Lesson learnt in the implementation of PHC - Health Systems Trust

3 Quality
of Care
The TB Control Programme,
Elundini Sub-district, Ukhahlamba, Eastern Cape
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TB patients from rural clinics were referred to the hospital, where the patients could have
their sputum tested and treatment initiated. Thereafter patients were referred back to the
clinic for follow up, but would still need to go back to the hospital for the sputum tests in
month 2 and 3 and at the end of their treatment. Some patients were unable to get to the
hospital because of the costs involved, while others simply got lost in the system because
both clinic and hospital were under the impression that the client was attending at the other
facility.
Over 75% of clinics did not have TB protocols or any system in place for sputum collection
Around half of the clinics were not recording clinical progress on the blue cards
Staff in the majority of the clinics had received no training on the new TB register.
Approach
The results of the in-depth review were presented to the management team and clinic staff. A facilitation
process to find solutions to these problems was followed.
Outcome
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A TB committee was formed to plan and implement activities that would improve TB services
Nurses received training on the preliminary findings of the in-depth TB review, the South
African National TB Control Programme, the new TB register and quarterly reporting of TB
indicators
Outstanding TB stationary was supplied to clinics including TB registers, blue and green
patient profile cards, National TB control programme guidelines and TB protocols
Recording TB patient data into the new registers was backdated and completed from July
2002
The sub-district manager motivated for a car from the Provincial Department of Health for
sputum collection. A motorbike was provided and as a result case finding is taking place in
all clinics.
The challenges facing the TB programme have been discussed at community level with the
clinic committees. Volunteers for DOTS support training were selected in communities and
clinic sisters were trained on how to train DOTS supporters.
Supervision
The next step was supporting staff at facility level with emphasis on in-service training specific to
individual clinic needs. The supervisory system was strengthened by allocating clinics to supervisors.
The supervisors mentored and trained in the use of the supervision manual and were involved in the
TB training processes. This enabled them to assist the TB coordinator in supporting and monitoring the
progress of the clinics.
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