MAXIMIZING POSITIVE SYNERGIES - World Health Organization

are vacancies of regularized doctors and lab technicians at health facilities designated for TB
services, the RNTCP follows a policy of filling a fixed percentage of these vacancies with
contractual doctors and lab technicians. In one of the states studied, the programme had even
created a new cadre of lab technician called the ‘sputum microscopist’ to overcome the acute
shortage of qualified general lab technicians. In this way, the RNTCP has enabled health facilities,
particularly those at the periphery of the health system, to continue providing health services.
The NACP also delivers services through a range of public health facilities and places a variety of
contractual health workers - doctors, lab technicians and counsellors – at designated health
facilities. Unlike the RNTCP, the programme does not seek to fill vacancies in the existing public
health workforce. However, some of the NACP lab technicians reported doing a variety of
laboratory tests and did not confine themselves to only HIV testing.
The presence of contractual staff at health facilities need not translate into human resource
strengthening. Several factors influence whether contractual health workers limit themselves to
specific programme obligations or not. First, the type of health facility these health workers were
placed determines the scope of their activities. Contractual health workers in both the RNTCP and
the NACP almost never went beyond their programme duties at district or teaching hospitals. In
contrast, their counterparts at peripheral health facilities usually went beyond their contractual
obligations because they typically were the only resource available and programme specific
workload was lower. Another factor was the attitude that senior programme managers and their
supervisors had towards integration. Where programme managers and supervisors felt that
integration was a good, programme specific health workers tended to be less restrictive in the
scope of their duties.
Global Fund-supported programmes can strengthen lab services by sharing resources
The presence of the RNTCP and the NACP programmes at health facilities strengthened laboratory
services at peripheral health centres in several ways and beyond the provision of human resources
or enabling a diversity of lab tests to be conducted at these facilities. These included the using of
lab supplies purchased for these programmes with non-programme specific patients. Further, at
some health facilities programme specific labs provided free services to general patients,
especially those who were poor.
Global Fund- supported programmes can increase trust in the public health facilities
The presence of disease control programmes at health facilities, according to key informants,
appears to have contributed to increasing trust in the public system. By placing qualified health
workers at health facilities where there were none earlier and sharing resources with non-disease
specific health services, both the RNTCP and, to a lesser extent, NACP have contributed to the
ability of health facilities to provide quality health services. Further, by providing good quality
services, disease control programmes improve trust in public health facilities and build public
expectations for better overall service quality.
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