Overview

Under the TB REACH project, funded by the Stop TB Partnership, we worked with Ethiopia’s Amhara Regional Health Bureau to address gaps in private-sector engagement and build the capacity of private health providers in TB service delivery.

Ethiopia ranks third in Africa and eighth among the 22 highest TB burden countries in the world according to the World Health Organization. A high percentage of TB cases have been missed in Amhara, which is one of the most populous regions of the country. In 2017, fewer than 10% of private clinics in the region—the primary entry point for people seeking care—were engaged in TB services. 

Key interventions included:

1. Building the capacity of health care providers on presumptive TB case identification and referral to public-sector facilities
2. Standardizing reporting in accordance with National TB Program guidelines, linking sputum referrals to DHIS 2, and monitoring performance for improvement and learning
3. Strengthening private health sector and postal service capacity to collect and transport sputum samples to GeneXpert sites 

Highlights

• Between December 2018 and September 2019, 269 health care workers from project-supported private clinics were trained and/or sensitized on TB case detection, referral to treatment, and reporting.
• An innovative private-public model was used to network more than 270 primary- and middle-level clinics to 20 GeneXpert testing labs, 20 chest X-ray sites, and 3 pathology service providers. 
• Established a patient and specimen referral system using Ethiopia’s postal system through which 48 postal officers were sensitized on proper transport of sputum samples from private clinics to testing labs and returning test results to referring clinics.
• Between December 2018 and November 2019, 92% (317,964 of 345,028) of patients were screened, 53% of whom were female. More than 4,000 presumptive TB cases were registered and 467 new TB cases were identified—all of whom were initiated on directly observed treatment, short-course, at a nearby public health facility.