THE Government is committed to raising awareness on tuberculosis (TB) in all communities in Zimbabwe through the community TB care approach, so that the disease can be curbed.
Deputy director in the Aids and TB Unit in the Ministry of Health and Child Care, Dr Charles Sandy said community health workers are very crucial in the fight against TB, in bridging a gap between communities and health facilities.
“Community TB care as a strategy, is complementing the health system approach of service delivery where people are getting their services from professional health workers. We know that communities in general have limitations of access to our health facilities.
“The community component bridges that gap to some extent because the community’s health responses can help in early identification of presumptive TB patients and refer them to a health facility for confirmation of diagnosis,” said Dr Sandy.
The community system can also play an important role in strengthening adherence to treatment.
According to Dr Sandy, community health care workers working with the family members can assist in supporting and monitoring patients when they are on treatment. This would then help avoid the emergence of resistance.
“In addition, we also use the community system to assist in retrieval of those who may have been lost to follow up or those who have been diagnosed with TB and you want to screen their families and their contacts so that you can identify those who may have been infected, early,” said Dr Sandy.
The city of Bulawayo is the first local authority to implement a successful patient-centred approach which incorporates family members in the planning and the evaluation of healthcare, especially on matters to do with TB.
According to the 2017 Global TB report, about one third of the world’s population is infected with the TB bacteria.
Only a small proportion of those infected will become sick with TB, thus people with weakened immune systems have a much greater risk of falling ill from TB.
One major aim of the approach is to provide combined HIV-TB testing services in a “One Stop Shop” integration.
Bulawayo’s Health Services department is banking on contact tracing as one of its strategies in fighting the spread of TB amongst families and communities around its 19 clinics dotted around the city.
Health Services director, Dr Edwin Sibanda said Bulawayo has a commendable community TB Care strategy, pioneered by 98 community health workers whose responsibilities involve home visits, contact tracing and to conduct other programmes such as immunisation of children.
“We have 98 health workers, and the community health nurse is the one who oversees the TB programme, among other responsibilities. So, what she must do is make sure that from the time the patient is presumed to have TB, his/her sputum is taken and sent to the laboratory. If the patient is diagnosed of TB, he/she is commenced on treatment immediately,” said Mr Sibanda.
Throughout the country, many health facilities are banking on community health workers in the fight against TB.
Environmental Health Officer responsible for TB co-ordination within the city of Mutare, Mr Thomas Mandina said health promoters play a crucial role within the primary health care system and in identifying presumptive cases of TB within the city.
“Community health workers are very critical in the community and they’re the first people to identify the presumptive cases such that when they’re identified, they are referred to the clinic. So, they play a critical role and it’s not only TB but other conditions especially children with malnutrition,” said Mr Mandina.
Said Mr Padson Sazunza, a community health worker:
“My job is to go around the Mutare community to screen for TB and referring patients to the clinic. I’m also involved in disease surveillance such as measles, acute placid paralysis among other things. If I come across children who require growth monitoring and don’t go to the clinic, I do some investigation as to why.”
However, community health workers reveal they sometimes face serious resistance from some community members due to stigma and cultural beliefs and values.
“If I identify a person with TB, I normally give them a referral slip and do follow-ups and check if the person went to the clinic or not. If they don’t go to the clinic, I don’t tire but keep on persisting until the patient goes to the clinic. So far, I’ve managed to refer two cases to the clinic. The challenge with many TB patients is that they don’t easily accept they have contracted TB and it takes a clever person to convince someone to accept their situation,” said Mr Sazunza.
The International Union Against Tuberculosis and Lung Disease’s (The Union) country director in Zimbabwe Dr Christopher Zishiri said his organisation is the sub-recipient for the Global Fund for the community TB care component.
“Specifically, we focus on active case findings for TB in those high-risk areas and high-risk groups. So, we’ve stratified and arranged our districts such that we focus on districts with poor notification of TB cases and those districts with poor outcomes. In our active case finding initiatives, we also work with Community Health Workers (CHWs) who help in screening presumptive TB cases and refer presumed cases to the nearest health facility. The CHWs further assist in mobilisation of communities to access TB services which are for free. The Union is complementing efforts of the National Tuberculosis Programme with support from Challenge TB, which is a funding mechanism from USAid,” said Dr Zishiri.