Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia.
Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.
Health Res Policy Syst. 2024 Aug 19;22(1):112. doi: 10.1186/s12961-024-01194-8.
Multi-drug-resistant tuberculosis (MDR-TB) infections are a public health concern. Since 2017, the Ministry of Health (MoH) in Zambia, in collaboration with its partners, has been implementing decentralised MDR-TB services to address the limited community access to treatment. This study sought to explore the role of collaboration in the implementation of decentralised multi drug-resistant tuberculosis services in Zambia.
A qualitative case study design was conducted in selected provinces in Zambia using in-depth and key informant interviews as data collection methods. We conducted a total of 112 interviews involving 18 healthcare workers, 17 community health workers, 32 patients and 21 caregivers in healthcare facilities located in 10 selected districts. Additionally, 24 key informant interviews were conducted with healthcare workers managers at facility, district, provincial, and national-levels. Thematic analysis was employed guided by the Integrative Framework for Collaborative Governance.
The principled engagement was shaped by the global health agenda/summit meeting influence on the decentralisation of TB, engagement of stakeholders to initiate decentralisation, a supportive policy environment for the decentralisation process and guidelines and quarterly clinical expert committee meetings. The factors that influenced the shared motivation for the introduction of MDR-TB decentralisation included actors having a common understanding, limited access to health facilities and emergency transport services, a shared understanding of challenges in providing optimal patient monitoring and review and their appreciation of the value of evidence-based decision-making in the implementation of MDR- TB decentralisation. The capacity for joint action strategies included MoH initiating strategic partnerships in enhancing MDR-TB decentralisation, the role of leadership in organising training of healthcare workers and of multidisciplinary teams, inadequate coordination, supervision and monitoring of laboratory services and joint action in health infrastructural rehabilitation.
Principled engagement facilitated the involvement of various stakeholders, the dissemination of relevant policies and guidelines and regular quarterly meetings of clinical expert committees to ensure ongoing support and guidance. A shared motivation among actors was underpinned by a common understanding of the barriers faced while implementing decentralisation efforts. The capacity for joint action was demonstrated through several key strategies, however, challenges such as inadequate coordination, supervision and monitoring of laboratory services, as well as the need for collaborative efforts in health infrastructural rehabilitation were observed. Overall, collaboration has facilitated the creation of a more responsive and comprehensive TB care system, addressing the critical needs of patients and improving health outcomes.
耐多药结核病（MDR-TB）感染是一个公共卫生关注点。自 2017 年以来，赞比亚卫生部（MoH）与合作伙伴合作，实施了去中心化的 MDR-TB 服务，以解决社区获得治疗的机会有限的问题。本研究旨在探讨合作在赞比亚去中心化多药耐药结核病服务实施中的作用。
采用定性案例研究设计，在赞比亚选定省份使用深入访谈和关键知情人访谈作为数据收集方法。我们总共进行了 112 次访谈，涉及 18 名医护人员、17 名社区卫生工作者、32 名患者和 21 名在 10 个选定地区医疗机构的护理人员。此外，还对医疗机构、地区、省和国家各级的 24 名医护人员管理人员进行了 24 次关键知情人访谈。主题分析受协作治理综合框架的指导。
原则性参与受到全球卫生议程/峰会影响去中心化 TB 的影响、利益相关者参与启动去中心化、去中心化过程的支持性政策环境以及指南和季度临床专家委员会会议的影响。影响引入 MDR-TB 去中心化的共同动机的因素包括参与者有共同的理解、有限的获得卫生设施和紧急交通服务的机会、共同理解提供最佳患者监测和审查的挑战以及对证据为基础的决策在 MDR-TB 去中心化实施中的价值的欣赏。联合行动战略的能力包括 MoH 发起战略合作以加强 MDR-TB 去中心化、领导力在组织医护人员和多学科团队培训方面的作用、实验室服务协调、监督和监测不足以及联合行动在卫生基础设施修复中的作用。
原则性参与促进了各利益相关者的参与，传播了相关政策和指南，并定期举行季度临床专家委员会会议，以确保持续的支持和指导。参与者之间的共同动机是基于对实施去中心化努力所面临的障碍的共同理解。联合行动的能力是通过几项关键战略来展示的，然而，也观察到了一些挑战，例如实验室服务协调、监督和监测不足，以及在卫生基础设施修复方面需要协作努力。总的来说，合作促进了更具响应性和全面的结核病护理系统的创建，满足了患者的关键需求，并改善了健康结果。
