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Performance Monitoring, Resources, and Effects on Quality of Care for Tuberculosis Patients: Facility Audit in the Tigray Region, Northern Ethiopia

Tesfay Gebregzabher Gebrehiwot, Kebede Embaye Gezae, Belete Assefa, Letekirstos Gebreegziabher Gebretsadik, Mimmie Claudine Watts, Amaha Kahsay Adhanu, Zinabu Hadush, Yohannes Hagos, Yodit Zewdie Berhe, Abate Bekele Belachew, Liya Mamo Woldu

Background: Tuberculosis (TB) is a disease caused by a single infectious agent and is the ninth leading cause of death worldwide ranking above HIV/AIDS. Though the global efforts improved the supply, material, and human workforce, still the quality of TB care remains poor in sub-Saharan African countries. Ethiopia is among the 30 high TB burden countries with an absolute number of estimated incident cases (10,000 per year). Hence, evidence of health facility audit in assessing the quality of TB care is insufficient.

Objective: This study aimed to assess the quality of TB care in the health facilities in terms of input and processes of TB diagnosis and treatment.

Methods: Facility based cross sectional study was carried out in Tigray region from March to June 2019. A tailored checklist which was adopted from the TB national guideline was applied for data collection. The research team members conducted the audit and collected the data from 36 health facilities. Data were cleaned prior to data analysis. Frequencies, proportions, mean and other relevant descriptive statistics were calculated.

Results: A facility audit was performed in 36 health facilities. Due to the absence of laboratory technologists, three health facilities quit to perform laboratory activities for the period of six months. Only 12 health facilities had electronic medical recording data bases. Less than two third (61%) of the TB focal persons obtained monitoring and supportive supervision. Regular mentoring and case base discussion were conducted in only 4 and 3 of ten facilities, respectively.

Conclusion: Despite the availability of reasonable input at the audited health facilities, quality of TB care in terms of process, diagnosis and outcome remains poor. The practice of performance monitoring and supportive supervision was seen to be highly compromised. Standardized mentoring and integrated supportive supervision tailored to quality of TB care need to be strengthened.