Structured performance monitoring of TB-care at facility, district and province levels - Pakistan experience.
OBJECTIVE
To develop and evaluate a more structured process for effective tuberculosis control monitoring.


METHODS
The quasi-experimental exploratory study was conducted from April 2007 to January 2008 in the Punjab province of Pakistan. Eight intervention districts were compared with eight control districts. Intervention consisted of managers using performance monitoring guidelines and tools for monitoring meetings at the facility and district levels. Proportion of tuberculosis suspects among outpatients, registered confirmed cases and patients' default rate were monitored. Semi-structured interviews were done to assess the experience of the participants.


RESULTS
The proportion of TB suspects among outpatient attendees was significantly higher in the intervention districts (95% confidence interval 1.6-1.8%). The pre-registration default also showed difference (p=0.07). The case finding during 9 months of the intervention showed 96.3% increase compared to the 9 months of the preceding year.


CONCLUSIONS
The new process was effective in improving tuberculosis case finding. The process may be used to improve tuberculosis monitoring systems and other such healthcare services.
Association for Social Development, Islamabad, Pakistan.
Muhammad Amir
MA
Khan
Association for Social Development, Islamabad, Pakistan.
Muhammad Arif
MA
Munir
College of Medicine, King Saud University, Riyadh, KSA; Public Health Solutions Pakistan, Lahore, Pakistan.
Shirin
S
Anil
Association for Social Development, Islamabad, Pakistan.
Maqsood
M
Ahmad
Nuffield Center for International Health, University of Leeds, UK.
John
J
Walley
National Tuberculosis control Program Pakistan.
Ejaz
E
Qadeer
World Health Organization for EMRO.
Karam
K
Shah
Association for Social Development, Islamabad, Pakistan.
Nida
N
Khan
Association for Social Development, Islamabad, Pakistan.
Athar
A
Nazir
D000328:Adult; D000553:Ambulatory Care; D003695:Delivery of Health Care; D019468:Disease Management; D005260:Female; D006302:Health Services Research; D006767:Hospitals, District; D006801:Humans; D008297:Male; D010154:Pakistan; D015397:Program Evaluation; D036301:Qualitative Research; D011785:Quality Assurance, Health Care / Q000379:methods*; D014376:Tuberculosis / Q000175:diagnosis* / Q000628:therapy; D055815:Young Adult
Tuberculosis, Delivery of healthcare, National health programmes, District hospitals, Monitoring.