Health System Strengthening
Health system strengthening for TB service delivery encompasses many areas, such as information management, human workforce development, and improvement of laboratories, their networks, and essential tools in diagnosis and treatment. USAID recognizes these critical needs for improved information systems, better trained workforces, and better tools and approaches to service delivery. in developing countries. It is committed to supporting the following:
- Strengthen health information management systems through improved data quality and reporting: The establishment of a robust system to monitor and evaluate multiple health indicators is crucial to understanding the trends in and impact of TB control. Thus, USAID provides support to efforts to improve data management and collection processes and aids in the analysis of that data to inform decision-making.
- Increase capacity of the health workers to provide high quality health services: DOTS expansion and strengthening requires an adequate and well-trained workforce. As part of its overall efforts to improve the quality of TB care, USAID works to build the capacity of health workers through both pre-service and in-service training, supervision, management and support. Attention is given to ensuring that capacity building for TB is coordinated with system-wide human resource development strategies and plans. Currently, the needs for such an effective TB workforce outstrip the supply of trained personnel at all levels of service delivery. To address this problem, USAID supports all aspects of human resource capacity development, including training for physicians, nurses, laboratory technicians, program managers, epidemiologists, community outreach workers, social workers, and pulmonary specialists. In addition to training in the core elements of DOTS and TB control, capacity building in areas such as problem solving, supervision, management and planning is provided. These measures facilitate effective program expansion, improve program performance, and enhance the ability of program managers and supervisors to address problems in program implementation. Attention is given to increasing and strengthening the training and technical capacity of academic institutions such as Schools of Public Health, Medicine and Nursing, and other Allied Health Professions. Specialized training in areas such as operations research, drug management, treatment of MDR TB and TB-HIV co-infection, and infection control is also being provided. USAID supports the development, adaptation, translation and dissemination of training materials that address DOTS and related skill areas described above. USAID also provides drug management training for MDR-TB pilot sites approved by the Green Light Committee in a variety of regions.
- Increase TB diagnosis by scaling up a fully functioning laboratory network with appropriate biosafety provisions: USAID helps to strengthen and expand national, regional, and local laboratories to bring TB diagnostic services closer to the community. Quality assurance systems are being rolled out, and capacity within laboratory and other diagnostic networks organizations are being built.
Laboratory Strengthening
USAID supports the comprehensive strategy for laboratory strengthening from the STOP TB Partnership Global Laboratory Initiative working group to develop an integrated laboratory and quality assurance system and support cross-cutting disease control mechanisms. The Global Laboratory Initiative is mapping the needs to strengthen laboratory capacity for TB diagnostics worldwide and is unifying a network of partners to respond to the needs. USAID supports an integrated health systems approach for strengthening the capacity of laboratory services for sputum smear microscopy, culture, drug susceptibility testing, quality assurance, and new diagnostic tools, in concert with authorities responsible for the planning, management, and supervision of laboratories and diagnostic centers, in both the public and private sectors. New safe, affordable, and easy-to-use diagnostics are desperately needed to accurately screen for and identify active TB, monitor treatment response, rapidly detect drug resistance, and identify latent infection in those at greatest risk of the disease.
Vertical disease-funded programs, such as those for HIV, malaria, polio eradication, and TB, have historically been the major source of support for laboratory strengthening. USAID actively promotes the harmonization of these programs as a means to strengthen broader overall surveillance capacity, establish supranational reference laboratories, and build sustainable public health laboratory capacity at the country level.
USAID looks for laboratories to provide high-quality test results. The development of a tiered, integrated laboratory network is one approach that could provide laboratories that have: competent staff who are adequately trained and are effectively supervised by managerial staff; sufficient infrastructure to provide a safe and suitable physical working environment with functioning laboratory equipment and a supply chain management system to provide adequate supplies of reagents, consumables, and quality control materials; and effective laboratory quality systems, including well-written policies and procedures, and a total quality management system that includes quality control, quality improvement, external quality assessments, and accreditation standards.
USAID supports the development of new and improved diagnostics appropriate for use in developing and transitional countries that are accurate, rapid, affordable, uncomplicated, appropriate to developing and transitional countries, and functional in a variety of settings (including areas of high HIV prevalence).
USAID recognizes the need for key components in health system infrastructure that can enhance national surveillance of multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB), as well as the specific safety needs in TB laboratories, where the risks of infection are greatly increased if laboratory workers become HIV-positive. Biosafety in the laboratory setting is fundamental to effective operations, and building on existing global biosafety standards and recommendations, while also providing new approaches and more specific guidance through the risk assessment process, will assist in identifying practical solutions for implementation and integration of efforts across diseases and methodologies.
USAID coordinates with the international community to build a platform for laboratories to introduce new diagnostic technologies; upgrade laboratory infrastructure, including improved smear microscopy and laboratory quality assurance and expanded culture and drug susceptibility testing; provide support to strengthen and expand supranational reference laboratories; and work with WHO, the Centers for Disease Control and Prevention (CDC), in-country partners, and others to conduct drug resistance surveys and surveillance. In PEPFAR focus countries, USAID, CDC, and other organizations work together to strengthen diagnosis/referral systems so that co-infected TB-HIV patients are accurately diagnosed and put on treatment as quickly as possible. USAID focuses on building sustainable public health laboratory capability at the country level.
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