Barriers in Sustainability of Active Case Finding Intervention for Tuberculosis case detection in Pyuthan and Kapilvastu districts of Nepal: An Implementation Research

Acharya, Shraddha, dr. Riris Andono Ahmad, MPH, PhD and Prof. dr. Ari Probandari, MPH, PhD

2021 | Tesis | MAGISTER ILMU KESEHATAN MASYARAKAT

Mean scores for Funding Stability and Strategic Planning domains were the least while it was highest for Communications. Stakeholder interviews provided several gaps in ensuring sustainability of ACF intervention such as lack of sustained funding, reliance upon partner organizations and conditional grants from federal government at local levels, shortage of trained human resources, gaps in recording and reporting of cases detected through ACF in health system, lack of budget and sustainable plans by government as well as non-governmental stakeholders, lack of concern and commitment by local stakeholders in ACF policy formulation and budgeting, challenges regarding incentive-driven nature of donor-funded ACF projects and inability of the program to adapt in emergencies such as the recent COVID-19 pandemic. Local governments were perceived as the major stakeholders in ensuring funding stability and policy formulation to sustain ACF intervention.

Background Tuberculosis remains as one of the top ten causes of death but currently, only an estimated two-third of total tuberculosis cases have been notified globally. as high as 54 percent cases in the country were still missed out for diagnosis and treatment hence, active case finding interventions have been recommended in the policies. But ACF activities have been majorly initiated in Nepal through donor agencies suggesting concerns over sustainability of these ACF interventions. This study, therefore, tried to analyze the sustainability capacity of ACF intervention for tuberculosis and factors affecting it. Methods A concurred mixed method was used for total of 38 tuberculosis stakeholders. This study was conducted in two districts in Nepal with high incidence of tuberculosis, namely Pyuthan and Kapilvastu. Quantitative part of the research was conducted using PSAT tool on sustainability capacity with eight core domains and mean scores across each sustainability domain was measures. In-depth interviews were taken and thematic analysis was done. Results Mean scores for Funding Stability and Strategic Planning domains were the least while it was highest for Communications. Stakeholder interviews provided several gaps in ensuring sustainability of ACF intervention such as lack of sustained funding, reliance upon partner organizations and conditional grants from federal government at local levels, shortage of trained human resources, gaps in recording and reporting of cases detected through ACF in health system, lack of budget and sustainable plans by government as well as non-governmental stakeholders, lack of concern and commitment by local stakeholders in ACF policy formulation and budgeting, challenges regarding incentive-driven nature of donor-funded ACF projects and inability of the program to adapt in emergencies such as the recent COVID-19 pandemic. Local governments were perceived as the major stakeholders in ensuring funding stability and policy formulation to sustain ACF intervention. Conclusion Partner organizations have, so far, taken the lead in ACF implementation, but it is required for stakeholders to also have a sustainable vision and develop sustainable plans and institutionalize effective ACF modality into routine health system of government.

Kata Kunci : sustainability, Active case finding, tuberculosis, institutionalization, Nepal