Education and Integration Help Technicians Improve TB Services in South Sudan

Dr. Anyo takes staff and interns through a hands-on training exercise during onsite supervision. {Photo credit: Gladys Anyo/MSH.}Photo credit: Gladys Anyo/MSH.

While tuberculosis (TB) is receiving widespread attention in the global health community, many in South Sudan still consider this disease a repulsive affliction and feel uncomfortable associating with TB patients. In addition to fear and discrimination in the general population, the nation’s health professionals often avoid working with TB patients, TB equipment, and sputum samples for fear that they could become infected themselves. As a result, problems plaguing South Sudan’s TB care systems include poor patient follow-up and inadequate health worker skills due to a lack of training in TB transmission, diagnosis, and treatment.

To improve this situation, USAID’s TB CARE I project, led by KNCV Tuberculosis Foundation (KNCV), with partners including Management Sciences for Health (MSH) and the World Health Organization (WHO), are supporting South Sudan’s Ministry of Health to improve care of TB patients.

In June 2012, TB CARE worked with the National TB Program to revise its strategic plan to align with the South Sudan Health Sector Development Plan. Part of this plan involves training laboratory technicians to integrate TB diagnosis into routine laboratory services.

TB CARE has trained technicians and other health facility staff on safe laboratory practices and, through discussions and hands-on exercises, helped them understand TB disease transmission, especially in the work place. Noticing that many TB laboratory technicians were overworked, TB CARE retrained staff and encouraged the technicians to regularly rotate through different departments to prevent over-exertion on TB cases and diversify their clinical skill sets. The training team also helped facility staff identify gaps in laboratory performance and quality assurance systems and design and implement corresponding corrective actions.

These interventions are already starting to glean positive results. In the laboratory at Yei Civil Hospital, for example, TB CARE began training technicians in March 2012 and by July laboratory reports showed that they had examined 55 percent more TB smear samples than they had in March 2012.

The TB State Coordinator for Central Equatoria, Dr. James Wani, has also noticed that TB CARE’s interventions are helping build the confidence of laboratory technicians, who often feel embarrassed to be working with TB. “[TB CARE]’s presence in the facilities, working with staff and teaching them, has improved their morale. They tell me that they no longer feel ashamed and are looking forward to TB CARE’s next visit,” said Wani.

In the last six months, TB CARE has trained 20 technicians and plans to train another 40 technicians in the coming months. Technician trainees come from all 10 states in South Sudan. TB CARE also trains and encourages laboratory technicians to share their new knowledge and skills with colleagues at their respective facilities to strengthen TB laboratory practices across the nation.