Community-based interventions in improving tuberculosis treatment outcomes in rural South Africa

Bambisanani is a community-based organization operating in rural areas of South Africa’s Eastern Cape Province. Tuberculosis (TB) is a major cause of death in South Africa – in 2010, over 10,000 people died of TB in the Eastern Cape Province alone. Recognizing the acute importance of improving and expediting the efforts against TB in South Africa, the Bambisanani organization, supported by the Bristol-Myers Squibb Foundation, implemented the WHO ENGAGE-TB approach between November 2013 and August 2015.

The ENGAGE-TB approach was developed by WHO to provide guidance on policies and programmes that are needed to support NGOs in integrating TB into their community-based work in maternal, newborn and child health, HIV care, primary health care, education, agriculture and livelihood development programmes.

The approach prioritizes strengthening the role of communities in TB care, especially in case notification and treatment adherence. The Bambisanani project engaged community leaders, women’s and youth groups, traditional healers and other community structures through community dialogue sessions and community meetings. Emphasis on community engagement prioritized building a stable environment for the care and support of community TB management. The approach was successful in improving rates of TB diagnosis and treatment as well as income generating activities on the community level.

As part of the project, a filing system was developed in the participating clinics, where previously poor filing systems made it difficult to track and verify TB client information. The entire province has since adopted this simple yet effective system. The project prioritized joint-training of all participating bodies. The joint trainings have contributed to the elimination of competition, and strengthened professional networks. A partnership between Bambisanani and the Mine Workers Development Agency led to the development of 670 home gardens in Bizana, which were developed to help supplement the income of ENGAGE-TB clients below the poverty line.

Poor infrastructure in the province also led to challenges of accessibility for ENGAGE-TB staff in the pursuit of their objectives. Bambisanani developed a motorbike model of transport in order to make it easier to access hard-to-reach areas. These motorbikes are still used to follow up with patients who discontinue treatment.

The project has created long-term platforms for sustainability and there are ongoing plans by the Department of Health to further engage community health workers so that they can get paid, provide services and continue their good work. The community health workers are well trained and, in some clinics, they even work in the TB clinic itself.

Volunteers’ access to communities ensured that TB patients and potential patients were identified and linked to appropriate screening. Data from the ten health facilities supported by the project showed that, since the project’s inception, nearly one in four new TB cases diagnosed and notified were referred by community health workers.

The community engagement approach contributed towards improving treatment outcomes. Data from the clinics visited showed that community volunteers supported TB patients to ensure that they were treated and cured. Data from health centers show improvements in treatment outcomes from 83% prior to the project to 94% at the time of documentation. Treatment outcomes are calculated as the number of TB patients who are successfully treated and cured with support from community health workers as a percentage of the total number of TB patients successfully treated and cured.

The results of this project by Bambisanani shows that community-based interventions have the potential for remarkable impact in improving outcomes for TB patients, especially in connecting undiagnosed patients to testing and treatment. At the same time, partnerships with other groups and organizations in the community mean that the ripple effects of a project of this type for capacity building and improving infrastructure extend far beyond just tuberculosis.

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