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Why TB goes undiagnosed

Next steps

To increase the uptake of diagnostics, we identified a number of important steps governments should take.

First, governments need to create a decentralised hub system supported by an efficient referral system.

The laboratory capacity of level three and four healthcare facilities (at the district level) need to be increased. These would serve as hubs receiving referral specimens from level 1 and 2 healthcare facilities.

Uganda has tried to do this with TB diagnostics, and there’s been some success, but it needs to be made more efficient. There needs to be more awareness and strengthen specimen referral system at level 1 and 2 healthcare facilities.

The hub system would allow the consolidation of skilled human resource. It would also mean that the supply of essential utilities – like water and electricity – are better harnessed.

Alongside the creation of hub systems, governments must invest in digital information systems. This would ensure that test results are fed back to clinics and patients in real-time.

Governments also need to run public awareness programmes aimed at healthcare administrators, practitioners and service users. The awareness programmes should explain the health system structure, the available services and how to access them.

They also need to streamline procurement systems. We recommend that unnecessary bureaucracy be removed, and that partnerships are created between the public and private sector to ensure the swift acquisition of laboratory supplies.

Rooting out corruption in the procurement system would also go a long way in ensuring healthcare facilities acquire all their diagnostic supplies on time.

Encouraging and supporting the local manufacture of diagnostic and treatment tools would also significantly ease the procurement difficulties.

The elephant in the room is financing. As researchers we support the idea of a national health fund that specifically addresses healthcare needs. A percentage of the country tax revenue would be dedicated to health. We believe that this would enable countries to meet the Abuja agreement target of allocating 15% of their national annual budget to healthcare. It would also increase the resilience of health system to manage effectively in periods of health emergency like COVID-19.


The main report of this research first appeared in The Conversation.

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