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Taking capacity building to the workplace to increase TB program efficiency and outcomes in the West Coast District

Taking capacity building to the workplace to increase TB program efficiency and outcomes in the West Coast District
Publication date: 
Oct 2019
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Background and challenges to implementation  

Building capacity in the Department of Health’s facilities remains challenging in rural areas in the West Coast district, Western Cape province, in South Africa. Staff numbers are low, making it impossible to take staff out of facilities to build their skills. Identifying gaps is easy but finding ways to build capacity to address challenges remains problematic. To this end, the West Coast district implemented the low-dose, high frequency (LDHF) model of capacity building.

Intervention 

The LDHF model comprises in-service training and mentoring. Facilities are visited monthly for evaluations of the TB program and identification of gaps and challenges. In-service training sessions last 30 to 90 minutes and address specific challenges identified. Staff in TB rooms are trained using latest guidelines and treatment regimens while they are working with patients. Staff practically exercise what they have been trained on, and facilitators are available for questions. Mentoring is done monthly to ensure that healthcare workers implement what they were trained on in previous visits.

Results

Baseline audits of the TB program were done in nine facilities in early 2018. Five out of nine facilities show an average score of lower than 60%, with the lowest one at 34%. In total, 66 LDHF sessions were conducted in nine facilities. The LDHF model was used to capacitate 29 staff members, of which 11 participated in more than four sessions each. After nine months, audits were repeated.  All nine facilities scored higher than 60%, with the highest score being 84%. Four of five facilities showed improvements between 22% and 34%.

Conclusion

The LDHF model addresses the “know-do gap” at intermittent intervals and it is sustainable. Implementation of this capacity building model has positive impacts on TB service delivery. Staff do not need to leave facilities, and services can proceed as normal. The model will be rolled out to all facilities in West Coast.