Small Change, Big Results: Boosting TB Screening in Ethiopia

{Photo Credit: Warren Zelman}Photo Credit: Warren Zelman

By Berhanemeskal Assefa Woldemariam, Principal Technical Advisor, Management Sciences for Health

As a country with high rates of tuberculosis (TB), Ethiopia is working to expand services and improve TB case finding. However, engagement with private clinics has been limited at primary- and medium-level care clinics, leading to less than 20% of all TB cases being reported (NTP 2018 Report).

Under the TB REACH Project, funded by the Stop TB Partnership, MSH is working in partnership with the Amhara Regional Health Bureau to address gaps in private-sector engagement and build the capacity of private health providers in TB service delivery within the densely populated region.

Markos Tamrat, a clinical nurse working at Medhanialem Medium Clinic in Bahir Dar, shares his story.

[Markos Tamrat, Clinical Nurse. Photo Credit:MSH staffIn my four years’ of working at a private clinic, I did not screen patients for TB until a MSH TB REACH Project training. My co-workers and I did not have a lot of practice in screening and documenting TB results on patient cards. We were also prescribing antibiotics to many patients, even if they were presenting symptoms of TB.

Recently, MSH TB REACH, in collaboration with the Regional Health office, started engaging private clinic health care providers in TB care. We were, for the first time, trained on the basics of TB, identification of presumptive TB patients, and referring either samples or patients to the nearby public health facility for testing.

After this training, I realized the importance of screening all patients for TB, regardless of their presenting illness. I started thinking outside of the box and came up with a simple change to help clinicians consistently screen for TB: adding the column “TB Screening” to the patient cards we already use to remind clinicians to always ask about symptoms of TB, no matter what illness the patient is presenting. 

After discussing this change with the clinic owner, we printed the new patient cards with the added column. Now all providers are required to indicate that they have screened a patient for TB as part of the visit.

In just one year, we have increased the number of patients screened for TB from 41% to 100%. We think it is critical that this very simple but effective innovation should be adopted at all health facilities, public and private, to ensure that we identify as many TB cases as possible across the region.

For a more in-depth look at TB REACH’s efforts in Amhara to improve private sector engagement in TB services, read the technical highlight “Redefining primary health care unit through private sector collaboration in Ethiopia”.