Abstract:

The Zambian government, through the Vision 2030 policy, has prioritized health and is committed to the attainment of ‘equity of access to cost-effective quality health services, as close to the family as possible by providing a continuum of care with particular emphasis on promotional, preventive, curative, and rehabilitation services. This, however, is challenged by the high disease burden of communicable and Non-Communicable Diseases (NCDs) tuberculosis inclusive. This study was conducted to identify and assess determinants of the quality of TB services. The study utilized a cross-sectional design involving a mixed-methods approach consisting of a desk review facility-based survey of patients on TB treatment using quantitative and qualitative data collection techniques. The study covered 352 randomly selected TB patients, 58 conveniently selected TB treatment support persons, 9 purposively selected TB community volunteers, and 6 purposively selected facility-based service providers. The determinants of good quality of TB care include technical performance, access to services, the effectiveness of care, interpersonal relations, the efficiency of service delivery, continuity of service, safety, physical infrastructure, comforts, and choice of service. Results confirm that good health is a function of the quality of healthcare and utilization of healthcare services and service utilization is affected by social demographics of patients such as age, sex, marital status, type of TB treatment support person, inter alia. Patient’s demographic factors determined how the patient view the quality of TB serviced they received.

References:

[1] Global tuberculosis report 2020. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.MoH (2015), The National Health Strategic Plan (NHSP) 2017-2021, Lusaka. Zambia.

[2] Silva, D.R., Muñoz-Torrico, M., Duarte, R., Galvão, T., Bonini, E.H., Arbex, F.F., Arbex, M.A., Augusto, V.M., Rabahi, M.F. and Mello, F.C.D.Q., 2018. Risk factors for tuberculosis: diabetes, smoking, alcohol use, and the use of other drugs. Jornal Brasileiro de Pneumologia, 44(2), pp.145-152.

[3] NAC. 2019. Global Fund 2020-2022 Allocation Letter. Access online at: http://www.nac.org.zm/ccmzambia/wp-content/uploads/2020/04/Zambia-2020-2022-allocation-letter-signed.pdf on15th December 2020.

[4] Kapata, N., Chanda-Kapata, P., Ngosa, W., Metitiri, M., Klinkenberg, E., Kalisvaart, N., Sunkutu, V., Shibemba, A., Chabala, C., Chongwe, G. and Tembo, M., 2016. The prevalence of tuberculosis in Zambia: results from the first national TB prevalence survey, 2013–2014. PLoS One, 11(1), p.e0146392.

[5] MoH, (2012) NATIONAL HEALTH POLICY “A Nation of Healthy and productive People” Lusaka, Zambia accessed at https://www.moh.gov.zm/docs/healthpolicy.pdf on 26th February 2021.

[6] Swati Sadaphal, Neeraj Kak, Silvia Holschneider, Alisha Smith-Arthur, and Refiloe Matji TB Care II. 2013. Quality Improvement Handbook for TB and MDT-TB. University Research Co., LLC.

[7] WHO consolidated guideline on self-care interventions for health: sexual and reproductive health and rights. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO.

[8] TB CARE I. International Standards for Tuberculosis Care, Edition 3. TB CARE I, The Hague, 2014.

[9] Fecso, A.B., Szasz, P., Kerezov, G. and Grantcharov, T.P., 2017. The effect of technical performance on patient outcomes in surgery. Annals of Surgery, 265(3), pp.492-501.

[10] Masiye, Felix & Kaonga, Oliver. (2016). Determinants of Healthcare Utilisation and Out-of-Pocket Payments in the Context of Free Public Primary Healthcare in Zambia. International Journal of Health Policy and Management. 5. 693-703. 10.15171/ijhpm.2016.65. accessed on https://www.researchgate.net/publication/310050022_Determinants_of_Healthcare_Utilisation_and_Out-of-Pocket_Payments_in_the_Context_of_Free_Public_Primary_Healthcare_in_Zambia/citation/download on 20th January 2021.

[11] Kruk ME, Larson E, Twum-Danso NA. Time for a quality revolution in global health. Lancet Glob Health 2016;4(9): e594–6.

[12] Zyaambo, C., Siziya, S., & Fylkesnes, K. 2012. Health status and socio-economic factors associated with health facility utilization in rural and urban areas in Zambia. BMC health services research, 12, 389. https://doi.org/10.1186/1472-6963-12- Accessed at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3536624/ on 20th January 2021.

[13] Al-Yateem N. (2020) Determinants of Quality of Healthcare for Adolescents and Young Adults. In: Betz C., Coyne I. (eds) Transition from Pediatric to Adult Healthcare Services for Adolescents and Young Adults with Long-term Conditions. Springer, Cham. https://doi.org/10.1007/978-3-030-23384-6_3 https://link.springer.com/chapter/10.1007/978-3-030-23384-6_3 accessed on 3rd December 2020.

[14] Mpaata, Kaziba & Lubogoyi, Bumaali & Okiria, John. (2017). Determinants of Quality of Patients Care in Public Hospitals in Uganda: Requirements for Organizational Effectiveness Clients’ Perspective. International Journal of Science and Research (IJSR). 6. 469-472. 10.21275/ART20172157. Accessed at https://www.researchgate.net/publication/329245439_on 3rd December 2020.

[15] Johnson I, McDonnell C, O’Connell AM, Glynn L. Patient perspectives on health, health needs, and health care services in a rural Irish community: a qualitative study. Rural and Remote Health 2011; 11: 1659. Available: www.rrh.org.au/journal/article/1659 accessed 6th January 2021.

[16] Azuh, D., Ogundipe, A. and Ogundipe, O. 2019, Determinants of Women Access to Healthcare Services in Sub-Saharan Africa; Department of Economics, Development Studies Covenant University, Ota, Ogum, Nigeria; DOI: 10.2174/1874944501912010504 accessed at https://openpublichealthjournal.com/contents/volumes/V12/TOPHJ-12-504/TOPHJ-12-504.pdf on 20th January 2020.