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. 2013 Nov;9(2):51-64.

Active referral: an innovative approach to engaging traditional healthcare providers in TB control in Burkina Faso

Berthollet Bwira Kaboru  1
Affiliations

Active referral: an innovative approach to engaging traditional healthcare providers in TB control in Burkina Faso

Berthollet Bwira Kaboru. Healthc Policy. 2013 Nov.

Abstract
in English, French

Background and objective: The involvement of traditional healthcare providers (THPs) has been suggested among strategies to increase tuberculosis case detection. Burkina Faso has embarked on such an attempt. This study is a preliminary assessment of that model.

Methods: Qualitative data were collected using unstructured key informant interviews with policy makers, group interviews with THPs and health workers, and field visits to THPs. Quantitative data were collected from program reports and the national tuberculosis (TB) control database.

Results and analysis: The distribution of tasks among THPs, intermediary organizations and clinicians is appealing, especially the focus on active referral. THPs are offered incentives based on numbers of suspected cases confirmed by health workers at the clinic, based on microscopy results or clinical assessment. The positivity rate was 23% and 9% for 2006 and 2007, respectively. The contribution of the program to national case detection was estimated at 2% for 2006. Because it relied totally on donor funding, the program suffered from irregular disbursements, resulting in periodic decreases in activities and outcomes.

Conclusions: The study shows that single interventions require a broader positive policy environment to be sustainable. Even if the active referral approach seems effective in enhancing TB case detection, more complex policy work and direction, domestic financial contribution and additional evidence for cost-effectiveness are needed before the approach can be established as a national policy.

Contexte et objectif:: La participation des prestataires de soins de santé traditionnels (PST) a été proposée comme stratégie pour accroître la détection de cas. Le Burkina Faso a mis cette stratégie à l'essai. La présente étude est une évaluation préliminaire de ce modèle.

Méthodes:: Les données qualitatives ont été recueillies par: des entrevues non-structurées auprès d'informateurs clés, notamment des responsables de politiques; des entretiens de groupes avec des PST et des travailleurs de la santé; et des visites pour rencontrer les PST sur le terrain. Les données quantitatives proviennent des rapports du programme ainsi que de la base de données nationales sur le contrôle de la tuberculose.

Résultats et analyse:: La distribution des tâches entre les PST, les organisations intermédiaires et les cliniciens est intéressante, particulièrement l'accent mis sur l'orientation active. Les PST reçoivent des incitatifs en fonction du nombre de cas suspects confirmés par les profession-nels de la clinique, à l'aide des résultats de microscopie et des évaluations cliniques. Les taux positifs étaient de 23 % et 9 % respectivement pour 2006 et 2007. L'apport du programme à la détection de cas à l'échelle nationale a été estimé à 2 % pour 2006. Puisqu'il repose entièrement sur le financement de donateurs, le programme souffre de versements irréguliers, ce qui a causé un déclin des activités et des résultats.

Conclusions:: L'étude montre que la durabilité des interventions est tributaire d'un environnement politique plus favorable. Même si la démarche de l'orientation active semble efficace pour accroître la détection de cas de tuberculose, il faudra mettre en place des politiques complexes, assurer une contribution financière intérieure et obtenir plus de données sur le rapport coûtefficacité avant d'implanter la démarche à l'échelle nationale.

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Figures

FIGURE 1.
FIGURE 1.
The Burkina Faso model of engaging THPs
FIGURE 2.
FIGURE 2.
Flow of suspected TB cases referred and detected
FIGURE 3.
FIGURE 3.
Lost referrals and positivity ratios
FIGURE 4.
FIGURE 4.
Contribution of THPs to national case detection in 2006
See this image and copyright information in PMC

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