Administrative Support for TB Programme

The objective of this programme is to reduce the rate of TB infection by improving treatment adherence and outcomes through improvements in the execution of key administrative tasks. In order to accomplish this, MHDS and City Health, in partnership with the TB Care Association, identified 27 of the most overburdened clinics in the Cape Town area (including Luvoyo, Ikwezi, and Klenvlei) based each clinic’s number of cases, ratio of TB patients per staff member, and cure rate. They also recruited, trained and employed 46 TB assistants and 13 TB clerks from the local community to ensure that key administrative tasks that affect the performance of the TB programme are executed in the identified health facilities.

Innovation

This project is innovative in its successful use of unemployed local community matriculants to perform administrative functions under the supervision of existing health officials in formal health facilities, easing the load of overburdened nurses. City Health and the TB Care Association have been commended by the National TB Programme as well as other provincial and local departments for this particular initiative.

Effectiveness

The Administrative Support for TB Programme has succeeded in reducing the treatment default rate from 11% in 2005, to 9% in 2006. Overall TB programme performance improved by 7% (from 69% to 76%) in 2006. In addition, it has provided formal employment to 59 previously unemployed local community members. TB assistants receive an annual salary of R18,000 and TB clerks receive R24,000 per year. Facility staff are extremely satisfied and grateful for the additional support provided. It has impacted significantly on the ability of facility staff to recall patients and perform particular interventions key to measuring their response to treatment and to retaining patients who have willfully defaulted from treatment. Ideally, government and not an NGO would employ TB assistants and clerks; however government human resource policy creates long delays in recruitment and higher costs in employment.

Poverty Impact

This project has improved the efficiency of TB-related health care in 27 clinics located in disadvantaged communities around Cape Town resulting in faster and more effective treatment for residents of these poorer communities. In addition, this project has created a source of income for 59 previously unemployed young people. TB assistants and clerks have acquired administrative skills which they are able to use to further their careers elsewhere.

Sustainabilty

The projects's budget in 2007/2008 was R1 310 798. The Western Cape Provincial Department of Health provides 50% of the funding via Metro District Health Services, and City Health provides the other 50% of the funding. The project ensures cost-effectiveness by using a third party (TB Care Association) to recruit and employ TB assistants and clerks. This is considerably cheaper and more efficient than it would have been if government was the sole provider because of government's restrictive human resource policy. Funding for this intervention has been earmarked by the DOH as part of a TB Enhanced Response policy making continued funding likely to continue.

Replication

This type of project could be replicated in other metropolitan areas given that government is able to enter into a partnership with a reputable and reliable non-governmental organization.

Partnerships

• Metro District Health Services (funding)
• City Health (training and funding)
• TB Care Association (employment)