TUBERCULOSIS

1. Achieve a minimum of 85% cure rate of new sputum positive TB cases.

2. Achieve a passive case finding rate per 100,000 population to be defined.

3. Achieve two days turn around times of sputum results in more than 90% of cases.

4. Every clinic has at least one staff member who has or has had opportunities for continuing education in TB management.

5. Receive a six monthly assessment of quality of care by a supervisor who also evaluates the degree of community involvement in planning and implementing care.

1.1 The latest edition of the TB training manual for health workers.
1.2 The South African TB control programme practical guidelines.
1.3 TB register manual, latest edition.
1.4 Tackling TB at work – Guidelines from South Africa’s national TB control programme.
1.5 A resource list of HIV/AIDS services.
1.6 DOTS and training material (e.g. Provincial or NGO). A hospital referral protocol.
1.7 Leaflets and pamphlets in local languages for distribution.
1.8 TB posters on the walls in local languages changed yearly.
1.9 Flow charts on TB diagnosis
1.10 The latest EDL manuals on TB management.

2.1 Screw top sputum containers

3.1 Uninterrupted supply of TB drugs recorded on bin cards.
3.2 Clinic knows how to get emergency supplies of TB drugs.
3.3 Combination and single TB tables as per protocols.
3.4 Sterile syringes and needles and water for injection.

Staff are able to

4.1 Initiate and follow up treatment of patient using the latest recommended TB management regimen and protocol.
4.2 Suspect and identify TB by early symptoms such as chronic cough, loss of weight and tiredness.
4.3 Educate with the emphasis on correcting misinformation and seeking to prevent spread of the disease.
4.4 Start direct observed treatment (DOT) supported by volunteers chosen and accepted by the patient.
4.5 Enter all sputum results on TB register and forms.

5.1 Only patients sick enough to require hospital care are referred for hospitalisation and then sent with a completed TB register form and proposed discharge plan.
5.2 Patients referred to the clinics after discharge from hospital and with a discharge plan are followed up immediately to ensure the discharge plan is effectively implemented.
5.3 Before being transferred to another area the patient receives a completed transfer form and a sufficient supply of medication and when possible the facility to which he/she is transferred is notified by telephone.
5.4 If HIV positive the patient is given a confidential sealed letter with relevant data to give to the new facility.
5.5 Any severe complication of TB or adverse drug reaction is referred for admission.
5.6 Children with extensive TB or gross lymphadenopathy or not improving on treatment are referred.
5.7 Patient with need for additional health or social services are referred as appropriate.
5.8 All cases of MDR TB are referred to the Provincial MDR Committee/Unit.

6.1 Patients, relatives and the community receive high quality information on TB.
6.2 Patients are given group education each month when their situation is reviewed.
6.3 Patients are educated about HIV/AIDS/STDs in addition to TB so that they can recognise predisposing conditions and so prevent them.

7.1 As TB is a notifiable disease the cases are correctly classified by location of disease, result of sputum smear and by the treatment regimen.
7.2 All registers, smear conversion rate forms and quarterly reports are kept up to date.

8.1 The clinic has an agreement with resulting support from the community health committee about the use of DOT.
8.2 The quality of DOT management within the clinic and the community-based supporters are monitored and evaluated quarterly.
8.3 Active case finding is done on all chronic cough patients and TB contacts through home visits.
8.4 In exceptional cases some MDR cases are allowed by MDR Committee to receive guaranteed intensive care treatment by DOT at community level.

9.1 The clinic collaborates with social welfare for social assistance.
9.2 Staff collaborate with NGOs, schools and workplaces in the catchment area to enhance the promotion of TB prevention and care.