Implementing active surveillance for tuberculosis: A quality improvement project.

Background:  South Africa is a high tuberculosis (TB)-burden country with the worst multidrug-resistant TB (MDRTB) epidemic in Sub-Saharan Africa. The recommendations of the World Health Organization (WHO) in high TB-burden settings are to institute processes for identifying patients with active TB and to improve social support. The community-oriented primary care (COPC) model relies on the community health workers' (CHW) every encounter in the community as an opportunity to screen for TB symptoms. This study aimed to evaluate the implementation of active surveillance for TB in a CHW team.

Methods:  This was a quality improvement project (QIP) focused on the implementation of TB screening in the community-based services at a primary care facility in the Nelson Mandela Bay Health District (NMBHD).

Results:  The baseline audit revealed one team was available in the facility even though it serviced two and a half municipal wards. The team comprised an outreach team leader and three CHWs. There were no records of community-based TB screenings done. The midway audit showed a remarkable rise in clients screened in the community. There was a failed attempt to introduce the use of mHealth technology to the team. The audit at the end of the QIP showed a continuing lack of adequate records of activities in the community.

Conclusion:  The CHWs in this study, although capable and motivated, lacked opportunity to perform adequate community-based TB screening because of the lack of supportive supervision, inadequate recordkeeping, and a district managerial team that focused on the practice population rather than the population at risk.Contribution: We recommend a continuing QIP and a re-education of health care providers about community-based health services.