The Union Zimbabwe Trust (UZT) in collaboration with the Ministry of Health and Child Care (MoHCC), through the National TB Control Programme (NTP) with USAID support recently embarked on a Drug Resistant TB (DRTB) mortality/non-evaluated/loss to follow up audit exercise, in order to reset local DRTB program priorities to mitigate deaths and poor outcomes among this group of patients.
Zimbabwe is one of 24 priority countries for the United States Government when it comes to DRTB Programing and the improvement of quality of care for DRTB patients through systems strengthening.
The assessment was conducted by a team of local and regional DRTB, Monitoring & Evaluation and Programming experts in high DRTB Burden regions with a large number of negative outcomes.
Dr Mashofong Matabane, one of the consultants noted that the audit was conducted on the background of a notable decline in DRTB notification rate.
District and health facility representatives also led the audit teams as they conducted laboratory and pharmacy department visits to assess medicines status and laboratory support visits to assess the availability of DRTB treatment monitoring tests.
The community mortality assessment interview guide captured the deceased’s qualitative data on demographics, social profile, support network/home circumstances, taking of treatment & health literacy, living conditions, proximity of health facility, educational & income status, social and occupational history, religious & socio-cultural practices as well as time that led to the patient’s demise. The focus of these interviews included care giver’s experience in living with the patient, assessment of care rendered, stigma and discrimination as well as assessment financial constraints.
From the community interviews, it was summarily found that patients and their families faced catastrophic costs in the work up towards a DRTB diagnosis. In addition to catastrophic costs faced by patients and their families, late presentation of clients to health facilities and poor disease insights are some of the findings of key concern for MoHCC and partners. Medicine stock ruptures also left families in despair as this was reported as leading to the demise of several DRTB recipients of care by their caregivers.
What next after the audit?
During a feedback session for stakeholders in the national TB response, there were recommendations on increasing index suspicion, by taking a ‘back to basics approach’ through staff training and mentorship. Health facility work force should be ‘guided’ to implement Drug Resistant TB policies and guidelines.
The stakeholders agreed on the need for the strengthening of health services integration, through ‘one-stop-shop’ model across facilities. Clients should be able to access HIV, TB social & mental healthcare services in one place.
