Matenga Tulani Francis L, Chavula Malizgani Paul, Zulu Joseph Mumba, Silumbwe Adam, Maritim Patricia, Munakampe Margarate N, Habib Batuli, Liusha Namakando, Banda Jeremiah, Sinyangwe Ntazana N, Mweemba Chris, Mubanga Angel, Kaonga Patrick, Musukuma Mwiche, Phiri Henry, Halwiindi Hikabasa
Department of Health Promotion, School of Public Health, University of Zambia, Lusaka, Zambia.
Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia.
Arch Public Health. 2025 Jul 24;83(1):193. doi: 10.1186/s13690-025-01672-7.
The Zambian government decentralised tuberculosis control programs by transferring responsibility for the care and treatment of multidrug-resistant tuberculosis (MDR-TB) patients from a two-national hospital model to provincial hospitals and other lower-level healthcare structures. Limited evidence exists on the effects of decentralisation on the quality of TB care provided through public sector decentralisation. In this paper, we explored the impact of decentralising MDR-TB on patient and service outcomes.
This study used a mixed-methods approach. Quantitative data were collected through a survey of 244 MDR-TB patients, while qualitative data was collected through interviews with TB coordinators, healthcare providers, patients, and caregivers. Participants were drawn from health facilities and the Ministry of Health. Quantitative data was analysed in STATA version 16.0, while thematic analysis was used for the qualitative data.
Decentralisation has improved patient care and management by increasing access to essential commodities such as medication and diagnostic testing. It has led to more equitable distribution of MDR-TB healthcare services and resources across different population groups, regardless of social, economic, or demographic factors. Furthermore, the quality of life for MDR-TB patients has improved, with better adherence to medication resulting from increased family support. Due to decentralisation, tailored community and patient-centred services have been integrated resulting in reduced congestion at facilities. The study also identified challenges, including heavy workload for healthcare staff, fragmented coordination of supervisory responsibilities, and confusion over roles in patient management, which negatively impacted the decentralisation process.
The decentralisation of MDR TB services offers significant benefits but is not a guaranteed solution, as poor planning or implementation can lead to challenges in service delivery.
赞比亚政府通过将耐多药结核病（MDR-TB）患者的护理和治疗责任从两国立医院模式转移至省级医院及其他更低层级的医疗结构，实现了结核病控制项目的权力下放。关于通过公共部门权力下放对结核病护理质量产生的影响，现有证据有限。在本文中，我们探讨了耐多药结核病权力下放对患者及服务结果的影响。
本研究采用了混合方法。通过对244名耐多药结核病患者进行调查收集定量数据，同时通过对结核病协调员、医疗服务提供者、患者及护理人员进行访谈收集定性数据。参与者来自医疗机构和卫生部。定量数据在STATA 16.0版本中进行分析，而定性数据则采用主题分析法。
权力下放通过增加获取药物和诊断检测等基本物资的机会，改善了患者护理和管理。它使耐多药结核病医疗服务和资源在不同人群中得到了更公平的分配，无论其社会、经济或人口因素如何。此外，耐多药结核病患者的生活质量有所提高，家庭支持增加导致患者对药物的依从性更好。由于权力下放，量身定制的社区和以患者为中心的服务得以整合，从而减少了医疗机构的拥堵。该研究还确定了一些挑战，包括医护人员工作量大、监督责任协调分散以及患者管理中的角色混乱，这些都对权力下放进程产生了负面影响。
耐多药结核病服务的权力下放带来了显著益处，但并非万无一失的解决方案，因为规划或实施不当可能导致服务提供方面的挑战。
