Lee T, Price M
Department of Community Health, University of the Witwatersrand Medical School, Parktown, South Africa.
Tuber Lung Dis. 1995 Oct;76(5):441-9. doi: 10.1016/0962-8479(95)90012-8.
An evaluation of the Tuberculosis Control Programme (TBCP) of KaNgwane, a rural, previously designated 'homeland' of South Africa, was performed in 1990.
The evaluation is presented as a case study to illustrate a proposed methodology for rapid, comprehensive, management oriented TBCP research.
The components of the TBCP were categorised into direct TBCP activities, management processes and integration of the TBCP into Primary Health Care (PHC). The methods used to evaluate indicators for each of these components included: policy analysis, interviews with staff and patients, observation of in-patient and ambulatory patient care, record reviews and a household survey.
The regional scope of the study yielded a wealth of useful information at a managerial level. Detailed, quantitative information was obtained, allowing for the identification of weaknesses in the TBCP and the targeting of appropriate action. Particularly problematic aspects were: the health information collection, case-finding and case-holding, health education and coordination and supervision. Comparative analyses between different health wards helped identify particular areas of weakness. Both illustrative results and methodological limitations are presented. The methodology used is related to previous South African TB health service research and to the emerging field of rapid assessment methods.
A rapid but comprehensive review of a TBCP can be done if indicators and research methods are carefully selected and record systems are functional. If record systems are not functional, the non-record review methods still offer substantial information on many indicators and one or two quantitative indicators (e.g. case holding) could be selectively measured through reviewing a sample of records.
1990年，对南非一个农村地区、以前被指定为“家园”的卡恩格瓦内结核病控制项目（TBCP）进行了评估。
将该评估作为一个案例研究进行展示，以说明一种针对结核病控制项目快速、全面、以管理为导向的研究方法。
结核病控制项目的组成部分被归类为结核病控制项目的直接活动、管理流程以及结核病控制项目与初级卫生保健（PHC）的整合。用于评估这些组成部分各项指标的方法包括：政策分析、与工作人员和患者的访谈、住院和门诊患者护理观察、记录审查以及家庭调查。
该研究的区域范围在管理层面产生了大量有用信息。获得了详细的定量信息，有助于识别结核病控制项目中的弱点并确定适当的行动目标。特别成问题的方面包括：健康信息收集、病例发现与管理、健康教育以及协调与监督。不同卫生区之间的比较分析有助于确定具体的薄弱领域。同时展示了说明性结果和方法学局限性。所使用的方法与南非以前的结核病卫生服务研究以及快速评估方法这一新兴领域相关。
如果仔细选择指标和研究方法并且记录系统有效，就可以对结核病控制项目进行快速但全面的审查。如果记录系统无效，非记录审查方法仍然可以提供许多指标的大量信息，并且可以通过审查记录样本有选择地测量一两个定量指标（例如病例管理）。
