Improving TB screening at Nine TB Diagnostic Treatment Units: Tested Changes and guidance from Uganda
In Uganda, ASSIST worked with the MOH and implementing partners to build the capacity of health workers to be able to screen, diagnose, and manage TB to improve TB care services using the continuous quality improvement (QI) model as well as the collaborative approach. This change package details the experience of improving TB treatment response and provides guidance to others who may want to improve TB screening.
Following a baseline assessment conducted in October 2015 at the participating health facilities it was found that TB screening for clients aged 0-14 years attending the out-patient department (OPD) was at 8.1% and clients aged 15 years and above was at 11.5% at all the sites. ASSIST engaged the facility based health workers to review the performance and identify reasons for the observed poor performance. Regular support through on-site coaching was provided to the facility teams to review performance and teams came up with service innovations (changes) which they tested to attain improved TB screening for all clients attending OPD.
The various changes the facility teams implemented led to 90% TB screening among OPD clients 0-14 years by August 2016 and 88% for OPD clients above 14 years.
These changes are recommended because the 9 health facilities that tested and implemented these changes reported significant improvement in TB screening for clients attending OPD. Persons involved in TB work need to focus on:
• Capacity enhancement for health workers
• Improving documentation and routine data reviews
• Communicating between providers
• Assigning roles
This change package is intended to provide guidance among individuals and QI teams wishing to improve screening for TB. It provides the general idea and acts as a guidance on concepts with examples of innovative changes to improve screening for TB. Teams are urged to adapt these changes to suit their clinic settings for improvement to occur.