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Good leadership and quality improvement principle change the TB cascade in Drakenstein sub-district

Good leadership and quality improvement principle change the TB cascade in Drakenstein sub-district
Publication date: 
Oct 2019

Background and challenges to implementation

The USAID Tuberculosis South Africa Project supports the National Department of Health (NDoH) to improve South Africa’s tuberculosis (TB) outcomes by scaling up the implementation of continuous quality improvement (QI) methodologies across the TB Care Cascade. All patients who present at health facilities must be screened for TB, but this has not been happening.  To address this, the TB Quality Improvement Project (TB QIP) was initiated and piloted in 14 health facilities in the Drakenstein sub district in Cape Winelands from January 2017 to December 2018.


Technical assistance was provided by the USAID TB South Africa Project to each facility by mentorship, support and in-service training. Leadership commitment ensured QI teams formed comprised of management, health care staff and information officers. Defining and managing the QI vision facilitated
ground level staff to incorporate quality principles into their policies, plans and procedures.  Ongoing monitoring by the Information Officers provided regular feedback on their facilities’ TB cascade improvements and gaps.


From 2017 to 2018, the Drakenstein sub district improved TB screening rates from 48% to 65,6%. For the same period presumptive TB patients increased from 1,730 to 2,233 per quarter and positive TB testing improved from 239 to 305.  The TB treatment initiation rate increased from 92% in 2017 to 98% in 2018.


The improved performance in finding TB patients illustrates that good leadership and ongoing mentorship can bring change. To ensure sustainable change, a step by step QI approach must be followed starting with leaders taking ownership and involving all staff from the beginning. Success would not have been as easily achieved without the full involvement and creativity of staff and management.

The TB Quality Improvement Project of Drakenstein sub district was nominated as one of the five best implemented projects in the Western Cape Province at the 5th Western Cape Government Service Excellence Awards.