The Union Uganda Office's SPARK-TB project (Slum Partnership to Actively Respond to Tuberculosis in Kampala) launched its activities on 1 October 2011. Funded by TB REACH, this project is designed to improve access to quality TB diagnosis and treatment within private health facilities in the slums of Kampala, the capital city. Since these urban poor have been neglected until now, the hope is that better services will improve both TB case detection and treatment success.
In order to achieve this, SPARK-TB is working with Uganda's National TB and Leprosy Programme (NTLP) to create a public-private partnership with 100 private clinics across Kampala district's five administrative divisions. An initial mapping exercise helped the SPARK-TB team select the participating clinics. In addition to this, a TB KAP assessment was done at inception within Kampala district and the information from it guided the development of IEC materials; another one will be done at the end of the project as a point of comparison post implementation.
Engaging Private for Profit (PFP) health facility owners as partners
Kawempe division was used as the pilot. PFP owners were invited to an introductory meeting that outlined the key benefits of the partnership. The response was very enthusiastic, so this approach has also been also used with the other four divisions. Among the "lessons learnt" is that the non-monetary benefits need to be emphasized to foster the sustainability of the partnership. To date, 50 PFP health facilities from all divisions have agreed to participate, and 50 more are being recruited. These clinics are now undergoing branding so that they can easily be identified as facilities offering TB services within the community.
Training health care workers (HCWs) and laboratory personnel
Clinics are asked to send a minimum of two health care workers for training. So far, 72 people have been trained, primarily doctors, nurses and clinical officers. The curriculum covers the basics of TB, diagnosis and treatment, how to foster adherence, recording and reporting tools and special issues relating to TB in children. In order to allow business continuity at the clinics while staff are being trained, two schedules are offered: four mornings or two full days.
Training for laboratory personnel, conducted in collaboration with the National TB Reference Laboratory (NTRL) team, has been offered concurrently with HCW training. This training is offered onsite, since many PFP laboratories are staffed by one person who has to conduct all the lab tests done each day. More than 20 laboratories are have been trained and now incorporated into the EQA program under NTRL.A major challenge is that the low level of staffing makes it difficult for interested staff to be able to attend the training. However, all of the clinics in Kawempe that have had their health workers trained have endorsed a memorandum of understanding between them and the NTLP and are proactively involved in implementing project activities.
Support supervision helps maintain continuity
Support supervision has been key as a follow-up to the training. The majority of the health facilities had problems filling out TB registers so further training on this was provided onsite. The high turnover of HCWs makes continuity and consistency a challenge. The team hopes to overcome this barrier by ensuring that each PFP trains a minimum of two people. Owners are also encouraged to participate in the training to help offset this turnover.
PFP health workers in Kampala with their SPARK-TB training certificates