Journal Article

Collaboration for implementation of decentralisation policy of multi drug-resistant tuberculosis services in Zambia

Matenga, Tulani Francis L., Habib, Batuli, Munakampe, Margarate N., Mweemba, Chris, Liusha, Namakando, Banda, Jeremiah, Sinyangwe, Ntazana N., Halwiindi, Hikabasa, Phiri, Henry, Mubanga, Angel, Zulu, Joseph Mumba, Chavula, Malizgani Paul, Maritim, Patricia, Kaonga, Patrick, Chewe, Mwimba

2024

Overview

Background Multi-drug-resistant tuberculosis (MDR-TB) infections are a public health concern. Since 2017, the Ministry of Health (MoH) in Zambia, in collaboration with its partners, has been implementing decentralised MDR-TB services to address the limited community access to treatment. This study sought to explore the role of collaboration in the implementation of decentralised multi drug-resistant tuberculosis services in Zambia. Methods A qualitative case study design was conducted in selected provinces in Zambia using in-depth and key informant interviews as data collection methods. We conducted a total of 112 interviews involving 18 healthcare workers, 17 community health workers, 32 patients and 21 caregivers in healthcare facilities located in 10 selected districts. Additionally, 24 key informant interviews were conducted with healthcare workers managers at facility, district, provincial, and national-levels. Thematic analysis was employed guided by the Integrative Framework for Collaborative Governance. Findings The principled engagement was shaped by the global health agenda/summit meeting influence on the decentralisation of TB, engagement of stakeholders to initiate decentralisation, a supportive policy environment for the decentralisation process and guidelines and quarterly clinical expert committee meetings. The factors that influenced the shared motivation for the introduction of MDR-TB decentralisation included actors having a common understanding, limited access to health facilities and emergency transport services, a shared understanding of challenges in providing optimal patient monitoring and review and their appreciation of the value of evidence-based decision-making in the implementation of MDR- TB decentralisation. The capacity for joint action strategies included MoH initiating strategic partnerships in enhancing MDR-TB decentralisation, the role of leadership in organising training of healthcare workers and of multidisciplinary teams, inadequate coordination, supervision and monitoring of laboratory services and joint action in health infrastructural rehabilitation. Conclusions Principled engagement facilitated the involvement of various stakeholders, the dissemination of relevant policies and guidelines and regular quarterly meetings of clinical expert committees to ensure ongoing support and guidance. A shared motivation among actors was underpinned by a common understanding of the barriers faced while implementing decentralisation efforts. The capacity for joint action was demonstrated through several key strategies, however, challenges such as inadequate coordination, supervision and monitoring of laboratory services, as well as the need for collaborative efforts in health infrastructural rehabilitation were observed. Overall, collaboration has facilitated the creation of a more responsive and comprehensive TB care system, addressing the critical needs of patients and improving health outcomes.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Access / Action / Antitubercular agents / Appreciation / capacity for joint action / Caregivers / Case studies / Clinical governance / Clinical outcomes / Clinical practice guidelines / Collaboration / collaborative governance / Committees / Community health aides / Community health workers / Community Health Workers - organization & administration / Cooperation / Cooperative Behavior / Coordination / Data collection / Data entry / decentralisation / Decentralization / Decision making / Delivery of Health Care - organization & administration / Dissemination / Drug development / Drug resistance / Drug resistance in microorganisms / Drug therapy / Drugs / Female / Global health / Governance / Guidelines / Health Administration / Health aspects / Health care / Health care facilities / Health facilities / Health Personnel / Health Policy / Health services / Health Services Accessibility - organization & administration / Health Services Research / Health status / Hospitals / Humans / Implementation / Infections / Interdisciplinary aspects / Interviews / Laboratories / Leadership / Male / MDR-TB / Medical personnel / Medicine / Medicine & Public Health / Meetings / Motivation / Multidisciplinary teams / Multidrug resistance / Patients / Pharmaceutical industry / policy / Politics / principled engagement / Public Health / Qualitative analysis / Qualitative Research / R & D/Technology Policy / Rehabilitation / Respondents / shared motivation / Stakeholder Participation / Success / Supervision / system context / Teams / Telemedicine / Tuberculosis / Tuberculosis, Multidrug-Resistant - drug therapy / Workers / Zambia