Assessment of health system factors influencing treatment of mult-drug resistant tuberculosis: a case of ambulatory and hospital based care models

Abstract

Background The two approaches, i.e. Ambulatory and Hospital Care models used in the treatment of multi-drug resistant tuberculosis require a functioning health care system with a multidisciplinary team of providers, including physicians, pharmacists, laboratory experts, nurses, social workers, community health workers and volunteers. Aim: This study was intended to assess factors in the health system influencing treatment of multi-drug resistant tuberculosis in ambulatory and hospital care model. Methodology: A cross sectional study design was used to gather information from respondents in the hospital and ambulatory models. A qualitative study design was used in three districts of Dar es Salaam Region and Kibongoto Infectious disease Hospital. Purposeful sampling was used in selecting the three districts of Ilala (Ukonga Prisons Health Centre), Temeke (Rangi Tatu Health Centre) and Kinondoni (Sinza Health Centre) which are in Dar es Salaam Region and have MDR-TB patients. Sample of 24 respondents was purposefully selected based on their position they hold in their institution: include 2 Clinicians, 2 nurses who were working at the TB Clinic or TB ward, 1 CHMT members (DTLC) and staff at (2 Laboratory, 2 Pharmacy). In depth interview of key informants was the method used to collect data by using interview guide and digital tape recorder to record the conversations. Results: The findings of this study revealed that the decentralisation of MDR TB Services is a new approach and hence the health workers do not yet have experience on management of the ambulatory model in all departments. Health workers are afraid of working in the TB department for the reason that they may contract the disease. On integration of service delivery points is excellent as patients turn up from other departments and there is no discrimination. Due to the layout of the infrastructures, i.e. waiting area, injection room, and dispensing room) in our health facilities, the threat of spreading infection is high. Conclusion: The study has shown that both ambulatory and hospital models are needed and they are both accepted by the community members. However, there are barriers that should be overcome and strategic initiatives should be adopted to address those challenges in a timely manner, especially in the new ambulatory model.